Advancing HIV Treatment: Insights Into Past And Present (2025)
HIV treatment has come a long way since it first made waves. In the early days, a diagnosis often meant a bleak future—limited options, and very little hope. Fast forward to today, and things look much different.
We’ve made huge progress in both treatment and prevention, and while a cure may not be here just yet, it’s not out of the question. Let’s take a look at how we got to this point and where things might be headed.
The Early Days: Struggles and Breakthroughs
When HIV first emerged in the 1980s, doctors barely understood what it was. People diagnosed with HIV had little to no hope, as there was no clear way to manage the virus. The introduction of zidovudine (AZT) in 1987 was a step forward, but it wasn’t easy to take. High doses led to nasty side effects like nausea and anemia, which made sticking to treatment difficult. It wasn’t a cure, but it was progress.
In the 1990s, HIV treatment took a giant leap forward with combination antiretroviral therapy (cART), also known as Highly Active Antiretroviral Therapy (HAART). This combination approach used multiple drugs to suppress the virus in different ways and prevent resistance.
Death rates plummeted, falling from about 10.3 deaths per 100 people each year in the mid-1990s to under 2 by the early 2000s. For the first time, living with HIV became a reality, rather than a death sentence.
But even with this breakthrough, the treatment was still tough: multiple pills, complicated schedules, and side effects that could be hard to handle.
The Role of Patient Advocacy and Community Initiatives
Advocacy groups like ACT UP refused to accept slow progress during the HIV crisis of the 1980s and 1990s.
Pushing for Faster Treatments
People staged protests, confronted drug companies, and pressured the FDA to act faster. Thanks to their relentless efforts, drugs like zidovudine (AZT) were approved quickly, and combination antiretroviral therapy (cART) changed things up completely, turning HIV into a treatable condition.
Breaking Down Stigma
Public fear and misinformation about HIV were major barriers to treatment. Advocacy campaigns stepped in to challenge this.
Movements like U=U (Undetectable = Untransmittable) delivered a simple, powerful message: if the virus is suppressed, it can’t be passed on sexually. This helped reduce fear, encourage testing, and empower people living with HIV.
Fighting for Affordable Medicines
Access to HIV drugs wasn’t always possible, especially in low-income countries. Advocacy groups changed that.
The Treatment Action Campaign (TAC) in South Africa forced drug prices to drop, helping millions afford treatment. These victories also influenced global efforts like PEPFAR and the Global Fund, which now provide treatment to people worldwide.
Reaching the Most Vulnerable
Advocacy didn’t stop at lowering costs—it also worked to include those most often left behind. Male-male couples, transgender individuals, and people in poor, high-stigma areas were often excluded from care.
Programs like the Ryan White HIV/AIDS Program made sure these groups weren’t forgotten, proving that no one should face HIV alone. Advocacy did more than open doors—it kicked them down. From changing laws to changing minds, it has been the driving force behind better treatments, wider access, and new hope for millions.
The Shift to Safer and More Effective Therapies
Today’s HIV treatments are much safer and more effective than before. The focus has shifted from just making medications accessible to improving them—making them easier to take, with fewer side effects.
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Tenofovir Alafenamide (TAF): TAF is a newer, improved version of tenofovir, one of the core drugs used in treatment. It works at lower doses and targets the virus more directly, which means fewer risks to bones and kidneys. Studies have shown that TAF maintains high rates of viral suppression over long-term treatment, with improved renal and bone safety profiles compared to its predecessor, tenofovir disoproxil fumarate (TDF).
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Dolutegravir (DTG): Dolutegravir (DTG) is also a leading HIV treatment due to its strong viral suppression and low resistance risk. Clinical trials show suppression rates of 88-90% in treatment-naïve patients. Commonly paired with drugs like lamivudine (e.g., Dovato), DTG causes fewer side effects, such as headache (3%), nausea (2%), and diarrhea (2%), leading to a smoother treatment experience.
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Generics: Generic Truvada and Generic Atripla Viraday have made HIV treatment and prevention more affordable in 2025. Truvada, which contains tenofovir disoproxil fumarate and emtricitabine, is widely used for managing HIV and as part of PrEP. Generic Atripla Viraday, combining efavirenz, tenofovir, and emtricitabine, offers a convenient one-pill-a-day solution for controlling the virus. These cost-effective options have opened doors for better care and access.
