Gr. Kaufmann et al., Relative significance of different pathways of immune reconstitution in HIV type 1 infection as estimated by mathematical modeling, AIDS RES H, 17(2), 2001, pp. 147-159
A major goal of antiretroviral HIV-1 therapy is the reversal of HIV-1-assoc
iated immunological dysfunction, However, the pathogenetic mechanisms invol
ved and their significance are largely unknown. On the basis of the life cy
cle of naive, activated, and memory CD4(+) T cell subsets, a mathematical m
odel of immune reconstitution was developed and applied to data for T cell
subsets in individuals with acute or chronic HIV-1 infection receiving anti
retroviral therapy. The final model that most accurately fitted the data, a
nd resulted in realistic estimates for CD4(+) T cell turnover, considered t
hree pathways of immune reconstitution for naive cells, including thymic pr
oduction, peripheral expansion, and redistribution of naive cells from lymp
hoid tissue. The reconstitution of the memory compartment. was fitted throu
gh differentiation and expansion of naive cells and peripheral expansion of
memory cells as well as redistribution of memory cells trapped in the lymp
hoid tissue. Estimated median half-lives for naive and memory CD4(+) T cell
s were 114 and 21 days, while total production rates were 9.1 x 10(7) and 2
.4 x 10(9) cells/day, respectively. Peripheral expansion and thymic product
ion contributed equally to the regeneration of naive cells, but peripheral
expansion of memory cells was larger than production of these cells by diff
erentiation of naive cells. A comparison of immune reconstitution in acute
and chronic HIV-1 infection revealed that, after adjustment for age, the ma
in difference was the more rapid release of a larger number of naive cells
in treated acute HIV-1 infection. Thymic function and peripheral expansion
rates, however, were similar in both cohorts.