Searching for a HIV-1 Cure

Advances in stem cell transplantation, broadly neutralizing antibodies, ultra-long-acting antiretroviral drugs, therapeutic vaccines, cell engineering, gene therapy, and immune-based molecular therapies have highlighted efforts to cure human immunodeficiency virus type 1 (HIV-1). However, none of these are durable. The challenges to achieve complete viral eradication include durability, accessibility, delivery, off-target effects, and practicality. All approaches, including combinatorial therapies with ultra-long-acting antiretrovirals, broadly neutralizing antibodies, or latency-reversing agents, which reduce reservoir size and achieve durable viral suppression, are discussed. These include key translational insights for clinical relevance. Among these, gene-editing technologies have shown promise in disrupting proviral DNA and delivering targeted therapies by targeting latent reservoirs and host viral receptors. This review examines the scientific, clinical, and ethical considerations, focusing on direct viral excision and co-receptor editing as key strategies for a viral cure.