Eradication of latent human immunodeficiency virus (HIV) infection is a global health challenge. Reactivation of HIV latency and killing of virus-infected cells, the so-called “kick and kill” or “shock and kill” approaches, are a popular strategy for HIV cure. While antiretroviral therapy (ART) halts HIV replication by targeting multiple steps in the HIV life cycle, including viral entry, integration, replication, and production, it cannot get rid of the occult provirus incorporated into the host-cell genome. These latent proviruses are replication-competent and can rebound in cases of ART interruption or cessation. In general, a very small population of cells harbor provirus, serve as reservoirs in ART-controlled HIV subjects, and are capable of expressing little to no HIV RNA or proteins. Beyond the canonical resting memory CD4+ T cells, HIV reservoirs also exist within tissue macrophages, myeloid cells, brain microglial cells, gut epithelial cells, and hematopoi-etic stem cells (HSCs). Despite a lack of active viral production, latently HIV-infected subjects con-tinue to exhibit aberrant cellular signaling and metabolic dysfunction, leading to minor to major cellular and systemic complications or comorbidities. These include genomic DNA damage; telo-mere attrition; mitochondrial dysfunction; premature aging; and lymphocytic, cardiac, renal, he-patic, or pulmonary dysfunctions. Therefore, the arcane machineries involved in HIV latency and its reversal warrant further studies to identify the cryptic mechanisms of HIV reservoir formation and clearance. In this review, we discuss several molecules and signaling pathways, some of which have dual roles in maintaining or reversing HIV latency and reservoirs, and describe some evolving strategies and possible approaches to eliminate viral reservoirs and, ultimately, cure/eradicate HIV infection.

Human Immunodeficiency Virus (HIV) is a virus that is transmitted through certain bodily fluids and compromises the immune system of its host. Despite the emergence of antiretroviral therapy (ART) converting human immunodeficiency virus type 1 (HIV-1) infection from a fatal disease to a chronic condition, there is still no cure. ART frequently reestablishes peripheral CD4+ T cell counts, but persistent immune dysfunction and inflammation strongly correlate with increased risks of attaining non-AIDS morbidity and mortality. Elimination of this reservoir may occur by the proposed mechanism of combining latency-reversing agents (LRAs) with immune effectors, such as CD8+ T cells (Meås et al., 2020). Here, our study investigates Toll-like receptor 7/8 (TLR 7/8) superagonists that may act as potent, effective latency reversal agents (LRAs). Whether this will prove to be the case needs to be further studied, and potential adverse toxicities must be identified. Whether comparable results will be observed in peripheral blood mononuclear cells (PBMCs) infected with HIV-1 as in our study using PBMCs infected with simian immunodeficiency virus (SIV) remains to be tested. Our results provide further hope for a potential cure for HIV-infected individuals.

The treatment of human immunodeficiency virus (HIV-1) infection faces the challenge of drug resistance. The high mutation rate of HIV-1 allows it to develop resistance against all available drugs. New mechanisms of intervention that do not succumb to failure through resistance are thus being explored. Mutagens that increase the viral mutation rate are a promising class of drugs. They can drive HIV-1 past a critical mutation rate, called the error threshold, and induce a catastrophic loss of genetic information. The treatment duration for a mutagen to drive HIV-1 beyond this error threshold is not yet estimated. We devise a detailed stochastic simulation of HIV-1 infection to estimate this duration. The simulations predict that the required duration is inversely proportional to the difference between the mutation rate induced by a mutagen and the error threshold. This scaling is robust to changes in simulation parameters. Using this scaling, we estimate the required duration of treatment with mutagens to be many years. Unfortunately, all available drugs, including mutagens, fail to clear the infection because HIV-1 establishes a reservoir of latently infected cells harbouring silent HIV-1 integrated genomes. A new \shock and kill" strategy that aims to activate latent cells and render them susceptible to immune killing or viral cytopathicity and thus to eradicate the HIV-1 latent reservoir has been suggested. Several latency reversal agents (LRAs) have been developed. Individual LRAs fail to show any decline in the HIV-1 latent reservoir in clinical trials. Combinations of LRAs have been tested in a few in-vitro and ex-vivo experiments. It has been found that in combination LRAs act synergistically. Finding the drug concentrations that yield the maximum synergy may be helpful in achieving a sterilizing cure. Here, we develop an intracellular model to estimate these drug concentrations. We choose drugs from two different classes of LRAs and show that our model captures quantitatively recent in-vitro experiments of their activity individually and in combination. With this model, we estimate the concentrations of the drugs required to obtain the maximum synergy. Strong CD8+ T cell responses against viruses have been associated with low levels of viremia. Elite controllers of HIV-1, who are known to have low or undetectable viremia, mount a cross-reactive CD8+ T cell response against the pathogen which controls viral mutation-driven escape from immune activity. These cross-reactive responses are against specific epitopes of HIV-1. Our goal was to examine whether such epitopes could be identified systematically so that a cross-reactive immune response could be induced by using these epitopes as immunogens. Immune recognition of an epitope involves two parts: presentation of the epitope, or peptide, by the major histocompatibility complex (MHC) molecules in the host and high a finity binding of the peptide-MHC complex with a T cell receptor (TCR). Immune escape could occur at either of these steps. Here, we examined the first step. We devise the following procedure to identify peptides that sustain HLA binding despite mutations. First, from the full length HIV-1 (HCV) proteome, we identify viral peptides that bind tightly with MHC molecules using the software NetMHCpan2.8. Next, we pick the peptides and their complementary MHC molecules that yield tight binding and mutate the peptides bit by bit to examine whether binding was compromised. We identify several viral peptide-MHC pairs that display tight binding despite all possible single mutations of the peptides both with HIV-1 and HCV. These peptides present candidates which can be tested for their TCR binding and cross-reactive immunogenic potential.

