title: The value of preserving HIV-specific immune responses.
abstract: HIV-1 infection is characterised by persistent viraemia and a progressive decline in both number and function of CD4 T-helper lymphocytes. The inability to contain viral replication presumably results from the lack of an effective HIV-1-specific immune response observed in most HIV-infected individuals. The persistent viraemia and decline in the number and function of CD4 cells lead to a further loss of immunity to HIV-1 as well as to opportunistic pathogens. Highly active antiretroviral therapy (HARRT) has been shown to reconstitute pathogen-specific immune responses in a majority of subjects, with a dramatic drop in the morbidity and mortality caused by opportunistic infections. By contrast, HIV-1-specific immunity remains largely ineffective and most people with chronic HIV-1 infection cannot control viraemia after interruption of HARRT, indicating a need to develop new strategies to maintain and improve HIV-1-specific immunity. Here we review the relative role of CD4 T-helper cells in the immune response against HIV infection and their contribution to cell-mediated immune responses to other pathogens infecting people with AIDS. In addition, we discuss the concepts of: supervised treatment interruptions, therapeutic and preventive vaccination, optimisation of antigen presentation and T-cell priming by ex vivo stimulated and expanded dendritic cells.
authors.affiliation: Massachusetts General Hospital, Division of Infectious Disease, Gray J 529, 55 Fruit Street, GRJ 529, Boston, MA 02114, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Kaufmann
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rosenberg
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control; D000818:Animals; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D007111:Immunity, Cellular; D007155:Immunologic Factors / Q000627:therapeutic use; D007376:Interleukin-2 / Q000235:genetics / Q000627:therapeutic use; D018655:Lymphocyte Count; D016176:T-Lymphocyte Subsets; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D019444:Vaccines, DNA / Q000008:administration & dosage / Q000627:therapeutic use; D014766:Viremia / Q000276:immunology
chemical_list: D019380:Anti-HIV Agents; D007155:Immunologic Factors; D007376:Interleukin-2; D019444:Vaccines, DNA