Department of Health Sciences, Clinic of Infectious Diseases and Tropical Medicine, ASST Santi Paolo e Carlo, University of Milan, San Paolo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
BMC Infect Dis. 2018 Jan 5;18(1):8. doi: 10.1186/s12879-017-2942-3.
Individuals lacking immune recovery during suppressive cART will still represent a clinical issue in the years to come, given the high proportion of HIV-infected subjects introducing therapy late in the course of disease. Understanding the mechanisms underlying poor CD4+ T-cell gain is crucial for the correct clinical management of individuals in this context.
An HIV-infected subject with poor CD4+ T-cell gain in the course of suppressive antiretroviral therapy was extensively investigated to identify the mechanisms behind inadequate CD4+ reconstitution. In particular, we studied the phenotype of circulating T-cells, interleukin-7 signaling in peripheral blood and bone marrow, gut function and microbial translocation markers as well as the composition of the faecal microbiota. Numerous therapeutic interventions ranging from antiretroviral therapy intensification to immunotherapy and anti-hepatitis C virus treatment were also employed in order to target the possible causes of poor immune-recovery.
Poor CD4+ T-cell gain on suppressive antiretroviral therapy is multifactorial and thus represents a clinical challenge. Clinicians should investigate subjects' immune profile as well as possible causes of chronic antigenic stimulation for the administration of the most appropriate therapeutic strategies in this setting.
鉴于在疾病进程中晚期开始治疗的 HIV 感染者比例较高，在未来的几年中，抑制性 cART 期间无法实现免疫恢复的个体仍将是一个临床问题。了解导致 CD4+T 细胞获得不良的机制对于正确管理该环境下的个体的临床管理至关重要。
一名 HIV 感染者在抑制性抗逆转录病毒治疗过程中 CD4+T 细胞获得不佳，对其进行了广泛的研究，以确定 CD4+重建不足的背后机制。特别是，我们研究了循环 T 细胞的表型、外周血和骨髓中的白细胞介素-7 信号转导、肠道功能和微生物易位标志物以及粪便微生物群的组成。还采用了许多治疗干预措施，包括抗逆转录病毒治疗强化、免疫治疗和抗丙型肝炎病毒治疗，以针对免疫恢复不良的可能原因。
抑制性抗逆转录病毒治疗后 CD4+T 细胞获得不佳是多因素的，因此代表了一个临床挑战。临床医生应调查患者的免疫状况以及慢性抗原刺激的可能原因，以便在这种情况下制定最合适的治疗策略。
