Project: Investigation of the impact of inducible, replication-competent latent HIV-1 as an impediment to HIV/AIDS cure in the context of sustained viral suppression

Acronym	Latent HIV-1, Viral Suppress and Hope for HIV Cure (Reference Number: TMA2017CDF-1852)
Duration	01/05/2019 - 30/04/2022
Project Topic	In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for Human Immunodeficiency Virus (HIV), the 90-90-90 target. The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. However, achieving viral suppression will not culminate into HIV free society by 2030. Although it is important to track success results at each stage of the HIV continuum of care to evaluate progress towards the 90-90-90 target, detecting how much of the inducible virus is left in the human body after ART and expunging them will be important if we hope for HIV free society. Although ART can suppress HIV-1 infection to undetectable levels of plasma viremia, HIV DNA integrate and persist in resting CD4+ T cells. Latent HIV-1 genomes that encode replication-competent virus can resurface once ART is discontinued and is believed to be the largest impediment to a cure by ART alone. The vast majority of HIV-infected individuals currently live in sub-Saharan Africa where fully suppressive ART is expanding rapidly. Due to this expansion, a large number of patients are expected to achieve viral suppression. To date, there have been no systematic studies to quantify the latent reservoir in virally suppressed HIV-infected patients in Africa. Detecting how much of the inducible virus is left in the human body after ART poses the greatest challenge to fully curing HIV. In this study, we propose a longitudinal, descriptive study to document antiviral cocktail in aviremic HIV-1 patients, viral suppression and incidences of rebound, measure the size of the latent HIV reservoir in virally suppressed HIV-infected individuals and examine the immunological correlates of the latent reservoir. Data generated through this study will provide a clear framework for high-burden countries to reduce gaps at each stage of the HIV continuum of care, maximize linkage, retention and health outcomes. It will also enable identification of patients who will be eligible candidates for latency reactivation treatment when one becomes available, with a noble approach to link these patients to latency reactivation regimen care. Ultimately these data may inform strategies aimed at reducing HIV-1 reservoirs, inflammation and activation that persist despite ART.
Network	EDCTP2
Call	Career Development Fellowships 2017

Project partner

Number	Name	Role	Country
1	Kenya Medical Research Institute	Coordinator	Kenya