Currently, no cure for HIV exists. Some treatments help in slowing the progression of the disease and keep the virus in check. However, patients need to take these medications for the rest of their lives. A definite cure for HIV does not exist.
Despite there being no cure for HIV, there have been isolated instances where HIV patients have seemingly been cured of their ailment. This is true of one Timothy Ray Brown, also known as the Berlin patient. His HIV status simply vanished following a fortunate and successful bone marrow transplant for his Leukemia. The same results have been replicated in at least one more instance, where Adam Castillejo seemed to have been cured of HIV following a bone marrow transplant as well.
Both of these cases, and a handful of others, are peculiar because bone marrow transplant is not an approved treatment for HIV. The procedure is expensive, highly invasive, and simply does not guarantee the same results in every HIV patient.
WHY IS THERE NO CURE FOR HIV?
HIV is one of the most common diseases in the world. More than 37 million people are living with HIV worldwide. The World Health Organization, WHO lists HIV as the 6th leading cause of death around the globe. Despite such staggering numbers and a ton of research into the area, we are still far from a cure for this deadly virus. Treatments available for HIV do an excellent job in keeping the virus in check, but none of these treatment regimens effectively cure an HIV patient once and for all.
Although the Berlin and the London patient were seemingly cured of HIV following a bone marrow transplant, this is by no means a regular occurrence. Both of these patients received marrow transplants from people with a genetic makeup that is resistant to HIV. Both of these patients also received marrow transplants to cure their Leukemia and not HIV. Therefore, these results cannot be replicated in every HIV patient. Moreover, bone marrow biopsies are not indicated, nor approved, for HIV treatment. The biopsy is an extremely invasive procedure that carries multiple risks. It is also extremely expensive and, thus, not a practical solution for everyone.
The reason why HIV is so hard to cure lies in the behavior of the virus itself. HIV is a DNA virus that infects host cells and resides in their genetic material. Here, the virus takes over their protein-creation factory and replicates to survive, using all the nutritional supplies of that particular cell. The virus is exceptionally good at hiding itself from the hosts’ immune system.
In contrast, the Hepatitis C virus is easier for both drugs and the immune system to find and kill. The reason why Hepatitis C is an easier target for the immune system and anti-HCV drugs is that it is an RNA virus that resides in the cytoplasm and never truly makes its way into the DNA.
HIV, on the other hand, takes over the genetic material of a cell in the nucleus and starts to replicate. This replication, however, is not perfect – and that works out well for the virus. How? This sloppy replication by the virus allows it to replicate multiple times and mutate to acquire increasing resistance against newer treatments.
Another problem in formulating a cure for HIV is that the virus infects and attacks the body's defense system. HIV infects white blood cells and renders them incapable of functioning normally. HIV can also lie dormant in these cells for long periods. Essentially, a dormant virus is pretty hard to find, both for the drugs and the immune system. Finding and effectively killing HIV in the DNA of these cells is a problem because it’s like finding a needle in a haystack.
WHEN CAN WE EXPECT A CURE FOR HIV IN THE FUTURE?
A cure for HIV would mean one of the two things. A functional cure, where the viral load is decreased to such an extent that the virus is left incapable of replicating inside the body without the use of drugs. The other approach is finding a sterilizing cure that would effectively eliminate all viruses from inside the body. While the possibility of achieving any of the two sounds amazing, it is still a long time before both of these options could become a reality for HIV patients.
Researchers are looking into multiple sophisticated techniques to rid the body of HIV essentially. Some of these methods look promising, but they are far less developed to cure HIV effectively.
The biggest problem with HIV is that it hides in the genetic material and makes it almost impossible to be found. Research into several techniques to effectively "flush out" the virus by triggering cell responses shows promise. Once HIV is shocked out of hiding, anti-retroviral drugs can take over from there and eliminate the virus.
Gene editing techniques are also considered. CRISPR gene-editing tools are looked into to effectively "cut out" the viral part from a cell's DNA. This technique, however, is only studied in mice until now, and there is a long way before it is perfected to be used in humans.
Perhaps the most promising avenue in finding a cure for HIV is the advent of broadly neutralizing antibodies. Although the immune system of an HIV patient is always under attack, some HIV patients seem to have an overactive component in their immune system. A fraction of HIV patients have broadly neutralizing antibodies that seem to always win from HIV. Research into harnessing these antibodies and employing them to eliminate HIV from the body is being conducted. However promising, the problem of latent HIV reserves remains untouched even with these antibodies.
HOW DOES THE HIV TREATMENT WORK?
Anti-retroviral therapy, or ART, is the current mainstay of HIV treatment. ART is very effective in treating HIV. It keeps the virus in check by stopping it from replicating inside the host cells. However, the treatment is not effective in eliminating latent HIV reserves that seem to be the biggest contributor to the immortal status of HIV.
The treatment is centered on lowering the viral load of a patient. The viral load of a patient refers to the viral particles found in their blood. Low viral loads mean that the treatment is successful. Achieving undetectable viral loads in a patient is ideal. Undetectable viral load means that it is so low that HIV diagnostic tests cannot detect it.
The viral load of a patient represents the success of their treatment. The lower the viral load, the better the treatment seems to be working. Low viral loads are also associated with increasing CD4+ cell counts. Increasing CD4+ cell counts indicate that the immune system is recovering, and the patient will experience a much better quality of life.
When a patient achieves undetectable viral loads, their chances of transferring the virus to another person through sexual contact become negligible. This means that the patient can enjoy a better sex life as well. Moreover, when the virus is stopped from replicating, the patient stays largely protected from opportunistic infections common with HIV infections.
HOW TO PREVENT AN HIV INFECTION?
Since there is no cure for HIV, taking steps to protect yourself from HIV is the best course of action. Effective prevention of HIV is possible even though there is no preventative vaccine for this infection. Multiple preventative measures have been developed that can reduce your chances of contracting the virus down to negligible.
First and foremost, eliminating high-risk behaviors from your daily life is the best preventative measure to protect yourself from HIV. The following measures are extremely effective:
- Practicing safe sex by using a condom for every sexual intercourse
- Buying and using a new condom for every new sexual act
- Reducing the number of your sexual partners
- Getting tested for HIV regularly
- Getting your sexual partner(s) tested for HIV
- Avoid coming into contact with another person’s blood
This is by no means an exhaustive list, meaning that there are other preventative measures to protect from HIV as well. However, you can reduce the risk of coming into contact with HIV just by practicing these measures in your daily life.
Preventative medication regimens are also available that reduce the risk of HIV infections. PrEP is a pre-exposure prophylactic treatment that prevents an HIV infection when taken regularly. The prEP regimen involves taking a pill daily for as long as protection is required from HIV. When taken regularly and properly, PrEP can provide up to 97% protection against HIV.
Another preventative regimen called nPEP, post-exposure prophylaxis, also provides effective protection against HIV. This regimen works by preventing an HIV infection after exposure to HIV has already occurred. However, it is important to note that nPEP only works when taken within 3 days, or 72 hours, of being exposed to HIV. When taken after 3 days, nPEP does not provide any protection against HIV at all. Generally, nPEP is taken for 28 days straight after HIV exposure to achieve effective protection against HIV.