title: HIV RNA suppression and immune restoration: can we do better?
abstract: HAART has significantly changed the natural history of HIV infection: patients receiving antiretrovirals are usually able to control viremia, even though not all virological responders adequately recover their CD4+ count. The reasons for poor immune restoration are only partially known and they include genetic, demographic and immunologic factors. A crucial element affecting immune recovery is immune activation, related to residual viremia; indeed, a suboptimal virological control (i.e., low levels of plasma HIV RNA) has been related with higher levels of chronic inflammation and all-cause mortality. The sources of residual viremia are not yet completely known, even though the most important one is represented by latently infected cells. Several methods, including 2-LTR HIV DNA and unspliced HIV RNA measurement, have been developed to estimate residual viremia and predict the outcome of antiretroviral therapy. Considering that poor immunologic responders are exposed to a higher risk of both AIDS-related and non-AIDS-related diseases, there is a need of new therapeutic strategies, including immunomodulators and drugs targeting the latent viral reservoirs, in order to face residual viremia but also to "drive" the host immunologic responses.
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy. marilia.pinzone@virgilio.it
authors.forename: Marilia Rita
authors.initials: MR
authors.lastname: Pinzone
authors.forename: Michelino
authors.initials: M
authors.lastname: Di Rosa
authors.forename: Bruno
authors.initials: B
authors.lastname: Cacopardo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D012367:RNA, Viral / Q000096:biosynthesis / Q000276:immunology*; D016896:Treatment Outcome; D014766:Viremia / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D014775:Virus Activation; D017735:Virus Latency
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral