Different profiles of immune reconstitution in children and adults with HIV-infection after highly active antiretroviral therapy

BACKGROUND: Recent advances in characterizing the immune recovery of HIV-1-infected people have highlighted the importance of the thymus for peripheral T-cell diversity and function. The aim of this study was to investigate differences in immune reconstitution profiles after highly active antiretroviral therapy (HAART) between HIV-children and adults. METHODS: HIV patients were grouped according to their previous clinical and immunological status: 9 HIV-Reconstituting-adults (HIV-Rec-adults) and 10 HIV-Reconstituting-children (HIV-Rec-children) on HAART with viral load (VL) ≤400 copies/ml and CD4(+ )≥500 cells/μL at least during 6 months before the study and CD4(+ )≤300 cells/μL anytime before. Fifteen healthy-adults and 20 healthy-children (control subjects) were used to calculate Z-score values to unify value scales between children and adults to make them comparable. RESULTS: HIV-Rec-children had higher T-cell receptor excision circles (TREC) and lower interleukin (IL)-7 levels than HIV-Rec-adults (p < 0.05). When we analyzed Z-score values, HIV-Rec-children had higher TREC Z-score levels (p = 0.03) than HIV-Rec-adults but similar IL-7 Z-score levels. Regarding T-cell subsets, HIV-Rec-children had higher naïve CD4(+ )(CD4(+)CD45RA (hi+)CD27(+)), naïve CD8(+ )(CD8(+)CD45RA (hi+)CD27(+)), and memory CD8(+ )(CD8(+)CD45RO(+)) cells/μl than HIV-Rec-adults, but similar memory CD4(+ )(CD4(+)CD45RO(+)) counts. HIV-Rec-children had lower naïve CD8(+ )Z-score values than HIV-Rec-adults (p = 0.05). CONCLUSION: Our data suggest that HIV-Rec-children had better thymic function than HIV-Rec-adults and this fact affects the peripheral T-cell subsets. Thus, T-cell recovery after HAART in HIV-Rec-adults could be the consequence of antigen-independent peripheral T-cell expansion while in HIV-Rec-children thymic output could play a predominant role in immune reconstitution.