title: Strategies to limit immune-activation in HIV patients.
abstract: Antiretroviral treatment of HIV infection reduces, but does not eliminate, viral replication and down modulates immune activation. The persistence of low level HIV replication in the host, nevertheless, drives a smouldering degree of immune activation that is observed throughout the natural history of disease and is the main driving force sustaining morbidity and mortality. Areas covered: Early start of antiretroviral therapy (ART) and intensive management of behavioural risk factors are possible but, at best, marginally successful ways to manage immune activation. We review alternative, possible strategies to reduce immune activation in HIV infection including timing of ART initiation and ART intensification to reduce HIV residual viremia; switch of ART to newer molecules with reduced toxicity; use of anti inflammatory/immunomodulatory agents and, finally, interventions aimed at modifying the composition of the microbiota. Expert commentary: Current therapeutic strategies to limit immune activation are only marginally successful. Because HIV eradication is currently impossible, intensive studies are needed to determine if and how immune activation can be silenced in HIV infection.
authors.affiliation: a Clinic of Infectious Diseases, 'San Gerardo' Hospital - ASST Monza, School of Medicine and Surgery , University Milano-Bicocca , Monza , Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bandera
authors.affiliation: a Clinic of Infectious Diseases, 'San Gerardo' Hospital - ASST Monza, School of Medicine and Surgery , University Milano-Bicocca , Monza , Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Colella
authors.affiliation: b Department of Infectious Diseases , ASST Fatebenefratelli Sacco , Milano , Italy.|c School of Clinical Medicine, Faculty of Health Science , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Rizzardini
authors.affiliation: a Clinic of Infectious Diseases, 'San Gerardo' Hospital - ASST Monza, School of Medicine and Surgery , University Milano-Bicocca , Monza , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gori
authors.affiliation: d Department of Physiopathology and Transplants , University of Milano , Milano , Italy.|e Don C. Gnocchi Foundation , Istituto di Ricovero e Cura a Carattere Scientifico [IRCCS] , Milano , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Clerici
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology; D000069467:Fecal Microbiota Transplantation; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D055633:Immune System Phenomena / Q000187:drug effects*; D008213:Lymphocyte Activation / Q000187:drug effects / Q000276:immunology; D056692:Prebiotics / Q000008:administration & dosage; D019936:Probiotics / Q000008:administration & dosage / Q000627:therapeutic use; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects*
chemical_list: D000893:Anti-Inflammatory Agents; D044966:Anti-Retroviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D056692:Prebiotics
keywords: HIV; antiretroviral therapy; comorbidity; immune activation; microbial translocation