Genotypic analysis of HIV-1 drug resistance at the limit of detection: virus production without evolution in treated adults with undetectable HIV loads

TL Kieffer, MM Finucane, RE Nettles… - The Journal of …, 2004 - academic.oup.com
TL Kieffer, MM Finucane, RE Nettles, TC Quinn, KW Broman, SC Ray, D Persaud
The Journal of infectious diseases, 2004academic.oup.com
Human immunodeficiency virus (HIV) production continues in patients receiving highly
active antiretroviral therapy (HAART) with undetectable (< 50 copies/mL) virus loads. Our
initial cross-sectional study showed that this viremia is composed of viruses that lack new
resistance mutations to the HAART regimen. Here we describe a longitudinal, clonal
genotypic analysis of plasma virus loads in treated adults who had undetectable virus loads.
We document a continuous production of virus in 8 HIV-1-infected adults who maintained …
Abstract
Human immunodeficiency virus (HIV) production continues in patients receiving highly active antiretroviral therapy (HAART) with undetectable (<50 copies/mL) virus loads. Our initial cross-sectional study showed that this viremia is composed of viruses that lack new resistance mutations to the HAART regimen. Here we describe a longitudinal, clonal genotypic analysis of plasma virus loads in treated adults who had undetectable virus loads. We document a continuous production of virus in 8 HIV-1-infected adults who maintained suppression of viremia for up to 15 months. Using analytical approaches for distinguishing selected resistance mutations from nonselected mutations and polymerase chain reaction errors, we detected no evolution of resistance in the reverse-transcriptase and protease genes. Sporadic resistance mutations were detected in some viral clones that were not selected for subsequently. Thus, in some patients, HAART suppresses replication to a level that does not allow the evolution of drug resistance over a time frame of years.
Oxford University Press