Towards a cure: HIV reservoirs and strategies to control them

Can HIV infection ever be cured? The prospect of efficiently controlling HIV persistence in infected persons was the topic of a high-level, two-day meeting of researchers gathered here on the eve of AIDS 2010, the biennial international conference of HIV researchers, funders, policy-makers and advocates.

The workshop, "Towards a Cure: HIV Reservoirs and Strategies to Control Them," brought together basic scientists, clinical researchers, scientific journalists, community leaders and research funding agencies from around the world to review and debate the latest research on HIV reservoirs and to address whether and how it may one day be feasible to fully control the virus in an infected individual.

While increasingly potent combinations of antiretroviral therapy (ARV) have greatly improved the health and substantially reduced mortality rates of people living with HIV and AIDS, current accessible treatments do not eradicate the virus from an infected person. Even in successfully treated individuals, HIV remains hidden in certain cells called HIV reservoirs located in several compartments of the body. Patients must continue taking ARV therapy indefinitely in an attempt to keep these viral reservoirs under control. Otherwise, at cessation of therapy, the virus rebounds as a consequence of the activation of viral reservoirs.

"The science in this area is evolving rapidly, but HIV persistence remains a daunting challenge," said 2008 Nobel Laureate for Medicine, upcoming President-elect of the IAS and workshop Chair Francoise Barr--Sinoussi. "There is a strong need for continued investment in research in order to better understand why and how HIV infection persists under therapy. Solving these mysteries is critical for developing future therapeutic strategies that will not depend on lifelong therapy.

Topics related to HIV reservoirs strategies have been part of a rich program of basic and translational science presented in abstracts, posters, workshop and other sessions at AIDS 2010. State-of-the-art research presented at the workshop and in sessions here addressed topics such as viral reservoirs and sanctuary sites, genetic determinants of viral control, the problem of virus reactivation and the role of the immune system in HIV persistence. The therapeutic strategies needed to target HIV reservoirs - such as the complex stem cell transplant procedure that seems to have successfully eliminated the virus from one infected individual - were discussed, as well as the tools needed to assess their effect.

The issues and findings presented at the workshop are disseminated through a special edition of Science Magazine on HIV and AIDS, titled "HIV persistence and the prospect of long-term drug-free remissions in HIV-infected individuals". Abstracts presented at the workshop and an impact report will also be published in the Journal of the International AIDS Society (JIAS).

"HIV Reservoirs research is in its early stages, but is presenting important findings and raising questions that could have significant implications for HIV treatment and management in years ahead. This work deserves far more funding and support to achieve its potential and should be pursued vigorously as we search for alternatives to life-long dependence on ARV" commented Elly Katabira, upcoming IAS President.