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Genital reservoir: a barrier to functional cure?

Gantner, Pierrea,b; Ghosn, Jadec,d,e

doi: 10.1097/COH.0000000000000486
PROGRESS IN ACHIEVING LONG-TERM HIV REMISSION: Edited by Jean-Daniel Lelièvre and Timothy J. Henrich

Purpose of review HIV functional cure requires the elimination or a major reduction of HIV reservoir pool including male and female genital HIV reservoirs. A comprehensive understanding of HIV dynamics in these compartments is mandatory.

Recent findings Data from chronically HIV-infected therapy-naïve individuals or fully suppressed on combined antiretroviral therapy (cART) or undergoing ART interruptions are now available. Using paired blood/genital samples, HIV-RNA/DNA quantification and sequencing provide new insights on HIV dynamics in genital reservoirs.

Summary In the absence of cART, HIV shedding in semen and cervicovaginal secretions is frequent, resulting most likely from passive transfer of HIV strains that originates from bloodborne virions or infected blood cells. Partial and intermittent HIV compartmentalization in the male and female genital tracts can occur not only in chronically infected ART-naïve individuals but also when cART is used to prevent active blood replication. This transient autonomous HIV replication in the genital reservoir in a few individuals originates from recent transfer of virions or infected blood cells. cART interruption studies showed that blood and genital quasispecies are closely related, in agreement with a passive transfer. Altogether these data suggest that HIV genital reservoirs seem not to be a significant barrier to achieve HIV cure.

aLaboratoire de Virologie, Hôpitaux Universitaires de Strasbourg

bStrasbourg University, INSERM, UMR-S U1109, Strasbourg

cAPHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Nord site Bichat-Claude Bernard

dUniversité Paris Diderot, Inserm U 1137 IAME, PRES Sorbonne Paris-Cité

eINSERM U 1137 IAME, Université Paris Diderot, Paris, France

Correspondence to Dr Pierre Gantner, PharmD, PhD, Laboratoire de Virologie, Institut de Virologie, Hôpitaux Universitaires de Strasbourg, 3, rue Koeberlé, 67000 Strasbourg, France. E-mail: pierre.gantner@chru-strasbourg.fr

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