Failure of CD4+T-cell Recovery upon Virally-Effective cART: an Enduring Gap in the Understanding of HIV plus Immunological non-Responders

摘要

The introduction of cART in the treatment of HIV infection has significantly decreased morbidity and mortality by inducing suppression of viral replication and recovery of CD4+ T-cell counts. However; about 30% of HN-infected individuals fail to achieve normalization of CD4+ T-cell counts, despite antiretroviral therapy and complete suppression of the HIV load: these patients are referred to as "immunological non-responders". Several studies have shown an increased risk of clinical progression to both AIDS and non-AIDS events as well as a higher mortality in these patients. The pathogenetic factors underlying this condition are multiple and none of these alone can exhaustively explain the mechanism of incomplete immune reconstitution. In light of this, the purpose of the present review is to: i) describe in detail the pathogenetic mechanisms that contribute to scarce immune recovery; ii) discuss the higher morbidity and mortality which feature such a condition; iii) take stock of therapeutic strategies used in recent years for these patients.