Thursday, April 18, 2019
NIH scientists identify paradoxical response to HIV medication in five individuals
What is antiretroviral therapy (ART) is usually very effective at suppressing HIV in the body , allowing a person's immune system to recover from the virus from destroying CD4 + T cells. Scientists have now identified a rare, paradoxical response to ART known as extreme immune decline, or EXID. Five individuals evaluated at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, experienced a significant decline in CD4 + T cell levels despite suppression of HIV below detectable levels for more than three years, according to report published online today in JCI Insight. The research team was led by Irini Sereti, MD, chief of the HIV pathogenesis section in NIAID's Laboratory of Immunoregulation, and Andrea Lisco, MD, Ph.D.
The NIAID researchers found that the immune systems of people with EXID fared more than those of another subset of individuals defined as immunological non-responders, or INRs, who respond inadequately to ART. INR participants consistently took ART for four years had CD4 + T cell counts increased on average by 1
According to the NIAID team, there is no single cause of EXID among the five individuals studied . Their analyzes revealed that genes influencing immune cell activity and autoimmunity – the immune system of own healthy tissue – may play a role. Specifically, two of the individuals with EXID produced antibodies that attacked their own T cells, while two others had overactive cellular immune responses that lead to increased inflammation. All five participants with EXID had HIV-related other than clade B HIV (the most common strain circulating in North America and Europe), indicating that certain combinations of individual genes and the HIV strain may be associated with EXID. While EXID is probably an extremely rare response to ART, the researchers indicate that this phenomenon may further illuminate CD4 + T cell reconstitution and inflammation in HIV disease and suggest possible treatment strategies for INRs and individuals with EXID.
A Lisco et al. Identification of rare HIV-1 infected patients with extreme CD4 T-cell decline despite ART-mediated viral suppression. JCI Insight DOI: 10.1172 / jci.insight.127113 (2019)
NIAID Director Anthony S. Fauci, MD, is available for comment.
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