JAIDS Journal of Acquired Immune Deficiency Syndromes:
Department of Hygiene, Public Health and Infectious Diseases
The introduction of the HAART has not only drammatically reduced the mortality and morbidity of AIDS but has also transformed HIV infection in a manageble, chronic condition.HIV infection requires frequent virologic and immunologic monitoring to detect early virologic failure to the therapy and to monitoring the evolution of viral variants.To date the standard markers are: CD4+T cells and HIV-RNA.The study of HIV-DNA could be useful to improve the life long treatment of HIV infection. HIV-DNA plays an important role in the pathogenesis of AIDS, in the establishment and persistence of the reservoir and for the monitoring of therapeutic strategies. The persistence of the virus depends on the long-term survival of a pool of infected cells called “resting CD4+ lymphocytes” which represent the HIV reservoir. The frequency of latently infected cells is approssimately 1 in 106 resting CD4 +T cells. This reservoir is generated early during an acute infection by reversion of the infected CD4+ into quiescent memory lymphocytes. These resting CD4 +T cells are transcriptionally silent but they can produce new infectious virions when activated again. The stability of this set of cells can depend on several factors: cellular, host, and by limits of HAART.
New therapeutic approaches are needed to purge these latent provirus, otherwise the goal to eradicate HIV infection will be out of reach. The hypothetical introduction of regimens active on the reservoir requires new markers for the monitoring of the size of reservoir. HIV-DNA load may give an estimate on the number of infected cells, including CD4+ T lymphocytes, and on the size of the viral reservoir which infectious virions can potentially be released. Secondly, it can be useful in clinical management in predicting very early failures and in sequencing the combined antiretroviral therapy.