Challenges and Solutions for The Incomplete Immune Restoration in HIV-infected Patients Under Antiretroviral Therapy

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About this Research Topic

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Background

The morbidity and mortality of HIV-related diseases were dramatically diminished by the introduction of highly active antiretroviral therapy (ART), which induces persistent suppression of HIV replication and gradual recovery of CD4+ T cells. However, approximately 10% to 40% of HIV-1-infected individuals fail to achieve normalization of CD4+ T cells despite persistent virological suppression. These patients are called immune non-responders (INRs) and show severe immune dysfunction. In fact, INRs clinically progress to an increased risk of AIDS and non-AIDS events and have a higher mortality rate than HIV-1-infected patients with complete immune restoration. So far, the underlying mechanism of incomplete immune restoration in HIV-1-infected patients has not been fully elucidated. In view of this limitation, it is of great practical significance to deeply understand the immune restoration mechanism and design an effective individualized treatment strategy. Therefore, the investigation of the challenges and solutions of incomplete immune restoration in HIV-infected patients under ART will highlight the mechanisms and risk factors of incomplete immune restoration and intervention strategies.

Despite the extensive studies carried out to better understand the mechanism of incomplete immune restoration in HIV-infected patients under ART, there are still numerous questions that need to be addressed. Gaps still exist in many facets including decreased hematopoiesis of bone marrow, insufficient thymic output, residual viral replication, aberrant immune activation, host metabolic factors, microbial translocation or intestinal flora imbalance, and specific genetic or metabolic characteristics. However, none of the above-mentioned independent factors can fully explain the mechanism of incomplete immune restoration. Therefore, it calls for more studies to dissect the interaction between viral infection and host immune response, thus improving our understanding of the mechanisms involved. This knowledge is essential for the further development of new treatment strategies to improve immune restoration in HIV-1-infected patients.

Submissions are welcome for the following article types: Original Research, Brief Research Report, Reviews, Mini-Reviews, Systematic Reviews, Perspective, Opinion, and Hypothesis. Please note that abstract submission is not mandatory, and you can submit your manuscript to the topic even without submitting an abstract. We particularly welcome contributions that include, but are not limited to, the following topics:

• Host genetic factors associated with incomplete immune restoration;

• Viral factors associated with incomplete immune restoration;

• Immune dysfunction associated with incomplete immune restoration;

• Microbial translocation and intestinal flora imbalance;

• Different antiretroviral drugs and immune restoration;

• Therapeutic vaccination and immune restoration;

• Effects of long-term ART initiated during acute HIV-1 infection on reservoir size;

• Discovery of novel intervention measures for poor/incomplete immune restoration;

• Other important topics such as HIV-associated cancers and related diseases with immune restoration.

Keywords: HIV-1 infection; Immunological non-responders; Immune restoration/reconstitution; Antiretroviral therapy; CD4+ T cells

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