Effects of combination chemotherapy and highly active antiretroviral therapy on immune parameters in HIV-1 associated lymphoma.
OBJECTIVE
To measure the effects of combined chemotherapy and highly active antiretroviral therapy (HAART) on immune cell counts and plasma HIV-1 RNA loads in patients with AIDS-related lymphoma (ARL) to determine the implications for opportunistic infection prophylaxis and medium-term immune function.


METHODS
Peripheral blood total lymphocyte count, CD4 T-cell count, CD8 T-cell count, CD19 B-cell count, CD16/CD56 natural killer cell count and plasma HIV-1 RNA load were prospectively measured at ARL diagnosis, at 1 and 3 months during and 1, 3 and 6 months after chemotherapy in twenty patients receiving HAART.


RESULTS
Significant declines in T-helper cell (CD4) count, natural killer cell (CD16/CD56) and B lymphocyte count (CD19 cells) occurred during the first 3 months of chemotherapy. There was no significant alteration in the T-cytotoxic cell (CD8) count, CD4 percentage or HIV-1 RNA load during the study period. The T-helper cell and natural killer cell counts recovered to pre-treatment levels within 1 month of finishing chemotherapy. The recovery of B-cells was slower with pre-treatment levels only being achieved after 3 months. The recovery of CD4 T-cell count following completion of chemotherapy was more rapid than described for ARL patients who were not receiving concomitant HAART.


CONCLUSIONS
By combining chemotherapy with HAART, immune function is better maintained in the medium term. The CD4 T-cell count falls by 50% during chemotherapy and this will help to identify patients who require opportunistic infection prophylaxis during chemotherapy.
Powles
Tom
T
Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Imami
Nesrina
N
Nelson
Mark
M
Gazzard
Brian G
BG
Bower
Mark
M
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001402:B-Lymphocytes / Q000166:cytology; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D019002:CD56 Antigen; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007694:Killer Cells, Natural / Q000166:cytology; D018655:Lymphocyte Count; D016483:Lymphoma, AIDS-Related / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017452:Receptors, IgG; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019562:Viral Load
D019380:Anti-HIV Agents; D015415:Biomarkers; D019002:CD56 Antigen; D017320:HIV Protease Inhibitors; D017452:Receptors, IgG; D018894:Reverse Transcriptase Inhibitors