The HIV Reservoir and Cure and Remission Strategies

Abstract HIV-1 persists quiescently in cellular reservoirs not detected by the immune system because of the lack of active viral replication; these reservoirs represent the biggest obstacle to cure approaches. Reversal of HIV-1 latency and induction of virus expression by a variety of interventions may render infected cells susceptible to immune recognition and active clearance. Strategies to boost immune responses via active or passive immunization, immunomodulation, or gene therapy are being evaluated with the aim of achieving HIV-1 control or remission without antiretroviral therapy (ART), if not viral eradication. This chapter covers HIV reservoir and cure and remission strategies. It details the importance of why we should try to cure HIV and includes clinical observations where the concept of a “functional cure” has been introduced. Early establishment and persistence of the latent HIV-1 reservoir is discussed as well as latency reversal approaches and latency silencing. A variety of immune enhancing and/or modulating strategies and immunomodulatory treatments are reviewed. Special attention is paid to therapeutic and preventive vaccines.