Media Advisory

Thursday, April 18, 2019

NIH scientists identify a paradoxical response to HIV treatment in five people

What

Antiretroviral therapy (ART) is usually very effective in suppressing HIV in the body, allowing the immune system to recover by preventing the virus from destroying CD4 + T cells. Scientists have now identified a rare and paradoxical response to ART known as extreme immune decline or EXID. According to a report, five people assessed at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, experienced a significant decline in CD4 + T cell counts despite lower HIV suppression. at detectable levels for over three years published online today in JCI Insight. The research team was led by Irini Sereti, MD, head of the HIV pathogenesis section at the NIAID Immunoregulatory Laboratory, and Andrea Lisco, MD, Ph.D.

NIAID researchers found that the immune system of EXID people had even worse results than those of another subgroup of individuals defined as non-immune responders, or INRs, who did not respond correctly antiretroviral treatment. INR participants who regularly took ART for four years had a CD4 + T cell count that increased an average of 193 cells per microliter (μL) of blood. Participants who responded normally to ART increased their CD4 + T cell count by more than twice. In contrast, the five participants with EXID experienced an average decline of 157 CD4 + T lymphocytes / μL while systematically maintaining viral suppression on antiretroviral therapy.

According to the NIAID team, there appears to be no cause of EXID among the five individuals studied. Their analyzes revealed that genes influencing immune cell activity and autoimmunity – the immune system attacking the body's own healthy tissue – could play a role. Specifically, two of the people with EXID produced antibodies that attacked their own T cells, while two others had an overactive cellular immune response that resulted in an increase in inflammation. The five participants with EXID had HIV strains other than HIV from clade B (the most common strain in North America and Europe), indicating that some combinations of an individual's genes and strain HIV could be associated with EXID. Although EXID is probably an extremely rare response to antiretroviral therapy, researchers say that studying this phenomenon could further illuminate the reconstitution and inflammation of CD4 + T cells in HIV infection and suggest treatment strategies. possible for RNI and people with EXID.

article

A lisco et al. The identification of rare patients infected with HIV-1 with an extreme number of CD4 T cells declines despite the viral suppression induced by ART. JCI Insight DOI: 10.1172 / jci.insight.127113 (2019).

who

Anthony S. Fauci, Director of NIAID, is available for comment.

Contact

To schedule interviews, please contact Judith Lavelle at (301) 402-1663, [email protected].

NIAID conducts and supports research – at NIH, in the United States, and around the world – to investigate the causes of infectious and immune-mediated diseases and to develop better ways to prevent, diagnose and treat these diseases. NIAID press releases, fact sheets and other documents are available on the NIAID website.

About the National Institutes of Health (NIH):
The NIH, the country's medical research agency, has 27 institutes and centers and is part of the US Department of Health and Human Services. NIH is the lead federal agency that leads and supports basic, clinical and translational medical research. She studies causes, treatments and cures for common and rare diseases. For more information on NIH and its programs, visit www.nih.gov.

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