AIDSWEEKLY Plus, Monday, 10 February 1997
Daniel J. DeNoon, Senior Editor
HIV and its damaging effects are greatly reduced in mucosal lymphoid tissues during potent combination antiretroviral therapies.
The findings are good news for people with access to the new treatments. They also provide new insights into the pathogenesis of HIV disease.
D.P. Kotler of St. Luke's-Roosevelt Hospital Center, New York, and colleagues previously showed that the presence of HIV in the intestinal mucosa is associated with clinical symptoms, tissue changes, deletion of CD4(+) lymphocytes, cytokine expression, and, perhaps most importantly, apoptosis of mononuclear cells in the lamina propria (Gastro, 1992;103:919; Dig Dis Sci, 1993;33:1119).
More recently, they tested their hypothesis that such alterations are the direct result of local HIV infection by comparing rectal mucosal biopsies taken before and seven days after initiation of treatment with potent antiretroviral combination therapy. They reported their findings at the Fourth Conference on Retroviruses and Opportunistic Infections, held January 22-26 in Washington, D.C.
After treatment, plasma viral load fell by 1.3 log[10] and mucosal viral burden fell by 1.2 log[10]. CD4 counts rose by nearly 100 cells/(micro)L; similarly, mucosal CD4(+) lymphocytes increased by 80 percent.
"Treatment also was associated with reduced number of lamina propria mononuclear cells undergoing apoptosis (P=0.05)," Kotler et al. reported.
The researchers drew three conclusions: 1) the mucosal lymphoid compartment and the blood compartment respond similarly to antiretroviral therapy; 2) HIV replication appears to have a direct role in cell death, as shown by the reduction in apoptosis after treatment; and 3) loss of CD4(+) lymphocytes in the intestinal mucosa appears to make a major contribution to the decline in CD4 counts characteristic of HIV disease. - by Daniel J. DeNoon, Senior Editor
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