Evidence of ongoing immune reconstitution in subjects with sustained viral suppression following 6 years of lopinavir-ritonavir treatment

Background. We evaluated the immunologic impact of highly active antiretroviral therapy in subjects who maintained human immunodeficiency virus type 1 (HIV-1) suppression through 6 years of receiving a lopinavir-ritonavir- based regimen. Methods. A total of 100 antiretroviral-naive subjects with any CD4⁺ T cell count initiated therapy with lopinavirritonavir, stavudine, and lamivudine. Sixty-three subjects who remained in the study for 6 years were assessed. Laboratory measurements included plasma HIV-1 RNA levels, multiparameter flow cytometry of immune cells, and markers of maturation and activation. Results. After 6 years, 62 of 63 subjects had plasma HIV-1 RNA levels <50 copies/mL. The mean increase in CD4⁺ T cell count was 528 cells/ftL (P < .001), and 81% of subjects had CD4⁺ T cell counts >500 cells/μL, compared with 21% of subjects at baseline. The mean ratio of CD4⁺ T cell count to CD8⁺ T cell count increased from 0.38 at baseline to 0.96 at year 6 (P < .001). The percentage of subjects with cell counts below the lower limit of normal at year 6, compared with at baseline, was significantly decreased for total T cells, B cells, and natural killer cells. At year 6, the median CD4⁺ T cell activation level was 3.4%, and the median CD8⁺ T cell activation level was 5.8%. Conclusions. The receipt of a lopinavir-ritonavir-based regimen resulted in ongoing immune reconstitution through 6 years of therapy in a cohort of HIV-1-infected, antiretroviral-naive subjects with suppressed HIV-1 RNA levels. Normalization of activation marker expression on CD4⁺ and CD8 ⁺ T cell subsets was demonstrated.