Tracking replication-competent HIV reservoirs in infected individuals

Abstract

Prolonged suppression of plasma viremia is now achievable in a majority of HIV-infected individuals receiving antiretroviral therapy (ART). However, ART alone cannot eradicate HIV in infected individuals. The purpose of this review is to discuss the importance of tracking levels of infected CD4(+) T cells carrying replication-competent HIV in basic and clinical research and how the use of this virologic marker could help determine the efficacy of ART and several novel therapeutic strategies that are being proposed for eliminating persistent viral reservoir in infected individuals receiving ART. In recent years, there has been a growing interest within the HIV/AIDS scientific community to develop therapeutic strategies aimed at eliminating persistently infected CD4(+) T cells in order to achieve a cure for HIV in infected individuals receiving ART. These approaches include administration of HIV-activating agents, modification of the genetics of CD4(+) T cells, stem cell transplantation, and therapeutic vaccination. Such approaches would ultimately require careful and accurate assessments of the effect of therapeutic agents on HIV burden in infected individuals. Given that the majority of infected CD4(+) T cells in vivo carry replication-defective HIV, longitudinal measurements of the frequency of cells carrying replication-competent HIV along with other quantitative virologic parameters, such as levels of plasma viremia and cell-associated viral nucleic acid, can provide critical insight into the dynamics of the persistent viral reservoirs. Information related to HIV pathogenesis and the feasibility of eradicating the virus in infected individuals receiving ART in combination with novel therapeutic agents can also be gained from these analyses.