About this Research Topic
Controlling viremia is a key component of strategies to manage HIV pathogenesis and transmission, especially in low to middle income countries, where the vast majority of people living with HIV (PLHIV) now reside. Antiretroviral therapy (ART) has become over the past decades the acknowledged standard of therapy and foundation for global HIV management strategies such as the UNAIDS 90:90:90 program. However, recent and cumulative data have highlighted issues with adherence to treatment due to side effects, increased resistance and HIV rebound from elusive reservoirs, clearly underscoring the inadequacy of ART as the sole measure to achieve the now contemplatable goal of global HIV eradication.
In the current era of life long ART challenges faced include ART failure, sub-optimal CD4 rebound, serious non-AIDS related adverse events (SNAEs) and lack of immune restoration. Thus, there is an urgent need to find new therapeutic approaches to control HIV pathogenesis and viremia.
Many of the strategies that are currently investigated do not target the virus directly, but target host proteins that interact with HIV replication (host dependency facWtors, HDFs), activate latent virus from reservoir cells (“shock-and-kill”) or modulate the immune system to control the infection.
Also, newer immune modulation approaches towards achieving a ‘Functional Cure’ for HIV have gained attraction. Findings in SIV infection and HIV-infected individuals, where so-called viremic non-progressors (VNPs) could maintain CD4 counts in the face of ongoing viral replication, provide growing evidence that immunomodulatory approaches might achieve CD4 preservation with accompanying immune restoration (reduction in chronic activation). Interestingly, understanding the role of chronic immune activation and reservoir dynamics has become a key determinant to achieve “latency-reversal” in HIV eradication strategies. Also, spontaneous immune control of HIV viremia is observed in Long Term Non-Progressors (LTNPs). These patients represent an attractive phenotype that has driven extensive research towards establishing correlates of control and towards designing vaccines that aim to replicate immune responses observed in LTNPs. Viral diversity and evolution are other factors that can govern the efficacy of intra-individual immune responses as well as choice of rationally guided vaccine/therapeutic candidates such as broadly neutralizing antibodies and T cell vaccines.
The proposed article collection encourages submission of Original Research, Reviews and Mini Reviews, Perspectives, Clinical Trial, Case Report and Methods articles related to immune pathways controlling pathogenesis and viremia in HIV in the areas described above.
Topics of interest for this collection include 2 categories:
1. Immune responses
- Innate and adaptive immune pathways that interfere with HIV replication and viremia
- Viral evolution and intra-individual HIV immune responses
- Impact of HIV eradication strategies on the immune system (“shock-and-kill”, “lock-and-block”)
2. Therapeutic strategies
- Immunomodulatory strategies to control HIV infection
- Novel HIV dependency factors (HDF) targets and HDF-based therapy approaches
- Immunostimulatory and “latency-reversal” strategies
- Therapeutic approaches that aim at enhancing HIV-specific immune responses
- Animal models to study immune-based HIV therapy approaches
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.