HIV-1 RNA monitoring with a dual-target diagnostic assay: A case report
Giuseppe Sberna,
Roberta Gagliardini,
Gabriella Rozera,
Federica Forbici,
Stefania Cicalini,
Andrea Antinori,
Fabrizio Maggi,
Alessandra Amendola
Affiliations
Giuseppe Sberna
Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Roberta Gagliardini
Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Gabriella Rozera
Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Federica Forbici
Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Stefania Cicalini
Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Andrea Antinori
Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Fabrizio Maggi
Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy
Alessandra Amendola
Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, 00149, Rome, Italy; Corresponding author. Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS Via Portuense n. 292 00149, Rome, Italy.
In a restricted subset of people living with HIV-1 (PLWH) on antiretroviral therapy (ART) with persistent suppressed viral load (i.e., pol-based HIV-RNA repeatedly undetected), a dual-target (pol and LTR) diagnostic assay for HIV-RNA monitoring can measure quantifiable levels of viral loads (VL) above 30 copies/mL exclusively through the amplification of the LTR region, while the pol target results undetected.We report a patient who shows high levels of HIV-RNA detected exclusively through amplification of the LTR region while undetected by the pol region, during a long monitoring period, from 2018 to date. In this follow-up, the ART was modified without reaching LTR-based undetected HIV-RNA values. Immunological and virological parameters remained optimal with a progressive and steady gain of the CD4/CD8 ratio.The clinical history of this patient, shows that LTR-based viremia above 50 copies/mL can be found occasionally or persistently in the plasma of PLWH under suppressive ART, even at high levels. Based on previous studies, VL detected and quantified exclusively through the amplification of the LTR region corresponds to partial or incomplete HIV-RNA transcripts, which cannot trigger new infections. Interestingly, changes in ART do not eliminate repeated findings of these unusual viral elements.
