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Combination antiretroviral therapy can lower plasma viral load to undetectable levels, but infectious HIV-1 persists latently within resting memory CD4 lymphocytes. This latent reservoir decays slowly, in part because of incomplete viral suppression by current treatment regimens. We have previously shown that the decay rate of the latent reservoir on therapy is inversely correlated with the degree of the residual HIV-1 replication. Recently, we have extended this observation by demonstrating that treatment intensification could indeed decrease residual viral replication and increase the decay of the latent reservoir. In addition, we have initiated a study to examine whether a new 4-drug combination (lopinavir/ritonavir, efavirenz, tenofovir, and lamivudine) might be more potent than commonly used regimens by comparing the initial decay rate of plasma viremia after starting therapy. Frequent measurements showed that the first phase of viral decline in the new study was significantly faster than that seen with current drug regimens. Previous viral dynamics studies have shown that this initial phase of viral decay is a reflection of the product of two parameters: lifespan of the productively infected CD4 lymphocytes and potency of the antiviral regimen. Thus, assuming that the lifespan of infected cells is the same in comparable groups of patients, the relative potency of the regimens could be determined based on the slopes of the initial viral decline. Our results indicate that antiretroviral regimens in common use today may be significantly less potent (~20%) than the new drug combination. The magnitude of residual HIV-1 replication on standard antiretroviral therapy is substantial. This finding, therefore, impacts the interpretation of results on the persistence of viral reservoirs.
Authors
Aaron Diamond AIDS Res. Ctr., The Rockefeller Univ., New York, NY
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