Advancements in HIV Prevention and Treatment

Many discoveries for HIV treatment and prevention may be years away from clinical use. However, some research can have immediate impacts on care.

Two examples of this include anal cancer prevention and improvements in care for aging people living with HIV.

Anal cancer prevention

People with HIV frequently face secondary infections as a result of compromised immune systems, including human papillomavirus (HPV).

HPV triggers abnormal cell growth in the body. It’s commonly associated with cervical cancers but can also cause anal and oral cancers.

A June 2022 study published in the New England Journal of Medicine found that early detection and treatment of precancerous anal lesions can cut a person’s likelihood of developing anal cancer by more than half compared with only practicing surveillance monitoring of the lesions.

Anal cancer is the fourth most common cancer among people with HIV. According to the National Institutes of Health, anal cancer occurs in 89 out of every 100,000 HIV-positive men who have sex with men and between 18.6 and 35.6 HIV-positive women.

For comparison, the incidence of anal cancer in the general population is 1.6 in every 100,000 people.

Researchers believe screening for precancerous anal cell changes should become the standard of care in people with HIV, especially for men who have sex with men.

This level of screening can be closely compared to the Pap smear with its success at preventing cervical cancers.

HIV and aging

Nearly half of all people with HIV in the United States are over the age of 50, according to 2018 figures. As these people continue to age and experience new phases of life with an HIV infection, changing healthcare needs will inform research on treatment, intervention, and prevention for older people.

For example, people with HIV are more likely to experience age-related health issues earlier in life. Cardiovascular disease is more common in people with HIV. People with HIV also have an increased risk of developing some cancers, dementia, and osteoporosis.

Some medications for HIV, including antiretroviral therapy (ART), have been linked to osteoporosis. This is why monitoring for the disease is needed during treatment.

Current studies are focusing on how to treat and prevent these age-related conditions in people with HIV. Funding is being allocated to support comprehensive plans for screening and managing comorbidities in people with HIV.

Advocacy organizations are also seeking ways to connect with the community to make resources available to people who may not have access.

Headlines about cures and vaccines often dominate HIV news. Individual cases of people becoming HIV-free after years of infection are promising. But the reality is that research has not yet supported the effectiveness of a vaccine or cure.

Advancements reveal that a cure may not be too far down the road, though. For now, however, great strides are being made in treatments that can provide people with viral suppression that does not rebound or require intensive, daily intervention.

Potential one-time injection treatment

Antiretroviral therapies (ART) often require daily medication and treatment. ART has made HIV manageable and undetectable in many people.

But ART can be expensive, and it does require taking a pill or multiple pills every day. Following this treatment can be difficult, which is why researchers have wanted to find treatments that reduce the hands-on requirements.

In June 2022, Tel Aviv University revealed that a one-time injection might be the answer to a permanent cure. This injection uses genetically engineered type B white blood cells. Once inside the body, these blood cells secrete neutralizing antibodies that destroy HIV.

This research has only been examined in animals. It still needs to be reviewed and studied in humans, but the cutting-edge capability holds great promise.

Experimental vaccines

Vaccines for deadly infections and diseases are often the goal of medical research. For HIV, a vaccine remains elusive.

For example, in August 2021, the Imbokodo study was canceled. This study involved more than 2,600 women in seven southern African nations. The vaccine did not provide protection against HIV.

Several other vaccine studies have also been canceled for not showing effectiveness.

Researchers are reviewing the data gathered in the Imbokodo study. They hope to find information that could help them in their ongoing pursuit of an HIV vaccine.

As of March 2022, three new mRNA vaccines are also undergoing phase 1 clinical trials.

Stem cell transplant

Stem cells have long been studied for the treatment of some cancers and lymphomas. Now researchers are looking at what a stem cell transplant might do for people living with HIV.

In February 2022, researchers revealed at a medical conference that a third known person had been cured of HIV. This person, a woman from New York, had shown no detectable HIV since stopping ART and receiving a stem cell transplant to treat leukemia.

This stem cell transplant was unique to a patient with both HIV and leukemia. She was given donations from the umbilical cord of a baby with a rare genetic mutation that makes the baby immune to HIV. The woman was also given stem cells from a family member with a closer genetic match than the infant.

After the transplant, the woman had no detectable HIV for 14 months, and she was no longer using ART. She joins two other people, one in Berlin and another in London, who have been effectively cured of HIV.

However, stem cell transplants are cost-prohibitive and can be difficult to endure. It is also hard to find the rare genetic mutation needed for the transplant.

While this is not a long-term solution for treating or curing HIV, it does provide some insights into other treatments that may be beneficial.

Kick and kill strategy

If you find and kill infected cells inside the body, a virus will be eliminated. However, HIV is stealthy. It can easily hide and evade the immune system’s best efforts to eliminate it.

In what’s called the kick and kill strategy, researchers have created a two-pronged treatment for HIV. The first portion is a latency-reversing agent. It “kicks” the memory cells where HIV hides and wakes them up so the immune system can more easily find them.

In the second prong, a broadly neutralizing antibody is given. This stimulates the body’s immune system to kill the infected cells that are not awake and capable of being found.

Antibody injections

Researchers at Rockefeller University shared in April 2022 that antibody treatments used with ART were able to achieve viral suppression that allowed people to stop taking ART. Some study participants achieved viral suppression for a year.

This study suggests that treatment with antibodies might reduce a person’s HIV reservoir, or the group of latent cells that are infected with HIV. Reducing this number of infected cells may help people maintain viral suppression longer and reduce the chances of viral rebound.

Some research shows that combination antibody injections may also be more effective than single antibody treatment.

It’s important to note that some HIV medications have side effects. The mild, more common side effects include:

• diarrhea
• fatigue
• vomiting
• liver toxicity

Every year, researchers are finding new and exciting breakthroughs in HIV research. Some of these findings can also come with setbacks, but progress moves understanding forward.

Researchers are finding new avenues for study and exploration. In the near future, the news about HIV prevention and treatment may finally include success stories about cures and preventive vaccines.