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- Title
Restoration of T Cell Responses to Toxoplasma gondii after Successful Combined Antiretroviral Therapy in Patients with AIDS with Previous Toxoplasmic Encephalitis.
- Authors
Lejeune, Marylène; Miró, José M.; De Lazzari, Elisa; Garc, Felipe; Claramonte, Xavier; Martínez, Esteban; Ribera, Esteban; Arrizabalaga, Julio; Arribas, José R.; Domingo, Pere; Ferrer, Elena; Plana, Montserrat; Valls, María-Eugenia; Podzamczer, Daniel; Pumarola, Tomás; Jacquet, Alain; Mallolas, Josep; Gatell, José M.; Gallart, Teresa
- Abstract
Background. It is unknown whether a Toxoplasma gondii-specific T cell response is restored after successful combined antiretroviral therapy (cART) in patients with AIDS and current or previous toxoplasmic encephalitis (TE). Methods. We performed a multicenter cross-sectional study with 17 healthy T. gondii-positive human immunodeficiency virus (HIV)-1-uninfected individuals and 90 patients coinfected with HIV-1 and T. gondii distributed in 5 groups according to their CD4+ T cell counts and T. gondii infection (with or without current or previous TE). We investigated the lymphocyte proliferative response (LPR) and interferon (IFN)-γ production in response to T. gondii soluble antigen extract (SATg) and as CD4+ and CD8+ T cell subsets. Results. SATg-specific LPR and IFN-γ production were not observed in many of the most immunosuppressed patients (CD4+ T cell count, <200 cells/μL, with or without current or previous TE). By contrast, these responses occurred in a considerable percentage (LPR, 43%; IFN-γ production, 80%) of patients receiving successful cART (CD4+ T cell count, >200 cells/μL) who presented with TE and had already stopped secondary TE prophylaxis. Similar results were found in immunocompetent asymptomatic patients who did not receive TE prophylaxis. The predictors of SATg-specific T cell responses and IFN-γ production were a cART-mediated increase in CD4+ T cell count and LPR to phytohemagglutinin and viral suppression and a decrease in the activated (CD38+) CD8+ T cell count, respectively. Conclusions. cART restores T. gondii-specific CD4 T cell responses in most patients with AIDS who had previous TE. Our data support the safety of withdrawing TE prophylaxis when the CD4+ T cell count returns to levels >200 cells/μL.
- Subjects
T cells; TOXOPLASMA gondii; HIGHLY active antiretroviral therapy; COMBINATION drug therapy; AIDS patients; ENCEPHALITIS
- Publication
Clinical Infectious Diseases, 2011, Vol 52, Issue 5, p662
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciq197