Effect of Highly Active Antiretroviral Therapy on Viral Burden in the Lungs of HIV-Infected Subjects

• Published in: The Journal of infectious diseases 2008-01, Vol.197 (1), p.109-116
• Main Authors: Twigg, Homer L., Weiden, Michael, Valentine, Fred, Bick, Carol T. Schnizlein, Bassett, Roland, Zheng, Lu, Wheat, Joseph, Day, Richard B., Rominger, Helen, Collman, Ronald G., Fox, Lawrence, Brizz, Barbara, Dragavon, Joan, Coombs, Robert W., Bucy, R. Pat
• Format: Article
• Language: English
• Subjects: Adult; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Blood plasma; Bronchoalveolar Lavage Fluid - cytology; Bronchoalveolar Lavage Fluid - virology; DNA; DNA, Viral - drug effects; Female; Highly active antiretroviral therapy; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV-1 - drug effects; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Longitudinal Studies; Lung - drug effects; Lung - virology; Lungs; Lymphocytes; Male; Medical sciences; Pulmonary alveoli; Pulmonary Alveoli - drug effects; Pulmonary Alveoli - virology; RNA; RNA, Viral - drug effects; T lymphocytes; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/523766

Background. Human immunodeficiency virus (HIV) is readily detectable in the lungs of infected subjects and leads to an accumulation of CD8+ lymphocytes in the alveolar space. Although highly active antiretroviral therapy (HAART) is effective in reducing viremia, less is known about its effect on tissue compartments. The AIDS Clinical Trials Group Protocol 723 Team evaluated the effect of HAART on lung viral load and cellular constituents. Methods. Bronchoalveolar lavage (BAL) fluid and blood were collected before initiation of HAART and again at 4 and 24 weeks after initiation of therapy. The BAL cell differential was determined, lymphocyte phenotyping was performed, and acellular BAL fluid, plasma HIV RNA load, and BAL cell and peripheral blood mononuclear cell HIV RNA and DNA loads were measured. Results. HAART induced a rapid decrease in HIV that was detectable in acellular BAL fluid and a slower decrease in the HIV RNA and DNA loads in BAL cells. HAART was associated with a significant decrease in the absolute number and percentage of CD8+ alveolar lymphocytes. There was a significant correlation between residual BAL cell DNA at 24 weeks and the absolute number of CD4+ lymphocytes in the alveolar space. Conclusions. HAART is associated with a significant decrease in the pulmonary HIV burden and a return of alveolar cellular constituents to normal.