VZV Foundation - A Decade Of Leadership In The Fight Against VZV Infections

	Oral Presentation Abstracts: 3 [3] VARICELLA ZOSTER VIRUS (VZV) CELL MEDIATED IMMUNITY (CMI) IN HIV-INFECTED PATIENTS ON HIGHLY AFFECTIVE ANTIRETROVIRAL THERAPY (HAART) *P.W. Annunziato and K. Ampofo Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA As their immunodeficiency progresses, children and adolescents co-infected with HIV and VZV are at great risk for zoster because of poor CMI to VZV. It is not known if CMI to VZV improves and the risk of zoster decreases as immunity is restored by HAART. In order to determine if VZV CMI is restored in patients on HAART, VZV CMI was measured by lymphocyte proliferation assay (LPA) before initiating HAART or changing failing HAART in 6 moderately to severely immunodeficient pediatric patients co-infected with VZV and HIV. VZV LPAs were repeated 4 - 6 weeks after initiating the new HAART regimen and intermittently thereafter. Response to HAART was determined by measuring HIV viral load and CD4 counts. Episodes of zoster were recorded. Of 8 patients evaluated thus far, 5 have post-HAART LPA determinations. Of these 5 enrollees, VZV LPAs were negative in 4 patients at baseline. The VZV LPA of 1 patient was positive at baseline but negative 6 weeks after initiating HAART. One patient whose initial VZV LPA was negative had a positive VZV LPA 6 weeks after starting HAART. VZV LPAs of the other 3 patients remained negative 6 weeks after initiating or changing HAART. Three enrollees had suppression of HIV viral load (<400 copies/ml) and rises in CD4 counts 6 weeks after instituting new HAART regimens. All 3 patients had negative VZV LPAs at this time point, even though the VZV LPA of 1 patient was positive at baseline. VZV CMI has been followed for over 1 year in 3 patients, including 1 patient who developed zoster while in the study. Zoster occurred in this patient despite an adequate HIV response to HAART. His VZV LPA remained negative until 13 months following the episode of zoster. The number of patients studied thus far is small. However, this data suggests that immunity to VZV may not be reconstituted with successful HAART. As one case demonstrated, even after VZV reactivation while on successful HAART, VZV CMI may not be restored and these patients may remain at risk for repeated episodes of zoster. Corresponding Author: P.W. Annunziato, MD, Columbia University, 622 West 168th Street, Room PH West 4-464, New York, NY 10032, USA

[3]

VARICELLA ZOSTER VIRUS (VZV) CELL MEDIATED IMMUNITY (CMI) IN HIV-INFECTED PATIENTS ON HIGHLY AFFECTIVE ANTIRETROVIRAL THERAPY (HAART)
*P.W. Annunziato and K. Ampofo Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA

As their immunodeficiency progresses, children and adolescents co-infected with HIV and VZV are at great risk for zoster because of poor CMI to VZV. It is not known if CMI to VZV improves and the risk of zoster decreases as immunity is restored by HAART. In order to determine if VZV CMI is restored in patients on HAART, VZV CMI was measured by lymphocyte proliferation assay (LPA) before initiating HAART or changing failing HAART in 6 moderately to severely immunodeficient pediatric patients co-infected with VZV and HIV. VZV LPAs were repeated 4 - 6 weeks after initiating the new HAART regimen and intermittently thereafter. Response to HAART was determined by measuring HIV viral load and CD4 counts. Episodes of zoster were recorded. Of 8 patients evaluated thus far, 5 have post-HAART LPA determinations. Of these 5 enrollees, VZV LPAs were negative in 4 patients at baseline. The VZV LPA of 1 patient was positive at baseline but negative 6 weeks after initiating HAART. One patient whose initial VZV LPA was negative had a positive VZV LPA 6 weeks after starting HAART. VZV LPAs of the other 3 patients remained negative 6 weeks after initiating or changing HAART. Three enrollees had suppression of HIV viral load (<400 copies/ml) and rises in CD4 counts 6 weeks after instituting new HAART regimens. All 3 patients had negative VZV LPAs at this time point, even though the VZV LPA of 1 patient was positive at baseline. VZV CMI has been followed for over 1 year in 3 patients, including 1 patient who developed zoster while in the study. Zoster occurred in this patient despite an adequate HIV response to HAART. His VZV LPA remained negative until 13 months following the episode of zoster. The number of patients studied thus far is small. However, this data suggests that immunity to VZV may not be reconstituted with successful HAART. As one case demonstrated, even after VZV reactivation while on successful HAART, VZV CMI may not be restored and these patients may remain at risk for repeated episodes of zoster.

Corresponding Author: P.W. Annunziato, MD, Columbia University, 622 West 168th Street, Room PH West 4-464, New York, NY 10032, USA