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William Borkowsky
New York Univ. Sch. of Med., NY
Children and adolescents treated with highly active antiretroviral therapy can demonstrate different responses to therapy. These include 1) a "concordant" HIV inhibition and CD4 T cell increases over time with almost complete restoration of CD4 T cells in the peripheral blood; 2) the inability to suppress HIV and the absence of change in CD4; 3) the "discordant" suppression of HIV with negligible effects on CD4 T cells; and 4) transient suppression of HIV, with a return to pre-treatment levels of virus, a "discordance" presumably due to resistance to the treatment, but where CD4 T cells increase to normal or near normal levels. When this last effect is seen, the phenotype of the post-therapy viral isolates, often changes from one that grew in MT-2 cells and produced syncytia to one which is no longer able to grow in MT-2. In contrast to the immunologic restoration of CD4 T cells described in adults, the vast majority of returning CD4 T cells in children and adolescents consist of phenotypically naïve cells. This may be due to the enhanced thymic output of cells in children and adolescents relative to what is seen in adults. The combination of changes seen in T cell tropism of those treated with HAART and the increase of mainly naïve CD4 T cells which are relatively resistant to killing by CCR5 receptor utilizing cells may help explain some of these changes.
Session 57. State-of-the-Art Lecture
Wednesday, 8:30-9:00am
Ballroom I-X
© 8th Conference on Retroviruses and Opportunistic Infections