Long-Term Highly Active Antiretroviral Therapy in Chronic HIV-1 Infection: Evidence for Reconstitution of Antiviral Immunity

In this study we investigated the long-term effect of highly active antiretroviral therapy (HAART) on HIV-specific CD4⁺ T-cell responses in comparison with virus-specific CD4⁺ T-cell responses against the persistent herpes viruses cytomegalovirus (CMV) and Epstein-Barr virus (EBV). To this end, HIV- and herpes virus-specific cellular immune responses were measured longitudinally in 10 seroconverters with long-term follow-up including 55 months of successful suppression of viral load by HAART. HIV- and CMV-specific CD4⁺ T cells producing interferon-γ (IFNγ) or interleukin-2 (IL-2) were analysed as well as proliferative capacity. EBV-specific CD4⁺ T cells were determined using a 12-day ex vivo assay. Initiation of HAART resulted in a transient increase of HIV-specific IL-2⁺IFNγ⁺CD4⁺ T cells and, to a lesser extent, IL-2⁺CD4⁺ T cells. Long-term HAART resulted in an increase in HIV-, CMV- and EBV-specific CD4⁺ T-cell proliferative capacity. The increase in HIV- and herpes-virus-specific CD4⁺ T-cell proliferative capacity after 55 months of HAART suggests that the improved proliferative response is not specific for HIV, but reflects a more general improvement of antiviral immune responses, which is induced by HAART.