Persistence of episomal HIV-1 infection intermediates in patients on highly active anti-retroviral therapy

Mark E. Sharkey, Ian Teo, Thomas Greenough, Natalia Sharova, Katherine Luzuriaga, John L. Sullivan, R. Pat Bucy, Leondios G. Kostrikis, Ashley Haase, Claire Veryard, Raul E. Davaro, Sarah H. Cheeseman, Jennifer S. Daly, Carol Bova, Richard T. Ellison, Brian Mady, Kwan Kew Lai, Graeme Moyle, Mark Nelson, Brian GazzardSunil Shaunak, Mario Stevenson

Research output: Contribution to journalArticlepeer-review

364 Scopus citations


Treatment of HIV-1-infected individuals with a combination of anti- retroviral agents results in sustained suppression of HIV-1 replication, as evidenced by a reduction in plasma viral RNA to levels below the limit of detection of available assays. However, even in patients whose plasma viral RNA levels have been suppressed to below detectable levels for up to 30 months, replication-competent virus can routinely be recovered from patient peripheral blood mononuclear cells and from semen. A reservoir of latently infected cells established early in infection may be involved in the maintenance of viral persistence despite highly active anti-retroviral therapy. However, whether virus replication persists in such patients is unknown. HIV-1 cDNA episomes are labile products of virus infection and indicative of recent infection events. Using episome-specific PCR, we demonstrate here ongoing virus replication in a large percentage of infected individuals on highly active anti-retroviral therapy, despite sustained undetectable levels of plasma viral RNA. The presence of a reservoir of 'covert' virus replication in patients on highly active anti-retroviral therapy has important implications for the clinical management of HIV-1- infected individuals and for the development of virus eradication strategies.

Original languageEnglish (US)
Pages (from-to)76-81
Number of pages6
JournalNature medicine
Issue number1
StatePublished - Jan 2000
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)


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