A NEW TYPE OF NONSUPPRESSIBLE VIREMIA: HIV-1 CONSTITUTIVELY PRODUCED FROM INFECTED MACROPHAGES

The effectiveness of antiretroviral therapy against HIV-1 can be quantified by a decrease in HIV-1 RNA in the plasma. Individuals experience virological failure when the plasma viral load does not decrease, does not fully suppress below the limit of quantification, or returns after being suppressed. Here we describe three study participants who experienced an unusual form of virological failure, where a drug sensitive virus persisted despite adherence to ART. The persistent viral population was diverse, and macrophage-tropic, while CD4+ T cell-tropic viral populations were suppressed by ART. This viral population was rare or absent from PBMC DNA and found to have defects in the viral accessory protein Vpr. These participants have a rare presentation of macrophage-tropic virus, which is normally isolated in immune privileged compartments, suggesting the production by a large systemic population of infected macrophages that are more slowly cleared by immune cells when compared to CD4+ T cells.