Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy.

Abstract

BACKGROUND:

To determine if infectious disease events in HIV-infected patients treated with highly active antiretroviral therapy (HAART) are a consequence of the restoration of pathogen-specific immune responses, a single-centre retrospective study of all HIV-infected patients commencing HAART prior to 1 July 1997 was undertaken to determine the incidence, characteristics and time of onset of disease episodes in HAART responders (decrease in plasma HIV RNA of > 1 log10 copies/mL).

METHODS:

Baseline and post-therapy changes in CD4 T-cell counts and HIV RNA were compared in patients with and without disease and delayed-type hypersensitivity responses to mycobacterial antigens were measured in selected patients.

RESULTS:

Thirty-three of 132 HAART responders (25%) exhibited one or more disease episodes after HAART, related to a pre-existent or subclinical infection by an opportunistic pathogen. Disease episodes were most often related to infections by mycobacteria or herpesviruses but hepatitis C virus (HCV), molluscum contagiosum virus and human papilloma virus were also implicated. They were most common in patients with a baseline CD4 T-cell count of < 50/uL and occurred most often during the first 2 months of therapy and when CD4 T-cell counts were increasing. Mycobacteria- and HCV-related diseases were associated with restoration of pathogen-specific immune responses.

CONCLUSIONS:

We conclude that improved immune function in immunodeficient patients treated with HAART may restore pathogen-specific immune responses and cause inflammation in tissues infected by those pathogens.

• Authors: M A French, N Lenzo, M John, S A Mallal, E J McKinnon, I R James, P Price, J P Flexman, M L Tay-Kearney
• Journal: HIV medicine (HIV Med) Vol. 1 Issue 2 Pg. 107-15 (Mar 2000) ISSN: 1464-2662 [Print] England
• PMID: 11737333 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• AIDS-Related Opportunistic Infections (immunology)
• Adult
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• Female
• HIV Infections (drug therapy, immunology)
• Humans
• Immune System (drug effects)
• Immunocompromised Host
• Male
• Retrospective Studies
• Treatment Outcome