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Sustainable HIV remission without lifesaving antiretroviral therapy is a top priority in HIV research, says new commentary on HIV JAMA by experts from the National Institute of Allergy and Infectious Diseases (NIAID), which is part of the National Institutes of Health.
Antiretroviral therapy involves taking a combination (usually three) of medications daily, often combined into one tablet. Antiretroviral treatment has transformed the lives of people living with HIV, allowing people with access to medicines to live near normal lives. Despite this success, side effects, pill fatigue, stigma and costs badociated with taking daily antiretroviral therapy for life have prompted researchers to find an alternative, write Anthony S. Fauci, director from NIAID, and his colleagues. As a result, scientists are looking for ways to place HIV in complete and prolonged remission, thus avoiding the need for daily antiretroviral therapy. The authors say that feasible approaches must involve minimal risk and manageable side effects for people living with HIV, and must be inexpensive and scalable for millions of people.
The persistence of viral reservoirs is a major obstacle to sustained HIV remission without antiretroviral therapy. These reservoirs consist of HIV-infected cells containing genetic material that can generate new viral particles. The cells have entered a state of rest that they maintain until they are activated to produce HIV.
The authors explain that two pathways are underway to achieve sustainable remission of HIV without antiretroviral therapy: the total eradication of the HIV reservoir, clbadically called "curative treatment", and sustained virological remission, which would control the HIV replication but not the virus. The authors describe the specific strategies under study to achieve these goals.
Several approaches to eradicating the HIV reservoir have been attempted, but none has succeeded, other than stem cell transplantation from a donor with a specific genetic mutation – and only in two cases. The risks, costs and complexity of stem cell transplants do not make them practical for eradicating the HIV reservoir in people who do not need such a transplant for a distinct underlying health problem, the authors write.
Many advanced strategies to achieve sustained virologic remission are under study. The authors describe how some of these strategies have the potential to replace daily ARV treatment with an intermittent or continuous ARV intervention, while others seek to induce permanent immune mediated HIV control without further intervention. Clinical trials of many different approaches are underway.
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Material provided by NIH / National Institute of Allergy and Infectious Diseases. Note: Content can be changed for style and length.
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