Our objective was to describe the CD4-mediated human immunodeficiency virus (HIV)-specific cell-mediated immunity (CMI) and its virologic and immunologic correlates in children with chronic HIV infection on highly active antiretroviral therapy (HAART). Twelve HIV-infected children on stable antiretroviral therapy with a median level of CD4؉ lymphocytes (CD4%) of 25.5% and a median viral load (VL) of 786 HIV RNA copies/ml were enrolled in this study. Nine of these children were also cytomegalovirus (CMV) seropositive. Blood mononuclear cells, stimulated with HIV and CMV antigens, were used to measure lymphocyte proliferation and to enumerate gamma interferon (IFN-␥)-producing CD4 ؉ cells. HIV CMI and CMV CMI were detected in similar proportions of patients and correlated with each other, although the HIV responses were less robust. HIV lymphocyte proliferation significantly increased with lower HIV VL and showed a trend to increase with higher CD4% and longer time on HAART. The in vitro IFN-␥ response to HIV or CMV was not affected by CD4%, VL, or HAART. Pediatric patients with established HIV infection on HAART frequently exhibit HIV CMI despite undetectable HIV replication. We concluded that the association between HIV CMI and CMV CMI indicates that the same factors govern responsiveness to either antigen.
Human immunodeficiency virus (HIV) preferentially destroys CD4ϩ T lymphocytes and interferes with the functioning of the immune system, weakening defenses against infectious agents. Highly active antiretroviral therapy (HAART) restores CD4 ϩ cell numbers and greatly decreases the incidence of opportunistic infections, indicating that significant immune recovery occurs in treated patients (17,23,28). Furthermore, individuals who previously met AIDS diagnostic criteria recover cytomegalovirus (CMV)-, Mycobacterium avium-, Mycobacterium intracellulare-, and Candida-specific cell-mediated immunity (CMI) while on HAART (8,15,18).AIDS-associated impairment of the immune system includes the inability of the host to mount a protective response against HIV (21, 27). Although HIV-specific CD8-mediated cytotoxicity as detected in HIV-infected patients plays a protective role against the progression of infection (6, 13, 25), CD4-mediated immunity has been difficult to identify. Long-term nonprogressors and patients treated soon after primary infection display HIV-specific CD4-dependent lymphocyte proliferation (1, 20), but most chronically infected adults, including HAART recipients, do not (24, 29).The objective of this study was to compare the HIV-and CMV-specific CD4-mediated responses of HIV-infected children on HAART by using two recently developed and highly sensitive immunological assays, the enzyme-linked immunospot (ELISPOT) assay (32) and intracellular cytokine flow enumeration (ICCK) (34), coupled with an inactivated whole-HIV antigen preparation (3, 26).(Part of this study was presented at the 9th Conference on Retroviruses and Opportunistic Infections, 2002.)
MATERIALS AND METHODS
Patients.The study enrolled...