Residual human immunodeficiency virus (HIV) type 1 RNA and DNA in lymph nodes and HIV RNA in genital secretions and in cerebrospinal fluid after suppression of viremia for 2 years

Residual viral replication persists in a significant proportion of human im munodeficiency virus (HIV)-infected patients receiving potent antiretrovira l therapy. To determine the source of this virus, levels of HIV RNA and DNA from lymphoid tissues and levels of viral RNA in serum, cerebrospinal flui d (CSF), and genital secretions in 28 patients treated for less than or equ al to2.5 years with indinavir, zidovudine, and lamivudine were examined. Bo th HIV RNA and DNA remained detectable in all lymph nodes. In contrast, HIV RNA was not detected in 20 of 23 genital secretions or in any of 13 CSF sa mples after 2 years of treatment. HIV envelope sequence data from plasma an d lymph nodes from 4 patients demonstrated sequence divergence, which sugge sts varying degrees of residual viral replication in 3 and absence in 1 pat ient. In patients receiving potent antiretroviral therapy, the greatest vir us burden may continue to be in lymphoid tissues rather than in central ner vous system or genitourinary compartments.