实现HIV功能性治愈的策略和挑战

摘要

HIV can integrate into the infected cells' genome and persist in a stable latent reservoir in a resting state. Although combined antiretroviral therapy (cART) can successfully control HIV-1 replication, the latent reservoir is unaffected by ART. ART is a lifelong treatment with side effects for the individuals infected with HIV-1. Moreover, it is also a great financial burden for the world health system. A functional cure for HIV is a sustained post-treatment remission, which shows sustained viremia controlling and re-established immune function without ART. Although HIV reservoir is hardly to be eradicated, a functional cure can be achieved by several approaches, at least for a small proportion of infected people. Recently, several approaches including "kick and kill", early treatment, genetic and immune intervention are being explored to reach the aim of functional cure for HIV. Current studies have made some progresses, but many challenges still exist. A combination of these strategies will be the approach to achieve the goal.%HIV可潜伏感染形成病毒储存库。联合抗反转录病毒治疗能有效抑制病毒复制，但无法彻底清除病毒，且患者须终生服药，由此带来许多不良反应，并对世界卫生体系带来巨大的负担。通过特殊的治疗手段可实现即使中断抗反转录病毒治疗也能长期维持HIV RNA检测不到、机体免疫功能正常的治疗后控制状态，即HIV功能性治愈，这是治疗HIV感染的下一个可及的目标。研究人员正在探索包括激活病毒储存库、早期治疗、基因治疗和免疫治疗在内的多种策略，以期实现HIV功能性治愈。当前研究既取得一定进展也面临诸多挑战，未来仍需多种策略的联合以实现HIV功能性治愈的目标。