HUMAN IMMUNODEFICIENCY VIRUS: EMERGING MODALITIES IN TREATMENT

Abstract

Human immunodeficiency virus (HIV) continues to represent a major global health burden, with millions of individuals affected worldwide despite substantial progress in antiretroviral therapy (ART). The advent of combination ART has effectively transformed HIV infection into a chronic, manageable disease; however, therapeutic success remains constrained by challenges including suboptimal long-term adherence, the emergence of drug-resistant viral strains, and persistent inequities in access to care. Recent investigational efforts have prioritized the development of alternative therapeutic modalities, particularly long-acting injectable (LAI) antiretroviral agents and immunologically based interventions, with the dual aims of improving adherence and achieving durable virologic remission. Pharmacological innovation has facilitated a paradigm shift from conventional daily oral ART toward extended-duration formulations, exemplified by cabotegravir, rilpivirine, and lenacapavir. These LAI regimens mitigate the burden of daily pill-taking, enhance virologic suppression rates, and may reduce HIV-related stigma, especially within marginalized populations. 

Concurrently, immunotherapeutic strategies are under active investigation. These include broadly neutralizing monoclonal antibodies (bNAbs), immune checkpoint blockade, and chimeric antigen receptor (CAR) T-cell therapies, each with potential to augment host immune control and, in select contexts, induce sustained viral suppression or functional cure. Despite these advances, several barriers remain. Resistance-associated mutations pose a significant threat to therapeutic durability, while issues of cost, infrastructure, and equitable distribution limit global accessibility. Furthermore, long-term safety and tolerability of novel agents require ongoing evaluation.

This review synthesizes recent clinical trial data, delineates the therapeutic advantages and limitations of emerging HIV interventions, and highlights future research priorities. Continued progress in LAI formulations and immunotherapeutic approaches holds promise for optimizing treatment outcomes, broadening access to care, and advancing toward the ultimate goal of a functional cure for HIV infection.