Residual low-level viral replication could explain discrepancies between viral load and CD4+ cell response in human immunodeficiency virus-infected patients receiving antiretroviral therapy.
We report the evolution of chronic infection with human immunodeficiency virus type 1 (HIV-1) in a patient treated with stavudine plus didanosine, whose CD4+ lymphocyte count progressively decreased, despite a sustained plasma viral load <20 copies/mL. After 12 months of therapy, treatment was switched to zidovudine plus lamivudine plus nelfinavir. CD4+ T cell count decreased from 559 x 10(6)/L at month 0 to 259 x 10(6)/L at month 12. Plasma viral load decreased from 21,665 HIV-1 RNA copies/mL at baseline (month 0) to <20 copies/mL after 1 month of therapy with stavudine plus didanosine, and remained below 20 copies/mL until month 12, but always >5 copies/mL. Viral load in tonsilar tissue at month 12 was 125,000 copies/mg of tissue. After the change to triple-drug therapy, the plasma viral load decreased to 5 copies/mL, the CD4+ T cell count increased to 705 x 10(6)/L, and the viral load in tonsilar tissue decreased to <40 copies/mg of tissue at month 24. A low level of HIV-1 replication could explain the lack of immunologic response in patients with apparent virological response.
García
F
F
Infectious Diseases Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain. fgarcia@medicina.ub.es
Vidal
C
C
Plana
M
M
Cruceta
A
A
Gallart
M T
MT
Pumarola
T
T
Miro
J M
JM
Gatell
J M
JM
D000234:Adenoids / Q000473:pathology / Q000821:virology*; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001707:Biopsy, Needle; D018791:CD4 Lymphocyte Count / Q000187:drug effects; D016516:CD4-CD8 Ratio / Q000187:drug effects; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005434:Flow Cytometry; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D008991:Monitoring, Physiologic; D016176:T-Lymphocyte Subsets / Q000187:drug effects*; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents