Does HIV disease continues despite antiviral responses and antiretroviral therapy?

 

Combination antiretroviral therapy  to treat human immunodeficiency virus (HIV)this disease has proven  successful  for those who can access and afford it – yet HIV disease persists indefinitely in a reservoir of cells, despite efficient and despite host antiviral immune responses. An HIV cure is accordinglythe next aspirational goal and challenge, though approaches different in their objectives  with ‘functional cures’ aiming for durable viral control in the absence of ART, and ‘sterilizing cures’ aiming for the more difficult to realize objective of finalize viral eradication.

Viral persistence through anatomical sequestration virus

Anatomical sequestration of reservoir-harboring cells poses additional challenges to curative interfrence  strategies, by limiting access to, and function of, immune effectors. incresingly, a new study from the “Last Gift” cohort involving rapid autopsy of PLWH found persistent HIV reservoirs crosswise 28 tissues, with multiple sites acting as ‘hubs’ for dissemination, though blood and lymphoid tissues dollop as the important sources . There is evidence that multiple tissues, including the CNS  and reproductive organs, may be sanctuary sites for HIV due to their immune-privileged status and the evidence for secondary lymphoid tissues as a major donor to HIV persistence is unequivocal.

              · Rare individuals can commonly control HIV infection by immune-mediated mechanisms.

              ·  HIV cures could be functional or sterilizing.

              · Immunotherapies to cure HIV could exploit and boost  T-cell and B-cell responses.

              ·   Combination immunotherapies are most likely to succeed in HIV cure.

A critical focus of HIV cure research has focus around addressing latency as a barrier to CTL- or NK cell-interavene elimination of reservoirs through an approach termed ‘shock and kill’ or ‘kick and kill’. start from the premise that the viral reservoirs are invisible to the immune effectors , this approach aims to employ pharmacologic LRAs to induce antigen expression in latently effected cells, there by rendering these cells susceptible to elimination by CTL, or NK cells.


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