A recent study conducted by researchers at UC San Francisco (UCSF) has shown that it may be possible to control HIV without the need for long-term antiretroviral therapy (ART). The findings, published in Nature on December 1, World AIDS Day, suggest a new direction in the search for an HIV cure.
The clinical trial involved 10 participants who were treated with a combination of experimental immunotherapy agents. After discontinuing ART, seven of these participants managed to keep the virus at low levels for several months. This outcome provides initial evidence that combination immunotherapy could help reprogram the immune system to control HIV even after stopping standard treatment.
Steven Deeks, MD, co-senior author of the paper and professor of Medicine at UCSF’s Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, commented on the results: "The majority had some evidence of control, which we believe is unprecedented. I do believe we are finally making real progress towards developing a therapy that may allow people to live a healthy life without the need of life-long medications."
The study was supported by a $20 million partnership between amfAR (the Foundation for AIDS Research) and UCSF launched in 2015, as well as funding from the National Institutes of Health (NIH).
Since its introduction in the 1990s, ART has changed HIV infection from being fatal to manageable but does not eliminate the virus from the body. The virus can become active again if ART is stopped.
In this study, most participants had started ART soon after acquiring HIV. The treatment plan included a therapeutic vaccine designed to boost T cell response against latent HIV, followed by an antibody cocktail to reduce viral load. A second round of anti-HIV antibodies was given before discontinuing ART.
Typically, when someone stops taking HIV medication, their viral load increases rapidly within two weeks. In this trial, only three out of ten patients experienced this rapid rebound; six maintained low viral levels for months and one did not experience any rebound.
Researchers analyzed how those who controlled their virus achieved these results. However, they caution that more work needs to be done before this approach could replace current treatments.
"This is not the end game," said Michael Peluso, MD, assistant professor in UCSF's Department of Medicine and first author on the study. "But it proves we can push progress on a challenge we often frame as unsolvable."
