title: Restoration of T cell responses to toxoplasma gondii after successful combined antiretroviral therapy in patients with AIDS with previous toxoplasmic encephalitis.
abstract: BACKGROUND
  It is unknown whether a Toxoplasma gondii-specific T cell response is restored after successful combined antiretroviral therapy (cART) in patients with AIDS and current or previous toxoplasmic encephalitis (TE).
  
  
  METHODS
  We performed a multicenter cross-sectional study with 17 healthy T. gondii-positive human immunodeficiency virus (HIV)-1-uninfected individuals and 90 patients coinfected with HIV-1 and T. gondii distributed in 5 groups according to their CD4(+) T cell counts and T. gondii infection (with or without current or previous TE). We investigated the lymphocyte proliferative response (LPR) and interferon (IFN)-γ production in response to T. gondii soluble antigen extract (SATg) and as CD4(+) and CD8(+) T cell subsets.
  
  
  RESULTS
  SATg-specific LPR and IFN-γ production were not observed in many of the most immunosuppressed patients (CD4(+) T cell count, <200 cells/μL, with or without current or previous TE). By contrast, these responses occurred in a considerable percentage (LPR, 43%; IFN-γ production, 80%) of patients receiving successful cART (CD4(+) T cell count, >200 cells/μL) who presented with TE and had already stopped secondary TE prophylaxis. Similar results were found in immunocompetent asymptomatic patients who did not receive TE prophylaxis. The predictors of SATg-specific T cell responses and IFN-γ production were a cART-mediated increase in CD4(+) T cell count and LPR to phytohemagglutinin and viral suppression and a decrease in the activated (CD38(+)) CD8(+) T cell count, respectively.
  
  
  CONCLUSIONS
  cART restores T. gondii-specific CD4 T cell responses in most patients with AIDS who had previous TE. Our data support the safety of withdrawing TE prophylaxis when the CD4(+) T cell count returns to levels >200 cells/μL.
authors.affiliation: Immunology Service, Hospital Clinic-Institut d'Investigacions Biomèdiques Augustí Pi i Suñer, University of Barcelona, Barcelona, Spain.
authors.forename: Marylène
authors.initials: M
authors.lastname: Lejeune
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.forename: Elisa
authors.initials: E
authors.lastname: De Lazzari
authors.forename: Felipe
authors.initials: F
authors.lastname: García
authors.forename: Xavier
authors.initials: X
authors.lastname: Claramonte
authors.forename: Esteban
authors.initials: E
authors.lastname: Martínez
authors.forename: Esteban
authors.initials: E
authors.lastname: Ribera
authors.forename: Julio
authors.initials: J
authors.lastname: Arrizabalaga
authors.forename: José R
authors.initials: JR
authors.lastname: Arribas
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrer
authors.forename: Montserrat
authors.initials: M
authors.lastname: Plana
authors.forename: María-Eugenia
authors.initials: ME
authors.lastname: Valls
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
authors.forename: Tomás
authors.initials: T
authors.lastname: Pumarola
authors.forename: Alain
authors.initials: A
authors.lastname: Jacquet
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
authors.forename: José M
authors.initials: JM
authors.lastname: Gatell
authors.forename: Teresa
authors.initials: T
authors.lastname: Gallart
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000953:Antigens, Protozoan / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D049109:Cell Proliferation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D014122:Toxoplasma / Q000276:immunology*; D016781:Toxoplasmosis, Cerebral / Q000276:immunology*
chemical_list: D019380:Anti-HIV Agents; D000953:Antigens, Protozoan; D007371:Interferon-gamma