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Contempo 1998
May 6, 1998

Antiretroviral Therapy for HIV InfectionPromises and Problems

Author Affiliations

From the University of California, San Francisco, and San Francisco General Hospital.

 

Edited by Ronna Henry Siegel, MD, JAMA Fishbein Fellow.

JAMA. 1998;279(17):1343-1344. doi:10.1001/jama.279.17.1343

ALTHOUGH progress against the human immunodeficiency virus (HIV) over the past year has been real and dramatic, the limitations of current antiretroviral therapy are now beginning to be appreciated. In this brief assessment of HIV treatment, we focus on recent advances in antiretroviral therapy, new insights into the pathogenesis of HIV disease, and the implications for clinical practice.

In 1996, scientists began to explore the feasibility of HIV eradication in infected patients. This provocative speculation was based on the assumption that cellular reservoirs of HIV have a short half-life and that they are reached by current drugs. Theoretically, if aggressive interventions could completely prevent de novo infection of cells, then therapy could be safely discontinued after all currently infected cells had died. Mathematical models predicted that this goal could be achieved in 1 to 3 years, especially for patients who initiated therapy during acute, primary infection. This optimism has been challenged by several recent observations, including reports that a small proportion of resting CD4 memory cells from treated patients with undetectable plasma HIV RNA levels harbor integrated replication competent HIV proviral DNA, and that the half-life of these cells may be on the order of months to years.1

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