Medicinal Plant and Traditional Knowledge-guided Strategies to Combat HIV Persistence.

Purpose Of Review:  Combination antiretroviral therapy (cART) does not act on latent HIV reservoirs, and no latency-reversing agent (LRA) to date consistently reduces viral reservoirs in humans. In Sub-Saharan Africa and elsewhere, complementary and alternative medicines (CAM) are traditionally used to manage HIV/AIDS, including a subset with LRA properties.

Recent Findings: Several plants from the Euphorbiaceae and Thymelaeaceae families have been recently documented for traditional HIV/AIDS management and contain LRAs that function through protein kinase C activation.

An ethnopharmacological survey of medicinal plants traditionally used by the BaKalanga people of the Tutume subdistrict in Central Botswana to manage HIV/AIDS, HIV-associated conditions, and other health conditions.

Ethnopharmacological Relevance: While access to antiretroviral therapy (ART) continues to improve worldwide, HIV infection and AIDS persist as serious health challenges, particularly in sub-Saharan Africa. Complementary and Alternative Medicines (CAM), as part of indigenous and pluralistic medical systems, are important contributors to primary health care worldwide. However, this knowledge remains relatively undocumented in many parts of sub-Saharan Africa such as the Tutume subdistrict of Central Botswana, where CAM is widely used including potentially for HIV/AIDS and HIV-associated conditions.

The African natural product knipholone anthrone and its analogue anthralin (dithranol) enhance HIV-1 latency reversal.

A sterilizing or functional cure for HIV is currently precluded by resting CD4 T cells that harbor latent but replication-competent provirus. The "shock-and-kill" pharmacological ap-proach aims to reactivate provirus expression in the presence of antiretroviral therapy and target virus-expressing cells for elimination. However, no latency reversal agent (LRA) to date effectively clears viral reservoirs in humans, suggesting a need for new LRAs and LRA combinations.

Novel Histone Deacetylase Inhibitors and HIV-1 Latency-Reversing Agents Identified by Large-Scale Virtual Screening.

Current antiretroviral therapies used for HIV management do not target latent viral reservoirs in humans. The experimental "shock-and-kill" therapeutic approach involves use of latency-reversal agents (LRAs) that reactivate HIV expression in reservoir-containing cells, followed by infected cell elimination through viral or host immune cytopathic effects. Several LRAs that function as histone deacetylase (HDAC) inhibitors are reported to reverse HIV latency in cells and in clinical trials; however, none to date have consistently reduced viral reservoirs in humans, prompting a need to identify new LRAs.

Identification of Novel HIV-1 Latency-Reversing Agents from a Library of Marine Natural Products.

Natural products originating from marine and plant materials are a rich source of chemical diversity and unique antimicrobials. Using an established model of HIV-1 latency, we screened 257 pure compounds from a marine natural product library and identified 4 (psammaplin A, aplysiatoxin, debromoaplysiatoxin, and previously-described alotaketal C) that induced expression of latent HIV-1 provirus in both cell line and primary cell models. Notably, aplysiatoxin induced similar levels of HIV-1 expression as prostratin but at up to 900-fold lower concentrations and without substantial effects on cell viability.