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AIDS. 2002 Aug 16;16(12):1609-16.

Features of 'CD4-exploders', HIV-positive patients with an optimal immune reconstitution after potent antiretroviral therapy.

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Infectious Diseases Clinic, University of Modena and Reggio Emilia School of Medicine and Azienda Ospedaliera Policlinico Modena, Modena, Italy.



To identify crucial immunological characteristics of a group of patients, defined 'CD4-exploders', who were able to fully reconstitute their immune system after receiving highly active antiretroviral therapy (HAART).


Among a population of 540 HIV-positive patients treated with HAART, six individuals were identified who experienced a nadir of less than 85 x 106 CD4+ cells/l, had major opportunistic infections (four out of six), started HAART in 1996 or 1997, and showed a rapid and relevant CD4+ lymphocyte increase (mainly due to virgin cells), in some cases regardless of virological control.


Enzyme-linked immunosorbent assay for the determination of interleukin (IL)-7 plasma levels; flow cytometry to analyse surface antigens and CD127 (IL-7 receptor alpha-chain) expression; quantitative-competitive (QC) PCR for detecting cells containing T-cell receptor rearrangement excision circles (TREC); chest-computed tomography (CT) to analyse thymus volume and content.


In 'CD4-exploders', high levels of TREC+ lymphocytes were found among CD4+ T cells, which also contained a high percentage of naive cells. However, CT revealed a dramatic depletion of intrathymic lymphoid tissue. Plasma levels of IL-7 were significantly high. Most CD4+ and CD8+ T lymphocytes expressed CD127, whose level was similar to that of healthy donors. CD127 expression on CD8+ lymphocytes was markedly higher than in HIV-positive individuals treated with the same therapy or in patients with AIDS.


In 'CD4-exploders', HAART-induced reconstitution of the T-cell compartment is independent from thymus volume, and is favoured by the upregulation of the IL-7/IL-7 receptor system.

[Indexed for MEDLINE]

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