Residual human immunodeficiency virus (hiv) type 1 rna and dna in lymph nodes and hiv rna in genital secretions and in cerebrospinal fluid after suppression of viremia for 2 years

Residual viral replication persists in a significant proportion of human immunodeficiency virus (HIV)–infected patients receiving potent antiretroviral therapy. To determine the source of this virus, levels of HIV RNA and DNA from lymphoid tissues and levels of viral RNA in serum, cerebrospinal fluid (CSF), and genital secretions in 28 patients treated for 2.5 years with indinavir, zidovudine, and lamivudine were examined. Both HIV RNA and DNA remained detectable in all lymph nodes. In contrast, HIV RNA was not detected in 20 of 23 genital secretions or in any of 13 CSF samples after 2 years of treatment. HIV envelope sequence data from plasma and lymph nodes from 4 patients demonstrated sequence diver-gence, which suggests varying degrees of residual viral replication in 3 and absence in 1 patient. In patients receiving potent antiretroviral therapy, the greatest virus burden may continue to be in lymphoid tissues rather than in central nervous system or genitourinary compartments. The seeding of lymphoid tissues and the propagation of virus by CD4 cells (principally T lymphocytes) is established early in the course of infection for both human immunodeficiency virus (HIV) and experimental models of simian immunodefi