Incomplete Immune Reconstitution after Initiation of Highly Active Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Patients with Severe CD4+ Cell Depletion

Howard M. Lederman*, Paige L. Williams, Julia W. Wu, Thomas G. Evans, Susan E. Cohn, J. Allen McCutchan, Susan L. Koletar, Richard Hafner, Elizabeth Connick, Fred T. Valentine, M. Juliana McElrath, Norbert J. Roberts, Judith S. Currier

*Corresponding author for this work

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

Immune function was observed for 144 weeks in 643 human immunodeficiency virus (HIV)-infected subjects who (1) had nadir CD4+ cell counts of <50 cells/mm3, followed by a sustained increase to ≥100 cells/mm3 after the initiation of HAART, and (2) were enrolled in a randomized trial of continued azithromycin prophylaxis versus withdrawal for prevention of Mycobacterium avium complex disease. The median CD4+ cell count was 226 cells/mm3 at entry and 358 cells/mm3 at week 144. Anergy (80.2% of patients) and lack of lymphoproliferative response to tetanus toxoid (TT; 73%) after immunization and impaired antibody responses after receipt of hepatitis A (54%) and TT (86%) vaccines were considered to be evidence of impaired immune reconstitution. Receipt of azithromycin did not have an effect on CD4+ cell count but was associated with higher rates of delayed-type hypersensitivity responses to TT (25% of subjects who received azithromycin vs. 15% of those who did not; P = .009) and mumps skin test antigen (29% vs. 17%; P = .001). Although the subjects had only partial responses to immune function testing, the rate of opportunistic infections was very low, and none of the tests was predictive of risk.

Original languageEnglish (US)
Pages (from-to)1794-1803
Number of pages10
JournalJournal of Infectious Diseases
Volume188
Issue number12
DOIs
StatePublished - Dec 15 2003

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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    Lederman, H. M., Williams, P. L., Wu, J. W., Evans, T. G., Cohn, S. E., McCutchan, J. A., Koletar, S. L., Hafner, R., Connick, E., Valentine, F. T., McElrath, M. J., Roberts, N. J., & Currier, J. S. (2003). Incomplete Immune Reconstitution after Initiation of Highly Active Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Patients with Severe CD4+ Cell Depletion. Journal of Infectious Diseases, 188(12), 1794-1803. https://doi.org/10.1086/379900