Starting antiretroviral therapy immediately after HIV infection, then adding a vaccine and a drug that flushes the virus out of its hiding places, could shrink the pool of latently infected cells that make HIV incurable. Current antiretroviral therapy (ART) stops the virus from replicating but cannot eliminate it. HIV hides dormant inside certain cells—the viral reservoir—for a person’s entire life. If ART stops, the virus rebounds. The problem is that no one knows whether a combination of very early treatment, immune-boosting vaccination, and a “shock” drug can actually reduce that reservoir enough to matter. If this proof-of-concept study shows the combination can significantly shrink the reservoir, it would open the door to larger trials aiming for a functional cure—where the immune system controls HIV without lifelong daily pills. That would transform life for millions of people who currently face decades of uninterrupted treatment, drug side effects, and the stigma and cost of a chronic infection. This is fundamental science: testing a mechanistic hypothesis about reservoir reduction. It will not produce a cure tomorrow, but it will determine whether the strategy is worth pursuing at scale.
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Although treatment with antiretroviral therapy (ART) for HIV infection has markedly changed the life expectancy of people living with HIV, ART alone is unable to cure infection. This is because the virus is able to remain 'dormant' or latent for the life time of the infected person in certain cells of the body called the reservoir. It is for this reason that if ART is stopped the virus returns. Researchers have recently identified certain very rare individual cases where it appears that HIV has in fact been to some extent "cured", through either very complicated treatment or very early ART at the time of birth. In this study we will test whether starting ART as soon as an individual has become infected with HIV, followed by an HIV specific vaccination to strengthen the immune responses to HIV and another drug that forces virus out of the latently infected "reservoir" cells, may work in combination to reduce the number of latently infected cells. Research has shown that the fewer cells that contain 'latent viral infection' the better the chance the immune system has to control virus dividing without needing lifelong ART. In the first place this study will test whether the combination of interventions in very recent HIV infection has the ability to make a significant reduction on the size of the viral reservoir; this is called a 'proof of concept' study and if effective may the lead onto further research.
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