Shari Margolese was 30 when she tested positive for HIV.
The Mississauga native was busy raising her three-month-old baby when the diagnosis blindsided her — the year was 1993, a time when women weren’t considered at risk of the chronic viral infection. Soon after, Margolese learned her infant son was also HIV positive.
“Those days, we were wondering, ‘Who’s going to take care of our kids when we die? If our kids are sick, are they going to live?’” said Margolese, who went on to dedicate her life to patient and HIV treatment advocacy. “People were dying all around us. It was very, very dark.”
Over the ensuing decades, HIV research has advanced by leaps. What was once a death sentence became a manageable, though lifelong, condition for the estimated 65,270 Canadians living with HIV today — if they can access medication. Margolese’s son is now 32, with a family of his own. “I’ve been able to become a grandmother,” she said. “That’s something I didn’t think I’d ever see.”
Now, Canadian scientists leading an international collaboration say they’re on the cusp of a made-in-Canada cure that could eliminate HIV. But their goal is broader than that; it’s to make a cure that’s accessible to anyone who needs it. If successful, they say this could be an economic windfall for Canada — and it could avert what HIV experts are warning is another impending global AIDS crisis.
While a cure for HIV has technically existed since 2009, it remains wildly expensive and inaccessible; fewer than a dozen people worldwide have received it. It involves a bone-marrow transplant essentially replacing a person’s entire immune system. The procedure is risky and can cost upwards of $350,000.
This new cure, consisting of four injections, could cost about $20,000 in North America and Europe — roughly equivalent to one year’s worth of antiretroviral therapy in Canada, said Immunequity project lead Eric Arts, a professor at Western University’s Schulich School of Medicine and Dentistry. (It’s a very early estimate, since clinical trials haven’t started.)
That’s more than 10 times cheaper than the only known cure for HIV today.
What’s more, Arts said they’re aiming to make their cure available at a hundredth of the cost — around $250 for a course of treatment — in low- and middle-income countries where over 70 per cent of people living with HIV reside. In order to do that, the Immunequity initiative aims to manufacture the drugs not just in Canada, but also in countries such as Uganda.
The ‘Trojan Horse’ approach
HIV is a sneaky virus. Part of its life cycle involves merging its own genetic material with the DNA of “helper T cells” — critical immune cells responsible for roughly half of our immune response, Arts explained. Once inside, HIV can sit dormant for years, functionally invisible to our immune system and impervious to medication.
Antiretrovirals help suppress the virus. But with any stop in therapy, HIV can spring back into action, rapidly multiplying inside of these immune cells and going on to infect more cells. This cycle will eventually debilitate the immune system, progressing to AIDS in just a few years.
People who live with HIV can never forget to take their drugs, Arts said. As Margolese put it: “Every day I have to take a pill and so every day I think about how I have HIV.”
You can’t kill HIV if it’s squirrelled away inside the immune system. So Arts’s team developed a “Trojan Horse” capable of luring dormant HIV out of hiding.
“What we did is we made a dead HIV virus that is basically almost identical to the virus that the individual is infected with,” Arts said. When a helper T cell encounters this virus-like particle, it triggers an immune response, awakening the latent HIV and causing it to flee its hiding spot.
Once HIV is out in the open, you need a way to kill it. That’s where “broadly neutralizing antibodies” (bNAbs) come in — special proteins capable of destroying a broad range of HIV strains.
To get these bNAbs into the body, the researchers came up with an innovative solution: specially engineered immune cells, called B cells, designed to produce bNAbs at a consistent level over a long period of time. These could be implanted right inside the patients’ bodies as “protein production factories,” explained Peter Zandstra, a member of Immunequity who developed this framework.
“This has a number of advantages from a cost perspective, and from a clinical efficacy perspective,” said Zandstra, a professor and director of the School of Biomedical Engineering at the University of British Columbia. “B cell transplantation has been done for humans in clinical trials and it’s been shown so far to be safe.”
Arts said his virus-like particle is one to two years away from clinical trials, and Zandstra’s team is a year behind. They and the private companies backing them are now seeking funding; if all goes well, their product could be available within five to 10 years.
An equitable cure
There are other initiatives working toward an HIV cure, but the Immunequity project stands apart because it began with affordability and manufacturability in mind. To make it more equitable and accessible, they plan to run clinical trials in both Canada and Uganda, and hope to manufacture their drugs directly in low-income countries.
That’s a “paradigm shift” from the usual drug development pipeline, which involves racing for a product first and worrying about global accessibility second, said Zabrina Brumme, laboratory director of the B.C. Centre for Excellence in HIV/AIDS and a professor of health sciences at Simon Fraser University.
Brumme, who is not part of Immunequity, finds their potential cure “innovative.” But the truly promising part is the investment in developing infrastructure to produce these drugs at scale in low-income countries, she said. It means that even if this product doesn’t pass clinical trials, countries like Uganda would still have the manufacturing capabilities to begin pumping out drugs immediately once a cure is eventually discovered.
And that’s more important than ever. The U.S. has pulled back funding for HIV support around the globe, as have other G20 countries. Canada’s 2025 contribution to the UN HIV/AIDS program was 17 per cent less than in 2022. Without international aid, millions of people reliant on it for life-saving support are left without access to treatment. “If we don’t do something soon, we might have another major outbreak on our hands,” Arts said.
“We’ll go back to the days when people died every day — if it was not your sister, it was your friend or neighbour,” said Dr. Cissy Kityo, a Ugandan physician, epidemiologist and executive director of the Joint Clinical Research Centre in Kampala, who is collaborating with Immunequity.
“The main impact will be on the lowest resourced countries,” Kityo said. “That’s why we’re fighting.”
