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JAC Advance Access published online on March 13, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl092
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Commissioned leading article

HIV-1 viral load blips are of limited clinical significance

Patricia K. Lee 1, Tara L. Kieffer 2, Robert F. Siliciano 3, and Richard E. Nettles 4 *

1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Present address. Stanford University Medical Center
2 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Present address. Vertex Pharmaceuticals
3 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Howard Hughes Medical Institute, Baltimore, MD, USA
4 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

* To whom correspondence should be addressed.
Richard E. Nettles, E-mail: Richard.Nettles{at}BMS.com


  Abstract

Many patients on highly active antiretroviral therapy (HAART) who achieve undetectable HIV-1 RNA levels experience transient episodes of detectable viraemia or blips, suggesting there is incomplete suppression of viral replication. This raises concern that drug resistance mutations could develop and cause eventual treatment failure. However, data from recent studies indicate that most blips are actually random biological and statistical variations around a mean viral load below detectable levels (<50 copies/mL) or due to false elevations of viral load from laboratory processing artefacts. Blips are not typically associated with the development of resistance mutations and most importantly are not associated with virological or clinical failure of previously adequate HAART.

Keywords: HIV; genotypes; HAART; drug resistance.
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