What Is the State of HIV in Successfully Treated Patients?
The source of the low-level viremia seen in most patients on HAART (4, 14, 15) may be incompletely characterized, but we do have some hints (Table 1). The failure, thus far, of treatment intensification to clear this viremia (16) and the lack of evidence for nucleotide sequence evolution over long periods of treatment (17-19) indicate that this phenomenon may not be driven by ongoing rounds of replication. Patient data reveal that 1 in 106 CD4+ T cells are latently infected with HIV, despite the durable suppression of detectable plasma viremia, although the frequency can be much lower in some patients (20-22). In vivo, it is thought that these cells are intermittently activated by antigen recognition or as bystanders in a local inflammatory process, which leads to the release of progeny virions. Another source of virion production, which does not require ongoing replication, is the episodic production of HIV by long-lived cells. In situ hybridization of lymphoid tissue in simian immuno
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- What Is the State of HIV in Successfully Treated Patients?
