Immune restoration after treatment of HIV-1 infection with highly active antiretroviral therapy (HAART).
The availability of combination antiretroviral therapy (HAART) has been associated with dramatic decreases in HIV-related morbidity and mortality. These clinical benefits are probably mediated by a decrease in HIV-1 replication and an increase in the number and function of peripheral blood CD4+ lymphocytes. Despite many years of maintaining plasma HIV-1 RNA levels below the limits of detection, many patients do not achieve normal CD4+ lymphocyte counts. A larger proportion of patients who delay HAART for longer have incomplete numerical CD4+ restoration compared to patients who start therapy earlier. Even in patients who normalize their CD4+ lymphocytes insert counts, immune function remains impaired among those who delay HAART for longer periods. Whether subclinical immune deficiency will be associated over longer periods of follow-up with adverse clinical outcomes such as an increased number of infections and malignancies remains to be determined. If prolonged subclinical immunodeficiency is associated with adverse outcomes, the use of immune-based therapies may benefits patients while helping us ascertain the residual deficits responsible for incomplete immune restoration.
Valdez
Hernan
H
Center for AIDS Research, Case Western Reserve University, University Hospitals of Cleveland, 2061 Cornell Road, Room 401B, Cleveland, OH 44106, USA. valdez.hernan@clevelandactu.org
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007114:Immunization; D008213:Lymphocyte Activation / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology* / Q000502:physiology; D016896:Treatment Outcome