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Overview of mucosal transmission
In the June issue of Nature Reviews Immunology, Florian Hladik and Juliana McElrath review the current state of knowledge regarding mucosal transmission of HIV infection and the current concepts of the immediate events that follow viral exposure at genital mucosal sites where most documented transmissions occur. Thy also discuss the gaps in knowledge that are relevant to future studies, which will shape strategies for effective HIV prevention.
Access to the full text of the paper is free of charge but requires registration with the Nature website.
http://www.nature.com/nri/journal/v8/n6/full/nri2302.html
Hladik F and McElrath JM. Setting the stage: host invasion by HIV. Nature Reviews Immunology 8, 447-457 (June 2008) | doi:10.1038/nri2302
Four excellent articles have been recently posted online by this leading resource
http://www.prn.org
The gastrointestinal tract in HIV-1 infection: questions, answers, and more questions!
Saurabh Mehandru
The GI tract is targeted during all stages of HIV disease, and this is especially so during acute and early HIV infection. CD4 cells are preferentially lost from the GI tract within weeks of HIV infection. Despite long-term antiretroviral therapy, CD4+T-cell reconstitution remains deficient in the GI tract in spite of the reconstitution seen in the peripheral blood.
HIV-1 integrase inhibitors
Teresa Evering and Martin Markowitz
The integrase inhibitors are a welcome addition to the treatment armamentarium for HIV/AIDS in treatment-experienced patients failing available antiretroviral regimens. The promising efficacy and tolerability profile of the integrase inhibitors, absence of cross-resistance with other antiretroviral classes, and demonstrated synergism of the integrase inhibitors in combination with approved antiretroviral agents place them in a position to become important components of effective combination antiretroviral regimens in individuals living with HIV/AIDS.
Osteoporosis and adrenal insufficiency
Todd T. Brown
The care of HIV-infected patients has become increasingly complex. Endocrine problems, such as osteoporosis and AI, have been frequently reported in the HAART era. Additional considerations may be required regarding the etiologies, diagnosis, and treatment compared with the general population. Further research is required to understand the intricacies of these problems in HIV-infected patients in order to provide optimal care.
Update on CCR5 inhibitors: scientific rationale, clinical evidence, and anticipated uses
Athe Tsibris
The CCR5 antagonists are a welcome addition to the therapeutic armamentarium available for antiretroviral-experienced patients. Currently, their use in antiretroviral-naive patients should be restricted to enrollment in ongoing or planned clinical trials. The CCR5 antagonist maraviroc is FDA-approved for treatment-experienced patients with R5 virus (only), and no patient should receive maraviroc without first undergoing a tropism assay.
The Journal of Allergy & Clinical Immunology’s new issue has a special focus on HIV/AIDS, in recognition of the upcoming International AIDS Conference in Mexico City. There are several free full-text articles, including this review by Lin Shen and Robert Siliciano that summarises recent evidence indicating ART can completely suppress viral replication, and mulls the implications for efforts to eradicate HIV infection.
Viral reservoirs, residual viremia, and the potential of highly active antiretroviral therapy to eradicate HIV infection
Lin Shen, MD, Robert F. Siliciano, MD, PhD
Journal of Allergy & Clinical Immunology
Volume 122, Issue 1, Pages 22-28 (July 2008)
http://www.jacionline.org/article/PIIS0091674908010038/fulltext
Abstract: Although highly active antiretroviral therapy (HAART) can reduce HIV-1 viremia to levels that are below the limit of detection of clinical assays, the virus persists in reservoirs, and trace levels of free virions can be found in the plasma. Whether this residual viremia represents ongoing cycles of replication continuing despite HAART or simply the release of virus from stable reservoirs has been controversial. Here we summarize the evidence that HAART can stop ongoing cycles of replication. The evidence comes from a detailed analysis of the residual viremia, which shows it to be archival and nonevolving in character. In addition, new pharmacodynamic measures incorporating a previously ignored slope parameter have provided the first real indication of how well HAART actually suppresses viral replication in vivo. Together, these results argue that the ultimate theoretical potential of HAART to control viral replication has already been reached. Progress toward eradication of the infection will require novel approaches to target the stable reservoirs that persist even when viral replication is completely halted.
HPV Infection in HIV-Seropositive Men and Women
Dr. Joel Palefsky reviews human papillomavirus and HIV, including both cervical and anal disease, and vaccine development.
http://hivinsite.ucsf.edu/InSite?page=cfphp-palefsky2008
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