Decay of cell-associated HIV-1 DNA correlates with residual replication inpatients treated during acute HIV-1 infection

Objectives: To evaluate the decay rate of cell-associated HIV-1 RNA and DNA and to identify factors associated with residual viral load in patients tr eated at the time of primary HIV-1 infection. Patients: A group of 15 patients adherent to highly active antiretroviral t herapy (HAART) with sustained undetectable HIV-1 viremia for at least 24 mo nths. Methods: Viremia, cell-associated HIV-I RNA and DNA in blood and lymph node mononuclear cells were measured using ultrasensitive assays. Results: Viremia decreased rapidly in all patients; HIV RNA remained < 3 co pies/ml in nine patients and fluctuated between 3 and 50 copies/ml in five patients and between 50 and 200 copies/ml in one patient. Decay rates of ce ll-associated RNA and DNA presented an inflexion point at 1 and 3 months, r espectively: first-phase mean half-lives were 0.15 and 0.84 months, respect ively, and second-phase mean half-lives were 13.7 and 6.6 months, respectiv ely (95% confidence interval 4.4-13.8). The second phase decay rates were m arkedly slower, with a DNA decay rate that was highly associated with the m ean levels of cell-associated RNA measured in blood from 6 to 33 months (P = 0.001) and in lymph nodes collected at 14 months (P = 0.02). Conclusions: The clearance of HIV-1 infected cells is correlated with the e xtent of viral replication as measured by cell-associated RNA levels in bot h blood and lymph nodes. Quantification of cell-associated RNA and DNA furt her defines treatment efficacy in 'aviremic' patients. (C) 2000 Lippincott Williams & Wilkins.