TY - JOUR
T1 - Predicting Post-treatment HIV Remission: Does Size of the Viral Reservoir Matter?
AU - Pasternak, Alexander O.
AU - Psomas, Christina K.
AU - Berkhout, Ben
N1 - Funding Information: AP is supported by the grant no. 09120011910035 from the Dutch Medical Research Council (ZonMw). Publisher Copyright: © Copyright © 2021 Pasternak, Psomas and Berkhout. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2/26
Y1 - 2021/2/26
N2 - Combination antiretroviral therapy (ART) suppresses human immunodeficiency virus (HIV) replication and improves immune function. However, due to the persistence of long-lived HIV reservoirs, therapy interruption almost inevitably leads to a fast viral rebound. A small percentage of individuals who are able to control HIV replication for extended periods after therapy interruption are of particular interest because they may represent a model of long-term HIV remission without ART. These individuals are characterized by a limited viral reservoir and low reservoir measures can predict post-treatment HIV remission. However, most individuals with a low reservoir still experience fast viral rebound. In this Perspective, we discuss the possible reasons behind this and propose to develop an integral profile, composed of viral and host biomarkers, that could allow the accurate prediction of post-treatment HIV remission. We also propose to incorporate information on the chromatin context of the proviral integration sites into the characterization of the HIV reservoir, as this likely influences the reactivation capacity of latent proviruses and, together with the actual number of intact proviruses, contributes to the replication competence of the reservoir.
AB - Combination antiretroviral therapy (ART) suppresses human immunodeficiency virus (HIV) replication and improves immune function. However, due to the persistence of long-lived HIV reservoirs, therapy interruption almost inevitably leads to a fast viral rebound. A small percentage of individuals who are able to control HIV replication for extended periods after therapy interruption are of particular interest because they may represent a model of long-term HIV remission without ART. These individuals are characterized by a limited viral reservoir and low reservoir measures can predict post-treatment HIV remission. However, most individuals with a low reservoir still experience fast viral rebound. In this Perspective, we discuss the possible reasons behind this and propose to develop an integral profile, composed of viral and host biomarkers, that could allow the accurate prediction of post-treatment HIV remission. We also propose to incorporate information on the chromatin context of the proviral integration sites into the characterization of the HIV reservoir, as this likely influences the reactivation capacity of latent proviruses and, together with the actual number of intact proviruses, contributes to the replication competence of the reservoir.
KW - HIV
KW - antiretroviral therapy
KW - biomarker
KW - post-treatment controllers
KW - predictive marker
KW - profile
KW - viral reservoir
UR - http://www.scopus.com/inward/record.url?scp=85102447408&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fmicb.2021.648434
DO - https://doi.org/10.3389/fmicb.2021.648434
M3 - Article
C2 - 33717047
SN - 1664-302X
VL - 12
JO - Frontiers in Microbiology
JF - Frontiers in Microbiology
M1 - 648434
ER -