Immunological effects of antiretroviral therapy

The striking decline in HIV load with highly active antiretroviral combinat ion therapy (HAART) is accompanied by substantial improvements in immune fu nction, even in patients with move advanced disease. These include a genera l reduction in immune activation with increases in total CD4 and CD8 cell c ounts, memory and naive T cell subsets and antigen responses to certain opp ortunistic pathogens. At this time, it appears that HAART-induced improveme nts in function are limited to those T cells that have not yet been complet ely depleted by HIV. Long-term studies are needed to determine whether comp lete functional restoration of the repertoire is possible. Clinically, HAAR T improves survival and reduces progression of HIV disease. Some patients w ith active opportunistic disorders demonstrate complete or partial resoluti on of the infection or malignancy. However, persons with subclinical Mycoba cterium avium complex or cytomegalovirus retinitis and those with chronic h epatitis B virus infection may sometimes experience acute flares if prophyl actic therapy against the underlying disorder is not included in the regime n.