Preparation for antiretroviral interruption by boosting the immune system.
OBJECTIVE
In this review we report how recent insights into control of HIV replication in HIV-1-infected patients might provide a rationale for boosting the immune system prior to combined antiretroviral therapy interruption; and recent results of therapeutic immunization studies followed by combined antiretroviral therapy interruption.


RESULTS
Interruption of antiretroviral therapy is not without risk in HIV-infected patients. Baseline HIV-specific immunity does not prevent viral rebound and the loss of CD4 T cells. Recent findings in 'HIV controllers' and long-term nonprogressors showed that the immune system may contain HIV replication. These studies may help to define the objectives of therapeutic immunization. This strategy is aimed to contain viral replication or lower the viral 'set point' in patients who did not achieve this equilibrium on their own. From a clinical standpoint, the challenge is, therefore, to transform chronic treated patients into long-term nonprogressors following combined antiretroviral therapy discontinuation.


CONCLUSIONS
In the last 2 years several studies of therapeutic immunization showed that preparation of the immune system by boosting specific immune responses may help patients to contain viral replication following combined antiretroviral therapy discontinuation. Although some of these results are encouraging, further studies are needed to confirm these results and to identify patients who may benefit from this strategy.
Yves
Lévy
L
Department of Clinical Immunology, CHU Henri Mondor, Créteil, France.