HIV-1 infection and low steady state viral loads |
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Authors: | Callaway Duncan S Perelson Alan S |
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Institution: | (1) Department of Theoretical and Applied Mechanics, Cornell University, Ithaca, NY 14853, USA;(2) Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545, USA |
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Abstract: | Highly active antiretroviral therapy (HAART) reduces the viral burden in human immunodeficiency virus type 1 (HIV-1) infected
patients below the threshold of detectability. However, substantial evidence indicates that viral replication persists in
these individuals. In this paper we examine the ability of several biologically motivated models of HIV-1 dynamics to explain
sustained low viral loads. At or near drug efficacies that result in steady state viral loads below detectability, most models
are extremely sensitive to small changes in drug efficacy. We argue that if these models reflect reality many patients should
have cleared the virus, contrary to observation. We find that a model in which the infected cell death rate is dependent on
the infected cell density does not suffer this shortcoming. The shortcoming is also overcome in two more conventional models
that include small populations of cells in which the drug is less effective than in the main population, suggesting that difficulties
with drug penetrance and maintenance of effective intracellular drug concentrations in all cells susceptible to HIV infection
may underlie ongoing viral replication. |
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