Impact of Myeloid Reservoirs in HIV Cure Trials
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Purpose of Review
Gallant efforts are ongoing to achieve sustained antiretroviral therapy (ART)–free HIV remission in the HIV-infected person; however, most, if not all, current human clinical studies have primarily focused these efforts on targeting viral persistence in CD4 T cells in blood and tissue sanctuaries. The lack of myeloid centered HIV clinical trials, either as primary or secondary end points, has hindered our understanding of the contribution of myeloid cells in unsuccessful trials but may also guide successes in future HIV eradication clinical strategies.
Recent advances have highlighted the importance of myeloid reservoirs as sanctuaries of HIV persistence and therefore may partially be responsible for viral recrudescence following ART treatment interruption in several clinical trials where HIV was not detectable or recovered from CD4 T cells. Given these findings, novel innovative therapeutic approaches specifically focused on HIV clearance in myeloid cell populations need to be vigorously pursued if we are to achieve additional cases of sustained ART-free remission.
This review will highlight new research efforts defining myeloid persistence and recent advances in HIV remission and cure trials that would be relevant in targeting this compartment and make an argument as to their clinical relevancy as we progress towards sustained ART-free HIV remission in all HIV-infected persons.
KeywordsHIV Monocytes Macrophages Microglia Clinical trials Reservoirs Cure
The authors would also like to acknowledge Thomas Premeaux for his construction and design of Fig. 1.
LCN is supported by the National Institutes of Health (NIH), National Institutes of Mental Health (R01MH112457, R01MH104141), the National Institute of Neurological Disorders and Stroke (R21 NS106970), and the National Institute on Minority Health and Health Disparities (U54 MD007601). The funders of this study had no role in the design of the report.
Compliance with Ethical Standards
Conflict of Interest
LCN has received research support from Tobira Therapeutics and serves as advisory board member for ViiV Healthcare. Brooks I. Mitchell and Elizabeth I. Laws have nothing to disclose.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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