“Kick and Kill” HIV Cure Study Fails to Reduce Viral Load

In the first randomized controlled trial to evaluate a ‘’kick-and-kill’’ approach in patients with primary HIV infection, presented at AIDS 2018, there was no impact on measures of the HIV reservoir.

Antiretroviral therapy (ART) alone is unable to cure HIV because of an inaccessible pool of latently infected cells called the HIV reservoir. In this “kick-and-kill” approach, one agent is used to activate the latent virus (the “kick”) while an HIV-specific vaccine boosts the immune system’s response (the “kill”). 

In the RIVER study, researchers investigated the impact of HIV-specific T-cell vaccines and a latency-reversing agent (vorinostat) on the HIV reservoir. A total of 60 people living with HIV in the United Kingdom who started ART within 4 weeks of diagnosis and had viral suppression were randomized to receive ART alone or ART plus vorinostat and vaccination with ChAdV63.HIVconsv prime < 1 week post-randomization and a MVA.HIVconsv boost 8 weeks later.

While the researchers observed robust vaccine-induced immune responses and vorinostat activity, there was no difference between the arms in viral reservoir levels, as measured by HIV-DNA copies per million CD4⁺ T cells.

Further analysis is underway to understand why this regimen failed and to identify the mechanisms involved, the researchers noted.—Kara Rosania