Powderly W G, Landay A, Lederman M M
Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO 63110, USA.
JAMA. 1998 Jul 1;280(1):72-7. doi: 10.1001/jama.280.1.72.
Clinical care of people infected with human immunodeficiency virus (HIV) has been substantially affected by the introduction of potent antiretroviral therapy. Changes in the immune system after such therapy and the clinical consequences are important issues for clinicians treating patients with HIV.
A systematic review of MEDLINE, 1993 to January 1998, of peer-reviewed publications, abstracts from national and international conferences, and product registration information through January 1998.
Criteria used to select studies include relevance to immune reconstitution with potent antiretroviral therapy and having been published in the English language. Assessment of data quality and validity included consideration of venue of the publication and relevance to practice.
Suppression of viral replication after administration of potent antiretroviral therapy that includes inhibitors of the HIV-1 protease is associated with quantitative and qualitative changes in the immune system. In patients with relatively advanced disease, there is a first-phase rise (during the initial 3 months) in both naive and memory CD4+ and CD8+ T lymphocytes and B lymphocytes. This is followed by a slower second-phase increase (after 3 months) in cells primarily of the naive CD4+ and CD8+ phenotypes. These quantitative changes are associated with qualitative improvements in host immune responses, best characterized by dramatically reduced risk of opportunistic infection. Restoration of the immune system during the first year of potent antiretroviral therapy is partial at best.
Potent antiretroviral therapy has become the standard of care for people with HIV infection, and its use has led to significant reductions in the incidence of the acquired immunodeficiency syndrome (AIDS) and in mortality from HIV infection. Although incomplete, considerable immune recovery occurs, sufficient, in most cases, to provide adequate protection against most AIDS-associated opportunistic infections.
高效抗逆转录病毒疗法的引入对人类免疫缺陷病毒（HIV）感染者的临床护理产生了重大影响。这种疗法后免疫系统的变化及其临床后果是治疗HIV患者的临床医生面临的重要问题。
对1993年至1998年1月的MEDLINE进行系统回顾，包括同行评审出版物、国家和国际会议摘要以及截至1998年1月的产品注册信息。
选择研究的标准包括与高效抗逆转录病毒疗法免疫重建的相关性以及以英文发表。数据质量和有效性的评估包括考虑出版物的发表地点和与实践的相关性。
给予包括HIV-1蛋白酶抑制剂的高效抗逆转录病毒疗法后病毒复制的抑制与免疫系统的定量和定性变化相关。在疾病相对晚期的患者中，初始3个月内，初始和记忆性CD4+和CD8+T淋巴细胞以及B淋巴细胞均出现第一阶段上升。随后，主要是初始CD4+和CD8+表型的细胞在3个月后出现第二阶段较慢的增加。这些定量变化与宿主免疫反应的定性改善相关，最明显的特征是机会性感染风险显著降低。高效抗逆转录病毒疗法第一年期间免疫系统的恢复充其量只是部分恢复。
高效抗逆转录病毒疗法已成为HIV感染者的标准治疗方法，其使用已导致获得性免疫缺陷综合征（AIDS）发病率和HIV感染死亡率显著降低。尽管不完全，但会出现相当程度的免疫恢复，在大多数情况下足以提供针对大多数与AIDS相关的机会性感染的充分保护。
