title: Evaluation of lymph node virus burden in human immunodeficiency virus-infected patients receiving efavirenz-based protease inhibitor--sparing highly active antiretroviral therapy.
abstract: Although efavirenz-containing regimens effectively suppress plasma levels of human immunodeficiency virus (HIV) RNA, it is now clear that undetectable plasma viremia may not reflect a lack of viral replication. Because lymphoid tissue is an active site of HIV replication, the lymph node virus burden was analyzed in persons who received highly active antiretroviral therapy (HAART) containing either efavirenz or a protease inhibitor (PI). Testing with in situ hybridization revealed no detectable follicular dendritic cell-associated HIV RNA in either group, and only 2 of 8 persons in the efavirenz group and 1 of 4 in the PI group had detectable RNA in lymph node mononuclear cells (LNMC) when tested by use of nucleic acid sequencebased amplification. Low levels of replication-competent HIV were identified in both groups by use of quantitative coculture assays. There was no evidence of development of resistance to either regimen in virus isolated from LNMC. These data support the use of efavirenz as an alternative to a PI in initial HAART regimens.
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD 20892, USA. mdybul@nih.gov
authors.forename: M
authors.initials: M
authors.lastname: Dybul
authors.forename: T W
authors.initials: TW
authors.lastname: Chun
authors.forename: D J
authors.initials: DJ
authors.lastname: Ward
authors.forename: K
authors.initials: K
authors.lastname: Hertogs
authors.forename: B
authors.initials: B
authors.lastname: Larder
authors.forename: C H
authors.initials: CH
authors.lastname: Fox
authors.forename: J M
authors.initials: JM
authors.lastname: Orenstein
authors.forename: B F
authors.initials: BF
authors.lastname: Baird
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: L G
authors.initials: LG
authors.lastname: Green
authors.forename: D
authors.initials: D
authors.lastname: Engel
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.forename: J M
authors.initials: JM
authors.lastname: Mican
authors.forename: A S
authors.initials: AS
authors.lastname: Fauci
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D048588:Benzoxazines; D018920:Coculture Techniques; D003430:Cross-Sectional Studies; D003521:Cyclopropanes; D005838:Genotype; D006678:HIV / Q000235:genetics / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D006801:Humans; D017403:In Situ Hybridization; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology*; D010078:Oxazines / Q000627:therapeutic use*; D011480:Protease Inhibitors / Q000627:therapeutic use; D012367:RNA, Viral / Q000032:analysis; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019562:Viral Load; D014779:Virus Replication
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D010078:Oxazines; D011480:Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz