Immune Reconstitution in Children
- HIV-Infected Children on HAART Reconstitute Tetanus-Specific T Cell Responses without Booster Vaccination (Poster 688)
Authored by A. Weinberg, A. Kovacs, S. Pahwa, V. Carey, R. Oyomopito, L. Mofenson, M. Khoury, B. Zimmer, S. Burchett, and the PACTG 366 Team
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The issue of immune reconstitution due to HAART in children was addressed in a poster presented by A. Weinberg and colleagues. In adults it has been noted that effectively treated patients recover lymphocyte proliferative responses (LRTs) to pathogens such as candida and CMV but not to tetanus. One explanation for that discordance was that continuous exposure to candida and CMV is occurring but not to tetanus (no re-exposure to antigen). This study prospectively analyzed Candida and tetanus LPR in children with advanced HIV disease (average age = 6.1 years) beginning their first HAART regimen. For the 82 children with negative tetanus LTR at baseline, virologic suppression at week 24 was significantly associated with the recovery of tetanus and candida LTR. Children recovering either of those LTRs had a higher baseline CD4+ T-cell count but a similar baseline viral load. This study demonstrated that effective HIV therapy in children resulted in recovery of functional T-cell responses to candida (as in adults) and to tetanus even in the absence of re-vaccination (different from what is usually observed in adults).