Varied Patterns of Decay of Intact Human Immunodeficiency Virus Type 1 Proviruses Over 2 Decades of Antiretroviral Therapy
Rajesh T. Gandhi, Ronald J. Bosch, Hanna Mar, Gregory M. Laird, Elias K. Halvas, Laura Hovind, Ann C. Collier, Sharon A. Riddler, Albine Martin, Kristen D. Ritter, Deborah K. McMahon, Joseph J. Eron, Joshua C. Cyktor, John W. Mellors, Evelyn Hogg, Rebecca LeBlanc, Christine Scello, David Palm, Monica Gandhi, Courtney V. Fletcher, Anthony T. Podany, Fran Aweeka, Jeymohan Joseph, Susan Pederson, Leah H. Rubin, Davey M. Smith, Serena Spudich, Athe Tsibris
Abstract
Fourteen people with human immunodeficiency virus type 1 had longitudinal measurements of intact, defective, and total proviral DNA over the course of two decades of antiretroviral therapy. Three patterns of intact proviral DNA decay were revealed: (1) biphasic decline with markedly slower second-phase decline, (2) initial decline that transitions to a zero-slope plateau, and (3) initial decline followed by later increases in intact proviral DNA. Defective proviral DNA levels were essentially stable. Mechanisms of slowing or reversal of second-phase decay of intact proviral DNA may include the inability to clear cells with intact but transcriptionally silent proviruses and clonal expansion of cells with intact proviruses.