Early intervention, lasting impact: benefits of early antiretroviral therapy and implications for posttreatment control

Purpose of review Over the past few years, it has become increasingly clear that starting antiretroviral therapy (ART) during acute HIV infection (AHI) leads to a faster viral reservoir decay and partial preservation of the immune system. Here, we review the benefits of treating AHI for the reservoir composition and the adaptive immune function, as well as implications for HIV cure studies. Recent findings AHI is most commonly defined as the first 6 months following infection. During this early infection stage of infection, HIV viremia reaches its peak, concurrently with the development of the HIV-specific immune response. Early ART limits the size of the viral reservoir, and a smaller reservoir is associated with of longer time to viral rebound posttreatment interruption and, in some cases, posttreatment control (PTC). Moreover, initiating ART during AHI partially preserves the function of T and B cells, leading to improved control of the viral reservoir, and potentially creating windows for HIV cure strategies. Summary Recent cure studies show that both CD8 + T-cell and antibody responses provide important clues for predicting PTC, as individuals with robust, functional immune profiles are more likely to maintain viral suppression after stopping ART. However, while early ART initiation lowers the viral reservoir and preserves immune function, these factors alone are not sufficient for PTC, highlighting the need for a comprehensive molecular profile that integrates viral and host biomarkers to reliably predict PTC.