Abstract
Maintaining high rates of CD4 cells (>500/mm3) is a main objective of the treatment of HIV infections. Maraviroc blocks the entry of CCR5-tropic viruses, which play a major role in HIV transmission and predominate throughout infection. Viruses using CXCR4 co-receptor emerge later and are associated with disease worsening. Maraviroc showed a rapid and high immune response, partly due to its capacity to diffuse in sanctuary areas. Viraltropism appears very useful to predict both disease progression and CCR5- antagonist efficacy. Based on the V3 loop of HIV-envelope gp120, genotypic tests show an acceptable concordance with plasma-derived phenotypic tests and, when performed at blood cellular levels, a slightly higher prevalence of archived X4 variants. They also seem to be predictive of the virological response to treatment. The perspective of an accurate prediction of viral tropism in blood cell reservoirs could lead to discuss the use of CCR5-antagonists in patients with undetectable viral load.
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