Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Immunopathology as a result of highly active antiretroviral therapy in HIV-1-infected patients.
AIDS. 1999 Feb 4;13(2):177-84. Unique Identifier : AIDSLINE MED/99217473 Foudraine NA; Hovenkamp E; Notermans DW; Meenhorst PL; Klein MR; Lange JM; Miedema F; Reiss P; National AIDS Therapy Evaluation Center, Department of Internal; Medicine, Academic Medical Center, University of Amsterdam, The; Netherlands.
Abstract:
OBJECTIVE: Unusual clinical inflammatory syndromes associated with underlying previously unrecognized opportunistic infections are increasingly being noted shortly after starting highly active antiretroviral therapy (HAART). This study examined the possible relationship between such unexpected disease manifestations and in vitro parameters of microbial antigen-specific immune reactivity in patients infected with HIV-1 who had a Mycobacterium avium intracellulare or Mycobacterium xenopi infection. DESIGN: In vitro T-cell proliferation experiments were performed after specific stimulation of a patient's peripheral blood mononuclear cells (PBMC) with M. avium and M. xenopi antigen and non-specific stimulation with phytohaemagglutinin (PHA). The results were compared with appropriate controls. PATIENTS: Five patients who presented with unusual clinical syndromes associated with M. avium or M. xenopi infection within weeks of experiencing large rises in CD4+ cell counts following the initiation of antiretroviral therapy. RESULTS: In all patients except one, mycobacteria-specific lymphoproliferative responses rose significantly following HAART; this was temporally associated with elevations in CD4+ cell counts and the occurrence of clinical disease. The patient with M. xenopi infection appeared to clear his infection subsequently without antimycobacterial therapy. In three of the four patients with M. avium infection, antimycobacterial treatment could be stopped without recurrence of infection. CONCLUSION: Our findings support the hypothesis that HAART may lead to clinically relevant inflammation as a result of restoration of specific immune reactivity against microbial pathogens that are subclinically present at the time treatment is initiated. Continuation of HAART may subsequently result in protective immunity and clearance of infection.
Keywords: JOURNAL ARTICLE Adult Anti-HIV Agents/*THERAPEUTIC USE AIDS-Related Opportunistic Infections/DRUG THERAPY/*IMMUNOLOGY/ MICROBIOLOGY Case Report Drug Therapy, Combination Female Human HIV-1/*IMMUNOLOGY Male Mycobacterium avium-intracellulare Infection/DRUG THERAPY/ *IMMUNOLOGY/MICROBIOLOGY Mycobacterium xenopi/*IMMUNOLOGY Mycobacterium Infections, Atypical/DRUG THERAPY/*IMMUNOLOGY/ MICROBIOLOGY 990830
A9981015
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Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
