HIV leads to a complex disorder that combines an initial chronic activation of the immune system with a progressive decrease in the number of CD4+ T cells, which are involved in the immune response. If the number of CD4+ T cells falls below a certain level, the weakened immune system is less able to fight infections and the symptoms of AIDS develop.
Rejecting the commonly accepted view that the CD4+ T cells are killed solely by the HIV virus, Jean-Marie Andrieu and Wei Lu of Université René Descartes in Paris believe that the hyperactivity of the immune system is part of the problem. To test whether reducing the activity of the immune system can protect patients' CD4+ T-cell numbers and hence delay AIDS onset, the researchers initiated a trial where 44 patients with HIV were given the immunosuppressant drug, prednisolone.
After two years of taking the drug, 50% of patients had CD4+ T-cell counts higher than they did at the start of the trial. This compares with 5% of patients that did not take prednisolone.
After five years, more than 10% of the patients taking prednisolone had higher CD4+ T-cell counts than they did at the start of the trial, compared with virtually no patients in the control group.
Prednisolone was particularly effective at maintaining high CD4+ T-cell counts and delaying AIDS onset in patients that initially had a low level of virus in their body. Importantly, despite suppressing patients' immune response, prednisolone did not cause the HIV virus to replicate more vigorously.
Prednisolone is a very inexpensive drug belonging to the class of glucocorticoids. The side effects of the drug were mild at the low daily dose at which it was given.
The authors expect their study to prompt further clinical trials. These should test different doses of prednisolone or other glucocorticoids, to define the lowest dose that can maintain the population of CD4+ T-cells. In addition, researchers could investigate whether the antiretroviral therapy for AIDS, HAART, is more effective if given in conjunction with glucocorticoids.
This press release is based on the following article:
Long-term clinical, immunologic and virologic impact of glucocorticoids on the chronic phase of HIV infection
Jean-Marie Andrieu and Wei Lu
BMC Medicine 2004, 2:17
To be published on 5 May 2004
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