World AIDS Day: For decades science has been fighting to find ways to cure AIDS and has won many battles.

Although AIDS, Acquired Immune Deficiency Syndrome, cannot be cured, it can be treated very effectively with antiretroviral drugs that have been in use since the mid-1990s. They act to suppress the virus in the body and prevent it from reproducing. The virus is no longer contagious and is under control. Most patients take a combination of antiretroviral drugs in tablets with different targeting at different stages of the disease. Also very important are the exams that must be done every three months. What is measured is the viral load in the body, i.e. how much RNA of the specific virus is present in the blood. “The lower it is, the better,” Hendrik Streeck, director of the Institute of Virology at the University Clinic of Bonn, which specializes in AIDS research, tells Deutsche Welle.

Inhibitors of integration

The last major scientific breakthrough was the so-called integrase inhibitors. It is an enzyme that plays an important role in the multiplication of the HIV virus and is responsible for the integration of the viral genome into the host cell, where it multiplies. “This active substance,” says Hedrik Streek, “is simply extremely effective. These integrase inhibitors have literally saved the lives of many patients who may have already had a very resistant viral infection and no other active substances were available. In the meantime, they are part of every treatment.” AIDS research focuses on developing drugs that are better tolerated than previous ones with the fewest possible side effects. This has now become possible, assures the German professor.

“We have more and more good treatments, but the big question is how we can achieve long-term efficacy. In the near future we will have an injection that will be given once a year, so that the patient does not have to take a tablet every day.” But the greatest challenge to science today is the AIDS vaccine. Even after 40 years from the onset of the viral disease it does not exist. “But we wouldn’t have had a vaccine against the coronavirus so quickly if we hadn’t done all the research on the AIDS virus first. Many of the scientific approaches used were developed in vaccine research.”

Moral issues

People want a vaccine to be developed because they think it is the best solution. But, as Hedrik Streek says, the scientific community has not yet succeeded, every time a small research success is followed by a disappointment. And the latest vaccine trials have been halted ingloriously. “We haven’t figured out why we can’t achieve sterilizing immunity,” he says. “The difficulty is that the virus is constantly mutating, creating countless variations.” In addition to mRNA vaccines global AIDS research is also focused on the so-called CRISPR-Cas9 molecular gene scissors. This “cuts” the genetic material of HIV from the human DNA or allows the reprogramming of the cells of the immune system. A revolutionary method of genetic intervention and “correction” of “guilty” genes that raises many ethical questions. “But until all these scientific approaches are developed it is important to use the options we have,” notes Streek. “That means everyone’s access to education, testing, prevention and treatment.”

Editor: Irini Anastasopoulou