Imagine a game of chess where your opponent’s king is in check. It cannot move, but the game is not over – the piece remains on the board. This is how the body can control HIV on its own: the virus is contained and unable to replicate or spread, but it has not been eliminated.
This is the goal for Prof. Ole Schmeltz Søgaard and an international team of researchers – to enable more patients’ immune systems to keep the virus permanently in check without the need for daily medication. Their findings suggest that this requires two key components working in tandem: antibodies and T cells.
In a study published in Nature Immunology, the researchers followed patients who stopped taking their daily HIV medication after receiving experimental treatment. In a small group of patients, the virus has not returned.
“We can see that two branches of the immune system work together to control the virus. One targets one aspect of the virus, the other targets another. Together, they are effective enough to prevent the virus from escaping,” says Søgaard.
Lifelong treatment
Modern HIV treatment is highly effective and allows people to live normal lives – working, starting families and preventing transmission. Mothers with HIV can give birth to children without HIV. However, treatment does not cure the disease; it suppresses the virus.
“As long as patients remain on treatment, the disease stays under control. But the virus does not disappear – it hides within the cells. If treatment stops, the virus begins to multiply rapidly. Within just two to three weeks, high levels of virus can be detected in the blood again,” says Søgaard.
This is why the research team spent the past 15 years working to develop a treatment that could shift the burden from medication to the immune system itself.
Breakthrough: 10-20 % manage without medication
In clinical trials where patients discontinued medication following experimental treatment, something remarkable has been observed: in 10–20% of cases, the virus has not returned. In these patients, the immune system has taken over the role of medication and maintained control of HIV on its own.
The researchers have now identified what sets this group apart from the remaining 80–90%. The key lies in the interaction between antibodies and T cells – the immune system’s two “rooks”. In these patients, the two components attack the virus from different angles, preventing it from evading the immune response.
The study followed three patients for up to seven years. Two of them have lived without HIV medication throughout the entire period and remain healthy by all clinical measures. A third patient experienced a viral return after two and a half years without treatment. In this case, the virus had mutated, allowing it to escape both T cells and antibodies.
“For the patient, this was of course very unfortunate. But scientifically, we learned a great deal. We obtained indirect evidence that what we believed was important truly was,” says co-author Katie Fisher.
The road to a cure: from 20 % to 100 %
The research team is now planning new studies focusing on strengthening these immune mechanisms. They will test existing treatments from other disease areas, such as immunotherapy used in certain cancers, which may help enhance the immune response in people living with HIV.
“We have found something that works for 10–20% of patients. Now we need to understand exactly what is happening in their immune systems – and use that knowledge to develop a treatment that works for everyone,” says Søgaard.
The findings have significant global implications. A short-term treatment that permanently removes the need for daily medication could be transformative for millions of people in parts of the world where lifelong treatment is not a realistic option.
