Several misconceptions abound about treatment for HIV despite medical science getting much advanced. The World Health Organisation estimates that HIV resulted in the death of nearly 40 million people. While curiosity often begets the question of 'What causes it?' our focus should be on 'How can science help patients recover fully'? Subodh Gupta, CEO, Lord’s Mark Microbiotech, talks more about ways to tackle HIV

Although a cure for HIV is yet awaited, the current recourse has been antiretroviral therapies (ART).

This treatment allows individuals to suppress the virus to undetectable levels, enabling them to live long and healthy lives while significantly reducing the risk of transmission to others. However, ART does not eliminate the virus from the body; it simply keeps it controlled. If a person stops taking ART, the virus can reactivate from latent reservoirs within the body resulting in a relapse. Although the medical fraternity understands this, commoners need to be advised that this virus has a very high rate of mutation. This means that ART therapy may not always be a successful approach.

Why Can’t HIV Be Eradicated?

Unlike diseases that can be surgically treated or cured, HIV integrates into the host's DNA, creating latent reservoirs of the virus. These reservoirs remain hidden from the immune system and impervious to antiretroviral therapy (ART), even when the virus is undetectable in the bloodstream.

As a result, ART suppresses HIV but cannot eliminate it, requiring lifelong treatment. Modern ART regimens have transformed HIV into a manageable chronic condition, reducing viral loads to undetectable levels in over 90 per cent of patients who adhere to treatment. This has significantly reduced transmission rates, with new HIV infections dropping by 59 per cent since their peak in 1995, according to UNAIDS.

However, ART is not a cure, and adherence over a lifetime poses immense challenges.

Dependence on lifelong ART brings its own set of difficulties. Patients face side effects like cardiovascular issues and bone density loss, along with treatment fatigue and psychological burdens.

Financial strain is another barrier, especially in low-income regions, where less than half of those requiring ART have consistent access, as per UNAIDS. Addressing these challenges is vital to reduce the global burden of HIV and move closer to the goal of eradication.

Novel Approaches to Tackling HIV

The journey toward an HIV cure is not just a scientific challenge; it represents hope for millions living with the virus and the dream of a future free from its impact. Recent innovations like gene editing, stem cell transplants, immune modulation, and nanotechnology offer promising new pathways to achieving this goal. These approaches target HIV at its roots, aiming to eradicate the virus rather than merely managing its effects.

Gene editing technologies, particularly CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats), have shown the potential to alter DNA with precision. This tool has successfully treated genetic disorders like sickle cell disease in clinical trials and demonstrated the ability to remove HIV DNA from genomes in laboratory settings. However, challenges persist, including ethical concerns and the difficulty of delivering CRISPR safely to all infected cells in the body. Despite these hurdles, CRISPR remains a beacon of hope for the future.

Stem cell therapy also holds significant promise. The Berlin Patient case, where a stem cell transplant from a CCR5-mutated donor led to a functional HIV cure, highlights its potential. While ongoing trials aim to replicate such success with gene-edited stem cells, the treatment remains expensive, risky, and impractical for widespread use. These barriers underscore the need for more accessible and scalable alternatives.

Immune modulation and nanotechnology further expand the horizons of HIV treatment. Techniques like therapeutic vaccines and checkpoint inhibitors aim to empower the immune system to suppress or eliminate HIV. Meanwhile, nanotechnology has enhanced drug delivery systems, improving ART effectiveness while minimising side effects. While these innovations are promising, they require significant advancements in research, infrastructure, and ethical frameworks to reach their full potential.

Making HIV Treatment Accessible

Emerging economies like India face significant challenges in addressing HIV/AIDS, with high prevalence rates and limited access to advanced treatments. UNAIDS reports nearly 4 million people in Asia and the Pacific live with HIV, and India contributes the largest share. The high costs of cutting-edge therapies such as gene editing, CRISPR, and stem cell treatments further limit their accessibility in low- and middle-income countries. Advances in gene editing and biotechnology research are being made in India, but these therapies remain difficult to scale.

Collaboration is essential for overcoming these barriers. Governments must prioritise policy changes and partner with private entities to fund research, streamline distribution, and improve treatment accessibility.

Successful models like GAVI and The Global Fund demonstrate the power of collective action in improving healthcare access. Raising awareness is equally crucial, not only to tackle stigma but also to promote early testing and treatment, ensuring that these breakthroughs benefit everyone, especially in emerging economies.