Jun 3, 2007
I am confused about viral replication. The current antiretiroviral drugs prevent replication. However, when the meds are stopped is the virus still present in the infected cell and able to start replicating again?
Response from Dr. Sherer
Yes to both questions. The current antiretroviral drugs are 'static' drugs, i.e. they don't kill the virus, but they do prevent replication. Fortunately, the consequences of stopping replication are prolonged length of life and a dramatic reduction in the serious clinical consequences of HIV infection, i.e. opportunistic infections and conditions. We are able to measure the degree of virus replication reduction with the plasma viral load; when it is below the level of detection, i.e. < 50 copies/ml (or whatever the lower limit of detection is for the assay that your doctor uses), the best and most durable outcomes of ART are observed. Note that not all of the many HIV-related clinical consequences are stopped or delayed by ART, including some HIV-related cancers, and HIV-associated central nervous system disease.
When the drugs are discontinued, viral replication inevitably resumes, as you suggest, and, over time, the CD4 cell count will fall again by an average of 100 cells/year, and, if enough time elapses, HIV-related opportunistic infections will again occur.
Resistance test conflicts
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