The landscape of HIV is one of constant scientific and medical progress. Decades of research have transformed the virus from a terminal diagnosis into a manageable chronic condition for many. This progress continues to accelerate, with recent developments bringing new options for treatment, more effective strategies for prevention, and tangible steps toward a cure. These advancements represent a significant shift in the realities of the virus, offering improved quality of life and renewed optimism.
Advancements in HIV Treatment
The evolution of antiretroviral therapy (ART) has moved away from daily oral pills toward long-acting injectable medications. This shift improves convenience and helps overcome challenges with adherence to a daily regimen. A primary example is Cabenuva, a combination of cabotegravir and rilpivirine, administered as two intramuscular injections every one or two months for individuals who have already achieved viral suppression.
Studies show that injectable ART is highly effective at maintaining viral suppression and can help individuals who have struggled to achieve an undetectable viral load with oral medications. The goal of modern ART is to achieve an undetectable viral load, meaning the amount of HIV in the blood is so low it cannot be detected by standard tests.
This state of viral suppression is foundational to the concept of Undetectable = Untransmittable (U=U), a scientifically validated fact that a person with an undetectable viral load cannot sexually transmit HIV to others. Beyond injectables, new classes of drugs are expanding treatment options. Lenacapavir, the first approved capsid inhibitor, works differently than older medications and is administered as an injection just twice a year, though it must be combined with other antiretroviral drugs.
Developments in HIV Prevention
Just as treatment has evolved beyond daily pills, so has prevention. Pre-exposure prophylaxis, or PrEP, is a method for HIV-negative individuals to prevent acquiring the virus. While daily oral pills have been available for years, newer long-acting injectable options are changing the prevention landscape. Apretude, an injectable form of the drug cabotegravir, is administered every two months and offers a highly effective alternative.
Clinical trials have demonstrated that injectable PrEP provides superior protection compared to daily oral PrEP, largely by removing the barrier of daily adherence. The availability of multiple PrEP options allows individuals to choose the method that best fits their lifestyle and needs, a factor in increasing the effectiveness of prevention strategies.
Beyond direct HIV prevention, a more comprehensive approach to sexual health is emerging. This includes the strategy known as doxy-PEP, where the antibiotic doxycycline is taken as post-exposure prophylaxis after sex to prevent bacterial sexually transmitted infections (STIs) like syphilis and chlamydia. Studies have shown this approach can significantly reduce the incidence of these STIs among individuals also using HIV PrEP.
The Search for a Cure
The pursuit of an HIV cure is advancing along several distinct paths. A primary distinction is made between a “sterilizing cure,” which would completely eradicate every trace of the virus from the body, and a “functional cure,” which would suppress the virus to undetectable levels for life without the need for ongoing ART. While a sterilizing cure is the ultimate goal, a functional cure is considered a more achievable and scalable objective.
Recent years have seen cases where individuals have been deemed cured of HIV. These instances, such as the “Düsseldorf patient,” occurred in people who received stem cell transplants to treat life-threatening cancers like leukemia. The donors of these stem cells had a rare genetic mutation, CCR5-delta-32, which makes immune cells resistant to HIV infection.
After the transplant, the patient’s immune system was replaced with the donor’s HIV-resistant cells, and they have remained free of the virus for years after stopping ART. While these stem cell transplant cases are proofs-of-concept, the procedure is too risky and expensive to be a widespread solution. However, they provide scientific insights into how a cure might be achieved.
Researchers are exploring other avenues, including gene therapy techniques like CRISPR to edit the CCR5 gene in a person’s own immune cells. Therapeutic vaccines are also being investigated, designed not to prevent infection but to train the immune system to control the virus without drugs, aiming for a functional cure.
Global Public Health Updates
Global health organizations like UNAIDS have established “95-95-95” targets to measure the success of the global response. These goals are:
- For 95% of all people living with HIV to know their status.
- For 95% of those diagnosed to be on antiretroviral therapy.
- For 95% of those on treatment to achieve viral suppression.
According to the latest UNAIDS data, the world has made significant progress but still has ground to cover. As of 2024, an estimated 87% of people living with HIV knew their status. Of those who knew their status, 89% were accessing treatment, and of those on treatment, 94% were virally suppressed.
While these figures represent millions of lives saved, they show that gaps remain, particularly in testing and ensuring everyone diagnosed is linked to care. The data also reveals disparities, with men being less likely than women to know their status and access treatment. Achieving the 95-95-95 targets requires overcoming systemic barriers, fighting stigma, and ensuring that the latest scientific tools are made available equitably to all populations worldwide.