There is evidence that early and aggressive treatment with antiretroviral drugs can prevent
the loss of immune cell function that accompanies HIV infection. This study will use
leukapheresis (drawing blood, separating out the white cells and returning the blood to the
patient) to obtain blood cells from HIV-infected patients in either the acute or chronic
stage of infection who are being treated with early highly active antiretroviral therapy
(HAART). Leukapheresis is necessary to obtain enough cells to delineate the response of B
cells to CD4+ T cell help, the CD8 factors associated with suppression of viral replication
and normalization of immune function, and natural killer function relative to HIV disease.
Study participants will be adult (older than 18 years) HIV primary or acutely affected
patients (those with a history of exposure to HIV but not yet showing chronic symptoms of HIV
disease) and HIV chronically infected patients (those infected with HIV for longer than 12
months or showing other symptoms of HIV disease) who are not receiving HAART at the beginning
of the study. The study seeks to enroll 30 primary and 30 chronic patients. Pregnant women
will not be enrolled in the study; women who become pregnant will be dropped from the study.
Leukapheresis will be performed on each patient before HAART therapy begins and then three
times a year. Each session will take between 1 and 3 hours.
This longitudinal study will enable researchers to examine the function of certain B cells,
natural killer cells, and CD8+ T cells in people who do not have chronic HIV disease and in
those who do have the disease and are treated with HAART.
HIV infection is known to cause profound and irreversible dysfunction of both innate and
adaptive arms of the immune system. However, there is mounting evidence that early and
aggressive treatment with antiretroviral drugs can prevent loss of immune cell function. In
an attempt to further delineate the effect of early antiretroviral therapy (ART) on
maintenance of immune cell function, we wish to recruit drug-na(SqrRoot) ve HIVinfected
patients who are either in early or chronic stage of infection. The study will require that
patients undergo leukapheresis or research blood draw once before and several times after
enrollment. Leukapheresis will be used in order to obtain sufficient cells to pursue the
following objectives: delineating B cell response to CD4+ T cell help, delineating the effect
of ART on persistent HIV reservoirs in CD4+ T cells of infected individuals, and delineating
CD8+ T cell-mediated suppression of viral replication and normalization of immune function,
and characterizing natural killer (NK) function relative to HIV disease. The required number
of mononuclear cells needed to perform these experiments can be easily and safely obtained
using leukapheresis procedures in the Clinical Center Apheresis Unit. This protocol is
specifically designed to conform to the requirements of the Apheresis Unit for donors to have
leukapheresis procedures, but the protocol, by itself, is not an independent research study.
Alternatively, whole blood draws will be used in cases where patients are unable to undergo
leukapheresis. While this approach will limit extensive functional analyses, informative
phenotypic and limited functional analyses can nonetheless be performed.
- INCLUSION CRITERIA:
Adult (18 years old or older) HIV-1-infected patient
Adequate venous access for apheresis or sufficient research blood collection
Positive HIV antibody immunoassay and a positive confirmatory HIV test as defined by
current CDC criteria. Tests may be done in our clinic or by an outside provider. For
individuals with suspected early infection; the following criteria may be used: a history
of exposure to a known source of HIV-infected material or individual or clinical symptoms
and signs consistent with acute HIV infection (such as fever, sore throat, malaise,
maculopapular rash combined with one of the following: a positive HIV antibody immunoassay
and confirmatory HIV test as defined by current CDC criteria); or a positive HIV antibody
immunoassay, with negative confirmatory test that subsequently evolves to a positive
result; or HIV RNA levels of >2,000 copies/ml with a negative result from an HIV antibody
Willingness to be able to make follow up visits at least once in the next 4 months and
prior to the initiation of antiretroviral therapy.
Blood pressure less than 180/100; pulse rate between 50-100 unless a lower pulse reat is
considered normal for the volunteer
Adequate blood counts (hemoglobin greater than or equal to 9.0 g/dL, hematocrit greater
than or equal to 28 percent, platelets greaterhan or equal to 50,000)
Willingness to give informed consent including consent for the storage of blood samples and
Antiretroviral naive or no antiretroviral use in the last six months
Pregnant and/or breastfeeding women.
Be currently acusing alcohol or other drugs that potentially could interfere with patient
Have a condition in the opinion of the investigators would make the patient ineligible for