There are several important issues that this study brings up. First, it is obvious that some replication continues to take place, how much resistance is appearing is a question. Obviously not very much, otherwise their viral load would be higher. But what I think is even far more important is the fact, that 10/13 patients, the ones who were undetectable, had a substantial increase in their CD4 counts (100% of the pts with undetectable virus). This shows that although "Cure", can not be obtained (because of the CD45RO T Cells), there is an obvius improvement in the patients illness. Therefore, giving more to the idea of "Hit Hard, Hit Early". The earlier you can stop or slow down infection, the greater the "salvage" of the immune system, the less overall viral burden that is attained by the virus. Remember that HIV Disease is really a lymphoid system disease, and what we see in peripheral blood is only 5% of the viral burden. 95% is in the lymph.
Also note that none of these patients were on Viracept, and the limit of detection was 500 copies, we have to see what happens to the patients under 20 copies.
As always, this answers some questions, but makes many new, and far more complicated questions.
JLL |
