The advent of combined antiretroviral therapy (cART) more than 15 years ago has dramatically changed the outcome of HIV infection from a deadly to a chronic disease. However, patients still experience problems of compliance, resistance, toxicity and cost. Furthermore, these therapies are not available worldwide, in particular in poor-resource areas where most of HIV-infected patients live.
If plasma viremia can remain undetectable in the majority of patients taking everyday cART, HIV remains in hidden reservoirs allowing viremia to rekindle within a few weeks each time therapy is stopped.
Over the past few years major advances have been made in understanding the nature and persistence mechanisms of these HIV reservoirs. It is currently believed that HIV remains latent in some memory T cells, which have a very long life span and not affected by cART. This reservoir of a few million cells in the body is considered as the major obstacle towards HIV eradication in treated patients.
However, if a decade ago almost nobody dared to speak of curing HIV infection, scientific advances have allowed developing potential strategies for a cure, some of which have already reached clinical trials.
This renewed optimism has been spurred by 3 clinical observations:
1-The Berlin patient:
This case has been widely reported. It involves a man who developed acute leukemia during the course of HIV infection and received a bone marrow transplant from a donor with a genetic mutation that protects against HIV infection. With now more than 5 years of follow-up, this patient is off cART and has not experienced viremia rebound or immune deterioration.
If plasma viremia can remain undetectable in the majority of patients taking everyday cART, HIV remains in hidden reservoirs allowing viremia to rekindle within a few weeks each time therapy is stopped.
Over the past few years major advances have been made in understanding the nature and persistence mechanisms of these HIV reservoirs. It is currently believed that HIV remains latent in some memory T cells, which have a very long life span and not affected by cART. This reservoir of a few million cells in the body is considered as the major obstacle towards HIV eradication in treated patients.
However, if a decade ago almost nobody dared to speak of curing HIV infection, scientific advances have allowed developing potential strategies for a cure, some of which have already reached clinical trials.
This renewed optimism has been spurred by 3 clinical observations:
1-The Berlin patient:
This case has been widely reported. It involves a man who developed acute leukemia during the course of HIV infection and received a bone marrow transplant from a donor with a genetic mutation that protects against HIV infection. With now more than 5 years of follow-up, this patient is off cART and has not experienced viremia rebound or immune deterioration.