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Does this study weaken the good adherence argument?

Aug 31, 2011

Hi Joe.

What do you make of this study which suggests ongoing viral replication via cell to cell transfer in the presence of ART. If replication is occurring then this allows for selection and resistance despite perfect adherence. Please tell I'm wrong! Yours, Michael.

Study is here:

Response from Dr. McGowan

Thanks. The study is attempting to address the finding that most people will have very low levels of virus (1 or 2 copies) in their blood despite always being undetectable(by the standard tests which can only detect down to 20 or 50 copies) while on treatment. Most scientists have felt that these virus are produced by CD4 cells that were previously infected but are resting, waiting to be stimulated by the infection that they are sensitized to. For example a certain CD4 cell may be set to protect against chickenpox and will rest until the body is exposed to chickepox and then will "wake up" and start dividing to respond. If HIV genes are hiding in that cell then a burst of virus will emerge but will be blocked by the meds from infecting nearby cells. This study shows another possible mechanism...that some virus might spread not in the blood but rather from cell to cell. Since this study was done in the lab (in test tubes and not in the body), it may not actually reflect what happens in the tissues of the body and will need further work. However, there is no need to worry about loosing control of the infection because the vast majority of virus spread without medication is through the blood and that is effectively shut down. Also the trigger for most of the inflammation or "immune activation" that cauases much of the damage from unchecked HIV might not be triggered by this "under cover" spread of virus. It has more implications on trying to rid the body of virus and hope to be able to stop meds at some point...this makes it less likely that we could shrink down the pool of infected cells to the point that meds could be stopped. So we will stay tuned and see if this work can be confirmed and extended. Best, Joe

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