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Vol. 37. Issue 4.
Pages 265-273 (April 2019)
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Vol. 37. Issue 4.
Pages 265-273 (April 2019)
Review article
DOI: 10.1016/j.eimce.2019.02.001
Strategies for the cure of HIV infection
Estrategias de curación de la infección por VIH
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Jesús Rodríguez-Muñoz, Santiago Moreno
Corresponding author
smguillen@salud.madrid.org

Corresponding author.
Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Tables (3)
Table 1. Mechanisms of HIV persistence.
Table 2. Latency-reversing agents. Mechanisms of action and reactivating intensity.
Table 3. Proposed strategies for overcoming the obstacles identified in the functional cure for HIV.
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Abstract

The disadvantages of the long-term administration of antiretroviral therapy as well as the huge number of affected persons have placed the cure of HIV as a primary goal of Public Health. HIV may persist in the organism by at least four mechanisms: a latently infected cellular reservoir, the persistent replication of HIV in spite of antiretroviral therapy (ART), anatomic sanctuaries, and the immune dysfunction. Several strategies directed against these mechanisms have been developed. With all this, a complete eradication of HIV has been achieved in a patient using the transplantation of haemopoietic stem cells that were resistant to HIV-infection, and there are examples of functional cure either spontaneously (elite controllers) or after antiretroviral therapy (post-treatment controllers). However, no strategies have been successful in reducing the reservoir size, nor in achieving constant, uniform remissions. The failure of isolated strategies makes it likely that the combination of several of them may be the future solution.

Keywords:
HIV
Latency
Reservoirs
Eradication
Functional cure
Resumen

Los inconvenientes de la administración indefinida del tratamiento antirretroviral y el enorme número de personas infectadas convierten la cura del VIH en un objetivo primordial de salud pública. El VIH puede persistir en el organismo por al menos cuatro mecanismos: un reservorio celular latentemente infectado, la replicación persistente a pesar del tratamiento, los santuarios anatómicos y la disfunción inmunológica. Se han desarrollado estrategias para erradicar el VIH haciendo frente a estos mecanismos. Hasta el momento, se ha conseguido la erradicación completa del virus en un paciente mediante el trasplante de progenitores hematopoyéticos resistentes a la infección y existen casos de curación funcional de modo natural (controladores de élite) o tras tratamiento antirretroviral (controladores postratamiento). Sin embargo, ninguna estrategia ha conseguido disminuir el reservorio, ni lograr remisiones de modo constante y uniforme. El fracaso de las estrategias aisladas sugiere que la combinación de varias de ellas sea la solución futura.

Palabras clave:
VIH
Latencia
Reservorios
Erradicación
Curación funcional

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