HIV in Tears Despite ART?

In a research letter to be published in AIDS, a Beijing team shows that HIV-1 RNA remains detectable in tears from a majority of patients despite effective ART. This observation raises the possibility that lacrimal glands and/or other tear-associated tissues are a new reservoir for HIV.

This cross-sectional study involved 21 HIV-1 infected subjects (16 with successful plasma viral load suppression for at least 3 months, 2 ARV-naïve subjects and 3 with viral failure) and 5 controls (1). These patients did not have any clinical ophthalmic symptoms and a specific examination at this level was normal in each case.

Both qualitative and quantitative PCR were performed. HIV-1 RNA was measured in tear samples by bDNA in all cases and, in 7 cases, by TaqMan. The tear HIV-1 load was 5,181 ± 7,283 copies/ml in the 16 subjects with undetectable viral load in plasma (for 27.2 ± 14.3 months) and 4,477 ± 5,276 copies/ml in the 5 patients with detectable viremia (difference not significant). No positive detection was found in controls.

We asked Professor Taisheng Li, principal investigator of this study, a few questions:

Alain Lafeuillade: How did you come to study this body fluid?
Taisheng Li: We wanted to collect tear to separate HIV material and sequence env, gag or pol genes. The aim was to compare the differences of HIV genome sequences among tear, plasma and PBMCs.

AL: How did you collect these tears and what was the average amount of liquid you obtained?
TL: After informed consent, clinical nurse specialists and psychologist influenced patients mood to induce burst into tears. Technician collected these tears as soon as possible with RNase-free tip and tube. About 0.5ml-1.5ml tear collected from per patient was stored at -80 centigrade freezer for HIV-1 viral load assay.

AL: What are the principal drugs these patients were receiving in their antiretroviral combinations?
TL: For a total of 19 patients taking HAART, medicines were as follows:

AL: You concluded that precautions should be taken when doing eye examinations. How can you tell that this HIV RNA is infectious?
TL: We cannot verify the HIV RNA in tear is infectious or if living HIV particles are present in this kind of study. However, commercial viral load kit and quality PCR assay confirmed existence of HIV RNA or RNA fragment in tear, even in the presence of successful plasma viral load suppression in patients. Consequently, we suggested the necessity of taking precautions when operating on eyes.

AL: How do you explain your results and how are you trying to go further?
TL: We think it is very interesting findings. The results provide the possibility that lacrimal glands and/or other tear-associated tissues are a new reservoir for HIV. Therefore, our research team is trying to duplicate virus and isolate viral genomic full-length sequence by viral culture in PBMC or cell line.

Reference

Han Y, Wu N, Zhu W et al. Detection of HIV-1 viruses in tears of patients even under long-term highly active antiretroviral therapy. AIDS 2011, Epub ahead of print.