Document Detail


Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs.
MedLine Citation:
PMID:  23772630     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Antiretroviral therapy (ART) is a life-saving intervention in human immunodeficiency virus (HIV) infection. Immune restoration after ART dramatically reduces the incidence and severity of opportunistic diseases and death. On some occasions, immune restoration may be erratic, leading to acute inflammatory responses (known as immune reconstitution inflammatory syndrome) shortly after ART initiation, or incomplete, with residual inflammation despite chronic treatment, leading to non-infectious morbidity and mortality. We propose that ART may not always restore the perfect balance of innate and adaptive immunity in strategic milieus, predisposing HIV-infected persons to complications of acute or chronic inflammation. The best current strategy for fully successful immune restoration is early antiretroviral therapy, which can prevent acquired immunodeficiency syndrome (AIDS)-associated events, restrict cell subset imbalances and dysfunction, while preserving structural integrity of lymphoid tissues. Future HIV research should capitalize on innovative techniques and move beyond the static study of T-cell subsets in peripheral blood or isolated tissues. Improved targeted therapeutic strategies could stem from a better understanding of how HIV perturbs the environmental niches and the mobility and trafficking of cells that affect the dynamic cell-to-cell interactions and determine the outcome of innate and adaptive immune responses.
Authors:
Eleanor M P Wilson; Irini Sereti
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Intramural; Review    
Journal Detail:
Title:  Immunological reviews     Volume:  254     ISSN:  1600-065X     ISO Abbreviation:  Immunol. Rev.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-18     Completed Date:  2014-01-24     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  7702118     Medline TA:  Immunol Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  343-54     Citation Subset:  IM    
Copyright Information:
Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Antiretroviral Therapy, Highly Active* / adverse effects
HIV Infections / drug therapy*,  immunology*
Humans
Immune Reconstitution Inflammatory Syndrome / etiology
Inflammation / immunology
Grant Support
ID/Acronym/Agency:
Z99 AI999999/AI/NIAID NIH HHS; ZIA AI001121-03/AI/NIAID NIH HHS
Comments/Corrections

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