Antiviral Pharmacology Laboratory, Center for Drug Discovery, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.
Department of Pharmacology and Experimental Neuroscience, UNMC, Omaha, Nebraska, USA.
Clin Pharmacol Ther. 2021 Aug;110(2):334-345. doi: 10.1002/cpt.2237. Epub 2021 Apr 18.
Combination antiretroviral therapy (ART) can suppress plasma HIV-RNA to < 50 copies/mL, decrease HIV transmission, reduce mortality, and improve quality of life for people living with HIV. ART cannot, however, eliminate HIV from an infected individual. The primary barrier to cure HIV infection is the multiple reservoir sites, including adipose tissue, bone marrow, central nervous system, liver, lungs, male and female reproductive system, secondary lymph nodes, and gut-associated lymphoid tissue, established 1 to 2 weeks after acquisition of HIV. Additional challenges include understanding the mechanism(s) by which HIV is maintained at low or undetectable levels and developing treatments that will eradicate or produce a sustained suppression of virus without ART. To date, the most extensive clinical investigations of cure strategies have been the shock-and-kill approach using histone deacetylase inhibitors (HDACis) to induce reactivation of latent HIV. Despite evidence for HIV latency reversal, HDACis alone have not decreased the size of the latent reservoir. Clinical pharmacologic explanations for these results include a low inhibitory quotient (i.e., low potency) within the reservoir sites and intrinsic (e.g., sex differences and reservoir size) and extrinsic (physiochemical and pharmacokinetic drug characteristics) factors. We offer an outline of desired clinical pharmacologic attributes for therapeutics intended for clinical HIV cure research and call for research teams to have early and ongoing involvement of clinical pharmacologists. We believe such a collective effort will provide a solid scientific basis and hope for reaching the goal of a cure for HIV infection.
联合抗逆转录病毒疗法(ART)可以将血浆 HIV-RNA 抑制到 <50 拷贝/mL,降低 HIV 传播,降低死亡率,提高 HIV 感染者的生活质量。然而,ART 并不能从感染者体内清除 HIV。治愈 HIV 感染的主要障碍是多个储库部位,包括脂肪组织、骨髓、中枢神经系统、肝脏、肺部、男性和女性生殖系统、次级淋巴节点和肠道相关淋巴组织,这些部位在感染 HIV 后 1 至 2 周内建立。其他挑战包括了解 HIV 维持在低水平或无法检测到的水平的机制,并开发能够根除或在没有 ART 的情况下产生持续抑制病毒的治疗方法。迄今为止,治愈策略的最广泛临床研究是使用组蛋白去乙酰化酶抑制剂(HDACi)的“休克和杀伤”方法,诱导潜伏 HIV 的重新激活。尽管有 HIV 潜伏期逆转的证据,但 HDACi 单独使用并未减少潜伏储库的大小。这些结果的临床药理学解释包括储库部位的抑制性商数(即效力低)低和内在(例如,性别差异和储库大小)和外在(理化和药代动力学药物特征)因素。我们提供了用于临床 HIV 治愈研究的治疗药物的理想临床药理学特征的概述,并呼吁研究团队让临床药理学家尽早和持续参与。我们相信,这样的集体努力将为实现 HIV 感染治愈的目标提供坚实的科学基础和希望。