Apr 17, 2006
Can you please explain how HIV exists in reservoirs in the body? My partner has undetectable viral load, yet his doctor, for whom I have great respect, explained to me about viral reservoirs when I asked why he continues to be ill (fungal infections etc.) with an undetectable viral load. Can you please explain more about this? Thanks. Laurie
Response from Dr. Daar
When people discuss HIV reservoirs in the body they are generally speaking of places where virus may persist while having undetectable viral load on antiretroviral therapy. The term viral reservoirs can mean many things to different people. In my mind the most important potential reservoirs for HIV are in resting memory CD4 cells, the central nervous system (brain) and the genital tract. It is believed that it is because of the persistence of virus in these reservoirs that viral rebound almost always occurs upon discontinuation of treatment. The reason virus persists in these compartments may relate to limited drug penetration into the brain and/or the genital tract. It remains controversial as to why virus persists in resting memory CD4 cells and there continues to be research to better address this important question.
I am not quite sure what your partner's provider is referring to when he says that despite undetectable viral load in blood, persistence in reservoirs accounts for continued illness (e.g. fungal infections). While essentially all treated subjects have virus present in "reservoirs," most who have undetectable viral loads do not develope significant infections. I would encourage you and your partner to seek out further clarification on this issue from his provider. Clearly these are complex issues.
Best to you and your partner. Eric
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