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November 12, 1997

Immune Restoration Following Treatment

Author Affiliations

Associate Professor Department of Immunology/Microbiology Rush Medical Center Chicago, Ill e-mail: alanday@rush.edu

JAMA. 1997;278(18):1538. doi:10.1001/jama.1997.03550180092046

COMMENTARY  We clearly have entered a new era of treatment for the acquired immunodeficiency syndrome with the development of highly active antiretroviral therapy (HAART). With the institution of HAART has come the exciting discovery that HAART is not only capable of reducing virus to undetectable levels but also has the ability to potentially restore the lost CD4 cells.1In the article by Autran et al,2 it was demonstrated that patients infected with the human immunodeficiency virus (HIV) who have advanced disease have restoration of new functional immune responses 1 year following therapy. These data, although very promising, perhaps raise more questions than they answer. One of the critical questions in HIV disease is whether one can repair the holes in the immunologic repertoire.3 Recent studies of HIV-positive patients on protease inhibitor or cytokine therapy have not demonstrated normalization of the T-cell antigen repertoire.4 However, the rise