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To the Editor: Using an ultrasensitive reverse transcriptase polymerase chain reaction (RT-PCR) analytical method, Dr Dornadula and colleagues¹ found that human immunodeficiency virus type 1 (HIV-1) RNA (mean level, 17 copies/mL) was detectable in blood plasma of all 22 patients who had previously received suppressive highly active antiretroviral therapy (HAART) and who were found to have fewer than 50 copies/mL of plasma HIV-1 RNA by standard assays.

However, it is possible that even this ultrasensitive method could not distinguish the presence of viable HIV-1 live viruses from nonviable, albeit persisting, HIV-1 viral residues persisting after HAART. For instance, the finding of bacterial antigens in cerebrospinal fluid (CSF) of patients with bacterial meningitis^2-3 or the detection of cryptococcal antigen in the CSF of patients with cryptococcal meningitis,⁴ or a positive VDRL test result or fluorescent treponemal antibody absorption test in serum or CSF of patients with infectious syphilis^5-6 may not necessarily . . . [Full Text of this Article]

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