I. Mezzaroma et al., Long-term evaluation of T-cell subsets and T-cell function after HAART in advanced stage HIV-1 disease, AIDS, 13(10), 1999, pp. 1187-1193
Objectives: Evaluation of immunological reconstitution after 2 years of hig
hly active antiretroviral therapy (HAART) in AIDS patients.
Design: Previous data showed the effectiveness of HAART but conflicting evi
dence of immune reconstitution has been found in severely immunocompromised
patients. Therefore, T-cell subsets and functions were analysed during 24
months of HAART in 21 AIDS patients (mean baseline CD4 cell count, 20 x 10(
6)/l).
Methods: Subjects were tested at baseline and after 4, 12 and 24 months of
therapy for clinical symptoms and the following investigations were carried
out: plasma HIV RNA, T-cell subsets and lymphoproliferative responses to m
itogens (phytohaemagglutinin, anti-CD3), and recall antigens (Candida manno
protein, tetanus toroid and recombinant glycoprotein 160).
Results: Increase in body weight, improvement of Karnofsky's score and redu
ction of opportunistic infections were observed. All patients showed an ini
tial increase in the CD4 memory subset, whereas naive CD4 cells consistentl
y increased only after 1 year. The magnitude of immune recovery was stronge
r in patients showing a significant reduction in viral load. However seven
out of 21 patients who did not reach a sustained suppression of viral load
showed also an increase in T-cell subsets. The majority of patients recover
ed lymphoproliferative responses to mitogens, whereas only four subjects sh
owed a functional response to Candida mannoprotein. No patients showed a re
sponse to HIV recombinant glycoprotein 160 or tetanus toroid.
Conclusions: The immune recovery observed is slower and not complete in sev
erely immunocompromised patients. Our data suggest that HAART may be contin
ued also in the absence of a significant HIV RNA decrease if alternative dr
ugs are not available. (C) 1999 Lippincott Williams & Wilkins.