title: Residual immune dysregulation syndrome in treated HIV infection.
abstract: Antiretroviral therapy has revolutionized the course of HIV infection, improving immune function and decreasing dramatically the mortality and morbidity due to the opportunistic complications of the disease. Nonetheless, even with sustained suppression of HIV replication, many HIV-infected persons experience a syndrome characterized by increased T cell activation and evidence of heightened inflammation and coagulation. This residual immune dysregulation syndrome or RIDS is more common in persons who fail to increase circulating CD4+ T cells to normal levels and in several epidemiologic studies it has been associated with increased morbidity and mortality. These morbid and fatal events are not the typical opportunistic infections and malignancies seen in the early AIDS era but rather comprise a spectrum of cardiovascular events, liver disease, metabolic disorders, kidney disease, bone disease, and a spectrum of malignant complications distinguishable from the opportunistic malignancies that characterized the earlier days of the AIDS epidemic. While immune activation, inflammation, and coagulopathy are characteristic of untreated HIV infection and improve with drug-induced control of HIV replication, the drivers of RIDS in treated HIV infection are incompletely understood. And while inflammation, immune activation, and coagulopathy are more common in treated persons who fail to restore circulating CD4+ T cells, it is not entirely clear how these two phenomena are linked.
authors.affiliation: Division of Infectious Diseases and Center for AIDS Research, Case Western Reserve University and University Hospitals/Case Medical Center, Cleveland, Ohio, USA. lederman.michael@clevelandactu.org
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Funderburg
authors.forename: Rafick P
authors.initials: RP
authors.lastname: Sekaly
authors.forename: Nichole R
authors.initials: NR
authors.lastname: Klatt
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007113:Immunity, Innate; D007249:Inflammation / Q000276:immunology; D008213:Lymphocyte Activation; D008231:Lymphopenia / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; CD 127; CD14; CD163; CD38; Cell cycling; Coagulation; Cycling D-dimer; Gut-associated lymphoid tissue; HLA-DR; Immune activation; Immune failure; Indoleamine 2,3-dioxygenase; Inflammation; Interleukin-6 (IL-6); Lipopolysaccharide; Lymph node; Microbial translocation; Residual immune dysregulation syndrome