Human immunodeficiency virus type 1-infected persons with residual disease and virus reservoirs on suppressive highly active antiretroviral therapy can be stratified into relevant virologic and immunologic subgroups

A significant percentage of human immunodeficiency virus type 1 (HIV-1)–infected personstreated with highly active antiretroviral therapy (HAART) will develop plasma HIV-1–specificvirion RNA levels !50 copies/mL. HIV-1–infected persons receiving virally suppressiveHAART were studied with a viral outgrowth assay of the patients’ peripheral blood mononuclearcells (PBMC), and a quantitative polymerase chain reaction assay was used to analyzeHIV-1 2–long terminal repeat (2-LTR) circular DNA in PBMC, which indicates new HIV-1infections of cells in vivo. Viral outgrowth in vitro correlated inversely with the level ofperipheral blood CD4+ T lymphocytes. Detection and quantitation of 2-LTR circular DNAcorrelated strongly with viral outgrowth patterns and inversely with CD4+ T lymphocytecounts. Relevant subgroups of HIV-1–infected subjects on suppressive HAART with residualviral disease and reservoirs can now be stratified.