HIV: Current Research
Open Access

HIV-1 Latent Reservoir and Its Treatment

Siddhartha Norgay^{* *}Correspondence: Siddhartha Norgay, Department of Pharmacology, Western University, FWU line, Campus Rd, Bhimdatta 10400, Nepal, Email:

Author info »

Description

The initial identification of the human immunodeficiency virus 1 (HIV-1), antiretroviral therapy (ART), a targeted treatment, has successfully kept the observed plasma viremia below a very low level, and the method has advanced quickly. However, a sudden discontinuation of the medication would unavoidably result in HIV viral rebound and HIV progression because of the presence of the latent reservoir of replication-competent HIV-1 in patients receiving ART. Therefore, prior to creating a treatment that completely wipes out the reservoir, it is imperative to gain a better knowledge of the HIV-1 latent reservoir (LR). HIV-1 can spread from cell to cell as well as through the release of cell-free particles. There is growing evidence that cell-to-cell transmission is more effective than cell-free transmission of particles and may have an impact on HIV-1 infection pathogenesis.

This method of viral transmission also affects the development and upkeep of the latent reservoir, which is the principal barrier to the infection's recovery. The definition, creation, and maintenance of the HIV-1 LR, as well as cutting-edge quantitative techniques that directly measure HIV-1 intact proviruses, are clarified in this study. The treatment of HIV infection is highlighted. This study will rekindle optimism for a more effective and thorough treatment for HIV infection for all people and will motivate additional clinical studies to attain ART-free HIV remission.

Since the beginning of the HIV-1 epidemic, about 70 million people have acquired the human immunodeficiency virus 1 (HIV-1); since then, millions of survivors have endured HIV-1 infection and benefited from antiretroviral therapy (ART). According to estimates from the UNAIDS Report and the World Health Organization, there are 38–70 million persons worldwide who are HIV–positive. Nearly 25 million of them have access to antiretroviral therapy (ART).

The half-life of the HIV-1 reservoir has been found in numerous studies to vary between 44 months and 13 years, and in certain cohorts, no degradation was seen at all. The majority of people must therefore have lifelong ART in order to maintain viral suppression and achieve the greatest health outcomes. The latent reservoir (LR), also known as HIV latency, is a collection of dormant CD4+ T cells infected with replication-competent proviruses in patients receiving antiretroviral therapy (ART). In recent years, a number of studies have shown a correlation between the risk of recurrence and the LR of HIV-1. Since the therapy, these infected cells have temporarily or consistently stopped producing new virus particles. However, the primary barrier to HIV eradication is these infected memory CD4+ T cells that allow HIV-1 to evade immune monitoring. Therefore, it is now unfeasible to use ART to completely eradicate HIV.

Accurate measurement of the HIV-1 LR is still required for the elimination of HIV at this time. Although a cloudburst of enhanced tests for calculating the extent of the HIV reservoir have been created, there is still no widespread agreement on the methodology. Despite more than three decades of efforts, the understanding of the HIV-1 latent reservoir is inadequate, and improving it is the top priority before complete elimination (a cure) and the ability to permanently decrease plasma viremia following ART cessation can be achieved (a functional cure). The concept, creation, and maintenance of the HIV-1 LR are clarified in this paper, which also examines conventional and cutting-edge methods for estimating reservoir sizes.

Lastly, how far we have come in eliminating HIV LR is underlined. After measuring HIV-1 LR, the ART intervention for HIV-1 with recurrent infection is shown on the left. The method of eradicating HIV-1 LR on the right involves homeostatic stimulation of T cells and persistence in long-lived memory T cells.

Conclusion

Reductions in HIV-1 mortality and the measurement of HIV-1 LR are two examples of advances in the development of an HIV-1 cure. However, there is still a long way to go in terms of research and development for HIV-1 elimination and remission because current therapies cannot completely clear the virus due to persistent LR, and preexisting measurement cannot guarantee 100 percent accurate quantitation of the HIV-1 LR at each stage.

Numerous treatment plans have been put forth over the past ten years, with shock and kill therapy being the most promising. The time to viral rebound was not shorter or longer than expected in validation trials of the shock and kill technique, and the virus was nonetheless capable of reactivating in vivo. Therefore, after stopping ART, it is necessary to increase the killing impact against the HIV-1 LR and alternate approaches, such as therapeutic immunization and immunological boosters, to prevent HIV-1 infection. The effectiveness of emerging approaches including immune checkpoint inhibitors, gene editing instruments, and CAR-T cell therapy needs to be confirmed in more clinical research. With these methods, there is new hope for an HIV-1 cure. Difficulties following therapy, such as negative consequences weakening.