Review Article

Future approaches to clearing the latent human immunodeficiency virus reservoir: Beyond latency reversal

Alexander M.L. Hayes
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1089 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1089 | © 2020 Alexander M.L. Hayes | This work is licensed under CC Attribution 4.0
Submitted: 25 March 2020 | Published: 12 August 2020

About the author(s)

Alexander M.L. Hayes, Medical Sciences Division, Faculty of Clinical Medicine, University of Oxford, Oxford, United Kingdom


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Abstract

Background: While combined antiretroviral therapy (cART) allows near-normal life expectancy for people living with human immunodeficiency virus (HIV), it is unable to cure the infection and so life long treatment is required.

Objectives: The main barrier to curing HIV is the latent reservoir of cells, which is stable and resistant to cART.

Method: Current approaches under investigation for clearing this reservoir propose a ‘Shock and Kill’ mechanism, in which active replication is induced in latent cells by latency reversal agents, theoretically allowing killing of the newly active cells.

Results: However, previous studies have failed to achieve depletion of the T central memory cell reservoir, are unable to target other latent reservoirs and may be causing neurological damage to participants.

Conclusion: Future approaches to clearing the latent reservoir may bypass latency reversal through the use of drugs that selectively induce apoptosis in infected cells. Several classes of these pro-apoptotic drugs have shown promise in in vitro and ex vivo studies, and may represent the basis of a future functional cure for HIV.


Keywords

HIV; latency reversal; viral reservoir; pro-apoptotic drugs; cART

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