The available antiretroviral compounds can effectively suppress the replication of HIV-1 and block the disease progression. However it is impossible to eradicate the virus from the organism as the HIV-1 integrated in the genome is not affected by the existing anti-HIV-1 drugs. Therefore, new latency reversing agents are being actively developed as part of "shock and kill" therapy to reactivate the provirus and clear the reservoir. Normosang (heme arginate; HA) is a human hemin- containing compound used to treat acute porphyria. Heme is physiologically catabolised by heme oxygenases to form iron (Fe2+ ), carbon monoxide (CO) and biliverdin that is further converted to bilirubin by biliverdin reductase. In this study, we have demonstrated that HA inhibited HIV-1 replication during the acute infection, which was accompanied by the inhibition of reverse transcription. On the other hand, HA synergised with phorbol myristyl acetate (PMA) and reactivated the HIV-1 provirus in ACH-2 cells and the HIV-1 "mini-virus" in Jurkat cell clones A2 and H12. HIV-1 ''mini-virus'' was reactivated also by HA-alone. Further, we have studied the effects of heme degradation products on latent HIV-1 reactivation when added individually. We employed addition of ascorbate to generate Fe2+ , resulting in an increased...

The available antiretroviral compounds can effectively suppress the replication of HIV-1 and block the disease progression. However it is impossible to eradicate the virus from the organism as the HIV-1 integrated in the genome is not affected by the existing anti-HIV-1 drugs. Therefore, new latency reversing agents are being actively developed as part of "shock and kill" therapy to reactivate the provirus and clear the reservoir. Normosang (heme arginate; HA) is a human hemin- containing compound used to treat acute porphyria. Heme is physiologically catabolised by heme oxygenases to form iron (Fe2+ ), carbon monoxide (CO) and biliverdin that is further converted to bilirubin by biliverdin reductase. In this study, we have demonstrated that HA inhibited HIV-1 replication during the acute infection, which was accompanied by the inhibition of reverse transcription. On the other hand, HA synergised with phorbol myristyl acetate (PMA) and reactivated the HIV-1 provirus in ACH-2 cells and the HIV-1 "mini-virus" in Jurkat cell clones A2 and H12. HIV-1 ''mini-virus'' was reactivated also by HA-alone. Further, we have studied the effects of heme degradation products on latent HIV-1 reactivation when added individually. We employed addition of ascorbate to generate Fe2+ , resulting in an increased...

