JACI special issue on prospects for eradication

The Journal of Allergy & Clinical Immunology’s new issue has a special focus on HIV/AIDS, in recognition of the upcoming International AIDS Conference in Mexico City. There are several free full-text articles, including this review by Lin Shen and Robert Siliciano that summarises recent evidence indicating ART can completely suppress viral replication, and mulls the implications for efforts to eradicate HIV infection.

Viral reservoirs, residual viremia, and the potential of highly active antiretroviral therapy to eradicate HIV infection
Lin Shen, MD, Robert F. Siliciano, MD, PhD Journal of Allergy & Clinical Immunology Volume 122, Issue 1, Pages 22-28 (July 2008)

Abstract: Although highly active antiretroviral therapy (HAART) can reduce HIV-1 viremia to levels that are below the limit of detection of clinical assays, the virus persists in reservoirs, and trace levels of free virions can be found in the plasma. Whether this residual viremia represents ongoing cycles of replication continuing despite HAART or simply the release of virus from stable reservoirs has been controversial. Here we summarize the evidence that HAART can stop ongoing cycles of replication. The evidence comes from a detailed analysis of the residual viremia, which shows it to be archival and nonevolving in character. In addition, new pharmacodynamic measures incorporating a previously ignored slope parameter have provided the first real indication of how well HAART actually suppresses viral replication in vivo. Together, these results argue that the ultimate theoretical potential of HAART to control viral replication has already been reached. Progress toward eradication of the infection will require novel approaches to target the stable reservoirs that persist even when viral replication is completely halted.

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