In summary, HDACis present an exciting new approach to activate
HIV production from latently infected cells to potentially enhance
elimination of these cells and achieve a cure. Multiple HDACis can
potently activate viral production in vitro, but evidence of activity of
HDACis in vivo is lacking and results of initial clinical trials of
vorinostat in HIV-infected patients on suppressive cART are eagerly
awaited. Although the exact dosing schedule of HDACi required for
elimination of latently infected cells remains unknown, careful consideration
of both short-and long-term toxicities as well as activity of
these drugs in the central nervous system as well as in non-T-cell
reservoirs are key issues in further developing this class of compounds
for use in HIV. Finally, it is likely that, as in cancer, HDACis will form
part of a multi-pronged strategy that will be required to eliminate
latently infected cells to achieve the ultimate goal of a functional or
sterilizing cure for HIV.