Epstein-Barr Virus load and immune activation in Human Immunodeficiency Virus type 1-infected patients
Section snippets
Background
EBV infects B lymphocytes and has a potent transforming ability, capable of inducing uncontrolled proliferation and transformation of infected cells.1 Patients with HIV-1 infection are at high risk of developing EBV-related diseases, ranging from lymphoproliferatives disorders to B-cell non-Hodgkin's lymphomas (NHL).2, 3
Besides immunodepression, chronic immune activation, a hallmark of HIV-1 pathogenesis,4 may play a critical role in the genesis of B-cell lymphomas.5, 6 Cell activation driven
Objectives
The aim of this study was to investigate the relationship between HIV-1 viremia, markers of immune activation and EBV load in HIV-1 infected HAART-naïve and HAART-experienced patients.
Patients and samples
A total of 156 (117 male and 39 female) HIV-1-infected patients who attended the Infectious Diseases Division of Rovigo Hospital consecutively from July 2007 to December 2009 were included in this study. Their median age was 41 (range 18–68) years. At the time of sample collection for the study, 71 (45%) were HAART-naïve, and 85 (55%) HAART-experienced with a median (range) of 6 (1–10) years of HAART. Patients were treated according to current guidelines for HIV-1 infection.17, 18 Among
EBV-DNA levels in relationship to CD4 cell count and HIV-1 load
EBV-DNA was detected in 114 patients; in all but 3 cases EBV was type 1. The median [interquartile, IQR] EBV-DNA load was 43[1–151] copies/105 PBMC. EBV-DNA levels were higher in naïve and out of therapy patients than in those in HAART (overall, p = 0.001) (Table 1).
CD4 cell number was lower in naïve patients and in those out of therapy than in HAART patients (overall, p < 0.0001) (Table 1). Only 17 naïve patients had severe immunodepression (CD4 < 200 cells/μl), whereas 52 (73%) naïve, 21 (33%)
Discussion
Following the introduction of HAART, the incidence of opportunistic infections and AIDS-related diseases, such as Kaposi sarcoma, dramatically decreased.22, 23 However, the impact of HAART in preventing EBV-associated lymphomas seems to be less effective.15 Chronic immune activation is a hallmark of HIV-1 infection and may contribute to the expansion of EBV-infected cells. Persistence of plasma viremia during HAART, despite immunoreconstitution, is not an infrequent observation,16, 20, 24, 25,
Acknowledgment
We thank Lisa Smith for editorial assistance and Pierantonio Gallo for the artwork.
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