Broadly Neutralizing Antibodies for Human Immunodeficiency Virus Treatment: Broad in Theory, Narrow in Reality

Broadly neutralizing antibodies might play a role in the future of HIV treatment and cure, but important limitations, including baseline and emergent resistance, must be overcome. Until then, the legacy of classical antiretroviral therapy will remain intact. In this viewpoint, we briefly review the status of antiretroviral therapy (ART), its unmet needs, and the role that broadly neutralizing antibodies (bNAbs) might have in the near future for the treatment of human immunodeficiency virus (HIV). We summarize advances in the development of bNAbs as antiretroviral therapy, the results of main clinical trials of bNAbs for HIV treatment and prevention, and its role in cure trials. The limitations of broadly neutralizing antibodies are the current need for primary resistance testing, the still unclear number of antibodies that must be combined, the lack of penetration in anatomical reservoirs, and the role they might play in cure studies. We compare the advantages and disadvantages of "classical ART" and therapy based on broadly neutralizing antibodies. We conclude that broadly neutralizing antibodies still need considerable improvements before they can be considered an alternative to classical ART.