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Can you please elaborate on the new immune functionality test s you mentioned?
Apr 11, 2004

First I would like to echo what someone wrote recently about how important your forum is to many thousands of people, because of the considerable medical and scientific knowledge you bring to it. I have learned many things reading your answers, which are not accessible elsewhere (not even through Nexis or Google searches).

You did mention in a couple of posts today that more sensitive tests have recently been developed (at least in research settings) to detect flaws or subtle underlying changes in the immune system caused by HIV infection. Yet in another answer, you conveyed that tests of immune functionality (beyond testing for antibodies etc.) are not consistent and may miss some defects (my words, but I hope I understood your various answers correctly).

Anyway, could you please elaborate on what these newer immune functionality tests are?...and what types of subtle HIV induced flaws they can detect? If these flaws are present, is the only remedy to start HAART regardless of CD4 count and/or VL?

Thanks again for the wonderful advice and support that you provide through your work on this forum.

Response from Dr. Holodniy

This unfortunately is an extremely complex topic to delve into without alot of detail. You can look at this like unpeeling the layers of an onion. The first level is looking at whole blood samples incubated with certain mitogens (immune stimulants) or antigens (usually what we term recall antigens like tetanus or candida) an measure their ability to proliferate (grow and multiply in the presence of a stimulus). Next you can look at certain subsets of t cells or macrophages, using flow cytometry to count each subset and/or physically separate or combine and incubate them in the presence of whole HIV or small pieces of different HIV proteins (peptides) and ask questions about what they are making and are they making the appropriate amount of these chemicals (like IL-2 or gamma interferon) in response to being in the presence of these HIV proteins,or you can determine if the cell subsets are talking to each other effectively, or you can assess the ability of these cells to kill HIV infected cells. So in almost all HIV infected people you can can see a response to immune stimulants, in most patients (even in some below 200 CD4 cells) you can see responses to recall antigens. However, if you look at HIV specific responses, whether it is proliferative responses or gamma interferon production, or some other indicator, you will see reduction or losses in these HIV specific responses quite early in HIV infection (or in those with high CD4 counts), unless they are long term nonprogressors.



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