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[Complete immune and clinical recovery after highly active antiretroviral therapy in advanced vertically HIV-1 infected children].

Abstract：

BACKGROUND AND OBJECTIVE:The aim of this study was to evaluate the ability of long-term highly active antiretroviral therapy (HAART) to fully reconstitute the immune system in children with severe AIDS. PATIENT AND METHOD:Lymphoproliferative responses (LPR) were evaluated by incorporation of [3H]-thymidine. Cytokine production in culture (IFN- gamma, IL-5) was quantified using commercially available specific ELISA assays. T-cells subsets were determined by 3-color flow cytometry and thymic production of T-cells was assessed by quantification of TCR rearrangement excision circles (TRECs). RESULTS:We present a vertically HIV-1-infected child at clinical category C, with long-standing CD4+ T-cells below 50/l, who was monitored during 3-years after starting HAART by quantifying the viral load (VL), naïve, memory, and activated T-cell subsets, and thymical function as well as clinical events. VL was suppressed to undetectable levels since the beginning of HAART with d4T, 3TC, nelfinavir, and efavirenz resulting in a dramatic immune reconstitution, achieving normal CD4+ T-cells counts after 6 months (25%, 597 CD4+ T-cells/l) and perdurable undetectable VL levels. Naïve CD4 and CD8 T-cells increased in parallel to TCR rearrangement excision circles (TRECs) levels, with a concomitant decrease in T-cell activation markers. Interestingly, the patient showed an increase in the lymphoproliferative responses to PHA; the IFN-gamma production by PBMCs increased with HAART while the production of IL-5 diminished, thus indicating a switch of type 2 to type 1 response. He recovered clinically and immunologically (up to normal levels) and remains asymptomatic at present. CONCLUSION:This report demonstrates that at least in these children, an immune and clinical recovery from an advanced stage of HIV-disease can be possible throught HAART.

journal_name

Med Clin (Barc)

journal_title

Medicina clinica

authors

Resino S,Sánchez-Ramón S,Correa R,Navarro ML,Bellón JM,Muñoz-Fernández MA

doi

10.1016/s0025-7753(03)73723-3

keywords:

subject

Has Abstract

pub_date

2003-03-29 00:00:00

pages

417-20

issue

eissn

0025-7753

issn

1578-8989

pii

S0025-7753(03)73723-3

journal_volume

120

pub_type

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[Complete immune and clinical recovery after highly active antiretroviral therapy in advanced vertically HIV-1 infected children].