Current views on interferon therapy for HIV

ABSTRACT

Introduction: Knowledge of IFN-antiviral activity against HIV infection dates from the first years of the AIDS epidemic. Recombinant IFN had an inhibitory effect on HIV and was not toxic to peripheral blood mononuclear cells (PBMC), and this finding was the basis for the design of clinical trials that evaluated the potential role of IFN-alpha as an inhibitor of HIV replication.

Areas covered: This review summarizes the history of IFN-alpha in the treatment of HIV infection with reviews of studies performed in different clinical settings; in the pre-highly active antiretroviral therapy (HAART) era, as part of a structured treatment interruption (STI) strategy, in acute HIV infection, as part of salvage therapy, and eliminating the HIV reservoir.

Expert opinion: The role of IFN-alpha has been dismissed in the area of HIV therapy. For this reason, with the advent of HAART, which substantially reduced mortality and the appearance of AIDS, IFN-alpha ceased to be used as an antiretroviral agent in different strategies. In contrast, because of the promising results achieved with IFN-alpha therapy in eliminating the HIV viral reservoir, this may constitute the main research field for IFN-alpha in the HIV setting.

KEYWORDS:

• HIV
• interferon-alpha
• Pegylated interferon
• HIV reservoir
• viral persistence

Article highlights

• There is evidence in favour of treating HIV infection during different phases of infection with IFN-alpha

• Pre-HAART era: the use of IFN-alpha delays, but does not completely reduce the development of AIDS or HIV-associated malignancies.

• Structured treatment interruption (STI): Peg-IFN shows partial control of viral rebound, delaying the resumption of viral replication during the STI.

• Acute HIV infection: The benefit of using Peg-IFN during acute HIV infection is uncertain, since it could lead to an increased viral reservoir

• Salvage therapy in the HAART era: Adding Peg-IFN to HAART therapy in patients with multiple class resistance resulted in control of HIV viremia. However, there are few studies evaluating this aspect.

• HIV-1 Reservoir: Studies suggest that long-term interferon-α therapy could reduce the size of the HIV reservoir; this may be useful in a kick & kill eradication strategy.

This box summarizes key points contained in the article.

Declaration of interest

Dr. Rivero-Juarez and Dr. Frias are supported by the Instituto Maimonides de Investigación Biomédica (IMIBIC). Dr. Rivero is supported by the Hospital Universitario Reina Sofía de Córdoba, part of the Sistema Andaluz de Salud (SAS). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.