Interventions during Early Infection: Opening a Window for an HIV Cure?

Area of Science:

• Immunology
• Virology
• Infectious Diseases

Background:

• Combination antiretroviral therapy (ART) controls human immunodeficiency virus (HIV) but does not eliminate latent reservoirs, hindering a cure.
• Early ART initiation limits reservoir expansion and preserves immune function, potentially enabling ART-free remission in some individuals.
• Latent HIV reservoirs represent the primary obstacle to achieving a functional HIV cure.

Purpose of the Study:

• To review current clinical and investigative HIV interventions.
• To discuss the potential of these interventions to improve post-treatment remission when initiated early in combination with ART.
• To explore strategies for overcoming the challenge of latent HIV reservoirs.

Main Methods:

• Review of existing clinical trials and preclinical research on HIV interventions.
• Analysis of data on the efficacy of strategies like 'Block and Lock,' 'Shock and Kill,' broadly neutralizing antibodies (bNAbs), T cell therapy, and gene therapy.
• Examination of the impact of early intervention timing on treatment outcomes.

Main Results:

• Several novel HIV interventions have shown promise in delaying viral rebound or achieving remission in animal models and some people living with HIV (PLWH).
• The effectiveness of these interventions when applied during early HIV infection requires further investigation.
• Early ART is crucial for limiting reservoir size and preserving immune function.

Conclusions:

• Eliminating latent HIV reservoirs is essential for an HIV cure.
• Combining early ART with novel therapeutic strategies may enhance the likelihood of achieving sustained, ART-free HIV remission.
• Further research is needed to determine the optimal timing and combination of interventions for functional HIV cure.