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Can antiretroviral therapy ever be stopped?
1Johns Hopkins University School of Medicine, Baltimore, USA.
The AIDS Reader
|May 16, 2000
Summary
The latent HIV reservoir in CD4+ T cells persists for decades, even with effective combination antiretroviral therapy. Activating this reservoir is toxic and unsuccessful, highlighting the need to study natural controllers for long-term HIV control strategies.
Area of Science:
- Immunology
- Virology
- Infectious Diseases
Background:
- A latent reservoir of HIV-infected CD4+ T cells forms early in infection.
- This reservoir remains hidden from immune surveillance and antiretroviral drugs.
- Current combination antiretroviral therapy does not eliminate this latent reservoir within a clinically relevant timeframe (estimated at 60 years).
Purpose of the Study:
- To investigate the persistence of the latent HIV reservoir.
- To evaluate the efficacy and safety of reservoir-activating strategies.
- To identify potential mechanisms for long-term HIV control.
Main Methods:
- Analysis of HIV persistence in CD4+ T cells in patients on combination antiretroviral therapy.
- Review of studies on therapeutic interventions aimed at activating the latent reservoir.
- Exploration of immune control mechanisms in rare individuals who naturally manage latent HIV.
Main Results:
- The latent HIV reservoir is highly persistent and does not decay significantly over decades with current treatments.
- Preventing new infections does not accelerate the decay of the existing latent reservoir.
- Treatments designed to activate the reservoir have proven toxic and ineffective in patients with suppressed viremia.
Conclusions:
- The latent HIV reservoir poses a significant barrier to complete HIV eradication.
- Novel strategies are required to address this persistent viral reservoir.
- Studying individuals with natural control of HIV activation may offer critical insights for achieving long-term viral suppression and potential cures.