title: Lymphoid tissue viral burden and duration of viral suppression in plasma.
abstract: OBJECTIVE
  To assess virological response in lymphoid tissue and its impact on the durability of response in plasma in HIV-1-infected persons who achieved sustained suppression of plasma viraemia with different antiretroviral regimens.
  
  
  METHODS
  Consecutive patients on first-line antiretroviral therapy were included if they had a plasma HIV-1 RNA viraemia < 20 copies/ml within the last 6 months and tonsillar tissue accessible for biopsy. First-line therapy contained two nucleoside analogues: alone (2NRTI group, n = 3); plus a HIV-1 protease inhibitor (PI group, n = 11) or plus nevirapine (NVP group; n = 16). Patients were followed until virus was detectable in plasma, they changed therapy or were lost to follow-up.
  
  
  RESULTS
  Tonsillar HIV-1 RNA could be detected (> 100 copies/mg) in 10 patients: one in the PI group (9%), six (38%) in the NVP group and in all three patients in the 2NRTI group. Primary resistance mutations could be detected in only 2 of these 10 patients. After a median of 9 months after the biopsies, viral suppression in plasma had failed in 6 of these 10 patients whereas failure had only occurred in 1 out of 20 with initially undetectable viral load in lymphoid tissue (P = 0.01; log rank test).
  
  
  CONCLUSIONS
  In patients with sustained viral suppression in plasma, triple therapy including a HIV-1 protease inhibitor was more potent than triple therapy containing nevirapine or dual therapy with nucleoside analogues to reduce viral burden in lymphoid tissue. A worse response in lymphoid tissue could not be explained by local selection of resistance and was associated with a less durable virological response in plasma.
authors.affiliation: Unit of Infectious Diseases, Clinical Institute of Infectious Diseases and Immunology IDIBAPS-Hospital Clínic Universitari, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Martínez
authors.forename: M
authors.initials: M
authors.lastname: Arnedo
authors.forename: V
authors.initials: V
authors.lastname: Giner
authors.forename: C
authors.initials: C
authors.lastname: Gil
authors.forename: M
authors.initials: M
authors.lastname: Caballero
authors.forename: L
authors.initials: L
authors.lastname: Alós
authors.forename: F
authors.initials: F
authors.lastname: García
authors.forename: C
authors.initials: C
authors.lastname: Holtzer
authors.forename: J
authors.initials: J
authors.lastname: Mallolas
authors.forename: J M
authors.initials: JM
authors.lastname: Miró
authors.forename: T
authors.initials: T
authors.lastname: Pumarola
authors.forename: J M
authors.initials: JM
authors.lastname: Gatell
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000821:virology*; D012367:RNA, Viral / Q000097:blood*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019562:Viral Load; D014766:Viremia / Q000821:virology
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors