Professor Thumbi Ndung'u emphasizes the importance of exploring HIV remission strategies, aiming to reduce lifelong ART reliance and provide a better quality of life for those living with HIV.
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A scientific breakthrough that could transform the fight against HIV has emerged from KwaZulu-Natal. For the first time in Africa, a clinical trial aimed at achieving long-term HIV remission — without lifelong antiretroviral therapy (ART) — has been conducted, sparking new hope in the global search for a cure.
Professor Thumbi Ndung’u, a leading scientist at the Africa Health Research Institute and professor at the University of KwaZulu-Natal (UKZN), has announced results from a pioneering study that could redefine how HIV. is treated. The trial — the first of its kind on the continent — marks a critical shift from managing the virus with daily medication to the tantalising possibility of drug-free remission.
The study involved 20 South African women living with HIV and tested a novel combination of two potent antibodies (VR07 and CAP256) with an immune stimulant, Vesatolimod (VES).
The aim? To rouse the virus from its hiding places in the body and give the immune system a fighting chance to control it — potentially without ART.
“This is a pivotal moment for HIV science in Africa,” Ndung’u said, noting that this was no ordinary study. “It’s the first HIV remission trial conducted on African soil. It took years of consultation, partnership, and perseverance to make it happen.”
The backdrop of this research could not be more urgent. In parts of KwaZulu-Natal, including the Umkhanyakude District, nearly 60% of women aged 25–44 are living with HIV. For Ndung’u, the mission is deeply personal and rooted in real-world impact. “Imagine if someone could take medication for two or five years — and then stop ART completely. That’s the vision,” he said.
The study aimed to answer a crucial question: Could the immune system maintain control over the virus after ART cessation? While the idea of a cure is still far off, remission, where individuals could control the virus without ART, became the focus of the study, he said.
Ndung'u emphasised the difference between eradication and remission, where individuals can control the virus without antiretroviral therapy (ART) approaches to curing HIV.
While complete eradication of HIV from the body has been achieved in a small number of individuals (around seven to nine cases globally), it remains a complex and risky process, often involving procedures like bone marrow transplants. On the other hand, remission allows people to control the virus without ART, potentially leading to a better quality of life, Ndung'u said.
The women involved had been on ART for an average of 6.9 years. The primary objectives were to assess the safety of the treatment and determine how long it would take for the virus to rebound after stopping ART.
The results were promising, though mixed, he said. While seven participants had to restart treatment within 16 weeks, four others managed to stay off ART for up to a year, and one participant is still controlling the virus after 2.5 years.
"We cannot say that this is a definitive cure, but it is a significant step toward understanding how we can achieve remission for people living with HIV," Ndung'u explained.
Ndung'u also highlighted the challenges faced in conducting this research, including political unrest and the need for strong community involvement.
"This kind of complex research can be done, but it requires collaboration between researchers, the community, and stakeholders. Without cooperation, it would be impossible to move forward."
Professor Kirsta Dong, a Clinical Director, FRESH Cohort Assistant and Professor of Medicine, and a leader in HIV research, spoke passionately about the importance of engaging women in HIV cure and remission strategies.
She and Professor Ndung'u have long been advocates for ensuring that women, particularly those in sub-Saharan Africa, are not underrepresented in clinical trials.
In 2021, they launched a more ambitious trial aimed at advancing HIV cure research, focusing on 25 women who were diagnosed early and started ART during the “window period” of infection, when the virus is most vulnerable.
Dong reflected on the beginning of this journey, which dates back to 2013, when she and Ndung'u envisioned a cohort of young women in Umlazi, South Africa, a region with a high rate of HIV transmission.
Their goal was to detect HIV during the hyperacute phase—just before the virus fully establishes itself in the body. "We thought, can we catch HIV so early that we could change the course of the infection entirely?" she recalled.
The study’s success in detecting hyperacute infections has already proven that early treatment can prevent the establishment of long-term viral reservoirs.
One of the key findings of their research, published in 2021, was the success of early treatment. Starting ART during the hyperacute phase of infection can significantly reduce the risk of developing HIV reservoirs.
"Since 2016, when we introduced the 'test and treat' strategy, people have been getting more used to the idea of starting treatment immediately, but back then, this was revolutionary," Dong said.
However, their work faced challenges, such as looting, floods, and the global COVID-19 pandemic, which temporarily shut down their clinics. "We lost everything—every stethoscope, every desk, every tool," Dong recalled. Yet, the team persevered, moving to a new site to continue providing treatment to their patients without interruption.
The current trial, launched in 2021, involves a complex combination of drugs designed to wake up dormant HIV reservoirs, allowing them to be targeted more effectively. The trial also explores the concept of Analytical Treatment Interruption (ATI), which involves temporarily halting ART under strict monitoring.
"ATI is not just taking a drug holiday," Dong explained. "It’s a carefully monitored process where we stop treatment and closely observe the participants to ensure their health is stable and the virus remains under control."
While the results of these trials are still unfolding, both Ndung'u and Dong remain hopeful. "We can't simply assume that what works in other parts of the world will work here," Dong noted, emphasising the unique challenges faced by African women living with HIV.
Her work has been instrumental in shifting the focus of HIV research to include women and their unique needs in HIV care.
"This is not just about curing HIV for one person," Dong said. "It’s about making a global impact, helping people across the world, and ensuring that the next generation of scientists, particularly from Africa, will lead the way."
As their studies continue, the hope is that by 2030, they will lead to a new era of HIV treatment, where lifelong ART may no longer be necessary, and the possibility of remission or even a cure could become a reality for those living with HIV in sub-Saharan Africa and beyond.
hope.ntanzi@iol.co.za
IOL News
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