Intermittent HIV-1 Viremia (Blips) and Drug Resistance in Patients Receiving HAART

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Abstract
Treatment of human immunodeficiency virus type 1 (HIV-1) infection with highly active antiretroviral therapy (HAART) can suppress viremia to below the limit of detection of available clinical assays.1-3 The current goal of antiretroviral therapy is suppression of viremia to below 50 copies/mL of HIV-1 RNA, the limit of detection of the most sensitive available clinical assay.4,5 Suppression to this level is necessary to prevent drug resistance, the major cause of treatment failure.6,7 After achieving suppression, many patients experience intermittent episodes of detectable viremia (“blips”).8-16 Blips may raise concern that resistance is developing and complicate management by increasing patient anxiety, triggering costly repeat measurements of viral load, and generating uncertainty regarding whether therapy should be altered.