HIV immune response unconnected to inflammation in people taking ART

[Jim Allen]

Interesting read, although further research is needed. Understanding and then resolving or managing ongoing inflammation could benefit a lot of us PLHIV.

Aidsmap.com article in full:

https://www.aidsmap.com/news/jan-2023/hiv-specific-immune-response-unconnected-inflammation-people-taking-art

In Brief:

Recent research results offer a new clue into the mystery of why some people living with HIV experience persistent inflammation. That sustained inflammation is borne from legacy effects that arise during untreated, chronic HIV infection.

Despite the success of antiretroviral therapy in suppressing HIV and allowing people with the virus to live long, healthy lives, many (especially those who begin ART after chronic infection sets in) experience a more active immune system that leads to persistent inflammation in the body.

A potential mechanism that could explain how HIV-specific immunity would promote inflammation involves interferon-gamma, an antiviral cytokine. When T-cells respond to pathogenic threats, they release this cytokine, which appears to activate macrophages – large cells with multiple immune functions, including releasing other cytokines that promote inflammation.

To investigate this possibility, Dr Adam Ward of Wiell Cornell Medicine and colleagues used data from a cohort of 99 people in the AIDS Clinical Trial Group (ACTG) study A5321, which investigated the HIV reservoirs of people on long-term ART.   

All told, the study authors conclude their results bolster a previous theory called “the die is cast” or “the legacy effect.” This theory posits that the pathogenic mechanisms that take place before someone starts ART are the predominate drivers of immune dysregulation. If correct, that would provide yet another argument to provide people with HIV access to ART soon as possible after infection.

Ward A et al. No evidence that circulating HIV-specific immune responses contribute to persistent inflammation and immune activation in persons on long-term ART. AIDS 36: 1617-1628, 2022.

https://doi.org/10.1097/QAD.0000000000003301

[leatherman]

interesting. a lot of fellow LTSes I know have inflammation issues and that would make sense as most of us have an AIDS diagnosis.  A lot of these people take an antihistamine every day. Figuring in later diagnosis (why bother when there was no treatment?), later treatment (who ever thought we needed to wait until our cd4s hit 250 before we could start meds??) and those early meds (24 AZT pills a day was never going to do anything but drag out your death) is it any wonder there are long term effects to having been diagnosed in the late 80s to late 90s.

I take a half a benedryl maybe once a month. Oh, I've had inflammation issues since the early 90s, but a half a pill is enough to knock me out for 9-12 hrs of sleep. Zzzzzz So I only use them as sleeping pills. LOL I usually only sleep about 6 hours anyway (I read for 2-3 hours ever night while Larry sleeps. LOL), so sleeping that long because of a drug really messes me up the next day.

If correct, that would provide yet another argument to provide people with HIV access to ART soon as possible after infection

isn't this just the same old same old? The longer you wait to treat HIV, the more it F-s you up.

[Jim Allen]

isn't this just the same old same old? The longer you wait to treat HIV, the more it F-s you up.

Absolutely. It adds to the already overwhelming evidence that starting treatment as soon as possible is best.