The road to eradication: is HAART hard enough?

At the ground-breaking 1996 international Conference on AIDS in Vancouver, Drs Martin Markowitz and David Ho, leading researchers at the Aaron Diamond AIDS Research Centre (ADARC), gave presentations charting the gradual depletion of HIV reservoirs in a small group of patients treated with antiretroviral regimens.

Dr Ho went on to suggest that it might be possible to completely eradicate HIV by early aggressive therapy that turns off all viral replication. The public consideration of what would be, in essence, a cure was met with enormous enthusiasm — and occasional criticism — by the international media, HIV-treating physicians and, of course, people living with HIV.

Needless to say, the original time frame postulated by Dr Ho and his colleagues — one and a half to three years of “maximally suppressive” antiretroviral therapy — proved to be improbable. Much research generated over the past six years, including several key studies conducted at ADARC, explored two potential caveats that were raised (although rarely reported in mainstream media accounts) by Drs Ho and Markowitz in 1996: 1) that HIV infection may persist for an extended period of time in certain cellular reservoirs, and 2) that highly active antiretroviral therapy may, in fact, not be potent enough to completely shut down viral replication. Sadly, both warnings proved true, and the hope of eradication all but fizzled out.

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