Immunological recovery and antiretroviral therapy in HIV-1 infection

Battegay, Manuel; Nüesch, Reto; Hirschel, Bernard; Kaufmann, Gilbert R.

doi:10.1016/s1473-3099(06)70463-7

Cited by 215 publications

(179 citation statements)

References 98 publications

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“…Potent antiretroviral therapy in HIV-infected patients leads to a suppression of the HIV load and to a concomitant increase in the number of CD4+ T cells [1][2][3] in the peripheral blood. However, the regulatory processes that are important for immune recovery take place in the lymphoid tissue which acts as a viral reservoir and major site of HIV replication.…”

Section: Introductionmentioning

confidence: 99%

Effect of Antiretroviral Therapy on Apoptosis Markers and Morphology in Peripheral Lymph Nodes of HIV-Infected Individuals

et al. 2008

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Background: CD4+ T cell depletion and destruction and the involution of the lymphoid tissue are hallmarks of HIV infection. Although the underlying mechanisms are still unclear, apoptosis appears to play a central role. The objective of this study was to investigate the effect of antiretroviral therapy on the lymph node tissue, particularly with respect to morphology and apoptosis. Patients and Methods: Between 1997 and 1999, two inguinal lymph nodes were excised from 31 previously untreated individuals who were in an early stage of HIV infection, the first one prior to treatment and the second after 16 to 20 months of treatment. Paraffin sections were investigated for lymph node architecture, distribution of cellular and viral markers, apoptosis, and expression of apoptotic key molecules which indirectly reflect apoptotic processes.

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Section: Introductionmentioning

confidence: 99%

Effect of Antiretroviral Therapy on Apoptosis Markers and Morphology in Peripheral Lymph Nodes of HIV-Infected Individuals

et al. 2008

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“…7,8 HAART promotes immune reconstitution in the peripheral blood and in the lymph nodes through the indirect induction of homeostatic memory T-cell proliferation and the production of new lymphocytes. 9 However, despite efficient suppression of viral replication and CD4 ϩ T-cell reconstitution by prolonged HAART treatment in the blood and in lymphoid tissues, CD4 ϩ T-cell restoration at mucosal sites generally does not occur 10 or is partial, 11 even though optimal restoration of gut CD4 ϩ T cells has been described in a single report. 12 Factors such as ongoing T-cell activation or a low nadir of the CD4 ϩ T-cell count before therapy initiation are predictive of this restoration.…”

Section: Introductionmentioning

confidence: 99%

IL-15 delays suppression and fails to promote immune reconstitution in virally suppressed chronically SIV-infected macaques

Lugli

Mueller

Lewis

et al. 2011

Blood

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“…These were most prominent in the lung apices ( Figure 2). The patient was asymptomatic, had been compliant with therapy and had a CD4 + count of 266 cells/mm 3 .…”

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confidence: 99%

“…Chest imaging revealed bilateral ground-glass infiltrates, and Pneumocystis jiroveci pneumonia (PCP) was confirmed by bronchoalveolar lavage (BAL) analysis. The patient was subsequently found to be positive for HIV, with a CD4 + lymphocyte count of 16 cells/mm 3 , an HIV viral load >5×10 6 copies/ mL and evidence of HIV dementia. He responded to a 21-day course of trimethoprim-sulfamethoxazole and prednisone, and was started on highly active antiretroviral therapy (HAART) shortly before completing treatment for PCP.…”

mentioning

confidence: 99%

“…He responded to a 21-day course of trimethoprim-sulfamethoxazole and prednisone, and was started on highly active antiretroviral therapy (HAART) shortly before completing treatment for PCP. Two months after initiating HAART, his CD4 + count had increased to 359 cells/mm 3 and his HIV viral load was 3.1×10 4 copies/mL. Due to an allergic reaction to sulfamethoxazole, PCP prophylaxis was discontinued.…”

mentioning

confidence: 99%

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Granulomatous Pneumocystis Jiroveci Pneumonia Associated With Immune Reconstituted Hiv

Sabur

Pendharkar

Kelly

et al. 2008

Chest

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A 40-year-old man presented with progressive cough, dyspnea and 20 kg weight loss over several weeks. Chest imaging revealed bilateral ground-glass infiltrates, and Pneumocystis jiroveci pneumonia (PCP) was confirmed by bronchoalveolar lavage (BAL) analysis. The patient was subsequently found to be positive for HIV, with a CD4 + lymphocyte count of 16 cells/mm 3 , an HIV viral load >5×10 6 copies/ mL and evidence of HIV dementia. He responded to a 21-day course of trimethoprim-sulfamethoxazole and prednisone, and was started on highly active antiretroviral therapy (HAART) shortly before completing treatment for PCP. Two months after initiating HAART, his CD4 + count had increased to 359 cells/mm 3 and his HIV viral load was 3.1×10 4 copies/mL. Due to an allergic reaction to sulfamethoxazole, PCP prophylaxis was discontinued. A routine chest radiograph performed four months later revealed multiple bilateral pulmonary nodules (Figure 1). Subsequent chest computed tomography (CT) scans confirmed the presence of multiple homogeneous and noncalcified pulmonary nodules, several of which were cavitary. These were most prominent in the lung apices (Figure 2). The patient was asymptomatic, had been compliant with therapy and had a CD4 + count of 266 cells/mm 3 .During the following year, the patient developed malaise, cough and wheeze. His CD4 + count had been consistently >250 cells/mm 3 for the previous seven months, with undetectable HIV viral loads. Chest CT revealed progression of the pulmonary nodules. Bronchoscopy with BAL and transbronchial biopsy was performed, in addition to transthoracic needle biopsy. Direct fluorescent antibody testing for pneumocystis was negative on all specimens, and bacterial culture, cytology and acid-fast bacillus (AFB) smears were consistently negative. Thoracoscopic lung biopsy was ultimately performed, and confirmed the presence of necrotizing granulomas containing Pneumocystis organisms surrounded by a hyalinized capsule (Figure 3). Treatment was initially deferred because the patient's symptoms were mild and not clearly attributable to PCP infection. However, the patient's symptoms progressed to include drenching night sweats, worsening cough and progressive dyspnea. He was subsequently treated for PCP with atovaquone, despite a CD4 + count of 374 cells/mm 3 . Within two weeks, his symptoms resolved, his weight increased and his diffusing capacity for carbon monoxide increased from 62% predicted to 87% predicted. A repeat chest CT scan three months later showed no significant change in the pulmonary nodules.

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Immunological recovery and antiretroviral therapy in HIV-1 infection

Cited by 215 publications

References 98 publications

Effect of Antiretroviral Therapy on Apoptosis Markers and Morphology in Peripheral Lymph Nodes of HIV-Infected Individuals

Effect of Antiretroviral Therapy on Apoptosis Markers and Morphology in Peripheral Lymph Nodes of HIV-Infected Individuals

IL-15 delays suppression and fails to promote immune reconstitution in virally suppressed chronically SIV-infected macaques

Granulomatous Pneumocystis Jiroveci Pneumonia Associated With Immune Reconstituted Hiv

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