AIDSWEEKLY Plus, Monday, 10 February 1997
Daniel J. DeNoon, Senior Editor

After aggressive antiretroviral therapy, a low level of HIV in the plasma is a bad sign.

It means that the virus may be going wild in the lymph nodes, according to a study by University of California, San Diego researcher J.K. Wong and colleagues.

"Presence of HIV RNA in the plasma, even at low levels after initial therapeutic response, is associated with significant viral replication in the lymph nodes while complete sustained suppression is associated with significant viral replication in the lymph nodes while complete sustained suppression in plasma correlates with a greater than 3.5 log[10] lower virus RNA level in lymphoid tissues," they wrote in their research abstract for the 4th Conference on Retroviruses and Opportunistic Infections, held January 22-26 in Washington, D.C.

Wong et al. obtained lymph-node biopsies from nine patients who were treated for 36 to 52 weeks with the protease inhibitor indinavir (IDV, Merck) plus zidovudine (AZT, Glaxo) plus lamivudine (3TC, Glaxo); IDV alone; or AZT plus 3TC.

Two of the five patients who received IDV/AZT/3TC had sustained suppression of HIV, as defined by undetectable levels (fewer than 20 copies/ml) of HIV RNA in the plasma and negative PBMC and lymph-node cultures.

Both of these individuals had low levels (50 to 100 copies) of HIV RNA in their lymph nodes.

Another of the subjects receiving IDV/AZT/3TC and one subject receiving IDV alone had very low plasma HIV RNA levels: 120 to 720 copies/ml. These individuals had only 150 to 220 copies/ml HIV RNA in their lymph nodes and were culture negative.

The two other patients receiving IDV/AZT/3TC, however, had relatively high levels of lymph-node HIV RNA (40,000 to 230,000 copies/ml) even though they had only low levels of HIV RNA in their plasma (2000 to 8000 copies/ml). PBMC and lymph node cultures from these patients were positive for HIV.

"These two subjects had multiple medication interruptions and HIV carrying IDV and 3TC resistance mutations had emerged," Wong et al. reported.

All of the patients receiving AZT/3TC without a protease inhibitor were culture positive with 3TC-resistant mutants. They had high levels of HIV RNA in their plasma (19,000 to 58,000 copies/ml) and lymph nodes (3600 to 230,000 copies/ml). - by Daniel J. DeNoon, Senior Editor

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