Hi Dr. Conway: I am trying to understand how HIV treatment works. If the treatment doesn't stop replication just controls replication what does this mean? If replication still occurs then how much HIV is still being produced and why can't you see this with viral load tests. And if wild type HIV is still being replicated then mutated HIV is also being replicated...if so wouldn't resistance occur naturally having nothing to do with someone skipping treatment? Thanks!

The treatment works by reducing HIV replication to very low levels, such that the immune system can recover and that the number of replication events is so low that the evolution of resistance is slow. Statistically, the virus is replicating so slowly that it cannot become resistant to the three drugs in a usual HAART regimen. When the viral load is undetectable, it simply means that the amount of virus in the blood is so low that the test can no longer accurately count it. It is still therejust possibly not doing any harmperhaps indefinitely.

Obviously, this is a fine balance, and one that can be broken if the virus begins replicating more rapidly and becomes resistant to the drugs (perhaps due to skipping treatment). However, until we find a cure for HIV infection, this is the best we have.