期刊
HIV MEDICINE
卷 5, 期 6, 页码 407-414出版社
WILEY
DOI: 10.1111/j.1468-1293.2004.00245.x
关键词
antiretroviral therapy; cytomegalovirus; HIV-1; interferon-gamma; T-cell responses
Objectives To define the level of pathogen-specific immune reconstitution persisting over 3 to 5 years of highly active antiretroviral therapy (HAART) in HIV-infected patients who began therapy with CD4 T-cell counts below 50 cells/muL. Methods Cytomegalovirus (CMV)-specific T-cell responses were analysed in adult HfV-1-infected patients with nadir CD4 T-cell counts below 50 cells/mul before HAART. CMV-specific CD4 T-cell responses were measured by interferon-gamma enzyme-linked immunospot assay (ELISpot assay), lymphoproliferation and interferon-gamma levels in cell culture supernatants. Results CD4 T-cell responses to CMV were low in untreated patients and remained low during the first year on HAART, but increased progressively to levels similar to those found in HIV-seronegative CMV-seropositive controls at 3 years. Responses then declined markedly and at 5 years were lower than controls. This could not be explained by changes in CD4 or CD8 T-cell counts or plasma HIV RNA levels. Interferon-gamma and interleukin-5 responses to a mitogen were maintained or elevated. Conclusions CMV-specific CD4 T-cell responses were found to decline after 3-5 years on HAART and may provide inadequate long-term protection against CMV disease in patients who are severely immunodeficient prior to treatment.
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