title: Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy.
abstract: BACKGROUND
  To determine if infectious disease events in HIV-infected patients treated with highly active antiretroviral therapy (HAART) are a consequence of the restoration of pathogen-specific immune responses, a single-centre retrospective study of all HIV-infected patients commencing HAART prior to 1 July 1997 was undertaken to determine the incidence, characteristics and time of onset of disease episodes in HAART responders (decrease in plasma HIV RNA of > 1 log10 copies/mL).
  
  
  METHODS
  Baseline and post-therapy changes in CD4 T-cell counts and HIV RNA were compared in patients with and without disease and delayed-type hypersensitivity responses to mycobacterial antigens were measured in selected patients.
  
  
  RESULTS
  Thirty-three of 132 HAART responders (25%) exhibited one or more disease episodes after HAART, related to a pre-existent or subclinical infection by an opportunistic pathogen. Disease episodes were most often related to infections by mycobacteria or herpesviruses but hepatitis C virus (HCV), molluscum contagiosum virus and human papilloma virus were also implicated. They were most common in patients with a baseline CD4 T-cell count of < 50/uL and occurred most often during the first 2 months of therapy and when CD4 T-cell counts were increasing. Mycobacteria- and HCV-related diseases were associated with restoration of pathogen-specific immune responses.
  
  
  CONCLUSIONS
  We conclude that improved immune function in immunodeficient patients treated with HAART may restore pathogen-specific immune responses and cause inflammation in tissues infected by those pathogens.
authors.affiliation: Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia. martfren@rph.health.wa.gov.au
authors.forename: M A
authors.initials: MA
authors.lastname: French
authors.forename: N
authors.initials: N
authors.lastname: Lenzo
authors.forename: M
authors.initials: M
authors.lastname: John
authors.forename: S A
authors.initials: SA
authors.lastname: Mallal
authors.forename: E J
authors.initials: EJ
authors.lastname: McKinnon
authors.forename: I R
authors.initials: IR
authors.lastname: James
authors.forename: P
authors.initials: P
authors.lastname: Price
authors.forename: J P
authors.initials: JP
authors.lastname: Flexman
authors.forename: M L
authors.initials: ML
authors.lastname: Tay-Kearney
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007107:Immune System / Q000187:drug effects*; D016867:Immunocompromised Host; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome