Background:  Low levels of HIV replication and HIV DNA have been reported in blood of some patients, particularly HIV controllers and patients in “remission.” We addressed the issue of HIV reservoir size in profound tissues like rectum in such patients, compared to others at different stages.

Methods:  Rectal biopsies were proposed to 14 patients, including 4 patients in “remission,” ie, who had initiated HAART during primary infection and presented sustained viral control (HIV RNA <1.7 log copies/mL) and CD4>500 cells/mm³ more than 30 months after HAART interruption, 2 HIV controllers, 5 patients who had initiated therapy during chronic infection and presented with HIV RNA <1.7 log copies/mL and 3 untreated patients (median HIV RNA at 4.5 log copies/mL). Total HIV DNA was quantified in peripheral blood mononuclear cells (PBMC) and in rectal biopsies using a real time polymerase chain reaction (RT-PCR) assay (LTR  region—ANRS), with an average of 2 PCR results in 4 rectal biopsies per patient was calculated. Median proportion of CD4⁺ cells in biopsies was estimated by immuno-staining. Spearman and Mann-Whitney tests were used.

Results:  HIV-1 DNA was detectable in all the 56 rectal biopsies. The median HIV DNA was 2.0, 2.0, 2.5, and 3.3 log copies/10⁶ rectal cells vs 1.9, 2.2, 3.5, and 3.7 log copies/10⁶ PBMC for patients in “remission,” HIV controllers, aviremic patients treated during chronic infection, and untreated patients, respectively. We observed a good correlation between HIV DNA in PBMC and in rectal biopsies (r = 0.898, p = 0.001 and r = 0.799, p = 0.004 with HIV DNA in rectum expressed in log copies/10⁶ rectal cells or log copies/10⁶ CD4⁺ rectal cells, respectively). HIV DNA level in PBMC permitted us to distinguish 2 groups of patients:  7 patients with HIV DNA <2.7 log copies/10⁶ PBMC (median:  2.2 log) including 4 patients in “remission,” 2 HIV controllers, 1 patient treated during chronic infection; and 7 patients with HIV DNA >2.7 log copies/10⁶ PBMC (median: 3.5 log), including 4 patients on HAART from chronic infection and 3 untreated patients. HIV DNA in rectal biopsies was significantly lower for group A than group B (medians 1.9 vs 2.8 log copies/10⁶ rectal cells, p = 0.002).

Conclusions:  Patients in “remission” and HIV controllers showed a very low HIV DNA level, not only in blood but also in some profound anatomical reservoirs, such as rectum. HIV DNA in blood reflects HIV DNA in rectal biopsies for patients at different stages of HIV infection.