Highly active antiretroviral therapy in human immunodeficiency virus type 1-infected children: Analysis of cellular immune responses

The present study analyzes the effect of highly active antiretroviral thera py (HAART) on restoration of cellular immunity in human immunodeficiency vi rus (HIV)-infected children over a 24-week period following initiation of H AART with ritonavir, nevirapine, and stavudine. The immunological parameter s evaluated at four time points (at enrollment and at 4, 12, and 24 weeks o f therapy) included cytokine production by monocytes as well as T-cell prol iferation in response to mitogen, alloantigen, and recall antigens includin g HIV type 1 envelope peptides. Circulating levels of interleukin-16 (IL-16 ) were measured, in addition to CD4(+) T-cell counts, plasma HIV RNA levels , and the delayed-ty-pe hypersensitivity (DTH) response. At enrollment the children exhibited defects in several immune parameters measured. Therapy i ncreased CD4(+) T-cell counts and decreased viral loads significantly. By c ontrast, the only immunological parameter that was significantly increased was IL-12 p70 production by monocytes; the DTH response to Candida albicans also showed a strong increase in patients becoming positive. In conclusion , these results demonstrate that HAART in HIV-infected children affects the dynamics of HIV replication and the CD4(+) T-cell count over 24 weeks, sim ilar to the pattern seen in HIV-infected adults. Furthermore, these data in dicate improvement in antigen-presenting cell immunological function in HIV -infected children induced by HAART.