Early Treatment and HIV-1 Reservoirs: A Stitch in Time?

Several recent high-profile studies have highlighted the potential impact of antiretroviral therapy (ART) initiation during acute human immunodeficiency virus type 1 (HIV-1) infection on viral reservoirs and persistence. Exciting observations presented at this year’s “Conference on Retroviruses and Opportunistic Infections” [1] on a child in Mississippi that started ART within hours of birth to an infected mother suggested that immediate treatment prevented HIV-1 from establishing a foothold in the infant, leading to lack of viral rebound after ART cessation. Two additional studies suggested that initiating early ART in adults with acute HIV-1 infection might limit seeding of key viral reservoirs, including those found in specific types of memory CD4 T cells [2–4]. Although the long-term significance of the observations in these provocative reports is not yet known, they have invigorated the field of HIV-1 curative strategies and persistence research. In this issue of The Journal of Infectious Diseases, 2 articles add to the growing discussion regarding the impact of early ART on reservoir size and T-cell activation, and help elucidate the composition of the HIV-1 reservoir in CD4 T-cell subsets in blood and gastrointestinal tissue.