NUMBER OF STUDIES HAVE REported the dramatic decreases in mortality among individuals infected with human immunodeficiency virus (HIV) since the widespread introduction of highly active antiretroviral therapy (HAART) in industrialized countries. 1,2 It is important to provide upto-date and robust estimates of expected mortality as anti-HIV drugs and strategies continue to improve. Such estimates help policy makers and those planning health care to monitor the effectiveness of treatments at a population level and provide an indicator of the ongoing and likely future impact of HIV disease on health care needs.With mortality among HIV-infected individuals decreasing to relatively low levels compared with the pre-HAART era and with patients living to older ages, it is also of increasing interest to assess how mortality rates of HIV-infected individuals compare with those of the general uninfected population, ie, the "excess mortality." 3 Overall mortality of HIV-infected individuals is likely to be increasingly influenced by deaths that would have occurred regardless of HIV infection, and mortality in the general uninfected population provides a natural reference point for taking this into account. This concept has been used in studies of other diseases in which successfully treated patients frequently live for many years, such as Hodgkin disease 4 and thyroid 5 and other 6 cancers.

To study the functional integrity of T cells from human immunodeficiency virus type 1 (HIV-1)-infected persons, CD4+ and CD8+ cells were examined for proliferation and secretion of interleukin-2 (IL-2) in response to staphylococcal superantigens and antibodies to CD3 and the alpha beta T cell receptor. A functional defect within CD8+ but not within CD4+ cells from HIV-1-infected persons was observed. Within CD8+ cells, proliferation and secretion of IL-2 was restricted to cells expressing the costimulatory molecule CD28. Such cells were proportionally reduced in HIV-1-infected persons. In patients with advanced immunodeficiency, however, evidence of functional derangement was found also within the CD28+ CD8+ cells. In a cross-sectional study of 73 HIV-infected persons and 15 controls, a significant correlation was observed between the number of CD28+ CD8+ cells and the presence of HIV-related disease. Our results suggest that regulation of expression of CD28 may play an important role in the immunopathogenesis of AIDS.

Most patients experience virologic rebound soon after cART interruption; however, although PTCs are rare, the results of this study confirm their existence.

Our data support phylodynamic findings that HCV incidence had already increased among HIV-infected MSM from the mid-1990s. However, the main expansion of the HCV epidemic started after 2002. Incidence estimates obtained from cohort studies may help identify changes in the spread of important infections earlier and should guide routine testing policies to minimize further disease burden.

In most individuals, control occurred rapidly after seroconversion; however, more than 3 years were required to achieve control in 25% of HIV-controllers. Control may be sustained even when CD4⁺ cell levels are below 500 cells/μl, opening important new perspectives to understand the physiopathology underlying control.