Non-suppressible HIV viremia sustained by clonally expanded CD4+ T cells harboring a genomically defective provirus with an immune-evasive protein expression profile

This study investigated why some people living with HIV continue to have low but persistently detectable levels of the virus in their blood despite taking treatment consistently and having no drug resistance. The researchers examined a case in which the virus remained detectable for more than four years and could not be attributed to issues with the participant’s medication.

They found that the virus was being produced by identical infected immune cells that had multiplied over time. These cells contained an incomplete form of HIV that could not produce a fully infectious virus. However, it was still able to produce some viral proteins, allowing the virus to remain detectable in the blood. The study also showed that these infected cells appeared to evade recognition and clearance by the immune system, allowing them to survive for extended periods.

The findings suggest that incomplete forms of HIV, previously thought to have little biological importance, may continue to influence the infection even when they cannot spread to new cells. The study also highlights that persistent virus in the blood does not always mean that treatment has failed or that the virus has become resistant to medicines.

Overall, this research improves understanding of how HIV persists during treatment and may help guide future HIV cure research and the clinical management of people with persistent low-level virus despite successful treatment.