A groundbreaking HIV clinical trial in Africa has shown that some women can control the virus without antiretroviral therapy for extended periods after receiving a combination of treatments. This marks a significant step toward a potential HIV cure. The trial, known as FRESH, was conducted in Durban, South Africa, and involved 20 women with acute HIV infection. Four of them have remained off antiretroviral therapy for approximately 18 months while maintaining undetectable viral loads and normal CD4 counts.
Researchers employed a combination immunotherapy approach. Participants first received antiretroviral therapy for at least a year to suppress the virus and preserve immune function. Following this, they were given immunotherapy using broadly neutralizing antibodies, which block HIV from attacking cells. Additionally, they received a toll-like receptor 7 agonist to enhance immune cell response against the virus.
After treatment interruption, participants fell into three categories: those whose virus rebounded within 16 weeks, those who controlled the virus for 16-44 weeks before requiring antiretroviral therapy, and those who maintained control for the full 48-week study period without medication. The findings indicate that, for a small percentage of people, this intervention may work in suppressing HIV without continuous therapy.
While previous HIV cure studies have been conducted in other parts of the world, many of them involved complex medical procedures like bone marrow transplants, which are not feasible for public health implementation. This study is significant because it tested a simpler approach involving immunotherapy, and it was conducted specifically in women, whereas most other studies have focused on men.
The trial combined three main elements: initial antiretroviral treatment to suppress the virus, immunotherapy to directly kill the virus or mobilize the immune system, and the use of a toll-like receptor 7 agonist to enhance the immune system’s ability to fight HIV. Researchers then stopped treatment to observe whether the virus would return. Among the participants, six showed promising results, with four still off antiretroviral therapy and controlling the virus naturally.
The individuals who have maintained control remain completely healthy. Their viral loads are undetectable, and their CD4 counts are within the normal range. They have not met the criteria to restart antiretroviral therapy, but researchers continue to monitor them closely. The duration for which they can remain off medication remains uncertain.
Since the intervention was effective only in a small number of participants, researchers do not plan to roll it out on a larger scale yet. Instead, they are conducting further laboratory studies to determine why these four women were able to control the virus without ongoing treatment, while the other 16 were not. Understanding the differences in immune responses between these groups may help in developing more effective treatments in the future.
This study paves the way for more HIV cure research in Africa. It signals progress toward controlling HIV without lifelong antiretroviral therapy, although more work is needed before such treatments can become widely available. The insights gained from this research could eventually contribute to the development of a functional cure, bringing hope for a future where HIV can be managed more effectively without continuous medication.
