Pharmaceutical approaches to eradication of persistent HIV infection.
Highly active antiretroviral therapy (HAART) has markedly decreased morbidity and mortality in human immunodeficiency virus type 1 (HIV-1)-infected individuals in the developed world. Successful therapy often results in stable plasma levels of HIV-1 RNA below the limits of detection of commercial assays. Nonetheless, HIV-1 has not been cured by HAART. The causes of persistence of HIV infection in the face of current therapy appear to be multifactorial: latent but replication-competent provirus in resting CD4+ T cells, cryptic viral expression below the limits of detection of clinical assays, and viral sanctuary sites might all contribute to persistence. Clearance of HIV infection will almost certainly require a multimodality approach that includes potent suppression of HIV replication, therapies that reach all compartments of residual HIV replication and depletion of any reservoirs of persistent, quiescent proviral infection. This review highlights the basic mechanisms for the establishment and maintenance of viral reservoirs and pharmaceutical approaches towards their elimination.
Bowman
Mary-Catherine
MC
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
Archin
Nancie M
NM
Margolis
David M
DM
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D013601:T-Lymphocytes / Q000276:immunology / Q000378:metabolism; D013678:Technology, Pharmaceutical / Q000639:trends; D014779:Virus Replication
D019380:Anti-HIV Agents