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Persistent HIV-1 replication during antiretroviral therapy.

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Despite effective antiretroviral therapy (ART), human immunodeficiency virus type 1 (HIV-1) may still replicate. Understanding residual HIV-1 replication during ART is crucial for developing effective cures.

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Area of Science:

  • Virology
  • Immunology
  • Infectious Diseases

Background:

  • Antiretroviral therapy (ART) effectively suppresses HIV-1 replication but does not cure infection.
  • HIV-1 persistence during ART is attributed to latency, immune dysfunction, and potential low-level viral spread.
  • Targeting these persistence mechanisms is key for HIV-1 cure strategies.

Purpose of the Study:

  • To review recent findings on the capacity of HIV-1 to replicate during ART.
  • To discuss the ongoing controversy and evidence regarding viral replication under therapy.

Main Methods:

  • Review of existing literature and studies on HIV-1 replication during ART.
  • Analysis of evidence from studies involving ART intensification and drug penetration.
  • Consideration of mathematical models predicting viral evolution.

Main Results:

  • Evidence for HIV-1 replication during ART is debated, with some studies showing no viral evolution in blood.
  • Intensified ART regimens and analysis of episomal DNA/RNA suggest possible replication.
  • Limited drug penetration in tissues and immune sanctuaries may facilitate viral spread.

Conclusions:

  • Residual HIV-1 replication likely persists in lymphoid tissues in some individuals.
  • Immune activation may play a role in sustaining viral replication during ART.
  • Further research is essential to determine the extent and mechanisms of HIV-1 replication during ART for curative interventions.