Advances in HIV Treatment

Human immunodeficiency virus, or HIV, is a virus that spreads through unprotected sex, sharing contaminated needles, and from mother to child. It attacks your immune system, which protects your body from germs. To do this, HIV invades an important type of immune cell called a T lymphocyte. Once inside the cell, HIV can make many copies of itself. 

HIV therapies have come a long way. Today, the standard treatment is antiretroviral therapy (ART). It’s not a cure, but it can help you live a longer, healthier life with HIV and also can stop you from spreading the virus. It usually combines two or three drugs in a once-daily pill. But these drugs can stop working, or some people get tired of taking pills.  These new and future possible HIV treatments are in various stages of development. 

Instead of taking an ART pill every day, you can try long-acting ART. This is a shot you get once a month or once every 2 months, after you have achieved undetectable virus using ART pills. The shot, marketed as Cabenuva, contains microscopic crystals made of two drugs, cabotegravir and rilpivirine. Both drugs stop the virus from making new copies of itself. As time passes, these crystals melt, slowly releasing the drugs into your body. 

Ibalizumab blocks HIV from entering blood cells. It’s a type of manmade immune protein called a monoclonal antibody. You take it through an IV once every 2 weeks in addition to other ART drugs. Ibalizumab is for people whose HIV infections haven’t been getting better despite treatment. 

Fusion inhibitors are a type of drug that prevents HIV from entering, or fusing, with T lymphocytes. The only FDA-approved fusion inhibitor is a twice-daily shot called enfuvirtide (Fuzeon/T20). It’s for people whose current HIV treatment isn’t working. You have to take it with other HIV medications.

Leronlimab is another monoclonal antibody that prevents HIV from entering cells. You get it as a weekly shot. The FDA has placed research on this drug on a partial clinical hold, which means that it has stopped some studies. Drug companies continue to work on this drug.

Lenacapavir stops HIV from making copies of itself. It’s a twice-yearly shot or a daily or weekly pill. It might help treat multidrug-resistant HIV. Although it has been approved in Europe, it’s still being studied in the United States. The FDA hasn’t approved it. 

To make copies of itself, HIV needs to hijack certain human genes. Someday, doctors might use gene editing technology to turn off some of these genes. A recent study identified more than 60 human genes that could potentially be used in this treatment.

Broadly neutralizing antibodies (bNAbs) are manmade immune molecules that can block many types of HIV from entering human cells. You take them through a shot or IV. It’s possible that you’ll only need to do this once every 6-12 months. Researchers are still studying whether they can treat HIV. 

Islatravir is a new type of drug intended for patients for whom other HIV therapies have failed. It works by stopping HIV from making copies of itself. It’s usually a pill taken daily or weekly. But after early reports that islatravir might lower white blood cell counts in some people, the FDA stopped most studies on the drug. Drug companies are still working to make islatravir safe and effective.