Research Toward HIV Cure
The National Institutes of Health (NIH) has made important contributions to treatments that have improved the lives of a great many people with HIV. Although combination antiretroviral therapy (combination ART, or cART) allows people with HIV to live longer and in better health, it does not cure HIV. Investing in research to find a cure for HIV is focused on two broad aims: sustained viral remission and, in the longer term, viral eradication.
Viral latency and sanctuaries
Latent HIV reservoirs—small amounts of HIV that persist in people taking ART—present a significant challenge to finding a cure for HIV. Latent reservoirs remain in people with HIV when HIV becomes part of the body’s DNA in infected cells. Additionally, reservoirs of HIV can be found in certain “sanctuary” sites in the body that allow the virus to hide and be protected from both the immune system and ART. To cure HIV, the NIH supports studies to develop novel approaches and treatments that target these HIV reservoirs.
Sustained viral remission and viral eradication
people with HIV who adhere carefully to treatment with ART can have undetectable levels of HIV in their blood and be durably suppressed. These individuals are less likely to experience symptoms and complications and have effectively no risk of transmitting the virus. However, latent HIV remains and people must stay on treatment to maintain durable suppression of the virus.
Current science suggests that the path to an HIV cure involves first achieving sustained viral remission without ART. This is called sustained ART-free viral remission or a functional cure. For sustained ART-free viral remission, infectious virus must remain undetectable by sensitive testing methods for a long time without treatment. One research aim will be to prolong the time between treatments to be measured eventually not in weeks, but in months or even years. The NIH supports research into treatments leading to sustained ART-free viral remission. New cure-inducing treatments must be as safe, effective, and available for widespread use as are current-day ART regimens.
Viral eradication—eliminating the virus entirely—is the more challenging, longer-term goal.
The NIH supports research to better understand how the HIV reservoir forms, persists, and reactivates, as well as investigations to develop new cure treatment strategies targeting HIV reservoirs.
A range of biomarkers and techniques, including single-cell and imaging technologies, are being studied to determine how to identify and describe the HIV reservoir. These techniques also are being used to better understand mechanisms of viral reactivation from latently infected cells.
Experimental treatments in development include therapeutic vaccines, genetically engineered immune cells that are resistant to HIV infection, drugs that reactivate latent HIV to make the virus visible to the immune system, cure-inducing immunotherapies, and interventions to permanently silence HIV in infected cells.
The search for an HIV cure involves important behavioral and social processes that complement the domains of biomedicine. BSSR in HIV cure research is focused on important aspects such as: counseling and support interventions to address the psychosocial needs and concerns of study participants related to analytical treatment interruptions (ATIs); risk reduction in the course of ATI study participation; motivation, acceptability, and decision‐making processes of potential study participants; how cure affects the identity and social position of people with HIV; and the scalability of a proven cure strategy in the context of further advances in HIV prevention and treatment.
Supporting research innovation and scientific stewardship
The NIH is leveraging resources toward an HIV cure through several public-private partnerships. NIH small business awards enable companies to help foster a diverse pipeline of experimental treatments in development. The combined support of government, industry, and nongovernmental foundations is fostering the expansion of a talented scientific workforce dedicated to advancing HIV cure research.