Moreover, we recently proved that the effects of AF can be enhanced in the context of a combined anti-reservoir therapy, inducing a drug-free remission of the disease in chronically SIVmac251-infected macaques.
Lorenzo-Redondo, R. et al. Persistent HIV-1 replication maintains the tissue reservoir during therapy.
There is evidence that immune-activated macrophages infected with the Human Immunodeficiency Virus (HIV) are associated with tissue damage and serve as a long-lived viral reservoir during therapy.
24 Therefore, HIV may persist in viral reservoirs during therapy, and there might be specific cell types that allow its replication during HAART.
Reservoir-specific therapies targeting monocytes or CNS directly may have utility, and some new studies are underway.
Treatment should be guided by a multidisciplinary approach and includes surgery (ventriculo-peritoneal shunt or Ommaya reservoir placement), radiation therapy to high burden sites and both intrathecal and systemic chemotherapy [37].
One approach to eradication of the latent reservoir is induction therapy, whereby latently infected cells are activated to initiate viral replication.
By contrast, more recent data indicate that the stability of the latent reservoir despite intensive therapy requires new strategies to eradicate HIV-1 from this reservoir (Gandhi et al. 2010; Sagot-Lerolle et al. 2008; Archin et al. 2010).
It is necessary, however, to measure the impact of eradication strategies on the size of the viral reservoir even as therapy is continued if clinical trials are to proceed in an efficient and ethical manner (International ASSWGoHIVC et al., 2012).
HIV-1 persists indefinitely in memory CD4 T cells and other long-lived cellular reservoirs despite antiretroviral therapy.
To be defined are the mechanisms contributing to cell proliferation, the role of proliferating cells in perpetuating the infectious virus reservoir, and whether therapies that target HIV-infected proliferating cells, specific genes, or their products may contribute to a curative strategy for HIV infection.
