Cytomegalovirus-specific cell-mediated immunity in HIV-infected children on HAART

The objectives of this study were to define the magnitude, time course, and virologic and immunologic correlates of HAART-associated reconstitution of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) in pediatric HAART recipients. Thirty-five HIV-infected CMV-seropositive subjects ≤22 years on or about to receive HAART had CMV-CMI measured by responder cell frequency (RCF) and interferon-γ (IFN-γ) secretion over 3 years. RCF was detected in 33, 52, 38, and 28% before HAART and at years 1, 2, and ≥3, respectively. Corresponding percentages for IFN-γ were 100, 85, 100, and 38%. Neither RCF nor IFN-γ was significantly associated with CD4% before or after HAART initiation. Lower HIV replication was associated with a higher proportion of subjects with positive RCF, but not IFN-γ. There were no clinical CMV manifestations during the study. HIV-infected children did not demonstrate a significant increase in CMV-CMI with longer HAART duration, which suggests that CMV immunereconstitution involves more complex immunologic and virologic interactions than previously anticipated.