Powderly WG
Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA.
Curr Infect Dis Rep. 1999 Apr;1(1):99-104. doi: 10.1007/s11908-999-0016-4.
Effective antiretroviral therapy that suppresses HIV replication is associated with dramatic increases in CD4 counts. Recent evidence suggests that this CD4 cell increase is biphasic in nature, with an initial phase (in the first 2 to 3 months) that represents redistribution of lymphocytes into the periphery and a second phase that is associated with true immunologic recovery and reconstitution. Immunologically there is evidence of increase in naive T cells, recovery of in vitro responses to microbial antigens, and repair of the damaged diversity of T cells. Clinically, this immune recovery has been characterized by decreasing morbidity and mortality from opportunistic infections, an ability to treat previously intractable infections, immune-mediated syndromes, and increasing reports of the ability to discontinue primary and secondary prophylaxis. Although there are still unresolved questions about the completeness of the immune recovery, most available evidence suggests in most patients the degree of immune reconstitution with effective antiretroviral therapy is sufficient to be protective against most opportunistic infections, and ultimately additional antimicrobial prophylaxis will be unnecessary.
抑制HIV复制的有效抗逆转录病毒疗法与CD4细胞计数的显著增加相关。最近的证据表明，这种CD4细胞的增加本质上是双相的，第一阶段（在最初的2至3个月）代表淋巴细胞重新分布到外周，第二阶段与真正的免疫恢复和重建相关。在免疫学上，有证据表明初始T细胞增加、对微生物抗原的体外反应恢复以及受损的T细胞多样性得到修复。临床上，这种免疫恢复的特征是机会性感染导致的发病率和死亡率降低、治疗先前难治性感染的能力、免疫介导综合征，以及越来越多关于停止一级和二级预防的报道。尽管关于免疫恢复的完整性仍有未解决的问题，但大多数现有证据表明，在大多数患者中，有效的抗逆转录病毒疗法的免疫重建程度足以预防大多数机会性感染，最终将不再需要额外的抗菌预防。
