Journal Article

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

Goldstein, Harris, Mueller, April L., Su, Hang, Hiner, Christopher R.

2024

Overview

Although combination antiretroviral therapy (ART) has been a landmark achievement for the treatment of human immunodeficiency virus (HIV), an HIV cure has remained elusive. Elimination of latent HIV reservoirs that persist throughout HIV infection is the most challenging barrier to an HIV cure. The progressive HIV infection is marked by the increasing size and diversity of latent HIV reservoirs until an effective immune response is mobilized, which can control but not eliminate HIV infection. The stalemate between HIV replication and the immune response is manifested by the establishment of a viral set point. ART initiation during the early stage limits HIV reservoir development, preserves immune function, improves the quality of life, and may lead to ART-free viral remission in a few people living with HIV (PLWH). However, for the overwhelming majority of PLWH, early ART initiation alone does not cure HIV, and lifelong ART is needed to sustain viral suppression. A critical area of research is focused on determining whether HIV could be functionally cured if additional treatments are provided alongside early ART. Several HIV interventions including Block and Lock, Shock and Kill, broadly neutralizing antibody (bNAb) therapy, adoptive CD8+ T cell therapy, and gene therapy have demonstrated delayed viral rebound and/or viral remission in animal models and/or some PLWH. Whether or not their application during early infection can improve the success of HIV remission is less studied. Herein, we review the current state of clinical and investigative HIV interventions and discuss their potential to improve the likelihood of post-treatment remission if initiated during early infection.

• Publisher: MDPI AG,MDPI
• Subject: Analysis / Animal models / Animals / Anti-HIV Agents - therapeutic use / Anti-Retroviral Agents - therapeutic use / Antibodies / Antiretroviral drugs / Antiretroviral therapy / Antiviral agents / Block and Lock / broadly neutralizing antibody / CD8 antigen / CD8-Positive T-Lymphocytes - immunology / Cell culture / Cell therapy / Chronic illnesses / Dosage and administration / early ART initiation / early HIV intervention / Gene therapy / Hematology / HIV / HIV cure / HIV infection / HIV Infections - drug therapy / HIV Infections - immunology / HIV Infections - virology / HIV-1 - drug effects / HIV-1 - physiology / Human immunodeficiency virus / Humans / Immune response / Immune system / Infections / Intervention / Lymphocytes T / Mortality / Mutation / Prevention / Quality of life / Remission / Remission (Medicine) / Replication initiation / Review / Risk factors / Shock and Kill / Transplants & implants / Viral infections / Viral Load / Virus Latency - drug effects / Virus Replication - drug effects