HIV-1-infected antiretroviral-treated patients with prolonged partial viral suppression: clinical, virologic, and immunologic course.
The long-term feasibility of a drug conservation strategy that allows low-level viral replication is unknown. We performed a retrospective study of treated HIV-infected patients with stable detectable viral replication (<10000 copies/mL [low-level viremia]) and compared their clinical, virologic and immunologic courses with those of treated patients with undetectable viremia and viremia (>or=10000 copies/mL [high-level viremia]). Viral reverse transcriptase and protease genotype and HIV-specific CD4 T-cell responses were determined using patient-derived samples. Clinical and immunologic benefits were maintained in patients with partial virologic suppression (<or=10000 copies/mL). Although low-level viral replication under drug pressure led to the accumulation of resistance mutations in most subjects' viruses, most subjects retained susceptibility to drugs in >or=2 classes of antiretroviral medications. HIV-specific CD4+ T-cell immunity was detected in most subjects with low-level and undetectable viremia and may have a role in controlling viremia in the setting of partial suppression.
Tenorio
Allan R
AR
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. allan_s_tenorio@rush.edu
Smith
Kimberly Y
KY
Kuritzkes
Daniel R
DR
Sha
Beverly E
BE
Donoval
Betty
B
Young
Russell
R
Jennings
Cheryl
C
Bremer
James
J
Shott
Susan
S
Landay
Alan
A
Kessler
Harold A
HA
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008297:Male; D009154:Mutation; D012367:RNA, Viral / Q000097:blood / Q000302:isolation & purification; D012189:Retrospective Studies; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects*
D019380:Anti-HIV Agents; D012367:RNA, Viral