Comparison of HIV DNA and RNA in gut-associated lymphoid tissue of HIV-infected controllers and noncontrollers

Objectives:HIV-infected controllers have provided novel insights into mechanisms of viral control. We investigated the degree to which HIV DNA and RNA are present in gut-associated lymphoid tissue (GALT) of controllers. Design:Cross-sectional cohort study. Methods:Colorectal biopsy pieces were obtained from five untreated noncontrollers, five ART-suppressed patients, and nine untreated controllers. Results:Rectal HIV DNA was lower in controllers (median 496copies/10(6) CD4(+) T cells) than in untreated noncontrollers (117483copies/10(6) CD4(+) T cells, P=0.001) and ART-suppressed patients (6116copies/10(6) CD4(+) T cells, P=0.004). Similarly, rectal HIV RNA was lower in controllers (19copies/10(6) CD4(+) T cells) than in noncontrollers (15210copies/10(6) CD4(+) T cells, P=0.001) and ART-suppressed patients (1625copies/10(6) CD4(+) T cells, P=0.0599). Rectal HIV RNA/DNA ratios were not statistically different between the three groups. Conclusion:Despite being able to maintain very low plasma HIV RNA levels in the absence of antiretroviral therapy (ART), HIV-infected controllers have readily measurable levels of HIV DNA and RNA in GALT. As expected, controllers had lower rectal HIV DNA and RNA compared with untreated noncontrollers and ART-suppressed individuals. Compared with the mechanisms of natural' viral control of controllers, long-term ART does not reduce the total HIV reservoir to the level of controllers.