Treatment interruption strategies as a way of developing a functional cure for HIV and the important role that the time point of HAART initiation might play

Abstract

With the development of highly active antiretroviral therapy (HAART), the outlook for patients suffering from HIV infection has been improved significantly. However, treatment of HIV is usually a lifelong commitment due to inability of current antiretroviral drugs to completely eradicate HIV from the body. Due to the complications involved in the development of a sterilizing cure an alternative solution to the problem is gaining in popularity, namely the development of a functional cure. Such a cure would not completely eliminate HIV from the body, but instead focus on enhancing the immune system’s ability to suppress viral replication and achieve a permanent form of viral control to the point where medication will no longer be required. Recent successes in the field have already demonstrated that long term viral control might be induced by cessation of treatment under specific circumstances. One particular point of debate appears to be the time point of HAART initiation, as large differences in study outcome have been observed when comparing the effect of treatment cessation in patients who started initial therapy in the acute phase of HIV infection versus those who deferred treatment until diagnosed with chronic phase HIV infection. In this review we will therefore give an overview of the different strategies utilized to obtain a functional cure and discuss the potential advantages and disadvantages associated with initiation of HIV therapy during the different stages of HIV infection.