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Lewis K. Schrager, MD; M. Patricia D'Souza, PhD

JAMA. 1998;280:67-71.

The eradication of human immunodeficiency virus 1 (HIV-1) from infected persons is the ultimate goal of HIV therapeutic interventions. Great strides have been made in developing potent antiretroviral regimens that greatly suppress HIV-1 replication. Despite these therapeutic advances, major obstacles remain to eradicating HIV-1. Reservoirs of HIV-1 have been identified that represent major impediments to eradication. Conceptually, there are 2 types of sanctuaries for HIV-1, cellular and anatomical. Cellular sanctuaries may include latent CD4⁺ T cells containing integrated HIV-1 provirus; macrophages, which may express HIV-1 for prolonged periods; and follicular dendritic cells, which may hold infectious HIV-1 on their surfaces for indeterminate lengths of time. The key anatomical reservoir for HIV-1 appears to be the central nervous system. An understanding of the nature of HIV within these reservoirs is critical to devising strategies to hasten viral eradication.

From the Epidemiology Branch (Dr Schrager) and the Pathogenesis and Basic Research Branch (Dr D'Souza), Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Md.

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