At the beginning of the AZT phase in the “evolution” of AIDS treatment there was some underlying logic to the strategy. Why you may ask? Well, the answer is that, heralded as a reverse transcriptase inhibitor, AZT could be expected to completely clear “HIV” from the system before it killed the patient. Although none of the anti-HIV drugs on the market at present prevent the replication of HIV directly, they putatively act to prevent the formation of new provirus i.e. infection of new cells (protease inhibitors) and integration of the HIV genome into the host cell DNA through reverse transcription. If reverse transcription is blocked then no new provirus can be formed so no new, actively infected cells can be formed. The latent (proviral) or actively infected immune cells present before therapy would be removed naturally, predominantly replaced by new uninfected cells eventually leaving the patient HIV free. Its rational to conclude on this basis that when you take combo therapy and your viral load (if that is what it is) is persistently undetectable, this is what has happened. Even if a few latently infected cells do remain, what basis is there for concluding that these cells can provide a sufficient source of resistant HIV?
For a virus to become resistant it has to mutate. If the viral load is undetectable, how much mutation can be going on? How likely is it that under these conditions a virus can mutate to become resistant to even one anti-HIV drug never mind 3, two of which target the virus in completely different ways? For the viral load to go up from persistently undetectable in someone on combo, HIV would have to not only be replicating but replicating to an extent that it becomes SIMULTANEOUSLY resistant to each anti-HIV drug in the combo.
So not only are we asked to defy our rational faculties and assume HIV is still present in immune cells during the condition of undetectable viral load, we are asked to defy them still further and assume HIV replication during this condition to an extent that HIV becomes simultaneously resistant to 3 different anti-HIV drugs, two of which act in completely different ways and, in the final affront to reason, we are asked to regard the resistant HIV produced as pathogenic.