Malgré les améliorations significatives apportées par la thérapie antirétrovirale à la durée et à la qualité de vie des personnes vivant avec le VIH, elle ne permet pas de complètement éliminer le virus de l’organisme. La persistance du virus est due à l’existence de réservoirs viraux, des cellules infectées de manière latente par le VIH. Ces réservoirs nécessitent un traitement antirétroviral à vie, car le virus réapparait en cas d’interruption du traitement, signifiant que l’immunité des cellules T spécifiques du VIH n’est pas restaurée. Bien que cela soit théoriquement possible, seule une fraction de personne vivant avec le VIH, appelée Contrôleurs Élites, parvient à contrôler le virus en absence de traitement. Pour la majorité des individus, l’infection par le VIH entraîne une évasion virologique ainsi qu’un épuisement et une altération des réponses cellulaires spécifiques au VIH. À ce jour, les stratégies thérapeutiques visant à éliminer les réservoirs viraux ont échoué, en partie en raison de la présence de provirus principalement défectifs dans ces réservoirs. Dans cette thèse, nous avons identifié et caractérisé les provirus défectifs latents du VIH pouvant être transcrits et/ou traduits, ainsi que la relation entre ces réservoirs et les réponses immunitaires spécifique du virus. Dans un premier temps, nous avons montré que bien que défectifs et potentiellement incapable de donner lieu à la réplication virale, ces provirus peuvent être transcrits et traduits soit par réactivation à l’aide d’agents de réversion de la latence, soit de manière spontanée. Ces réservoirs donnent lieu à plusieurs populations de réservoirs, en fonction de la présence ou de l’absence certains gènes viraux. Nous avons déterminé que ces différentes populations sont régies par le profil génomique des cellules infectées. Les provirus identifiés étaient très rarement intacts, mais l’intégrité du génome était associée à la processivité de la transcription et de la traduction. Dans un second objectif, nous avons caractérisé les réponses T CD4+ et CD8+ spécifiques du VIH avant et après le début du traitement antirétroviral. Nous avons observé que les réponses T CD4+ spécifiques étaient comparables pendant l’infection chronique et après le traitement. En revanche, les réponses T CD8+ diminuaient considérablement après l’initiation de la thérapie antirétrovirale. Nous avons également constaté que la taille du réservoir traductionnellement actif pendant le traitement antirétroviral était négativement associée aux réponses T CD8+ spécifiques avant le début de la thérapie, tandis que le réservoir incapable de traduire les protéines du VIH subsistait. Ces observations mettent en évidence le rôle des cellules T CD8+ dans le contrôle de l’infection par le VIH, comme nous l’avons observé chez les Contrôleurs Élites. Nos travaux contribuent à une meilleure compréhension des réservoirs viraux du VIH, qui pourraient potentiellement être impliqués dans l’inflammation chronique et la dysfonction immunitaire associé à la pathogénèse du VIH. / Despite the significant improvement brought by antiretroviral therapy in the duration and quality of life for people living with HIV, it does not completely eliminate the virus from the body. The persistence of the virus is due to the existence of viral reservoirs, which are cells latently infected with HIV. These reservoirs require lifelong antiretroviral treatment because of the viral rebound reoccurring in case of treatment interruption. This suggests that HIV-specific T cell immunity is not restored. Although theoretically possible, only a fraction of people living with HIV, known as Elite Controllers, are able to control the virus in the absence of treatment. For the majority of individuals, HIV infection leads to virologic escape, as well as exhaustion and altered cellular responses to HIV. To date, therapeutic strategies aimed at eliminating viral reservoirs have failed, partly due to the presence of predominantly defective proviruses in these reservoirs. In this thesis, we have identified and characterized latent defective proviruses of HIV that can be transcribed and/or translated. We also have characterized the relationship between these reservoirs and the specific immune responses to the virus. Firstly, we have shown that although defective and potentially replication-incompetent, these proviruses can be transcribed and translated either through reactivation using latency reversal agents or spontaneously. These reservoirs give rise to several populations of reservoirs, depending on the presence or absence of certain viral genes. We have determined that these different populations are governed by the genomic profile of infected cells. The identified proviruses were rarely intact, and genome integrity was associated with the processivity of transcription and translation. Then, we characterized the specific CD4+ and CD8+ T cell responses to HIV before and after the initiation of antiretroviral treatment. We observed that specific CD4+ T cell responses were comparable during chronic infection and after treatment. However, CD8+ T cell responses decreased significantly after the initiation of antiretroviral therapy. We also found that the size of the translationally active reservoir during antiretroviral treatment was negatively associated with the specific CD8+ T cell responses prior to treatment initiation, while the translation-incompetent cells persisted. These observations highlight the role of CD8+ T cells in the control of HIV infection, as observed in Elite Controllers. Our work contributes to a better understanding of HIV viral reservoirs, which could potentially be involved in chronic inflammation and immune dysfunction associated with HIV pathogenesis.