Rebound of HIV and reappearance of HIV reservoirs in patients treated with IL-2& combination antiretroviral drugs following cessation of therapy

In two HIV-infected patients treated with potent combinations of anti-HIV drugs and interleukin-2 (IL-2), and in whom even highly sensitive tests could detect no viable HIV, the virus quickly rebounded to substantial levels when therapy was stopped, according to researchers at the National Institute of Allergy and Infectious Diseases (NIAID).

NIAID Director Anthony S. Fauci, M.D., chief of the NIAID Laboratory of Immunoregulation (LIR), Tae-Wook Chun, Ph.D., a section head within the LIR, and their colleagues report their data in the Oct. 28, 1999 issue of the journal Nature.

The new findings add to recent reports that suggest eradicating HIV from the body with currently available anti-HIV therapies is unlikely because the virus can hide in sanctuaries which drugs cannot access and can exist in a latent form on which drugs have no effect.

Scientists frequently refer to these sanctuaries, which are established very early in the course of HIV infection, as viral "reservoirs."

Reservoirs of HIV include certain immune system cells - notably resting (non-activated) CD4+ T cells of the blood and lymph nodes - and probably cells of the brain, gut, bone marrow, genital tract and other organs. These reservoirs, in which the virus continues to replicate at low levels even during aggressive treatment, are probable sources of the resurgent HIV seen when therapy is discontinued. The current study shows that at least one HIV reservoir - the pool of latently infected, resting CD4+ T cells - is itself rapidly replenished after therapy is discontinued.

"The persistence of HIV reservoirs poses a significant impediment to the long-term control of HIV infection and must be addressed by comprehensive approaches to the therapy of HIV-infected individuals," says Dr. Fauci. "Our research and that of other groups underscores the importance of developing more potent anti-HIV therapies, treatment strategies that specifically target the hiding places of HIV, as we

Contact: Greg Folkers
NIH/National Institute of Allergy and Infectious Diseases

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