Assays to measure latency, reservoirs, and reactivation

JD Siliciano, RF Siliciano - HIV-1 Latency, 2018 - Springer
HIV-1 Latency, 2018Springer
HIV-1 persists even in patients who are successfully treated with combination antiretroviral
therapy. The major barrier to cure is a small pool of latently infected resting CD4+ T cells
carrying an integrated copy of the viral genome that is not expressed while the cells remain
in a resting state. Targeting this latent reservoir is a major focus of HIV-1 cure research, and
the development of a rapid and scalable assay for the reservoir is a rate-limiting step in the
search for a cure. The most commonly used assays are standard PCR assays targeting …
Abstract
HIV-1 persists even in patients who are successfully treated with combination antiretroviral therapy. The major barrier to cure is a small pool of latently infected resting CD4+ T cells carrying an integrated copy of the viral genome that is not expressed while the cells remain in a resting state. Targeting this latent reservoir is a major focus of HIV-1 cure research, and the development of a rapid and scalable assay for the reservoir is a rate-limiting step in the search for a cure. The most commonly used assays are standard PCR assays targeting conserved regions of the HIV-1 genome. However, because the vast majority of HIV-1 proviruses are defective, such assays may not accurately capture changes in the minor subset of proviruses that are replication-competent and that pose a barrier to cure. On the other hand, the viral outgrowth assay that was used to initially define the latent reservoir may underestimate reservoir size because not all replication-competent proviruses are induced by a single round of T cell activation in this assay. Therefore, this assay is best regarded as a definitive minimal estimate of reservoir size. The best approach may be to measure all of the proviruses with the potential to cause viral rebound. A variety of novel assays have recently been described. Ultimately, the assay that best predicts time to viral rebound will be the most useful to the cure effort.
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