Advertisement

TheBodyPRO Covers CROI 2019

News Analysis

Viral Reservoir Can Explain Persistent Low Level Viremia With Good Adherence on ART

March 8, 2019

The dynamics of HIV proliferation in the viral reservoir might be the explanation for why viral load fails to become undetectable, especially when adherence is good.

Such cases are often reported as a management challenge in the absence of drug resistance at baseline and when ART is started in very early infection. Anecdotally, replication in the viral reservoir has been suggested as a possible mechanism to explain this and this hypothesis is now supported by results from an oral presentation at CROI 2019.

Elias Halvas from the University of Pittsburgh and colleagues presented results that amplified HIV in 10 participants with persistent low level viral load for > 6 months on ART (>50 to

Advertisement
Median viral load and CD4 count was 98 copies/mL and 542 cells/mm3, and at baseline (pre-ART) was 189,000 copies/mL and 212 cells/mm3, respectively. Median cell associated HIV DNA and RNA at the time of the analysis was 1458 and 166 copies/million PBMCs respectively and was detectable in all ten participants.

The study used single-genome sequencing on plasma RNA, cell-associated DNA, and p24+ culture supernatants from quantitative viral outgrowth assays (qVOA). Phylogenetic analysis and integration site analysis was able to show the lack of viral evolution or variation in integration sites.

Although 1/10 participant was excluded due to drug resistance linked to ongoing HIV replication, all other sequences confirmed lack of viral evolution and the viral source was from clonal replication.

This showed that low level viral load was not the result of ongoing viral replication linked to suboptimal adherence or ART but was due to cell proliferation in the viral reservoir.

The study also concluded that the finding might have implications for cure-related research as this clonal reservoir might lead to more rapid viral rebound if ART is stopped in context of an analytic treatment interruption.

Comment

These findings have important clinical implications as management of such cases often focuses on intensifying treatment or other modifications to ART.

These results are also important for HIV positive people as intermittent adherence is often proposed as the likely cause.

The PARTNER study provided limited data that low level viral load (

Reference

Halvas EK et al. Nonsuppressible viremia on ART from large cell clones carrying intact proviruses. CROI 4 – 7 March 2019, Seattle. Oral abstract 23. (abstract) (webcast)

[Note from TheBodyPro: This article was originally published by HIV i-Base on March 6, 2019. We have cross-posted it with their permission.]


Related Stories

New Data on Identifying and Targeting the Latent HIV Reservoir
What Should We Do About Persistent Low-Level Viremia?
Coverage of CROI 2019: The 26th Conference on Retroviruses and Opportunistic Infections



This article was provided by HIV i-Base. Visit HIV i-Base's website to find out more about their activities, publications and services.
 



Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

Advertisement

The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.