[Hurdles to HIV cure. Part 2 : ongoing HIV replication despite therapy]

Area of Science:

• Virology
• Immunology
• Infectious Diseases

Background:

• Antiretroviral therapy (ART) significantly improves life expectancy for individuals with human immunodeficiency virus (HIV).
• ART suppresses HIV replication, leading to undetectable plasma viral loads, but is not curative.
• Viral persistence is attributed to latent reservoirs and ongoing replication, particularly in sanctuary sites with suboptimal drug penetration.

Purpose of the Study:

• To investigate the reasons for the non-curative nature of ART in HIV infection.
• To explore the role of ongoing HIV replication despite therapy.
• To identify potential strategies for achieving an HIV cure.

Main Methods:

• Review of existing literature on ART effectiveness and limitations.
• Analysis of studies on viral load dynamics and drug penetration in sanctuary sites.
• Examination of treatment intensification strategies and their impact on viral replication markers.

Main Results:

• ART effectively reduces viral load but does not eliminate latent HIV reservoirs.
• Ongoing HIV replication persists in sanctuary sites despite ART.
• Treatment intensification, such as adding integrase inhibitors, may transiently increase viral by-products, suggesting a reduction in ongoing replication.

Conclusions:

• Eliminating ongoing HIV replication is crucial for developing a curative strategy.
• Further research is needed to confirm and target persistent viral replication.
• Understanding and eradicating viral reservoirs and ongoing replication are essential steps towards an HIV cure.