Immune Therapy: Non–Highly Active Antiretroviral Therapy Management of Human Immunodeficiency Virus–Infected Patients

The complexity of human immunodeficiency virus (HIV) immunopathogenesis has prompted multiple strategic approaches to re-establish normal immune responses. Highly active antiretroviral therapy (HAART) can control viral replication, but it is unable to restore HIV-specific immunity. Newer approaches for managing HIV infection are focusing on cell-mediated immune responses, including the potential for improved immunologic control over HIV replication. Cytokines, such as interleukin (IL)-2 and IL-12, are being evaluated for their ability to enhance cell-mediated immunity, which is thought to be critical for immunologic control. Initial studies with IL-2 have demonstrated an improvement in CD4 cell counts, and large randomized trials are underway to determine the long-term clinical efficacy of IL-2 in combination with antiretroviral therapy, including HAART. Stimulating the immune response against HIV by use of exogenous (therapeutic vaccination) or endogenous (structured treatment interruption) antigens with or without immune adjuvants or cytokines, such as IL-2, is another approach currently being explored.