Journal Article

ART Suppresses Plasma HIV-1 RNA to a Stable Set Point Predicted by Pretherapy Viremia

Maldarelli, Frank, Brun, Scott C, Wiegand, Ann, Kovacs, Joseph A, Coffin, John M, King, Martin S, Dewar, Robin, Palmer, Sarah, Mellors, John W, Kempf, Dale J, Mican, JoAnn, Polis, Michael A, Rock-Kress, Diane, Liu, Shuying, Hanna, George J, Metcalf, Julia A, Rehm, Catherine, Davey, Richard T

2007

Overview

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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Anti-HIV Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiviral agents / Clinical trials / Cohort Studies / Dosage and administration / Double-Blind Method / Drug therapy / Drug Therapy, Combination / Genetic aspects / HIV / HIV infection / HIV Infections - virology / HIV-1 - genetics / Human immunodeficiency virus / Human immunodeficiency virus 1 / Humans / Infectious Diseases / Lamivudine - therapeutic use / Longitudinal Studies / Plasma / Proteinase inhibitors / Reproducibility of Results / Reverse Transcriptase Polymerase Chain Reaction - methods / RNA, Viral - blood / Sensitivity and Specificity / Stavudine - therapeutic use / Viremia - virology / Virology / Virus Replication - drug effects / Viruses