“Anti-retroviral therapy (ART) does not eradicate HIV infection,” said Dr Anthony Fauci, one of the world’s most respected AIDS researchers, in his address at yesterday’s plenary session.

“But,” Fauci continued, “this should not serve as a spurious excuse for not treating HIV infection.”

During his address, Fauci made the following points:

Most infected CD4 cells die while others retreat into latent reservoirs which can persist for between 6 and 44 months. With currently available ART, eradication of HIV would require over 40 years of therapy. There are recognisable differences between the T-cells in viraemic as opposed to non-viraemic individuals.

This knowledge prompted an investigation of the induction of cellular gene expression which might favor HIV replication in resting CD4 T-cells. The results allowed researchers to show that envelope-mediated signals might contribute to the production of virus in the resting reservoir. This occurs in the absence of expression of classic cell-surface markers of T-cell activation and proliferation.

This may in turn contribute to the propagation of a persistent low level of HIV replication in vivo. In viraemic patients, true latency does not exist as cells are continually poised to express virus. In aviraemic patients, much greater stability exists and this may represent a truly latent reservoir.

Future approaches will focus on suppression of viraemia, and the cellular and molecular characteristics of resting CD4 cells, in order to specifically target them.

Fauci ended by saying that basic and clinical scientists have reached the same conclusions as public health experts albeit by a different route:

“Treatment works saving and improving lives. Treatment should be made available to all who need it. Treatment cannot be separated from prevention.”

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team