Cell-associated HIV-1-DNA quantitation after highly active antiretroviral therapy-treated primary infection in patients with persistently undetectable plasma HIV-1 RNA
I. Garrigue et al., Cell-associated HIV-1-DNA quantitation after highly active antiretroviral therapy-treated primary infection in patients with persistently undetectable plasma HIV-1 RNA, AIDS, 14(18), 2000, pp. 2851-2855
Objective: To determine the usefulness of cell-associated HIV-1-DNA quantif
ication during the follow-up of highly active antiretroviral therapy (HAART
)-treated primary-infected patients with persistently undetectable plasma R
NA loads.
Patients and methods: In 27 patients given HAART within a median of 24 days
after symptomatic primary HIV infection, plasma and peripheral blood monon
uclear cell (PBMC) HIV-1 RNA were less than 50 copies/ml and less than 50 c
opies/10(6) cells after 18 months of treatment. HIV-1 RNA and DNA were quan
tified every 6 months in PBMC in these 27 patients, 14 of whom accepted exc
ision lymph node biopsy after month 18 for HIV-1-RNA and -DNA quantificatio
n in lymph node mononuclear cells (LNMC).
Results: The median decreases in plasma HIV-1 RNA, PBMC HIV-1 RNA and DNA o
ver the 18 months of follow-up were 3.6 log (P < 0.005) 1.1 log (P < 0.05),
and 1.0 log (P < 0.001), respectively. HIV-1 DNA was detected in 92.3% of
PBMC samples at baseline and at month 18. In LNMC, 100% of samples were det
ectable for HIV-1 DNA.
Conclusion: In this highly selected population of patients with excellent p
lasma virological response under HAART, HIV-1 DNA showed a progressive decr
ease but was still detectable in 92.3% of samples at month 18, whereas all
LNMC samples tested scored positive for HIV-1 DNA. The utility of proviral
HIV-1-DNA monitoring was not clearly demonstrated in this 18-month follow-u
p of HAART-treated primary-infected patients. However, this finding could b
e reconsidered when using other therapeutic strategies such as structured t
reatment interruptions, reinforced treatment or additive immunotherapy. (C)
2000 Lippincott Williams & Wilkins.