ART suppresses plasma HIV-1 RNA to a stable set point predicted by pretherapy viremia.
Current antiretroviral therapy is effective in suppressing but not eliminating HIV-1 infection. Understanding the source of viral persistence is essential for developing strategies to eradicate HIV-1 infection. We therefore investigated the level of plasma HIV-1 RNA in patients with viremia suppressed to less than 50-75 copies/ml on standard protease inhibitor- or non-nucleoside reverse transcriptase inhibitor-containing antiretroviral therapy using a new, real-time PCR-based assay for HIV-1 RNA with a limit of detection of one copy of HIV-1 RNA. Single copy assay results revealed that >80% of patients on initial antiretroviral therapy for 60 wk had persistent viremia of one copy/ml or more with an overall median of 3.1 copies/ml. The level of viremia correlated with pretherapy plasma HIV-1 RNA but not with the specific treatment regimen. Longitudinal studies revealed no significant decline in the level of viremia between 60 and 110 wk of suppressive antiretroviral therapy. These data suggest that the persistent viremia on current antiretroviral therapy is derived, at least in part, from long-lived cells that are infected prior to initiation of therapy.
Maldarelli
Frank
F
HIV Drug Resistance Program, National Cancer Institute, Frederick, Maryland, United States of America. fmalli@mail.nih.gov
Palmer
Sarah
S
King
Martin S
MS
Wiegand
Ann
A
Polis
Michael A
MA
Mican
JoAnn
J
Kovacs
Joseph A
JA
Davey
Richard T
RT
Rock-Kress
Diane
D
Dewar
Robin
R
Liu
Shuying
S
Metcalf
Julia A
JA
Rehm
Catherine
C
Brun
Scott C
SC
Hanna
George J
GJ
Kempf
Dale J
DJ
Coffin
John M
JM
Mellors
John W
JW
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008137:Longitudinal Studies; D012367:RNA, Viral / Q000097:blood*; D015203:Reproducibility of Results; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D018119:Stavudine / Q000627:therapeutic use; D014766:Viremia / Q000821:virology*; D014779:Virus Replication / Q000187:drug effects
D019380:Anti-HIV Agents; D012367:RNA, Viral; D019259:Lamivudine; D018119:Stavudine