title: CD4+ T-lymphocyte nadir and the effect of highly active antiretroviral therapy on phenotypic and functional immune restoration in HIV-1 infection.
abstract: To evaluate the effects of the timing of highly active antiretroviral therapy (HAART) on immune reconstitution, we compared lymphocyte subpopulations and lymphocyte proliferation (LP) in response to Candida albicans, cytomegalovirus, HIV p24, Mycobacterium avium complex, pokeweed mitogen, streptokinase, and tetanus toxoid in 43 patients with pretherapy advanced, moderately advanced, and early chronic HIV-1 infection. All patients had recent CD4+ T-cell counts >450/microl and HIV RNA <400 copies/ml for >12 months. CD4+ nadirs were positively correlated with recent numbers of CD4+ T-cells (P < 0.001), memory cells (P < 0.001), and naïve CD4+ T-cells (P < 0.05) and CD4+ CD28+ T-lymphocytes (P < 0.05) and were negatively correlated with recent CD8+ T-lymphocyte counts (P < 0.05). Only CD4+ naïve T-cells normalized when HAART was initiated at lower CD4+ T-cell levels. Fifty-three percent of patients had LP responses to HIV p24 antigen. While LP responses to prevalent antigens were usually present, responses to tetanus toxoid were more common with higher CD4+ T-lymphocyte nadirs (P < 0.05). Delaying HAART may limit phenotypic and functional immune restoration in HIV-1 infection.
authors.affiliation: Division of Infectious Diseases, Center for AIDS Research, Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA.
authors.forename: Christoph G
authors.initials: CG
authors.lastname: Lange
authors.forename: Hernan
authors.initials: H
authors.lastname: Valdez
authors.forename: Kathy
authors.initials: K
authors.lastname: Medvik
authors.forename: Robert
authors.initials: R
authors.lastname: Asaad
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D002176:Candida albicans / Q000276:immunology; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D016655:HIV Core Protein p24 / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D016130:Immunophenotyping; D008213:Lymphocyte Activation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000276:immunology; D011043:Pokeweed Mitogens / Q000276:immunology; D013300:Streptokinase / Q000276:immunology; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D013745:Tetanus Toxoid / Q000276:immunology
chemical_list: D016655:HIV Core Protein p24; D011043:Pokeweed Mitogens; D013745:Tetanus Toxoid; D013300:Streptokinase