AIDSWEEKLY Plus; Monday, March 30, 1998
Daniel J. DeNoon, Senior Editor
The results come from a very small study over the course of only one year. They require verification in studies with larger numbers of patients carried out over longer periods of time.
"These findings argue that HIV replication differs significantly between patients on potent antiretroviral therapy with plasma RNA levels of <20 copies/mL, those with 20 to 400 copies/mL, and those with >400 copies/mL," wrote University of San Diego researchers Huldrych F. Gunthard, Douglas D. Richman, and colleagues.
"These observations ... suggest that a therapeutic goal of plasma RNA levels of <20 copies/mL is important, because low-level replication can occur between 20 and 400 copies/mL and may potentially allow the selection of resistance mutations and subsequently lead to therapeutic failure."
Gunthard et al. reported their findings in the Journal of Virology ("Human Immunodeficiency Virus Replication and Genotypic Resistance in Blood and Lymph Nodes after a Year of Potent Antiretroviral Therapy," J Virol, 1998;72(3):2422-8).
The researchers searched for ongoing viral replication in 10 patients receiving potent antiretroviral therapy - the protease inhibitor indinavir and the nucleoside-analog reverse-transcriptase inhibitors zidovudine (AZT) and lamivudine (3TC) - for up to one year.
No viral replication could be detected in patients whose HIV RNA levels were undetectable on the highly sensitive Amplicor Monitor assay (Roche Diagnostic Systems), which can detect as few as 20 HIV RNA copies/mL.
But patients with HIV RNA levels greater than 20 copies/mL - even those with levels undetectable on less sensitive assays - showed unmistakable evidence of virus replication and the emergence of drug- resistance mutations.
HAART is still too new - and the introduction of the sensitive Roche assay too recent - to determine what proportion of patients receiving HAART are having suboptimal responses to therapy. But the new finding suggests that the percentage of patients failing the new treatments will increase as time goes by.
"These findings argue that HIV replication differs significantly between patients on potent antiretroviral therapy with low but undetectable viral loads and those with undetectable viral loads," Gunthard et al. concluded.
This work was supported by the Swiss National Science Foundation (grant 84AD-046176), by grants K 11 AI01361, AI 38201, AI 27670, AI 38858, and AI 36214 (Center for AIDS Research) and grant AI 29164 from the National Institutes of Health and by the Research Center for AIDS and HIV Infection of the San Diego Veteran Affairs Medical Center.
The corresponding author for this study is Huldrych F. Gunthard, University of California San Diego, Division of Infectious Diseases, Departments of Pathology and Medicine 0679, 9500 Gilman Dr., San Diego, California 92093-0679. Phone: (619) 552-7439. Fax: (619) 552-7445. Email: hgunthar@ucsd.edu.
980330
AW980319
Copyright © 1998 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA.
Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 http://www.newsfile.com
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 1998. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .