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Residual Immune Activation and Latency.

Elena Bruzzesi1,2, Irini Sereti3,4

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Current Topics in Microbiology and Immunology
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Summary

Combination antiretroviral therapy (cART) has improved HIV outcomes but has limitations. Further research is crucial to address incomplete immune recovery, persistent inflammation, and HIV persistence for better targeted therapies.

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Area of Science:

  • Immunology
  • Infectious Diseases
  • Virology

Background:

  • Combination antiretroviral therapy (cART) significantly improved outcomes for people with HIV, reducing AIDS and non-AIDS events.
  • Cancers, cardiovascular disease, liver/kidney disease, neurological disorders, and frailty are now leading causes of death in people with HIV on cART.
  • Despite cART's success, immunological non-responders fail to fully restore immune function, remaining at high risk for infections and non-AIDS events.

Purpose of the Study:

  • To investigate the pathophysiological processes linking incomplete immune recovery, immune activation, and HIV persistence.
  • To identify potential targets for novel therapies to address these persistent challenges in HIV management.

Main Methods:

  • This study is a review of existing literature on cART, HIV immunology, and associated comorbidities.
  • Analysis of data from clinical trials and observational studies focusing on treatment outcomes and immune reconstitution in HIV-infected individuals.

Main Results:

  • A significant proportion of individuals on cART are immunological non-responders, exhibiting persistent immune activation and inflammation.
  • Inflammation is identified as a key driver of HIV persistence, even with viral suppression.
  • Current cART strategies are insufficient for complete immune restoration or viral eradication.

Conclusions:

  • Incomplete immune recovery, persistent immune activation, and HIV persistence remain critical challenges despite effective cART.
  • Understanding the interplay between these factors is essential for developing more effective therapeutic strategies.
  • Future research should focus on targeting these mechanisms to improve long-term health outcomes for people with HIV.