A study of the immunology, virology, and safety of prednisone in HIV-1-infected subjects with CD4 cell counts of 200 to 700 mm(-3).
Adult Clinical Trials Group Study 349 examined the immunology, virology, and safety of 40 mg/d prednisone as an adjunct to antiretroviral therapy in 24 HIV-infected subjects with >200 CD4+ T cells/mm in a randomized placebo-controlled trial. After 8 weeks, median lymphocyte and CD4+ cell numbers increased >40% above baseline values (p =.08). No effect was observed on markers of cell activation or apoptosis, although the proportion of CD28+ CD8+ T cells increased (p =.006). Prednisone inhibited monocyte TNFalpha production without affecting T-cell responses to antigens or mitogens. Two subjects assigned to prednisone were subsequently found to have asymptomatic osteonecrosis of the hip. Many questions remain regarding the role of activation-induced sequestration and apoptosis as causes of progressive CD4+ T-cell loss in AIDS. The potential role of corticosteroids as tools to examine this question will be limited by concerns regarding their toxicity; however, further studies of other agents to limit cellular activation in AIDS are warranted.
Wallis
Robert S
RS
The University Medicine and Dentistry of New Jersey--New Jersey Medical School, Newark, USA. r.wallis@umdnj.edu
Kalayjian
Robert
R
Jacobson
Jeffrey M
JM
Fox
Lawrence
L
Purdue
Lynette
L
Shikuma
Cecilia M
CM
Arakaki
Richard
R
Snyder
Stuart
S
Coombs
Robert W
RW
Bosch
Ronald J
RJ
Spritzler
John
J
Chernoff
Miriam
M
Aga
Evgenia
E
Myers
Laurie
L
Schock
Barbara
B
Lederman
Michael M
MM
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D017209:Apoptosis; D018106:CD28 Antigens / Q000032:analysis; D018791:CD4 Lymphocyte Count; D016827:CD8 Antigens / Q000032:analysis; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D018655:Lymphocyte Count; D010020:Osteonecrosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D011239:Prednisolone / Q000009:adverse effects / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D011859:Radiography; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000096:biosynthesis
D019380:Anti-HIV Agents; D018106:CD28 Antigens; D016827:CD8 Antigens; D012367:RNA, Viral; D014409:Tumor Necrosis Factor-alpha; D011239:Prednisolone