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Bictegravir: Combined with emtricitabine and tenofovir alafenamide (Biktarvy), bictegravir has a high resistance barrier and minimal side effects, making it ideal for both new and experienced patients.
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Cabotegravir (CAB) and Rilpivirine (RPV): Cabotegravir, paired with rilpivirine, provides long-acting injections, reducing the need for daily pills. This regimen offers similar suppression rates with fewer side effects.
These mainly used HIV drugs represent a big step forward. They don’t just make HIV treatment easier—they make it safer and more sustainable for people living with the virus.
Breakthroughs on the Horizon
Looking ahead, we’re on the brink of even more changes.
New drugs and therapies could make living with HIV easier, and the hope for a cure is real.
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Lenacapavir: Lenacapavir is a long-acting medication requiring only two injections per year. In recent clinical trials, lenacapavir demonstrated a 96% reduction in HIV incidence compared to background rates, and was 89% more effective at reducing HIV infections than once-daily Truvada. If it lives up to its potential, it could offer an alternative to daily pills, making treatment simpler and more manageable for patients who struggle with daily medications.
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Broadly Neutralizing Antibodies (bNAbs): These specially engineered antibodies can target various strains of HIV. Early clinical trials suggest bNAbs are safe, tolerable, and capable of reducing HIV RNA levels. They could replace daily pills with periodic injections or infusions. While they’re still in trials, they could change the way we think about HIV treatment, offering a more convenient way to manage the virus.
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Gene Editing: Tools like CRISPR might seem like science fiction, but they’re getting closer to reality. In animal models, CRISPR/Cas9 genome editing has shown more than 50% HIV elimination from treated groups. While still in its early stages, gene editing offers hope for completely eliminating the virus from a person’s body.
These developments aren’t merely theoretical—they’re becoming real possibilities.
As exciting as they are, we’re still in the early days. But the potential to make HIV treatment even more effective—and to cure it—is on the horizon.
Bridging the Gap: Access and Equity
While new treatments are exciting, there’s still a major gap in who gets access to them.
Even though breakthroughs are happening, many people around the world still don’t have the resources to get the care they need.
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Global Programs: Initiatives like PEPFAR and the Global Fund have made a huge impact, increasing access to HIV medications and saving millions of lives. But despite these efforts, there are still regions that lag behind—places like Eastern Europe and Central Asia, where treatment rates are lower, and new infections continue to rise.
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Lowering Costs: Making newer HIV treatments affordable is a priority for many companies. Gilead Sciences, for example, is partnering with generic manufacturers to bring down the cost of newer drugs like lenacapavir. If these efforts continue, more people could access cutting-edge treatments, helping to reduce the global burden of HIV.
Making sure that breakthroughs reach everyone—no matter where they live—is a critical challenge. Without tackling access and affordability, many of the advances we’ve made will remain out of reach for too many people.
Shifting Public Health Goals
The global goal for HIV care has shifted. The focus is no longer just on treating people but on ending the epidemic altogether.
The UNAIDS 95-95-95 targets set an ambitious plan: 95% of people with HIV should be diagnosed, 95% of those diagnosed should be on treatment, and 95% of those treated should have the virus suppressed.
Progress has been made, but hitting those targets by 2025 will require persistent effort. Testing programs have reached more communities, and antiretroviral coverage is steadily improving.
These numbers show progress but also highlight the gaps that remain. Underserved regions, stigma, and inadequate healthcare infrastructure are significant barriers.
Looking Ahead: The Path to Ending HIV
HIV treatment has transformed radically over the years, evolving from toxic, cumbersome regimens to sophisticated, low-side-effect options. Long-acting injectables, antibody treatments, and gene editing represent the next frontier. Yet these innovations must be paired with expanded access and equity to truly turn the tide.
Ending HIV will take more than science—it will require global cooperation, policy shifts, and public health investment. The next decade holds promise, but only if the world remains committed to closing the gaps and ensuring everyone has access to life-saving care.
