Role of immune activation in progression to AIDS

Abstract

Purpose of the review To review recent insights into the impact of HIV-associated immune activation on AIDS and non-AIDS morbidity and mortality. Recent findings Immune activation has long been recognized as an important consequence of untreated HIV infection and predictor of AIDS progression, which declines but fails to normalize during suppressive antiretroviral therapy (ART), and continues to predict disease in this setting. Thus, a major research agenda is to develop novel therapies to reduce persistent immune activation in treated HIV infection. Yet, the optimal targets for interventions remain unclear. Both the specific root causes of immune activation and the many interconnected pathways of immune activation that are most likely to drive disease risk in HIV-infected individuals remain incompletely characterized, but recent studies have shed new light on these topics. Summary In the context of this review, we will summarize recent evidence helping to elucidate the immunologic pathways that appear most strongly predictive of infectious and non-infectious morbidity. We will also highlight the likelihood that not all root drivers of immune activation - and the discrete immunologic pathways to which they give rise - are likely to produce the same disease manifestations and/or be equally attenuated by early ART initiation.

Prevalence and risk factors of metabolic syndrome in HIV‐infected adults at three urban clinics in a post‐conflict setting, eastern Democratic Republic of the Congo

“…Baseline socio-demographic characteristics, risk factors and clinical and laboratory findings by ART status Table 1 summarises the baseline socio-demographic characteristics, risk factors and clinical and laboratory findings of the cohort stratified by ART status. In total, 495 HIV-infected adults were enrolled; 474 (95.76%) were receiving ART (ART-exposed patients) and 21 (4.24%) were not on ART (ART-unexposed patients or newly diagnosed patients; Figure 1 The median [IQR] duration on ART was 5 years [2][3][4][5][6][7][8]. Four hundred and fifty-five (90.8%) and 46 (9.2%) of participants were on first-line NNRTI (efavirenz or nevirapine)-or second-line PI (LPV/r)-based ART regimens, respectively.…”

Flavivirus-Mediating B Cell Differentiation Into Antibody-Secreting Cells in Humans Is Associated With the Activation of the Tryptophan Metabolism

“…This metabolite has been associated with a tolerizating immune response, especially for T cells (47)(48)(49). It does not seem to be the case for DENV, HIV, and SIV infections since they enhance the immunological status of patients (50)(51)(52)(53)(54). Another common characteristic of these viral infections is the induction of hypergammaglobulinemia (55-59), a hallmark of B cell activity that augments the ASC frequencies (29,60,61).…”

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

“…1). 14,[23][24][25] However, none of these independent factors can fully explain the mechanism of incomplete immune reconstitution. At any time, the CD4 + T-cell counts in HIV-1-infected individuals are associated with the production, destruction, and migration between secondary lymphoid organs and peripheral tissues.…”