Hi，
I am curious about a phenomenon that after the HAART treatment, most HIV-infected patients are in a state of undectable virus load. Dose it mean that the virus in an active state or the number of it is rare? If that is right, most T cells in the patients are HIV-free. And, the death of most T cells are not cause by HIV directly.
I recommend you to read the replication cycle of HIV virus and the targets for antiretroviral drugs. You can get sufficient information from any website about the virology of HIV.
The key targets for antiretroviral drugs are binding, fusion, reverse transcription, integration and viral particle assembly. If the drug is able to interfere any of those key processes in the replication cycle of HIV, then the viral load will decrease significantly. Thus, the number of new viruses that potentially infect healthy T-cells will be decreases, and the performance of the immune system of the host will be restored and starts to attack potential opportunistic infections.
I strongly recommend you to read the virology, immunology and pharmacology of HIV/AIDS to understand the subject matter.
The usual measurement of the HIV viral load (to follow-up the HAART response) is limited to the blood. When the pressure of the HAART is remove (e.g. Stop treatment, resistance), other tissues that are reservoir for HIV and the dormant t-cells reactivares and the viral load start to raise.
Here is an Article about the HIV infection in other tissues
Aside from these two excellent replies, you might want to review the literature on the pathogenesis of HIV which addresses the question of how does HIV cause AIDS? For example, most of the CD4+ T-lymphocytes (T cells) that die are uninfected. This is because in human hosts, HIV results in immune activation and inflammatory responses that are deleterious. In some parts of the body, notably the gut, this damage is severe. Of course, HIV also directly kills cells.
Antiretroviral therapy results in a massive inhibition of viral production. Sadly, many people do not receive proper ARV (or monitoring) so, depending on where one is and the kind of access to care one may have, undetectable levels may not be achieved. However, efforts are underway (if so far inadequate!) to assure at least 90% of local populations of HIV+ are undetectable.
With an undetectable viral load, the rate of T cell loss is stopped and peripheral blood levels very often return to "normal" ranges for the person's age (kids and adults are different). Indeed, a lot of the other problems diminish, but due in part to some HIV hiding in sanctuary cells and sites, there can remain residual inflammatory activity and immune dysregulation. That, added to toxicities of ARV, mean that people may experience higher risk of heart disease, for example, than uninfected individuals.
Comprehensive care with good continuity, access to food, clean water, micronutrients; a good amount of exercise and patient-centered care can largely reduce many of these risks and allow better monitoring. The reality, however, is that we live on an extremely racist and classist planet that needlessly fails to assure access to such care.
Greed, ignorance, stupidity and our common human failings too often conspire, along with stigma of vulnerable populations, result in a patchwork that leaves millions still without access to ARV, let alone the kind of care that should be every human being's right. It's not like we don't have the resources--they're out there.
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