Africa-Centred HIV Cure Strategy ideal

As global efforts to find a cure for HIV gather pace, experts are calling for an Africa-focused research agenda. They argued that scientific breakthroughs would have limited impact unless were designed to meet the unique realities, healthcare systems and needs of African populations, where the burden of the epidemic remained highest. Even though principal research scientist based at the Botswana Harvard Health Partnership (BHP), Professor Catherine Koofhethile said the global scientific community had made progress in HIV treatment, developing a cure remained one of medicine’s greatest challenges.

Despite decades of progress in HIV prevention and treatment, Prof. Koofhethile said Africa still faced major HIV burden, and that the continent had yet to meet key global HIV impact targets. She said the goal of reducing annual new HIV infections below 370 000 by 2025 and AIDS-related deaths below 250 000 had not yet been achieved, but instead, Africa recorded approximately 663 000 new HIV infections and 396 000 AIDS-related deaths in 2023.

“One death is a really big deal, so imagine 390 000,” she said. While Botswana has achieved and surpassed the UNAIDS 95-95-95 treatment targets, the ending HIV requires a coordinated international response. “We cannot solve the problem here only, we have to solve the global problem,” said Prof.

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Koofhethile. Meanwhile, she praised advances that had simplified HIV treatment from multiple daily pills to once-daily medication and long-acting injectable therapies, but emphasised that these treatments suppressed the virus rather than eliminate it. Koofhethile said when anti-retroviral therapy suppressed the virus, HIV could remain dormant inside certain CD4 T-cells, and if treatment was stopped, the hidden reservoirs could reactivate, leading to viral rebound.

“The main reason why we cannot eliminate HIV from the body using treatment is because of these reservoirs,” said Prof. Koofhethile, warning patients never to stop antiretroviral treatment without medical supervision, because research had consistently shown the virus returned once therapy was interrupted. In cure versus remission, Prof. Koofhethile distinguished between two goals of HIV cure research.

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