Evidence of Ongoing Immune Reconstitution in Subjects with Sustained Viral Suppression following 6 Years of Lopinavir-Ritonavir Treatment

Background. We evaluated the immunologic impact of highly active antiretroviral therapy in subjects who maintained human immunodeficiency virus type 1 (HIV-1) suppression through 6 years of receiving a lopinavir-ritonavir–based regimen. Methods. A total of 100 antiretroviral-naive subjects with any...

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Bibliographic Details
Published in:Clinical infectious diseases 2007-03, Vol.44 (5), p.749-754
Main Authors: Landay, Alan, da Silva, Barbara A., King, Martin S., Albrecht, Mary, Benson, Constance, Eron, Joseph, Glesby, Marshall, Gulick, Roy, Hicks, Charles, Kessler, Harold, Murphy, Robert, Thompson, Melanie, White, A. Clinton, Wolfe, Peter, McMillan, Florence I., Hanna, George J.
Format: Article
Language:English
Subjects:
Adult
AIDS
Anti-HIV Agents - therapeutic use
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiretroviral drugs
Antiretrovirals
Antiviral agents
B lymphocytes
Biological and medical sciences
Biomarkers
CD4-CD8 Ratio
Cells
Clinical Trials, Phase II as Topic
Cohort Studies
Drug therapy
Female
Follow-Up Studies
Funding
Highly active antiretroviral therapy
HIV
HIV 1
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - virology
HIV-1 - genetics
HIV-1 - isolation & purification
HIV/AIDS
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Lamivudine - therapeutic use
Lopinavir
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Protease inhibitors
Pyrimidinones - therapeutic use
Research universities
Ritonavir - therapeutic use
RNA
RNA, Viral - blood
Stavudine - therapeutic use
T lymphocytes
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:Background. We evaluated the immunologic impact of highly active antiretroviral therapy in subjects who maintained human immunodeficiency virus type 1 (HIV-1) suppression through 6 years of receiving a lopinavir-ritonavir–based regimen. Methods. A total of 100 antiretroviral-naive subjects with any CD4+ T cell count initiated therapy with lopinavir-ritonavir, stavudine, and lamivudine. Sixty-three subjects who remained in the study for 6 years were assessed. Laboratory measurements included plasma HIV-1 RNA levels, multiparameter flow cytometry of immune cells, and markers of maturation and activation. Results. After 6 years, 62 of 63 subjects had plasma HIV-1 RNA levels 500 cells/µL, compared with 21% of subjects at baseline. The mean ratio of CD4+ T cell count to CD8+ T cell count increased from 0.38 at baseline to 0.96 at year 6 (P < .001). The percentage of subjects with cell counts below the lower limit of normal at year 6, compared with at baseline, was significantly decreased for total T cells, B cells, and natural killer cells. At year 6, the median CD4+ T cell activation level was 3.4%, and the median CD8+ T cell activation level was 5.8%. Conclusions. The receipt of a lopinavir-ritonavir–based regimen resulted in ongoing immune reconstitution through 6 years of therapy in a cohort of HIV-1–infected, antiretroviral-naive subjects with suppressed HIV-1 RNA levels. Normalization of activation marker expression on CD4+ and CD8+ T cell subsets was demonstrated.
ISSN:1058-4838
1537-6591
DOI:10.1086/511681