In July 2024, we published a story with the headline: "One of the 7 people cured of HIV tells his story. Can his cure work for others." This summer, at the International AIDS Society conference, came news of an exciting new development in the the ongoing effort to bring the epidemic to an end. This story is the first in our annual end of August series, "Whatever happened to ..."
KIGALI, Rwanda — In a landmark first for the continent hardest hit by HIV, a new clinical trial in South Africa has delivered a rare but extraordinary outcome: One young woman may be cured of the virus.
The story begins in May 2016 when Anele got a call from nurses at a local clinical research center in Umlazi township, which lies in South Africa's southeastern province of KwaZulu-Natal. They told her she needed to come in for an urgent appointment, before breaking the news in person that she had tested positive for HIV. She felt like her world had ended.
"I cried a lot," recalled Anele, now 32, speaking to a group of assembled scientists, doctors and health officials on the first day at the International AIDS Society (IAS) conference in Kigali, Rwanda in mid-July. "I was only 23. That day, I was not OK at all." Anele explained at the IAS conference that she did not want to be fully identified due to the ongoing stigma associated with being HIV positive in Umlazi.
It may not have felt like it at the time, but compared with the estimated 5.2 million other women living with HIV in South Africa, Anele was fortunate. Her early diagnosis and treatment plan were only possible because of a new social empowerment and medical program called FRESH (Females Rising through Education, Support and Health) which had begun in Umlazi back in 2012. Six years after Anele's diagnosis, this program would see her enrolled in the first-ever clinical trial to attempt to cure HIV patients in Africa.
A trial born in Umlazi
According to a July 2025 article in the medical journal The Lancet, 10 people worldwide are considered cured of HIV after receiving stem cell transplants to treat aggressive blood cancer, which happened to destroy the virus. But that method is not considered safe or scalable. In recent years other "cure trials" have explored newer approaches including gene editing and CAR T-cell therapy to enhance immune response, but they have yet to yield successful results.
But almost all of these trials have taken place in the U.S. Yet 67% of the 40.8 million people living with HIV are in Africa where genetic and demographic profiles are remarkably different, said Thumbi Ndung'u, a professor at the University of KwaZulu-Natal, Durban, who led the lab work for the trial.
"In the West, the epidemic is predominantly in white, homosexual men, while in Africa, the majority of people living with HIV tend to be younger and female," Ndung'u told NPR.
This matters for several reasons. Biological responses to HIV differ between men and women, influenced by sex hormones. Yet, said Krista Dong, assistant professor at the Ragon Instute of Mass General Brigham, MIT and Harvard and FRESH's clinical director, women are vastly underrepresented in HIV cure research. "Women represent 53% of HIV infections globally but fewer than 19% of enrollees in HIV cure trials," Dong noted.
The biology of the virus also varies by region. While the dominant HIV strain in North America and Europe is clade B, sub-Saharan Africa sees mostly clades A, C, and D. Clade C, the world's most common subtype, has distinct features in how it interacts with the immune system, which potentially affects the success of curative therapies.
"To develop a cure intervention that has an impact, we have to make sure it is something that works in Africa," Ndung'u said. "And the only way we can ensure that's the case is by actually doing the trials in these populations."
A strategy of kick and kill
FRESH has taken a different approach from earlier HIV programs. In KwaZulu-Natal, researchers have long noted that young women are particularly vulnerable to infection due to socioeconomic factors, including financial dependence on male partners and limited access to education or employment.
Launched in 2012 in Umlazi, where more than 60% of young women contract HIV before age 23, FRESH offered twice-weekly HIV testing along with an empowerment curriculum that included lessons on self-esteem and gender-based violence as well as career mentoring. Initially funded by private philanthropy and later the Gates Foundation, the program helped participants resume schooling or gain employment, while allowing researchers to detect HIV infections within days. (The Gates Foundation is a sponsor of NPR and this blog.)
Having such frequent testing meant that the FRESH team could identify new HIV infections within a matter of days, enabling women to immediately start antiretroviral medication to suppress the virus, limiting the size and diversity of the viral reservoir. In theory, they would be easier to cure.
In 2022, the clinical trial began. Twenty women enrolled, including Anele. All of them had been on antiretroviral therapy for an average of seven years. Sponsored by California-based drugmaker Gilead Sciences, the trial used a new strategy: It aimed to flush HIV out of hiding, then neutralize it.
The approach used a unique drug called vesatolimod to kick HIV out of its hiding places in the body, followed by a one-time infusion of broadly neutralizing antibodies (bNAbs) on day seven. These antibodies, tailored to target clade C, would bind to the virus and summon immune cells to eliminate it.
"HIV doesn't live in our blood, it lives in reservoirs whether in the lymph nodes or the liver or the brain, so you need to kick it out, so that the bNAbs can reach it," Dong said. "So what we were going for was this strategy of kick and kill."
Over 20 weeks, participants received vesatolimod biweekly. Then, on day 35, they were asked to stop their antiretrovirals.
They had access to counselors and a community advisory board from the University of KwaZulu-Natal and FRESH staff, assuring that they would be monitored extremely closely. But when they were first diagnosed, nurses had emphasized that they would need to take antiretrovirals for the rest of their lives. Stopping this treatment came as a shock.
The antiretroviral pause also carried real risks. When HIV rebounds, it can cause inflammation and raise the risk of transmission, but as Ndung'u explained, stopping this treatment is currently the only way to assess whether a patient is truly in remission. "We had to make sure that the participants fully understood the risks," he said.
Within a year, 16 participants saw their virus rebound and resumed treatment — but four remained in remission, with undetectable viral loads.
Potentially cured
In the coming years, understanding what set the four women who stayed in remission apart could yield vital clues about who might benefit most from this treatment approach.
While Ndung'u and Dong don't yet have firm answers, they have hypotheses. Ndung'u suspects genetic factors may have helped the four women mount a more effective immune response. Dong is investigating why the therapy failed in the other 16 – whether their viral reservoirs were larger or their immune systems reacted negatively to one of the drugs. Unraveling these differences could be key to improving future strategies.
The pair are eager to continue. Ndung'u hopes to launch a trial involving women infected at an unknown time — representing a more typical HIV population and possibly giving the antibodies more viral material to act on.
There's also growing interest in how future cure trials might include participants with co-infections common in sub-Saharan Africa, such as tuberculosis or hepatitis B. "That's a unique but important challenge," Helena Lamptey, an immunology researcher at the University of Ghana, told NPR. "Many people with HIV have co-infections which are impacting the immune system and possibly helping HIV to persist." Cure strategies will need to reflect that reality.
For now, FRESH stands as a milestone. Of the four women who remained in remission at the trials' end, one later experienced a viral rebound. Two others chose to resume antiretrovirals – one for convenience after starting a new job that made weekly monitoring difficult, and the other to ensure a safe pregnancy.
That leaves Anele. More than two years after stopping medication, she remains HIV-free and off treatment. While she remains cautious about declaring herself cured, Dong believes that it is a very real possibility.
Her case is fueling interest across the region. Researchers in countries such as Botswana have expressed the desire to run their own trials. With other new treatment possibilities emerging such as therapeutic vaccines and more advanced, long-lasting antibody infusions which Dong calls "super bNAbs," there is genuine optimism that a corner has finally been turned for people with HIV in Africa.
"Even though the FRESH trial was not a home run, achieving long-term viral control in 20% of the participants is exciting," Dong said. "It has brought hope to the community that progress is being made."
David Cox is a freelance health journalist who has written for publications around the world including NPR, The New York Times, Wired and The Guardian. He has a Ph.D. in neuroscience.
Copyright 2025 NPR