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"Undetectable" questions
Apr 14, 2004

Three questions: 1)Under successful HAART with normal range CD4+ and non-detect VL, is the virus still active and replicating albeit at a very low level or is it just hanging out in reservoirs waiting for release into the peripheral system? 2)If you get a cold or other infection while on successful HAART (VL not detected) does this spike your VL because your immune system is more active? 3)With successful HAART have research labs been able to use "research" methods to see how low VL can go? Recently infected and on meds 12wks w/excellent results. Thanks!

Response from Dr. Pierone

Even with successful HAART and undetectable HIV there is low level replication of virus in some people. How do we know? Some studies with (experimental) extremely sensitive viral load tests show that some people have a viral load that is persistently in the 5 to 10 copies/mL range. Generally though, there is not ongoing genotypic evolution of virus suggesting that this very low level virus is just popping out of various reservoirs (like the late straggling kernels in a bag of popcorn).

Some of the blips that we see with a viral infection are probably related to immune mediated activation of latently infected CD4 cells. One can envision this as an innocent bystander activation scenario as follows: a CD4 cell programmed to react to rhinovirus, but latently infected with HIV, becomes activated in response to a cold. As a consequence of activation the latent HIV genome stirs to life and starts a cycle of viral replication. This CD4 cell is, in effect, hijacked by HIV on its way to respond to a simple rhinovirus infection.

Thanks for posting and good luck with your regimen!



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