PT - JOURNAL ARTICLE AU - Reeves, Daniel B. AU - Duke, Elizabeth R. AU - Hughes, Sean M. AU - Prlic, Martin AU - Hladik, Florian AU - Schiffer, Joshua T. TI - Anti-proliferative therapy for HIV cure: a compound interest approach AID - 10.1101/063305 DP - 2017 Jan 01 TA - bioRxiv PG - 063305 4099 - http://biorxiv.org/content/early/2017/05/03/063305.short 4100 - http://biorxiv.org/content/early/2017/05/03/063305.full AB - In the era of antiretroviral therapy (ART), HIV-1 infection is no longer tantamount to early death. Yet the benefits of treatment are available only to those who can access, afford, and tolerate taking daily pills. True cure is challenged by HIV latency, the ability of chromosomally integrated virus to persist within memory CD4+ T cells in a non-replicative state and activate when ART is discontinued. Using a mathematical model of HIV dynamics, we demonstrate that treatment strategies offering modest but continual enhancement of reservoir clearance rates result in faster cure than abrupt, one-time reductions in reservoir size. We frame this concept in terms of compounding interest: small changes in interest rate drastically improve returns over time. On ART, latent cell proliferation rates are orders of magnitude larger than activation and new infection rates. Contingent on subtypes of cells that may make up the reservoir and their respective proliferation rates, our model predicts that coupling clinically available, anti-proliferative therapies with ART could result in functional cure within 2-10 years rather than several decades on ART alone.