The HIV/AIDS epidemic started with its first case in 1981 and has caused irreparable, ongoing damage to communities around the world. Scientists around the globe have quickly moved to develop treatments and cures for those who contract HIV/AIDS. In many parts of the world, people have access to treatment that will stop a decline in quality of life for those living with the disease. These treatments are called antiretroviral therapies and work to reduce the HIV viral load in a patient who is taking the drug [1]. Decreasing the viral load allows the body to recover and fight off HIV infection and related illnesses and certain HIV-related cancers. These drugs often reduce the possibility of transmission of HIV as well. Overall, these therapies provide those living with HIV a chance at maintaining a high quality of life and increased life expectancy compared to those who are not being treated with HIV [2].
However, these treatments are not available everywhere. Antiretroviral therapies and pre-exposure prophylaxis (PrEP) are widely available in the United States for those who can afford them. Pre-exposure prophylaxis is a medication that is highly effective at reducing the chances of contracting HIV from sexual contact or drug use [3]. It is commonly prescribed for those at risk of contracting HIV. The gap between those who can access these treatments and those who cannot has a substantial impact on the prevalence of the disease. In South Africa, one country where the AIDS crisis is most severe, the HIV/AIDS epidemic is far from over. There, more than 18 percent of the adult population is infected with HIV/AIDS, whereas in the United States, the prevalence rate is below 1 percent [4]. These numbers are staggering.
They illustrate that the United States is faring quite well with regard to the HIV/AIDS epidemic, while other countries are continuing to struggle. In South Africa, the rate of new infections has lowered over the past ten years, but the number of people living with HIV/AIDS is increasing faster than the rate at which access to treatment can match [4]. Additionally, antiretroviral therapies require that you take them every single day. This has a possibility of being logistically challenging when medication starts to dwindle among a population. If you stop taking the antiretroviral therapy, the virus will begin to remultiply and you will become transmissible again [5]. It may be easy to take medication once a day if you have access to a stable source of medication, but this is not everyone’s reality. Luckily, cures have been undergoing development for some time.
One treatment that is showing promise is being developed using a cutting edge gene editing tool CRISPR. CRISPR may be able to act as a functional cure for HIV by inactivating integrated HIV DNA [6]. While CRISPR is a promising genetic tool, it is still in its early stages of being researched and applied. It requires further research and development in order to be both safe and effective. However, if safe and effective, it would allow for people who contract HIV to be able to take this treatment and be cured of HIV in a way that antiretroviral therapies would not be able to match. Tackling the HIV/AIDS epidemic would be much more logistically plausible and would not require broad, long-term medication regimes that could be hard, or, for some, impossible to follow [7].
The development of an HIV cure using CRISPR, however, is complicated and there are current limitations on the use of CRISPR as a way to neutralize or eradicate HIV in a host. One limitation is the delivery of the CRISPR/Cas apparatus when in vivo [8]. In some tests on mice and nonhuman primates, there has been successful obliteration of the HIV virus. However, precise targeting remains a significant challenge for effective administration of a CRISPR HIV cure. Clinical trials involving cell and gene therapy (CGT) have left people who participated in the trials with Leukemia, other illnesses, and even organ failure, which ultimately led to death [9]. These examples illustrate the very dangerous nature of using CRISPR to treat illnesses without extensive testing. And, even with further testing and development, it may be extremely difficult to predict the effect CRISPR and CGT will have on people. However, if the kinks are worked out, using CRISPR and other CGTs can have an enormous impact on not only HIV treatment, but also HIV prevention [8].
Every year, hundreds of thousands of people succumb to HIV/AIDS, with roughly two thousand people dying from the illness every day [9]. A cure is desperately needed. If we press forward with clinical trials using CRISPR or other forms of gene therapy, the risk associated with them may be too great. However, there is only so much that global access to antiretroviral therapies and PrEP can do for those who are living with – or are at higher risk of contracting – HIV. These are questions facing bioethicists and clinicians around the world and, frankly, an HIV cure could not come any sooner.
Work Cited:
U.S. Department of Health and Human Services. (2021). HIV treatment: The basics. National Institutes of Health. Retrieved April 7, 2023, from https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics.
Centers for Disease Control and Prevention. (2022). Treatment. HIV. Retrieved April 23, 2023, from https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html
Centers for Disease Control and Prevention. (2022). About PrEP. HIV. Retrieved April 23, 2023, from https://www.cdc.gov/hiv/basics/prep/about-prep.html.
South Africa. UNAIDS. (2022, December 4). Retrieved April 8, 2023, from https://www.unaids.org/en/regionscountries/countries/southafrica.
Wilberg, M. (2020, October 1). My HIV is undetectable, can I stop my medication? NAMaidsmap. Retrieved April 23, 2023, from https://www.aidsmap.com/about-hiv/faq/my-hiv-undetectable-can-i-stop-my-medication.
Hussein, M., Molina, M. A., Berkhout, B., & Herrera-Carrillo, E. (2023). A CRISPR-Cas Cure for HIV/AIDS. International Journal of Molecular Sciences, 24(2), 1563. https://doi.org/10.3390/ijms24021563.
Dybul, M., Attoye, T., Baptiste, S., Cherutich, P., Dabis, F., Deeks, S. G., Dieffenbach, C., Doehle, B., Goodenow, M. M.. Jiang, A., Kemps, D., Lewin, S. R., Lumpkin, M. M., Mathae, L., McCune, J. M., Ndung’u, T., Nsubuga, M., Peay, H. L., Pottage, J., … Sikazwe, I. (2020). The case for an HIV cure and how to get there. Lancet HIV, 8: e51-58. https://doi.org/10.1016/ S2352-3018(20)30232-0.
Bhowmik, R., Chaubey, B. (2022). CRISPR/Cas9: a tool to eradicate HIV-1.. AIDS Res Ther 19, 58 . https://doi.org/10.1186/s12981-022-00483-y.
World Health Organization. (n.d.). HIV, number of people dying from HIV-related causes. World Health Organization. Retrieved April 8, 2023, from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-deaths-due-to-hiv-aids.