title: Residual viraemia in subjects with chronic HIV infection and viral load < 50 copies/ml: the impact of highly active antiretroviral therapy.
abstract: OBJECTIVE
  To determine factors associated with < 2.5 copies/ml plasma HIV RNA in subjects treated with highly active antiretroviral therapy (HAART) and with viraemia < 50 copies/ml.
  
  
  METHODS
  Cross-sectional analysis of 84 HIV-positive patients taking HAART with plasma HIV RNA < 50 copies/ml for at least 6 months and no history of virological failure.
  
  
  METHODS
  Current HAART therapy was based on a non-nucleoside reverse transcriptase inhibitor (NNRTI) in 66%, a protease inhibitor in 26% and nucleoside reverse transcriptase inhibitors in 7%. Viraemia levels were measured using a modified ultrasensitive Roche Amplicor HIV-1 Monitor test able to quantify plasma HIV RNA to a lower limit of 2.5 copies /ml; proviral DNA was measured with a real-time polymerase chain reaction assay. Analysis of variance and multiple logistic regression analysis were utilized to test for associations between residual replication and other variables.
  
  
  RESULTS
  Residual HIV viraemia > 2.5 copies/ml was found in 50% of subjects; 94% of subjects had detectable proviral DNA (>or= 20 copies/10(6) peripheral blood mononuclear cells) and 21% had archived mutations. Usage of a NNRTI-based HAART was the only independent predictor of viral suppression below the cut-off value of the modified ultrasensitive assay.
  
  
  CONCLUSIONS
  In our population, NNRTI-based HAART seems to have a stronger impact on residual replication than protease inhibitor-based HAART. This finding may be considered in therapeutic decisions such as the choice of initial HAART regimen and the interruption or simplification of treatment.
authors.affiliation: Istituto Superiore di Sanità, Department of Drug Research and Evaluation, Rome, Italy. palmisan@iss.it
authors.forename: Lucia
authors.initials: L
authors.lastname: Palmisano
authors.forename: Marina
authors.initials: M
authors.lastname: Giuliano
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.forename: Maria Franca
authors.initials: MF
authors.lastname: Pirillo
authors.forename: Mauro
authors.initials: M
authors.lastname: Andreotti
authors.forename: Clementina M
authors.initials: CM
authors.lastname: Galluzzo
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bucciardini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fragola
authors.forename: Massimo
authors.initials: M
authors.lastname: Andreoni
authors.forename: Stefano
authors.initials: S
authors.lastname: Vella
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics / Q000821:virology; D015497:HIV-1; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000821:virology; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D012367:RNA, Viral / Q000032:analysis; D012044:Regression Analysis; D019562:Viral Load; D014766:Viremia / Q000097:blood / Q000821:virology*
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral