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Elite control of HIV: is this the right model for a functional cure?
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Download the PDF here
Download the PDF here
A cure for HIV is still greatly needed and has become a global research priority. A unique subset of HIV- infected individuals who spontaneously control HIV exists, and these are known as 'elite controllers'. They may represent a natural model for a 'functional cure' in which there is long term control of viral replication and remission from symptoms of HIV infection in the ab- sence of antiretroviral therapy. However, controllers have evidence of ongoing inflammation, CD4+ T cell depletion, and perhaps even inflammation-associated cardiovascular disease, suggesting that this natural long term virologic control may be coming at an im-munologic and clinical cost. These individuals may continue to provide continued insights into mecha-nisms of host control; however, they may not represent the best model of a functional cure, if we believe that a cure should require a disease-free (and not just a treat-ment-free) state.
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Advancing the HIV cure agenda: the next 5 years
Purpose of review
To explore how ethical considerations, improved diagnostics and data from clinical trials might see the lowering of some of the barriers blocking a cure for HIV infection over the next 5 years.
Recent findings
Despite the recent well publicized but eventually disappointing case reports, there remains only one successful HIV cure, the 'Berlin patient'. We will review the data suggesting that more potent agents might achieve in-vivo viral activation and explore the tantalizing phenomenon of 'posttreatment control' following
treatment in primary HIV infection. We will also explore how new assays and novel interventions might move the field forward.
Summary
There is a need for new agents that can be safely tested to impact the viral reservoir, a more meaningful understanding of how to assay patient samples, and research into mechanisms behind how the reservoir is established and impacted by therapy. With HIV+ve individuals responding so well to antiretroviral therapy, new trials must be tested hand-in-hand with guidance from patient representatives, especially with respect to determining the acceptable risk. The road to a cure is going to be difficult, but it is vital that inevitable disappointments do not detract from the final goal, which remains worth striving for.
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