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Antiretroviral Treatment for HIV Elite Controllers?
In most HIV-infected persons, the natural history of untreated infection is one of sustained viremia, progressive CD4 T cell depletion with resultant morbidity and mortality. The advent of effective combination antiretroviral therapy (ART) that controls HIV replication has altered this landscape dra...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Pathogens and Immunity
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307444/ https://www.ncbi.nlm.nih.gov/pubmed/32582872 http://dx.doi.org/10.20411/pai.v5i1.364 |
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author | Ruiz-Mateos, Ezequiel Poveda, Eva Lederman, Michael M. |
author_facet | Ruiz-Mateos, Ezequiel Poveda, Eva Lederman, Michael M. |
author_sort | Ruiz-Mateos, Ezequiel |
collection | PubMed |
description | In most HIV-infected persons, the natural history of untreated infection is one of sustained viremia, progressive CD4 T cell depletion with resultant morbidity and mortality. The advent of effective combination antiretroviral therapy (ART) that controls HIV replication has altered this landscape dramatically. Yet a rare population of HIV-infected persons—elite controllers (EC)—can control HIV replication such that plasma levels of virus are “undetectable” without ART. The EC phenotype is heterogeneous, with some subjects durably controlling the virus—persistent elite controllers—and some eventually losing viral control—transient elite controllers. Overall, EC tend to have robust HIV-specific T cell responses and in some cases, mainly in transient elite controllers, elevated activation and inflammation indices that diminish with ART suggesting that endogenous defenses against this persistent pathogen come at the cost of heightened activation/inflammation. A limited data set suggests that cardiovascular disease risk as well as the occur-rence of other morbid events may be greater in the overall EC population than in treated HIV infection. ART in EC decreases activation indices but does not appear to increase circulating CD4 T cell numbers nor do we know if it alters clinical outcomes. Thus, it is difficult to recommend or discourage a decision to start ART in the EC population but the authors lean toward treatment particularly in those EC whose activation indices are high and those who are progressively losing circulating CD4 T cell numbers. Biomarkers that can reliably predict loss of virologic control and immune failure are needed. |
format | Online Article Text |
id | pubmed-7307444 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Pathogens and Immunity |
record_format | MEDLINE/PubMed |
spelling | pubmed-73074442020-06-23 Antiretroviral Treatment for HIV Elite Controllers? Ruiz-Mateos, Ezequiel Poveda, Eva Lederman, Michael M. Pathog Immun Research Article In most HIV-infected persons, the natural history of untreated infection is one of sustained viremia, progressive CD4 T cell depletion with resultant morbidity and mortality. The advent of effective combination antiretroviral therapy (ART) that controls HIV replication has altered this landscape dramatically. Yet a rare population of HIV-infected persons—elite controllers (EC)—can control HIV replication such that plasma levels of virus are “undetectable” without ART. The EC phenotype is heterogeneous, with some subjects durably controlling the virus—persistent elite controllers—and some eventually losing viral control—transient elite controllers. Overall, EC tend to have robust HIV-specific T cell responses and in some cases, mainly in transient elite controllers, elevated activation and inflammation indices that diminish with ART suggesting that endogenous defenses against this persistent pathogen come at the cost of heightened activation/inflammation. A limited data set suggests that cardiovascular disease risk as well as the occur-rence of other morbid events may be greater in the overall EC population than in treated HIV infection. ART in EC decreases activation indices but does not appear to increase circulating CD4 T cell numbers nor do we know if it alters clinical outcomes. Thus, it is difficult to recommend or discourage a decision to start ART in the EC population but the authors lean toward treatment particularly in those EC whose activation indices are high and those who are progressively losing circulating CD4 T cell numbers. Biomarkers that can reliably predict loss of virologic control and immune failure are needed. Pathogens and Immunity 2020-05-19 /pmc/articles/PMC7307444/ /pubmed/32582872 http://dx.doi.org/10.20411/pai.v5i1.364 Text en © Pathogens and Immunity 2020 This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Research Article Ruiz-Mateos, Ezequiel Poveda, Eva Lederman, Michael M. Antiretroviral Treatment for HIV Elite Controllers? |
title | Antiretroviral Treatment for HIV Elite Controllers? |
title_full | Antiretroviral Treatment for HIV Elite Controllers? |
title_fullStr | Antiretroviral Treatment for HIV Elite Controllers? |
title_full_unstemmed | Antiretroviral Treatment for HIV Elite Controllers? |
title_short | Antiretroviral Treatment for HIV Elite Controllers? |
title_sort | antiretroviral treatment for hiv elite controllers? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307444/ https://www.ncbi.nlm.nih.gov/pubmed/32582872 http://dx.doi.org/10.20411/pai.v5i1.364 |
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