Early antiretroviral therapy (ART) is an important step in the path towards an HIV cure. Acute HIV infection studies have demonstrated the ability to identify and treat very early infection in adults, resulting in significantly smaller HIV reservoirs, preserved immune functions with little viral escape to immune pressure. These results have been illustrated in the ongoing RV254 acute HIV infection study in Thailand that has enrolled close to 500 individuals. It has served as a platform to learn the effects of early ART and recruit participants for HIV remission trials.
Despite the favorable qualities, the majority of early treated individuals do not achieve HIV remission. Indeed this has been the experience to date in the RV254 HIV remission trials, which include 3 completed studies and one ongoing, with others in development. The interventions have included latency-reversing agent, broadly neutralizing antibody and therapeutic HIV vaccine. However, there are important lessons to be learned that would inform the design of future HIV remission trials.
There continues to be exciting new development of immune-based interventions. It is highly likely that combination therapies that can generate persistent and effective immune responses to control HIV will be required for a durable ART-free sustained remission of HIV.
US Military HIV Research Program (MHRP)