HAART-mediated immune reconstitution - Is it a realistic goal?

HIV infection leads to a severe decrease of CD4+ T lymphocytes and generalised immune activation with subsequent development of opportunistic infections and malignancies. Administration of highly active antiretroviral therapy (HAART) has been successful in reducing HIV plasma viraemia to extremely low levels. This leads to an improvement of immune function and to a dramatic reduction in the incidence of both opportunistic infections and HIV-related mortality. However, the ability of HAART to restore immunocompetence appears incomplete, especially in patients with chronic and advanced disease; also, its extended use is not without drawbacks, including reduced adherence, toxic effects and viral resistance. Development of any complementary approaches, particularly those able to compensate for the limitations of HAART, would be of interest. Additional therapeutic strategies with cytokines, immunomodulators or therapeutic immunisations are currently being investigated and their benefit in HIV patients receiving HAART is under evaluation.