Roger-Luc Chayer (Image : AI / Gay Globe)
Since the beginning of the HIV pandemic, which has caused a considerable number of victims, particularly affecting homosexual people and sex workers, LGBT communities have been hoping for the arrival of a treatment capable of permanently eliminating the virus.
Effective treatments, but not curative
Over the years, significant progress has made it possible to develop highly effective treatments, notably in the form of long-acting injections that successfully control the infection. However, these advances still do not allow the virus to be completely eradicated. So-called “anti-PD-1” immunotherapy could nonetheless represent a promising path toward achieving this goal.
A new approach inspired by oncology
For decades, the fight against HIV has been based on a well-known equation: controlling the virus without ever truly eliminating it. Antiretroviral treatments have transformed what was once a fatal infection into a chronic condition, but they require daily adherence and do not eliminate viral reservoirs. Today, an approach from the field of oncology could change the game: anti-PD-1 immunotherapy.
Understanding the role of PD-1 in the immune system
At the heart of this strategy lies a very specific target, PD-1, a protein that acts as a true brake on the immune system. Under normal circumstances, this mechanism is essential. It prevents our natural defenses from becoming overactive and attacking our own cells. But in the case of HIV, this system is hijacked. The virus manages to exhaust T lymphocytes, key immune cells, by activating this biological brake. The result is an immune system that is present but weakened, unable to fully eliminate the infection.
How anti-PD-1 treatments work
This is where anti-PD-1 therapies, already well known in oncology, come into play. Drugs such as nivolumab or pembrolizumab work in a seemingly simple way: they block this brake. By neutralizing PD-1, they allow T lymphocytes to regain their full functional capacity. In other words, they restore the immune system’s ability to do its job.
Hope in the face of HIV’s hidden reservoirs
Applied to HIV, this approach opens up new possibilities. The virus has the ability to hide in reservoirs that are invisible to conventional treatments. Even when viral load becomes undetectable, these reservoirs persist, ready to reignite the infection if therapy is interrupted. Anti-PD-1 immunotherapy could help “awaken” these dormant areas while strengthening the immune response to eliminate them.
Encouraging but still limited results
Early results from clinical trials remain cautious but encouraging. In some patients, improved immune responses have been observed and, in very specific cases, the ability to control the virus without continuous treatment. This is referred to as functional remission, a goal long considered out of reach.
Risks and limitations to consider
However, it would be premature to speak of an immediate breakthrough. Immune system activation is not without risk. By lifting the body’s natural brakes, these treatments can cause significant, sometimes severe, side effects related to an excessive immune response. In addition, not all patients respond in the same way, and the mechanisms of HIV remain particularly complex.
A paradigm shift in research
What is changing today is the very philosophy of research. The goal is no longer simply to contain the virus, but to enable the body to regain control. Anti-PD-1 fits into this logic: using the intelligence of the immune system rather than replacing it.
A treatment not yet accessible to the general public
Anti-PD-1 treatment for HIV is not currently available in routine clinical practice. But the reality is more nuanced — and more interesting.
Today, these therapies already exist… but only for cancer. Anti-PD-1 drugs are approved and used in oncology, not for HIV. In this context, their use against HIV remains experimental.
Promising clinical trials in Montreal
What is changing is that recent clinical trials — including some conducted right here in Montreal — have reached an important milestone. An initial human trial showed that this type of treatment is safe at low doses and could, in some patients, delay viral rebound after stopping antiretroviral therapy. In other words, evidence is beginning to show that it works… but not yet enough to make it a standard treatment.
Limited access in very specific contexts
In practical terms, this means that anti-PD-1 for HIV is currently accessible only in very specific contexts: within clinical trials, or sometimes in patients who are already receiving this type of immunotherapy for cancer. Outside of these situations, a person living with HIV cannot request this treatment from their doctor as an alternative to current therapies.
Still partial results
It is also important to understand why. First, the results remain partial: in the Montreal study, only a portion of participants experienced a sustained level of viral control.
Between research and tomorrow’s medicine
So where do we really stand? Anti-PD-1 can be seen as somewhere between research and the medicine of the future. Phase 2 trials are being prepared or are already underway, and if they confirm current findings, broader accessibility could be considered in the coming years — but not immediately.
Living with HIV today
Fortunately, current treatments make it possible to be more patient and to live an almost normal life, with minimal constraints. The next phases of research are highly anticipated to further explore this pathway, which could eventually free people living with HIV from the burden of multiple medications.
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