[Complete immune and clinical recovery after highly active antiretroviral therapy in advanced vertically HIV-1 infected children].
OBJECTIVE
The aim of this study was to evaluate the ability of long-term highly active antiretroviral therapy (HAART) to fully reconstitute the immune system in children with severe AIDS.


METHODS
Lymphoproliferative responses (LPR) were evaluated by incorporation of [3H]-thymidine. Cytokine production in culture (IFN- gamma, IL-5) was quantified using commercially available specific ELISA assays. T-cells subsets were determined by 3-color flow cytometry and thymic production of T-cells was assessed by quantification of TCR rearrangement excision circles (TRECs).


RESULTS
We present a vertically HIV-1-infected child at clinical category C, with long-standing CD4+ T-cells below 50/l, who was monitored during 3-years after starting HAART by quantifying the viral load (VL), naïve, memory, and activated T-cell subsets, and thymical function as well as clinical events. VL was suppressed to undetectable levels since the beginning of HAART with d4T, 3TC, nelfinavir, and efavirenz resulting in a dramatic immune reconstitution, achieving normal CD4+ T-cells counts after 6 months (25%, 597 CD4+ T-cells/l) and perdurable undetectable VL levels. Naïve CD4 and CD8 T-cells increased in parallel to TCR rearrangement excision circles (TRECs) levels, with a concomitant decrease in T-cell activation markers. Interestingly, the patient showed an increase in the lymphoproliferative responses to PHA; the IFN-gamma production by PBMCs increased with HAART while the production of IL-5 diminished, thus indicating a switch of type 2 to type 1 response. He recovered clinically and immunologically (up to normal levels) and remains asymptomatic at present.


CONCLUSIONS
This report demonstrates that at least in these children, an immune and clinical recovery from an advanced stage of HIV-disease can be possible throught HAART.
Resino
Salvador
S
Servicio de Inmunología. Hospital General Universitario Gregorio Marañón. Madrid. Spain.
Sánchez-Ramón
Silvia
S
Correa
Rafael
R
Navarro
M Luisa
ML
Bellón
José M
JM
Muñoz-Fernández
M Angeles
MA
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D007156:Immunologic Memory / Q000187:drug effects*; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D016207:Cytokines