Expert Reviews in Molecular Medicine

Review Article

Pharmaceutical approaches to eradication of persistent HIV infection

Mary-Catherine Bowmana1, Nancie M. Archina1 and David M. Margolisa1 c1

a1 Departments of Medicine, Microbiology & Immunology, and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.

Abstract

Highly active antiretroviral therapy (HAART) has markedly decreased morbidity and mortality in human immunodeficiency virus type 1 (HIV-1)-infected individuals in the developed world. Successful therapy often results in stable plasma levels of HIV-1 RNA below the limits of detection of commercial assays. Nonetheless, HIV-1 has not been cured by HAART. The causes of persistence of HIV infection in the face of current therapy appear to be multifactorial: latent but replication-competent provirus in resting CD4+ T cells, cryptic viral expression below the limits of detection of clinical assays, and viral sanctuary sites might all contribute to persistence. Clearance of HIV infection will almost certainly require a multimodality approach that includes potent suppression of HIV replication, therapies that reach all compartments of residual HIV replication and depletion of any reservoirs of persistent, quiescent proviral infection. This review highlights the basic mechanisms for the establishment and maintenance of viral reservoirs and pharmaceutical approaches towards their elimination.

Correspondence

c1 Corresponding author: David Margolis, 3302 Michael Hooker Research Bldg, CB#7435, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA. Tel: +1 919 966 6388; Fax: +1 919 966 0584; E-mail: dmargo@med.unc.edu