Immune restoration disease after the treatment of immunodeficient HIV‐infected patients with highly active antiretroviral therapy
Martyn A. French,Nat Lenzo,Mina John,Simon Mallal,Elizabeth McKinnon,Ian James,Patricia Price,James Flexman,M-L. Tay-Kearney +8 more
Reads0
Chats0
TLDR
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.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.read more
Citations
More filters
DatasetDOI
Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
TL;DR: The most recent version of the guidelines for the prevention and treatment of opportunistic infections (OI) in HIV-infected adults and adolescents was published in 2002 and 2004, respectively as mentioned in this paper.
Journal ArticleDOI
General Principles of Antimicrobial Therapy
TL;DR: By following the general principles of antimicrobial stewardship, all practicing physicians should be able to use antimicrobial agents in a responsible manner that benefits both the individual patient and the community.
Journal ArticleDOI
Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis.
TL;DR: Metaregression analyses showed that the risk of IRIS is associated with CD4 cell count at the start of ART, with a high risk in patients with fewer than 50 cells per microL, and might be reduced by initiation of ART before immunodeficiency becomes advanced.
Journal ArticleDOI
Immune restoration disease after antiretroviral therapy.
TL;DR: Differentiation of IRD from an opportunistic infection is important because IRD indicates a successful, albeit undesirable, effect of HAART, and it is also important to differentiateIRD from drug toxicity to avoid unnecessary cessation ofHAART.
Journal ArticleDOI
Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy
Samuel A. Shelburne,Fehmida Visnegarwala,Jorge Darcourt,Edward A. Graviss,Thomas P. Giordano,A. Clinton White,Richard J. Hamill,Richard J. Hamill +7 more
TL;DR: IRIS is common among HIV-infected persons coinfected with M. tuberculosis, M. avium complex, or C. neoformans and patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV-1 RNA level should be monitored for development of this disorder.
References
More filters
Journal ArticleDOI
Positive Effects of Combined Antiretroviral Therapy on CD4+ T Cell Homeostasis and Function in Advanced HIV Disease
Brigitte Autran,Guislaine Carcelain,T.S. Li,Catherine Blanc,Dominique Mathez,R. Tubiana,C. Katlama,Patrice Debré,Jacques Leibowitch +8 more
TL;DR: In this article, a three-phase T cell reconstitution was demonstrated after HAART, with an early rise of memory CD4(+) cells, a reduction in T cell activation correlated to the decreasing retroviral activity together with an improved CD4+ T cell reactivity to recall antigens.
Journal ArticleDOI
Paradoxical Worsening of Tuberculosis Following Antiretroviral Therapy in Patients with AIDS
TL;DR: In this paper, the incidence of paradoxical responses in patients with AIDS and TB who are treated with antituberculous therapy and subsequently with combination antiretroviral therapy (ARV) was determined.
Journal ArticleDOI
Long-lasting recovery in CD4 T-cell function and viral-load reduction after highly active antiretroviral therapy in advanced HIV-1 disease
TL;DR: HAART can induce sustained recovery of CD4 T-cell reactivity against opportunistic pathogens in severely immunosuppressed patients, and this recovery depends not on baseline values but on the amplitude and duration of viral-load reduction and the increase of memoryCD4 T cells.
Journal ArticleDOI
Immunologic Responses Associated with 12 Weeks of Combination Antiretroviral Therapy Consisting of Zidovudine, Lamivudine, and Ritonavir: Results of AIDS Clinical Trials Group Protocol 315
Michael M. Lederman,Elizabeth Connick,Alan L. Landay,Daniel R. Kuritzkes,John Spritzler,Marty St. Clair,Brian L. Kotzin,Lawrence Fox,Margo Heath Chiozzi,John M. Leonard,Franck Rousseau,Michael Wade,Joana D'Arc Roe,Ana Martinez,Harold A. Kessler +14 more
TL;DR: Dysregulated immune activation was partially corrected by this regimen; however, the perturbed expression of T cell receptor V regions in the CD4 and CD8 T lymphocyte populations was not significantly affected.
Journal ArticleDOI
Restoration of cytomegalovirus-specific CD4+ T-lymphocyte responses after ganciclovir and highly active antiretroviral therapy in individuals infected with HIV-1
Krishna V. Komanduri,Mohan N. Viswanathan,Eric D. Wieder,D K Schmidt,Barry M. Bredt,Mark A. Jacobson,Joseph M. McCune +6 more
TL;DR: Data indicate that the loss of CMV-specific CD4+ lymphocyte responses in individuals infected with HIV-1 who have active CMV EOD may be restored after ganciclovir therapy and HAART, which provides evidence for functional immune reconstitution to an important pathogen.