HIV Infections Clinical Trial
Official title:
Impact of MK-0518 (Raltegravir) Intensification on HIV-1 Viral Latency in Patients With Previous Complete Viral Suppression
An intensification with the HIV-1 integrase inhibitor Raltegravir (RAL) of a stable HAART regimen with persistent HIV-1 viral suppression could increase the slope of decay of the HIV-1 latent reservoir.
While highly active antiretroviral therapy (HAART) reduces plasma HIV-1 levels to below the
limits of detection with standard assays, replication-competent virus persist in a stable,
latent reservoir in resting CD4+ T cells. So, there is a rapid resumption in plasma viremia
when therapy is interrupted.
In addition to cellular reservoir, other pharmacologically privileged areas such as the
central nervous system and the genital tract might act as additional sources of residual
virus in patients with undetectable levels of plasma HIV-1 RNA. There is great current
interest in strategies for depleting and eliminating this reservoir.
The antiviral potency of current regimens emerges as an important determinant of complete
viral control. In certain patients, the latent reservoir decay can be hastened with treatment
intensification.
An intensification with the HIV-1 integrase inhibitor Raltegravir (RAL) of a stable HAART
regimen with persistent HIV-1 viral suppression could increase the slope of decay of the
HIV-1 latent reservoir. This could provide further insight into this area, decrease the size
of latent reservoir, and translate into clinical benefits for patients being simplified to
maintenance monotherapy with RAL or in the HIV-1 rebound kinetics and slope after a
programmed treatment interruption.
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