Future of bNAbs in HIV Treatment

Broadly neutralizing antibodies (bNAbs) represent a novel approach to HIV treatment, prevention, and cure strategies. As research advances, the clinical application of bNAbs continues to evolve. This review explores the potential role of bNAbs in HIV management, addressing their mechanisms of action, current limitations, and future directions.

Recent studies have demonstrated that bNAbs can effectively neutralize a broad range of HIV strains by targeting conserved epitopes on the viral envelope. Clinical trials have shown that bNAb combinations can maintain viral supression in the absence of antiretroviral therapy (ART), though pre-existing resistance remains a major challenge. Strategies such as Fc engineering and alternative delivery mechanisms (e.g., AAV, mRNA, DNA) are being explored to enhance bNAb efficacy and durability. Despite promising data, bNAbs have not yet demonstrated superior effectiveness compared to existing ART or pre-exposure prophylaxis (PrEP) options. While bNAbs offer exciting possibilities for long-acting HIV therapy, their widespread use is limited by logistical challenges, high production costs, and pre-existing viral resistance. The future of bNAbs may lie in combination strategies with small-molecule antiretrovirals in maintenance strategies, genetic delivery systems, and vaccine-based approaches to induce endogenous bNAb production. Further research is needed to refine these strategies and determine the optimal role of bNAbs in HIV care.