Comparison of T-cell subsets' reconstitution after 12 months of highly active antiretroviral therapy initiated during early versus advanced states of HIV disease.
This research comprised a pilot open prospective clinical study comparing T-cell subset reconstitution in antiretroviral-naive patients, after 12 months of HAART when treatment was initiated in early stages (ES; n = 18) of infection versus advanced stages (AS; n = 20).


METHODS
10 healthy HIV-negative individuals. Immunophenotypic markers were evaluated before and after 6-and 12-months' therapy. Functional assays were performed in one subset.


RESULTS
Viral load (VL) was < 200 copies/ml in all patients. Median percentages of CD4+ pretherapy were 33% and 6%, respectively, in the ES and AS groups, increment after 12 months of therapy was +15% and +13% respectively. Only the ES group achieved normal values. Declines of CD8+ percentage were significantly higher in the ES (-18%) than in the AS group (-2%). CD4+ memory and naive cells in the ES group were similar to those of controls before treatment and did not change after therapy. In contrast, CD4+ memory and naive cells in the AS group did not reach normal levels despite treatment. In the ES group, there was a significant increment in CD8+ naive cells (+8%) and a decrement in CD8+CD38+ cells (-17%), both populations reached values close to normal, whereas these subsets remained far from normal in the AS group. Improvement of lymphoproliferative response after therapy was observed in both groups. One patient in the ES group showed positive LPR against p24 after treatment. After 12 months' highly active antiretroviral therapy, only those who began such therapy in ES disease reached values within the range of healthy controls. To achieve a more complete immunologic reconstitution, early initiation of potent antiretroviral therapy should be recommended.
Tortajada
C
C
Infectious Diseases Unit and Immunology Laboratory, Institut d'Investigacions Biomediques August Pi I Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain. alamilla@medicina.ub.es
Garcia
F
F
Plana
M
M
Gallart
T
T
Maleno
M J
MJ
Miró
J M
JM
Gatell
J M
JM
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005434:Flow Cytometry; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000276:immunology / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D019469:Indinavir / Q000276:immunology / Q000627:therapeutic use; D019259:Lamivudine / Q000276:immunology / Q000627:therapeutic use; D008213:Lymphocyte Activation; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000276:immunology / Q000627:therapeutic use; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019438:Ritonavir / Q000276:immunology / Q000627:therapeutic use; D012588:Scintillation Counting; D018709:Statistics, Nonparametric; D018119:Stavudine / Q000276:immunology / Q000627:therapeutic use; D016176:T-Lymphocyte Subsets; D014316:Tritium; D019562:Viral Load
D000911:Antibodies, Monoclonal; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D014316:Tritium; D019259:Lamivudine; D019469:Indinavir; D018119:Stavudine; D019438:Ritonavir