The Evolution of HIV Care and the Quest for Cure

By Veronicah Keter
The engagive plenary sessions at the 16th KEMRI Annual Scientific and Health Conference (KASH), saw the Director of the KEMRI Walter Reed site Kericho, Dr. Fredrick Sawe delivering a comprehensive reflection on decades of scientific progress in HIV care which he presented in a plenary session titled “HIV Care: Past, Present Strategies, Future Directions and the Quest for a Cure,” bringing to discussions a powerful narrative of how the global HIV response has evolved from crisis to innovation over time.

His presentation traced back to the early days of limited treatment options to today’s advanced prevention tools and emerging cure research for HIV. According to UNAIDS, approximately 40.8 million people were living with HIV and 1.3 million people including children were newly infected resulting in 630, 000 deaths in 2024 and without continued support 6 million new infections and 4 million additional deaths would occur by 2029.

In his presentation, Dr. Sawe gave a historical background of how far HIV cure has come with the introduction of Antiretroviral Therapy (ART) in 1996 which marked a turning point in HIV care, dramatically reducing mortality rates and extending life expectancy however, the early regimens were toxic and complex and required taking  multiple pills daily often causing significant side effects.

Speaking on the evolution of treatment over time into simplified, highly effective regimen with fewer adverse effects, Dr Sawe highlighted on the  more transformative long-acting injectable Antiretrovirals like Cabotegravir and Rilpivirine, which can be administered once every eight weeks, a development that has the potential to improve adherence and reduce stigma associated with daily medication noting that HIV is now manageable , “The progress we have witnessed over the past three decades is extraordinary because what was once considered a death sentence is now a manageable chronic illness,” he said

While making his presentation, Dr. Sawe noted that despite the biomedical progress made , there are major challenges including  affordability, health system capacity, supply chain logistics and trained personnel to influence how quickly innovations reach communities and  he emphasized that scientific discoveries alone are insufficient without strong delivery systems and thus the need to incorporate Community engagement among healthcare workers, civil society, religious leaders, and the media to combat misinformation and improve uptake of both prevention, “Scientific breakthroughs must be matched with implementation solutions which includes Infrastructure, workforce capacity and community trust so that it can be of benefit to  populations at scale,” he noted.

Although there is currently no widely applicable HIV cure, a small number of patients globally have achieved sustained remission following complex medical procedures such as bone marrow transplantation. These cases demonstrate that eliminating the virus is scientifically possible, even if current methods are not safe and hence the need to identify multiple viable strategies which include targeting infected cells and enhancing immunity by conducting further research to find alternatives to remission.

His presentations highlighted that Sub-Saharan Africa houses to nearly two-thirds of people living with HIV and is expected to play a central role in advancing HIV cure research. Notably, research centers in the region contribute to valuable data and insights that inform global strategies noting that African research institutions operate at international standards and contribute meaningfully to global science, “The world needs us and we  have the patients and can generate the data that will help in research to find solutions that will benefit everyone,” he  said.

Researchers remain optimistic that sustained HIV remission without lifelong therapy may eventually become achievable and this will require continued investment in research, stronger health systems and sustained global collaboration. The session reinforced a powerful information in the fight against HIV and that it is no longer defined only by survival but by innovation, resilience and the optimism of getting a cure. As science advances and access expands, the vision of ending HIV as a public health threat that was once unimaginable is steadily moving into becoming a reality.