Residual immune dysfunction under antiretroviral therapy.

Area of Science:

• Immunology
• Infectious Diseases
• Public Health

Background:

• Combination antiretroviral therapy (cART) has significantly reduced morbidity and mortality in people with HIV (PWH).
• Despite cART, many PWH experience incomplete immune restoration, characterized by chronic inflammation and residual immune dysfunction.
• This immune dysfunction is linked to non-AIDS comorbidities, impacting quality of life and longevity.

Purpose of the Study:

• To review the pathogenesis of chronic inflammation and immune dysfunction in PWH.
• To discuss potential therapeutic interventions for ameliorating these conditions.
• To explore strategies for preventing or delaying non-AIDS comorbidities.

Main Methods:

• Literature review of studies on HIV pathogenesis, immune dysfunction, and comorbidities.
• Analysis of current evidence on therapeutic interventions.
• Synthesis of findings to inform clinical practice.

Main Results:

• Chronic inflammation and immune dysfunction in PWH are multifactorial, involving persistent viral activity, microbial translocation, and altered immune cell function.
• Several therapeutic strategies are being investigated, including immunomodulatory agents and targeted therapies.
• Early diagnosis and prompt initiation of cART, particularly at higher CD4 counts, are associated with improved immune recovery.

Conclusions:

• Addressing residual inflammation and immune dysfunction is crucial for improving long-term outcomes in PWH.
• Further research into novel therapeutic interventions is warranted.
• Optimizing the timing and initiation of cART remains a cornerstone of HIV management for enhanced immune recovery.