Persistent immune activation in chronic HIV infection: do any interventions work?

Persistent immune activation (IA) is a hallmark of chronic HIV infection. IA has been associated with poor CD4 T-cell recovery, non-AIDS defining illnesses and mortality during combination antiretroviral therapy (cART). Measures of chronic immune activation, namely T-cell activation and more recently monocyte activation and plasma inflammatory and thrombotic biomarkers, have all been shown to remain elevated despite years of suppressive cART. Here we review recent clinical trials and therapeutic approaches targeted to reduce persistent IA in HIV patients and discuss the impact of each of these approaches on clinically relevant end-points.