Advertisement covers The 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2012)

Ongoing HIV Infection Could Explain Low CD4 Counts Despite Undetectable Viral Loads, Study Suggests

September 23, 2012

Ongoing HIV infection of CD4+ cells may be the reason why some individuals with undetectable viral loads exhibit poor CD4+ cell count responses, according to study results presented at ICAAC 2012.

Researchers in Montpellier, France, used a qPCR assay to look for HIV DNA in the CD4+ cell cytoplasm. They posited that since cytoplasm has a short half-life, it could be a reliable marker of recent CD4+ cell infection.

The investigators studied CD4+ cell samples from virologically suppressed individuals who were on treatment. Further baseline information was reported by NATAP:

Twenty-five of 35 study participants were men, and their age averaged 48 (range 30 to 70). Duration of HIV infection averaged 7 years (range 1 to 18), and CD4 count averaged 491 (95% confidence interval [CI] 408 to 552). Sixteen people were taking a protease inhibitor, 11 each were taking a nonnucleoside or an integrase inhibitor, and 7 were taking a CCR5 antagonist.

The researchers found the presence of HIV DNA in the CD4+ cell cytoplasm of 10 of the participants, according to the study abstract. Average CD4+ cell count trends were lower in these 10 individuals (-4 CD4+ cells per month) than in the other 23 individuals (+13 CD4+ cells per month). Though the study group was small, this finding was statistically significant (P = .035).

The researchers also compared immune responses by measuring CD38, a marker for immune activation, at the surface of CD8+ cells in a subgroup of 20 participants. The percentage of activated CD8+ cells in the individuals with detectable cytoplasmic HIV DNA rose an average of 1.7% monthly, whereas in the other individuals it decreased an average of 0.5% monthly (P = .052). This finding further suggested that ongoing HIV infection was occurring despite virologic suppression.

NATAP reported:

The investigators believe their findings "argue for a role of ongoing HIV infection in the persistence of immune activation and in the impairment of immune restoration in some virologic responders." They suggested that their assay may offer a simple way to assess the potency of antiretroviral regimens, to monitor ART simplification, to determine which patients may need a stronger regimen, and to distinguish ongoing CD4-cell infection from other causes of poor CD4 gains.

While these findings could lead to better ways of increasing CD4+ cell counts in people living with HIV, more research needs to be done in larger groups.

Warren Tong is the research editor for and

Follow Warren on Twitter: @WarrenAtTheBody.

Copyright © 2012 Remedy Health Media, LLC. All rights reserved.

This article was provided by TheBodyPRO. It is a part of the publication The 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2012).


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