title: Restoration of human immunodeficiency virus-1-specific responses in patients changing from protease to non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy.
abstract: The effect of altering antiretroviral therapy (ART) on responses to viral, recall and human immunodeficiency virus (HIV)-1-specific recombinant antigens and interleukin-2 (IL-2) in HIV-1-infected patients was assessed. A longitudinal cohort study in eight HIV-1 infected individuals following a clinically indicated therapy change (seven for drug intolerance and one for virological failure) from protease inhibitor (PI) to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral regimens was performed. CD4 T-cell counts, viral loads, lymphoproliferative responses, cytokine production and latent proviral deoxyribonucleic acid (DNA) were measured at baseline and at weeks 12 and 24 after therapy substitution. Following therapy-switch there was a 33% proportional increase in mitogen response (95% confidence interval (CI), 3-33%) and a 31% increase (95% CI, 15-48%) in viral and recall-antigen responses. Six patients developed proliferative responses to low concentration IL-2 stimulation. All patients demonstrated an increase in median HIV-1-specific responses, as three had detectable virus at baseline (two being viral rebound); this may reflect an autovaccination effect. Proviral DNA changes largely reflected plasma HIV-1 ribonucleic acid (RNA). In conclusion, NNRTI substitution for a PI may favour immune reconstitution with an improvement in HIV-1-specific responses, which may reflect differential effects on antigen processing and presentation, an autovaccination effect or alternatively a potential suppressive effect of the PI.
authors.affiliation: Department of Immunology, ICSTM, Chelsea and Westminster Hospital, London, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Sullivan
authors.forename: C T
authors.initials: CT
authors.lastname: Burton
authors.forename: M R
authors.initials: MR
authors.lastname: Nelson
authors.forename: G
authors.initials: G
authors.lastname: Moyle
authors.forename: S
authors.initials: S
authors.lastname: Mandalia
authors.forename: F M
authors.initials: FM
authors.lastname: Gotch
authors.forename: B G
authors.initials: BG
authors.lastname: Gazzard
authors.forename: N
authors.initials: N
authors.lastname: Imami
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D066298:In Vitro Techniques; D007376:Interleukin-2 / Q000096:biosynthesis; D015847:Interleukin-4 / Q000096:biosynthesis; D008137:Longitudinal Studies; D008213:Lymphocyte Activation / Q000187:drug effects; D011533:Proviruses / Q000187:drug effects / Q000302:isolation & purification; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D014766:Viremia / Q000188:drug therapy / Q000276:immunology
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D017320:HIV Protease Inhibitors; D007376:Interleukin-2; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D015847:Interleukin-4