Wake me up before you go: a strategy to reduce the latent HIV reservoir

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Antiretroviral therapy (ART) does not eradicate HIV as demonstrated by the rapid return of viremia whenever treatment is interrupted. The possible long-term toxicity of ART, viral resistance, stigma, and cost all contribute to the necessity of finding a cure. In individuals on ART, HIV primarily persists in CD4+ T cells that do not spontaneously produce HIV particles unless activated. The few HIV remission cases reported to date were adults or children with extremely low reservoir either by initiating ART in the first hours of live, or by immune ablative treatment and allogeneic stem cell transplant [1–3]. These long-lived resting CD4+ latently infected cells are often considered as the major obstacle to HIV eradication, although low-level cryptic replication in tissue sanctuaries may be a contributing factor [4,5]. Overall, it is assumed that eliminating, or at least reducing significantly the size of the HIV reservoir is a prerequisite to the development of a cure for HIV infection.

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