Immune Reconstitution Under Highly Active Antiretroviral Therapy (HAART)

Highly active antiretroviral therapies (HAART) have been shown to induce a major and durable viral load reduction accompanied by stable CD4 increases that had never been observed previously. Consequently, dramatic declines in the mortality and morbidity of HIV-infected persons have been registered in all industrialized countries. All these observations had raised the question of immune restoration and its mechanisms. Recent studies have concluded that at whatever the stage of the disease HAART is introduced, it allows immune restoration and protection against opportunistic pathogens. The single condition required for this goal is an efficient and durable inhibition of virus replication. HIV does not definitively alter the lymphoid tissues nor the immune defenses, even after years of infection and severe immunedeficiency, except for HIV-specific CD4 T helper cells. The delay in recovery or the lack of reconstitution of a solid immunity against HIV itself might prompt additive therapeutic strategies based upon immune interventions, such as the administration of IL-2 or therapeutic vaccinations to resuscitate immune responses to HIV.