Continuous improvement in the immune system of HIV-infected children on prolonged antiretroviral therapy.
Continuous improvement in the immune system of HIV-infected children on prolonged antiretroviral therapy.
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DOI：
10.1097/qad.0b013e3283189bb3
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发表时间：
2008-11-12
期刊：
影响因子：
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通讯作者：
PACTG 1021 team
中科院分区：
文献类型：
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作者：
Weinberg A;Dickover R;Britto P;Hu C;Patterson-Bartlett J;Kraimer J;Gutzman H;Shearer WT;Rathore M;McKinney R;PACTG 1021 team
HAART的目的是促进CD4+ T细胞和其他免疫反应的重建。我们评估了144周成功HAART治疗后HIV感染儿童免疫重建的程度和动力学。37名接受首次HAART治疗的儿童定期测量血浆HIV RNA、T细胞和亚群、T细胞重排切除环（TREC）DNA、念珠菌、HIVCD4和HIVCD8酶联免疫斑点。81%的患者在24周时血浆HIV RNA检测不到，77%的患者在144周时仍然检测不到。相反，CD4+%持续升高。T细胞亚群的分布在HAART的前48周内迅速变化，此后变化较慢。在144周时，HIV感染儿童的总CD4+%、初始CD8+%和活化CD4+%与健康年龄匹配的对照组无显著差异，而总CD8 + %和活化CD8+%仍升高。CD4+和CD8+ TREC含量仅在HAART的前48周内增加。它们之间以及与总CD 4 +%、初始CD 4 +%和初始CD 8 +%呈正相关。念珠菌和HIVCD4酶联免疫斑点随着时间的推移而增加，分别在48周和144周达到峰值。HIVCD8酶联免疫斑点在144周的HAART治疗中下降，但保持其宽度。基线CD4+%与第144周时的CD4+%和功能性免疫重建呈正相关，而基线TREC与第144周时的TREC相关。HIV感染儿童获得了正常分布的CD4+ T细胞和其他亚群，并在144周的HAART后恢复了CD4介导的HIV免疫。
The goal of HAART is to promote reconstitution of CD4+ T cells and other immune responses. We evaluated the extent and the kinetics of immune reconstitution in HIV-infected children over 144 weeks of successful HAART. Thirty-seven children receiving their first HAART regimen had plasma HIV RNA; T cells and subpopulations; T-cell rearrangement excision circles (TREC) DNA; candida, HIVCD4 and HIVCD8 enzyme-linked immunospot measured at regular intervals. Plasma HIV RNA became undetectable in 81% of patients at 24 weeks and remained undetectable in 77% at 144 weeks. In contrast, CD4+% continuously increased. Distribution of T-cell subpopulations changed rapidly during the first 48 weeks of HAART and more slowly thereafter. At 144 weeks, total, naive and activated CD4+% and naive CD8+% of HIV-infected children were not significantly different from those of healthy age-matched controls, whereas total and activated CD8+% remained elevated. CD4+ and CD8+ TREC content increased only during the first 48 weeks of HAART. They positively correlated with each other and with total CD4+%, naive CD4+% and naive CD8+%. Candida and HIVCD4 enzyme-linked immunospot increased over time reaching peak values at 48 weeks and 144 weeks, respectively. HIVCD8 enzyme-linked immunospot decreased in magnitude over 144 weeks of HAART but retained its breadth. Baseline CD4+% positively correlated with CD4+% and with functional immune reconstitution at week 144, whereas baseline TREC correlated with TREC at week 144. HIV-infected children acquired normal distribution of CD4+ T cells and other subpopulations and recovered CD4-mediated HIV immunity after 144 weeks of HAART.