Immunotherapy in HIV disease: recent developments and future directions


ABSTRACT
Adjuvant immunotherapy, directly targeting the immune system, has been proposed as approach to modulate the immune response in HIV-infected subjects treated with HAART and without immune reconstitution. Most studies have been performed on Interleukin-2 (IL-2), focusing on immunological advantage of IL-2+HAART versus HAART alone in different stages of HIV infection. Preliminary results of two Phase III international studies, SILCAAT and ESPRIT, confirm a significant difference in CD4+ cells count, but underline that this immunological advantage does not reduce the rate of opportunistic infections and death. The authors do not provide any data of IL-2 driven immune reconstitution and this could be a bias in the interpretation of the results. Interleukin-7 (IL-7) Phase I studies are ongoing: the potential interest of IL-7 in the treatment of HIV-infection is based on its crucial role on T cell homeostasis both in thymic output and peripheral T proliferation and survival; despite SILCAAT and ESPRIT data, these studies are continuing. Finally, recently approved new class drugs, CCR5-antagonists, open a new scenario in HAART era: published results confirm an immune reconstitution better than other antiretroviral drugs.
Keywords: Immune reconstitution; Interleukin-2; Interleukin-7; CCR5-antagonists.


Articolo presente in – HAART and correlated pathologies n. 2

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Central nervous system immune reconstitution disease presenting with vasculitis-like lesions


ABSTRACT
The immune reconstitution inflammatory syndrome (IRIS) identifies a spectrum of clinico-pathological entities resulting from either paradoxical worsening or unmasking of previously quiescent disorders following the initiation of combination antiretroviral therapy (cART). The central nervous system (CNS) is a major target tissue for IRIS, and inflammatory forms of cryptococcosis and progressive multifocal leukoencephalopahy (PML) are well known manifestations of CNS-IRIS. We here describe the case of a patient who developed focal neurological disease two months after initiation of cART and one month after successfully treated herpes zoster. Magnetic resonance imaging (MRI) showed vasculitis-like lesions but cerebrospinal fluid analysis failed to reveal the presence of varicella-zoster virus or other opportunistic pathogens. The clinical and radiological picture improved dramatically following treatment with intravenous high dose corticosteroids and remained stable during the subsequent follow-up. CNS-IRIS may present in the form of vasculitis-like inflammatory CNS lesions that respond to anti-inflammatory treatment.
Keywords: HIV; IRIS; Central Nervous System.


Articolo presente in – HAART and correlated pathologies n. 2

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