Low level VL linked to defective copies released from viral reservoir

[Jim Allen]

A small study confirms previous conclusions & studies that blips can be defective HIV copies from viral reservoirs.

Article from I-base: https://i-base.info/htb/44755
Low level viral load on effective ART is linked to clonal expansion of reservoir: not affected by modifying ART

In Short:

Researchers investigating new and persistently detectable viral load in four people with a previous history of suppressive ART report that this is caused by clonal expansion of reservoir cells. All cases included people having excellent adherence and no evidence of drug resistance.

The four participants (P1–4) had been living with HIV for more than 15 years (range 15 to 32 years) and had been undetectable on long-term ART from 7 to 27 years, with good CD4 counts. Treatment changes, including intensification had not been successful.

P1 had persistently detectable viremia for more than four years, with a median plasma viral load of 80 copies/mL (range 37 to 156).

P2 had intermittent periods of detectable viremia for more than ten years, with a median of 75 copies/mL (range <20 to 300).

P3 had persistently detectable viremia for over four years, with a median of 123 copies/mL (range 26 to 857).

P4 was the most extreme example, with a median viral load of 2979 copies/mL (range 1145 to 5138) for almost two years.

[leatherman]

P2 had intermittent periods of detectable viremia for more than ten years, with a median of 75 copies/mL (range <20 to 300).

P2 could almost be me. Although I was P1 for my first 5 years with a much larger VL

intermittent periods of detectable viremia for more than 12 years, with a median of approx 175 copies/mL (range <20 to 7800)

That wouldn't count the blip 5 years later of 59k.

Two years afterwards, I changed regimens to Precobix/Tivicay (no resistance issues to anything prior, just an updated regimen) and haven't blipped in 11yrs.