Most episodes of HIV 'blips' not clinically significant in patients receiving HAART

Patients with human immunodeficiency virus type 1 (HIV-1) who have been able to suppress the virus while receiving highly active antiretroviral therapy (HAART) experience intermittent episodes of detectable viremia (presence of the HIV virus in the bloodstream), which are also known as "blips." These blips may raise concerns about drug resistance, lead to costly repeat testing, and sometimes result in changes in medications. A new preliminary communication published in the February 16 issue of JAMA, a theme issue on medical applications of biotechnology, finds most blips in the study population appear to be random variations rather than clinically significant elevations in viremia.

Richard E. Nettles, M.D., from Johns Hopkins University School of Medicine, Baltimore, and colleagues investigated the nature and clinical significance of blips by assessing the HIV-1 RNA (ribonucleic acid) levels of 10 patients every 2 to 3 days over 3 to 4 months between June 19, 2003 and February 9, 2004.

"With the intensive sampling, blips were detected in 9 of 10 patients," the researchers report. "There was no association between blips and demographic, treatment, or HIV-associated clinical factors. Furthermore, blips were unrelated to intercurrent illnesses, vaccination, or decreases in antiretroviral drug concentrations. Blips were marginally associated with self-reported nonadherence." The researchers add that most importantly, an ultrasensitive method for detecting drug resistance showed no new resistance mutations before, during, or shortly after blips in the study patients.

(JAMA. 2005; 293:817-829. Available post-embargo at JAMA.com)

Editor's Note: Please see JAMA study for funding sources and financial disclosures.

---

---