Dr. Daar:

I realize that several studies have shown viral "blips" of less than 200 on occasion to be no more indicative of viral breakthrough than with patients who remain constantly <50 on their viral essay; however, doesn't this defy scientific logic with the remarkable ability of HIV to mutate and get around even HAART when it has the ability to remain somewhat active in the bloodstream? And despite the studies that have proven otherwise, what is your hypothetical guess on the eventual ability of HIV to breakthrough HAART years from the first onset of "blips"? Thank you in advance.

Thank you for your very good question. You are correct that one would expect that "blips" would ultimately be associated with the emergence of resistance. It is for this reason that people have taken the time to carefully look at this issue. As you point out, the majority of studies do not suggest that these blips predict failure. This may relate to the fact that we do not completely understand where the virus detected in blips are coming from. In some cases this may reflect simple variation in the assay and in others it may be virus transiently pushed out of cells in the body without actual ongoing replication.

At least for now I would continue to reassure people that they should focus on taking there medications consistently and being followed closely and not be overly anxious regarding occasional emergence of detectable virus.

Best, Eric