Analytical Treatment Interruption as an Effective Tool to Evaluate Novel Therapies and a Cure for HIV Infection

Dear Colleagues,

Effective suppressive antiretroviral therapy (ART) has been made increasingly available to many people living with HIV. However, lifelong adherence to therapy is essential to curb HIV infection, which is a challenge for many people. Therefore, a functional or sterilizing cure for HIV is desperately needed. Analytical treatment interruption (ATI) is done to measure the effect of interventions on viral rebound. The most successful attempt involved stem cell transplantation with delta 32 bp CCR-5, which led to a complete remission of HIV after ATI in a Berlin patient, but this proved difficult to repeat. Therapeutic vaccinations as immunotherapy have been tested with less compelling results, although a decrease in viral set point may be achieved after ATI.

Early treatment helps to restrict seeding of the latent HIV reservoir and reduces impairment of the immune system, which may result in a number of participants becoming post-treatment controllers.

As we strive to develop more potent and scalable interventions to deplete the latent reservoir, ATI could be considered as a tool to measure the efficacy of these interventions. However, various technical and ethical issues surrounding ATI have to be considered. Can we reliably measure the reservoir and predict viral rebound? What are correlates of protection, and is it safe to stop therapy if the effectiveness of the intervention is uncertain? Is it ethical to stop therapy if transmission to partners may occur? Is it scientifically worthwhile to stop ART only for a short period, not allowing the virus to reach a set point? These and other questions shall be addressed in this Special Issue.

Dr. Rob A. Gruters
Guest Editor

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• HIV infection
• treatment interruption
• correlates of protection
• latent reservoir
• therapeutic vaccination
• post treatment control
• elite controllers of HIV infection
• cure
• shock and kill