Durban – In a moment of both triumph and uncertainty, South Africa’s scientific community has unveiled encouraging results from a landmark HIV cure trial conducted in Durban, KwaZulu-Natal. The University of KwaZulu-Natal (UKZN) announced that the trial demonstrated antiretroviral therapy (ART)-free virus control in a subset of HIV patients, marking a significant step forward in cure-related research. This beacon of hope emerges against a backdrop of growing apprehension over international funding cuts, particularly from the United States.
The trial, led by UKZN Professor Thumbi Ndung’u, Director for Basic & Translational Science at Africa Health Research Institute (AHRI), explored a novel approach using combination immunotherapy. The study aimed to either eliminate or reduce hidden traces of HIV in the body, enabling the immune system to effectively control the virus without the need for lifelong medication. The implications of this research are far-reaching, potentially revolutionizing the way HIV is managed and treated globally.
The results of the study, which were presented at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, USA, revealed that 20% of participants remained off ART and were virally suppressed after one-and-a-half years. This achievement is particularly remarkable considering the challenges inherent in HIV cure research, including the virus’s ability to hide within immune cells and rebound when treatment is stopped.
A Groundbreaking Approach: Combination Immunotherapy
The Durban trial’s success hinges on its innovative approach to HIV treatment. Combination immunotherapy seeks to harness the power of the immune system to fight the virus, rather than relying solely on antiretroviral drugs. This strategy involves two key steps:
- Early ART Intervention: Researchers treated participants with antiretrovirals very soon after they acquired HIV. This early intervention is crucial to suppress the virus and prevent it from establishing a large reservoir of infected cells.
- Immune-Boosting Therapies: Once the virus was controlled by ART, participants received powerful immune-boosters to enhance the immune system’s ability to fight the virus. These therapies aim to stimulate the immune system to recognize and eliminate HIV-infected cells, even those that are hidden in the reservoir.
Following these interventions, participants were closely monitored as they stopped ART to assess their bodies’ capacity to control the virus independently. The fact that 20% of participants were able to maintain viral suppression without medication for an extended period is a testament to the potential of this approach.
Focus on Women: Addressing a Critical Gap
A significant aspect of the trial was the inclusion of 20 women, a group disproportionately affected by HIV yet often underrepresented in cure-related research. This focus on women is essential to ensure that HIV cure strategies are effective and accessible to all populations.
The trial results showed that 30% of participants (six out of 20) were able to stay off HIV treatment for nearly a year, and 20% (four participants) remained off treatment until the trial ended at 55 weeks. Even after the trial, these four individuals, who are still being closely monitored, have continued without medication for an average of 1.5 years. This sustained viral control is a significant achievement and provides valuable insights into the mechanisms of HIV remission.
Professor Ndung’u’s Perspective: A Call for Continued Research
Ndung’u, who is based at the Africa Health Research Institute (AHRI) in Durban, emphasized the importance of continued research in this area. “While this treatment approach didn’t work for most participants, it is still a significant development in HIV cure research. Studying how the 20% managed to control the virus on their own will help scientists develop better HIV cure strategies, as well as work out ways to improve future treatments. This trial is also significant because it proves that complex HIV cure research can be successfully conducted in resource-limited settings where the need is greatest, and highlights the importance of including African populations in global scientific advancements.”
Professor Ndung’u’s words underscore the critical role that African researchers and communities play in the global fight against HIV. By conducting cutting-edge research in resource-limited settings, they are not only advancing scientific knowledge but also ensuring that HIV cure strategies are relevant and accessible to the populations most affected by the virus.
Global Concerns: Funding Cuts and Political Tensions
These findings come at a crucial time, as concerns mount over potential cuts in funding for public health and biomedicine, particularly in the United States. As epidemiologist Wafaa El-Sadr noted at the opening ceremony of the CROI conference, the termination of a major grant from the U.S. Agency for International Development and other funding cuts have created a climate of uncertainty and anxiety within the research community.
Trump’s executive order, signed a fortnight ago, said there were “countless government policies designed to dismantle equal opportunity in employment, education, and business, and hateful rhetoric and government actions fuelling disproportionate violence against racially disfavored landowners”. It added: “In addition, South Africa has taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the international court of justice, and reinvigorating its relations with Iran to develop commercial, military, and nuclear arrangements.”
South Africa’s foreign ministry said in a statement that there seemed to be a “campaign of misinformation and propaganda”. “It is ironic that the executive order makes provision for refugee status in the US for a group in South Africa that remains amongst the most economically privileged, while vulnerable people in the US from other parts of the world are being deported and denied asylum despite real hardship,” it said. “We reiterate that South Africa remains committed to finding diplomatic solutions to any misunderstandings or disputes.”
Conservative Afrikaner pressure groups said they were concerned about US aid to South Africa being cut and that South Africa would be excluded from the African Growth and Opportunity Act. The act is US legislation that needs to be renewed by the US Congress this year, which allows South African exporters, including farmers, to sell thousands of products to the US tariff-free.
These political tensions and funding cuts pose a significant threat to HIV research and treatment efforts in South Africa and across the continent. The loss of US funding could jeopardize ongoing research projects, limit access to essential medications, and undermine efforts to prevent new infections.
Other Promising Developments: PrEP and Broadly Neutralizing Antibodies
Despite these challenges, the CROI conference also highlighted other promising developments in HIV prevention and treatment. Data presented at the conference suggested that a single injection of a drug could ward off HIV infection for a full year, representing a potential breakthrough in preexposure prophylaxis (PrEP). This long-acting PrEP could significantly improve adherence and accessibility, particularly in resource-limited settings.
Additionally, researchers reported that unusual antibodies could help people control HIV without antiretroviral drugs, offering a possible step toward a cure. These broadly neutralizing antibodies (bNAbs) have the ability to target a wide range of HIV variants, making them a promising tool for achieving sustained viral remission.
However, researchers caution that PrEP alone cannot reverse worrisome trends in HIV epidemiology, with an estimated 1.3 million people infected last year, far exceeding the target set by the Joint United Nations Programme on HIV/AIDS. Epidemiologist Chris Beyrer emphasized that without a vaccine or a cure, HIV prevalence will continue to grow even if PrEP use is scaled up.
The Path Forward: Collaboration and Innovation
The Durban trial’s findings, along with other advancements presented at the CROI conference, offer renewed hope in the fight against HIV. While challenges remain, the dedication and ingenuity of researchers worldwide continue to drive progress towards a future free from the burden of this devastating virus.
The research was a collaborative effort involving the HIV Pathogenesis Programme at the University of KwaZulu-Natal, the Africa Health Research Institute, the Ragon Institute of Mass General, MIT and Harvard, and Gilead Sciences, Inc. This collaborative spirit is essential to accelerate progress and ensure that HIV cure strategies are developed and implemented effectively.
