Effects of Tapering Doses of Oral Prednisone on Viral Load among HIV-Infected Patients with Unexplained Weight Loss

Abstract

In an exploratory study of virologic and immunomodulatory effects of corticosteroid therapy for wasting syndrome, four HIV-infected adults with recent unexplained weight loss were given tapering doses of prednisone over a 2-month period. Serum neopterin and TNF receptor II levels decreased from baseline after 7 days. An antiretroviral effect was observed initially, peaking on days 14-21 (mean change in HIV-1 branched chain DNA assay on day 21 of -0.52 log10; mean change, from baseline to nadir for each individual, of -0.63 log10); subsequent bDNA levels returned toward baseline as prednisone was tapered. No patient lost weight and there was a mean weight gain of 3.5 kg. Anecdotal reports of corticosteroid benefits in the wasting syndrome may result in part from decreased T cell activation leading to decreased HIV replication, an effect that may be self-limited or that may occur only at higher prednisone doses. Studies involving more targeted immunomodulatory agents for wasting syndrome are warranted.

Inhibition of HIV-1-specific T-cells and increase of viral load during immunosuppressive treatment in an HIV-1 infected patient with Chlamydia trachomatis induced arthritis

“…The effect of treatment with steroids has been discussed controversially. Several studies suggested that at least short term or low-dose treatment by steroids is safe with regard to viral load and CD4 counts for the majority of HIV-1 infected patients (Kilby et al, 1997;McComsey et al, 2001;Montaner et al, 2003;Wallis et al, 2003;Walmsley et al, 1995;Ulmer et al, 2005). Indeed, dexamethasone has been shown to exert a direct inhibitory effect on HIV-1 LTR (Kino et al, 2000).…”

Urinary neopterin in idiopathic retinal vasculitis

“…In HIV positive patients with wasting disease, a reduction in neopterin is seen 7 days after starting oral prednisolone. 30 In both rheumatoid arthritis and SLE a fall in neopterin occurs when patients show a reduction in disease activity in response to immunosuppressive treatment. 18 20 It is interesting that there was no diVerence in UNC ratios between patients on diVerent doses of prednisolone, nor between those on additional second line immunosuppressants.…”

Corticosteroids and HIV infection: a review of experience

“…The treated patients showed reduced T-cell apoptosis in an ex-vivo assay in which mononuclear cells were stimulated with anti-CD3. A subsequent smaller uncontrolled study [24], in which patients with wasting syndrome were treated with corticosteroids for 2 months, observed similar reductions in viral expression and activation markers (serum neopterin and TNFRII). The authors suggested that the inhibition of T-cell activation and activation-induced apoptosis might account for the beneficial effects on T-cell numbers and HIV expression.…”