Immune checkpoint inhibitors in HIV infection: current evidence on viral reservoir regulation and immune restoration.

Immune checkpoint inhibitors (ICIs), particularly those targeting the programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) axis, have emerged as potential tools beyond cancer immunotherapy in people with HIV (PWH). In the setting of effective antiretroviral therapy (ART), chronic inflammation, T-cell exhaustion, and persistent viral reservoirs remain major obstacles to durable HIV remission or cure. Accumulating evidence suggests that ICIs may modulate these processes by reversing latency, enhancing HIV-specific immune responses, and contributing to reservoir regulation and immune restoration. In this review, we summarize current evidence on the role of ICIs in HIV infection, with a focus on reservoir regulation and immune restoration. We discuss the biological rationale for checkpoint blockade in chronic HIV infection and review available data from preclinical models, clinical studies in PWH with cancer, exploratory trials in non-cancer populations, and combination cure strategies. We also address recent findings on proviral landscape changes and key safety considerations. Overall, ICIs represent a promising but still limited component of HIV cure-oriented strategies. Their effects on reservoir dynamics and immune restoration remain heterogeneous, and further progress will require safer dosing approaches, biomarker-guided patient selection, standardized reservoir assessment, and well-designed clinical trials.