dReplication-competent human immunodeficiency virus (HIV) persists in infected people despite suppressive combination antiretroviral therapy (cART), and it represents a major obstacle to HIV functional cure or eradication. We have developed a model of cART-mediated viral suppression in simian human immunodeficiency virus (SIV) mac239-infected Indian rhesus macaques and evaluated the impact of the histone deacetylase inhibitor (HDACi) romidepsin (RMD) on viremia in vivo. Eight macaques virologically suppressed to clinically relevant levels (<30 viral RNA copies/ml of plasma), using a three-class five-drug cART regimen, received multiple intravenous infusions of either RMD (n ؍ 5) or saline (n ؍ 3) starting 31 to 54 weeks after cART initiation. In vivo RMD treatment resulted in significant transient increases in acetylated histone levels in CD4 ؉ T cells. RMD-treated animals demonstrated plasma viral load measurements for each 2-week treatment cycle that were significantly higher than those in saline control-treated animals during periods of treatment, suggestive of RMD-induced viral reactivation. However, plasma virus rebound was indistinguishable between RMD-treated and control-treated animals for a subset of animals released from cART. These findings suggest that HDACi drugs, such as RMD, can reactivate residual virus in the presence of suppressive antiviral therapy and may be a valuable component of a comprehensive HIV functional cure/eradication strategy.A lthough combination antiretroviral therapy (cART) can suppress viral replication in human immunodeficiency virus type 1 (HIV-1)-infected patients to levels below the limits of quantification for standard clinical assays, recrudescent virus emerges upon treatment interruption in virtually all patients who initiate therapy during the chronic phase of infection, even after many years of treatment and virologic suppression (1, 2). A long-lived residual virus pool persists despite apparently effective treatment (3-7). For this reason, current cART does not represent a definitive treatment for HIV infection, and lifelong treatment is required in the vast majority of infected patients. Despite the fact that cART can substantially improve the life expectancy of HIV-1-infected individuals, there are concerns about the development of viral drug resistance and drug-related toxicities in patients with such long-term treatment. In addition, the financial burden of lifelong cART is considerable (8), and recent studies have indicated that well-suppressed patients still have elevated levels of immune activation with increased non-AIDS morbidities and reduced life expectancies compared with those of uninfected people (9-21). These considerations have motivated a substantial scientific research effort to identify treatments that will result in either the eradication of residual virus or in the durable control of viral replication in the absence of cART.A number of different potential in vivo sources of replicationcompetent virus that can reemerge upon treatment cessation...