Another Potential Mechanism of HIV Persistence

Recent reports of HIV rebound in the Mississippi child and the Boston patients (NEJM JW Infect Dis Aug 1 2014) highlight the challenges involved in eradicating the virus from long-lived reservoirs. Understanding the mechanisms by which HIV persists in patients on antiretroviral therapy (ART) is critical to designing interventions to reduce these virus reservoirs and thereby prevent relapse. Now, two research groups have found evidence for clonal expansion of HIV-infected cells, which suggests a new mechanism for viral persistence.

Maldarelli and colleagues and Wagner and colleagues found that in patients on long-term ART, some HIV sequences were integrated at the same position in the host genome in multiple cells, providing evidence that the…