Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
New Microbiol. 2022 Jul;45(3):155-172.
The introduction of cART in the treatment of HIV infection has significantly decreased morbidity and mortality by inducing suppression of viral replication and recovery of CD4+ T-cell counts. How- ever, about 30% of HIV-infected individuals fail to achieve normalization of CD4+ T-cell counts, de- spite antiretroviral therapy and complete suppression of the HIV load: these patients are referred to as "immunological non-responders". Several studies have shown an increased risk of clinical pro- gression to both AIDS and non-AIDS events as well as a higher mortality in these patients. The pathogenetic factors underlying this condition are multiple and none of these alone can exhaustive- ly explain the mechanism of incomplete immune reconstitution. In light of this, the purpose of the present review is to: i) describe in detail the pathogenetic mechanisms that contribute to scarce immune recovery; ii) discuss the higher morbidity and mortality which feature such a condition; iii) take stock of therapeutic strategies used in recent years for these patients.
抗逆转录病毒疗法（cART）的引入通过诱导病毒复制的抑制和 CD4+T 细胞计数的恢复，显著降低了 HIV 感染的发病率和死亡率。然而，大约 30%的 HIV 感染者尽管接受了抗逆转录病毒治疗且 HIV 载量完全抑制，仍未能实现 CD4+T 细胞计数的正常化：这些患者被称为“免疫无应答者”。多项研究表明，这些患者发生 AIDS 和非 AIDS 事件的临床进展风险增加，死亡率也更高。导致这种情况的发病因素有很多，没有一个因素可以完全解释不完全免疫重建的机制。有鉴于此，本综述的目的是：i）详细描述导致免疫恢复不足的发病机制；ii）讨论该情况下的更高发病率和死亡率；iii）评估近年来针对这些患者的治疗策略。
