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Effectiveness Criteria of HAART

Mar 17, 2013

Dear Doctor, thank you for your concern. I'm a guy from HK. I learnt that only 3% of HIV viruse stay in the blood plasma and vast majority are stayed in the guts, lymphatic system, and other organs. Also, the guts are very riched in cd4 cells. Is it right? From these facts, my concern is that when we talk about the effectiveness of HAART as indicated by whether or not it can bring the viral load to an undetectable level, is it true that the medications can only suppress the viral level in the plasma, but not necessarily suppressing them in other tissues or organs where the vast majority of viruses situate? And may i ask about the circulation of HIV in the body? Is it that the viruses ,after replication, can be released back into the blood stream from the lymphatic system or other tissues and organs? Sorry for my bad English. Hope you can understand my questions. Best regards

Response from Dr. Holodniy

All great questions. The viral load we measure in blood plasma is a very good surrogate for what is going on in the rest of the body in terms of HIV replication, but it is not perfect. As you may be aware, HIV exists in two forms, the circulating cell free virus form (what we measure when we measure HIV viral load in blood) and the integrated DNA form that exists in a variety of cells (CD4+ t cells, monocytes, etc). HIV treatment is very good at suppressing viral load in blood and most tissues, but it only impacts the number of infected cells minimally and slowly over time. HIV drugs do get into all tissues but to varying concentrations. Thus, there can be places where some virus can be released into the blood stream and possibly be able to infect cells in other organs.

Viral Load Still Not Undetectable
Drop in CD4 count

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