title: Rebound of residual plasma viremia after initial decrease following addition of intravenous immunoglobulin to effective antiretroviral treatment of HIV.
abstract: BACKGROUND
  High dosage of intravenous immunoglobulin (IVIG) has been observed as a possible activator of HIV gene expression in latently infected resting CD4+ T-cells, leading to a substantial decrease in both the reservoir and the residual plasma viremia when added to effective ART. IVIG treatment has also been reported to expand T regulatory cells (Tregs). The aim of this study was to evaluate possible long-term effect of IVIG treatment on residual viremia and T-lymphocyte activation.
  
  
  METHODS
  Nine HIV-infected subjects on effective ART included in a previously reported study on IVIG treatment were evaluated 48-104 weeks after therapy. In addition, 14 HIV-infected controls on suppressive ART were included. HIV-1 RNA was analyzed in cell-free plasma by using an ultrasensitive PCR-method with a detection limit of 2 copies/mL. T-lymphocyte activation markers and serum interleukins were measured.
  
  
  RESULTS
  Plasma residual viremia rebounded to pre-treatment levels, 48-104 weeks after the initial decrease that was observed following treatment with high-dosage IVIG. No long-term effect was observed regarding T-lymphocyte activation markers, T-regulatory cells or serum interleukins. In a post-hoc analysis, a correlation between plasma HIV-1-RNA and CD4+ T-cell count was found in both IVIG-treated patients and controls.
  
  
  CONCLUSIONS
  These results indicate that the decrease in the latent HIV-1 pool observed during IVIG treatment is transient. Although not our primary objective, we found a correlation between HIV-1 RNA and CD4+ T-cell count suggesting the possibility that patients with a higher CD4+ T-cell count might harbor a larger residual pool of latently infected CD4+ T-cells.
authors.affiliation: Department of Infectious Diseases, University of Gothenburg, Sahlgrenska University Hospital, Sweden. tomas.mellberg@infect.gu.se.
authors.forename: Tomas
authors.initials: T
authors.lastname: Mellberg
authors.forename: Veronica D
authors.initials: VD
authors.lastname: Gonzalez
authors.forename: Annica
authors.initials: A
authors.lastname: Lindkvist
authors.forename: Arvid
authors.initials: A
authors.lastname: Edén
authors.forename: Anders
authors.initials: A
authors.lastname: Sönnerborg
authors.forename: Johan K
authors.initials: JK
authors.lastname: Sandberg
authors.forename: Bo
authors.initials: B
authors.lastname: Svennerholm
authors.forename: Magnus
authors.initials: M
authors.lastname: Gisslén