Scientific rationale behind the use of antiretroviral therapy

Johns Hopkins researcher and infectious disease specialist Robert Siliciano, M.D., Ph.D., will provide an update on the scientific rationale behind the use of antiretroviral therapy, focusing on the mechanisms that allow life-long persistence of HIV even in patients on potent medication.

Siliciano, a professor of medicine at Hopkins and a Howard Hughes Medical Institute investigator, has recently found a second reservoir for HIV in the body, where it "rests" and is not affected by current therapies that prevent the virus from replicating.

While the Hopkins findings await publication, Siliciano says the additional viral population makes it unlikely that HIV can be eradicated from the body, even though current therapies effectively reduce the replicating virus to levels undetectable by standard clinical techniques. According to the Hopkins team, the so-called second reservoir of HIV harbors unique HIV variants, or kinds of the virus that have generated in a patient, distinct from those that persist in a previously discovered reservoir in resting, CD4-positive T-cells.

The reservoir for HIV in resting CD4 cells harbors all of the major variants and all have the potential to reemerge from this reservoir at later times. However, recently published data by the Hopkins team on blips in HIV levels concludes that this archival virus is not mutating to become drug-resistant.