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Shocking HIV out of hiding: where are we with clinical trials of latency reversing agents?

Rasmussen, Thomas A.; Lewin, Sharon R.

Current Opinion in HIV and AIDS: July 2016 - Volume 11 - Issue 4 - p 394–401
doi: 10.1097/COH.0000000000000279
STRATEGIES FOR TARGETING RESIDUAL HIV INFECTION: Edited by Matthieu Perreau and Nicolas Chomont
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Purpose of review To provide an overview of the initial experiences with the use of latency-reversing agents (LRAs) in clinical trials in HIV and to discuss and contrast results arising from these studies.

Recent findings Although the clinical administration of histone deacetylase inhibitors (HDACis) and disulfiram to HIV-infected individuals on antiretroviral therapy significantly increased cell-associated HIV RNA in CD4+ T cells and in some cases plasma HIV RNA, this did not reduce the frequency of latently infected cells in blood. Potential reasons for this include insufficient potency in latency reversal, lack of virus or immune-mediated cytolysis of virus-expressing cells and/or a high frequency of immune escape mutations in the recently activated virus. Analyses of HIV-specific T-cell responses in vivo did not demonstrate that HDACis impair immune cell effector functions.

Summary More effective latency-reversing interventions and additional strategies to eliminate virus-expressing cells are needed. Key challenges include testing combinations of LRAs and/or LRAs with immune modulation to optimize potency in the absence of adverse events. A better understanding of the mechanisms of action of LRAs as well as strategies to enhance potency and penetration in tissue are key challenges for future studies.

aThe Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia

bDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark

cDepartment of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia

Correspondence to Thomas A. Rasmussen, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Elizabeth Street 792, Melbourne, 3010 VIC, Australia. Tel: +61 404 627 728; e-mail: thomas.rasmussen@unimelb.edu.au

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