Early and late effects of highly active antiretroviral therapy: a 2 year follow-up of antiviral-treated and antiviral-naive chronically HIV-infected patients.
BACKGROUND
Control of HIV replication can be observed in highly active antiretroviral therapy (HAART)-treated and, occasionally, in HAART-naive patients. The immunological correlates of these situations were examined in a longitudinal study.


METHODS
A prospective study. Immunovirological analyses in 16 chronically HIV-infected, HAART-naive patients (time 0) who started HAART. Fifteen patients (short-term HAART) were re-evaluated after 24 months (time 1). Results were compared with those of 30 patients who received HAART for more than 12 months before the study period (long-term HAART) and were analysed at the same timepoints. Fifteen patients who were antiviral therapy naive (naive) at both timepoints were also studied.


RESULTS
Over a 24-month period CD4 and CD8 cell counts and viraemia remained unchanged in naive and long-term HAART patients; CD4 cell counts increased and viraemia diminished in short-term HAART individuals. Antigen-stimulated proliferation was unmodified in naive and short-term HAART patients, but improved in long-term HAART individuals. Gp160-stimulated IL-2 and IFN-gamma production was augmented in long-term HAART patients and marginally modified in other patients. IL-7 production was unmodified in naive individuals, augmented in short-term HAART patients, and diminished in long-term HAART patients. Chemokine production was similar in all patients. Naive patients showed the highest CD8 cell counts at both timepoints.


CONCLUSIONS
HAART has a major impact on the outcome of HIV infection, even if functional immune modulation in HAART-treated patients is evident only after long periods of therapy. Low but detectable HIV replication in HAART-naive patients with preserved immune functions might not be associated with CD4 cell reduction, functional immune defects, or changes in viraemia.
Clerici
Mario
M
Cattedra di Immunologia, Università degli Studi di Milano, DISP LITA Vialba, Milano, Italy. mago@mailserver.unimi.it
Seminari
Elena
E
Maggiolo
Franco
F
Pan
Angelo
A
Migliorino
Marco
M
Trabattoni
Daria
D
Castelli
Francesco
F
Suter
Fredy
F
Fusi
Maria Luisa
ML
Minoli
Lorenzo
L
Carosi
Giampiero
G
Maserati
Renato
R
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D015851:Interleukin-7 / Q000378:metabolism; D008137:Longitudinal Studies; D011446:Prospective Studies; D016896:Treatment Outcome; D019562:Viral Load; D014766:Viremia / Q000821:virology
D016207:Cytokines; D015851:Interleukin-7