Editors' ChoiceHIV

A Shot in the Arm for ART

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Science Translational Medicine  28 Nov 2012:
Vol. 4, Issue 162, pp. 162ec217
DOI: 10.1126/scitranslmed.3005325

Antiretroviral therapy for HIV (ART) has changed the course of this deadly disease from a death sentence to a chronic illness. Daily ART has increased life expectancy among HIV-positive individuals to almost that of their HIV-negative counterparts. The enormous benefits of ART cannot be underestimated, but the complicated cocktail of daily pills and the side effects make the possibility of HIV control through other modalities an important goal. Now, Azzoni and colleagues investigate whether boosting the host immune system using interferon-α (IFN-α) can control HIV replication.

The authors recruited 23 HIV patients for whom ART was successfully suppressing viral replication. All the participants received a polyethylene glycol –modified version of IFN-α in addition to ART for 5 weeks. Next, ART was stopped for 12 to 24 weeks, but IFN-α treatment was continued. The investigators found that in 45% of patients, HIV replication continued to be suppressed after 12 weeks of IFN-α treatment, and that in 30% of patients, HIV replication was still suppressed 24 weeks after cessation of ART. In addition, among participants who were able to suppress viral replication (7 out of 13), concentrations of latent virus DNA decreased. Indeed, even in those who did not show virus suppression after cessation of ART (6 out of 13), concentrations of latent virus DNA did not increase but remained stable.

The study by Azzoni and colleagues demonstrates that boosting the host immune system with IFN-α could suppress HIV replication even after ART is stopped. Also, unexpectedly, the researchers report that IFN-α could decrease the amount of latent virus replication, which is an important goal for a functional cure in which elimination of latent virus is essential. Although the results of Azzoni et al. are intriguing, they need to be confirmed in larger studies. We also need to understand why some HIV patients responded to IFN-α treatment, whereas others did not.

L. Azzoni et al., Pegylated interferon-α2A mono-therapy results in suppression of HIV-1 replication and decreased cell-associated HIV DNA integration. J. Infect. Dis., published online 26 October 2012 (10.1093/infdis/jis663). [PubMed]

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