HIV-1 and T cell dynamics after interruption of highly active antiretroviral therapy (HAART) in patients with a history of sustained viral suppression

Identifying the immunologic and virologic consequences of discontinuing antiretroviral therapy in HIV-infected patients is of major importance in developing long-term treatment strategies for patients with HIV-1 infection. We designed a trial to characterize these parameters after interruption of highly active antiretroviral therapy (HAART) in patients who had maintained prolonged viral suppression on antiretroviral drugs. Eighteen patients with CD4+ T cell counts ≥ 350 cells/μl and viral load below the limits of detection for ≥1 year while on HAART were enrolled prospectively in a trial in which HAART was discontinued. Twelve of these patients had received prior IL-2 therapy and had low frequencies of resting, latently infected CD4 cells. Viral load relapse to >50 copies/ml occurred in all 18 patients independent of prior IL-2 treatment, beginning most commonly during weeks 2–3 after cessation of HAART. The mean relapse rate constant was 0.45 (0.20 log10 copies) day−1, which was very similar to the mean viral clearance rate constant after drug resumption of 0.35 (0.15 log10 copies) day−1 (P = 0.28). One patient experienced a relapse delay to week 7. All patients except one experienced a relapse burden to >5,000 RNA copies/ml. Ex vivo labeling with BrdUrd showed that CD4 and CD8 cell turnover increased after withdrawal of HAART and correlated with viral load whereas lymphocyte turnover decreased after reinitiation of drug treatment. Virologic relapse occurs rapidly in patients who discontinue suppressive drug therapy, even in patients with a markedly diminished pool of resting, latently infected CD4+ T cells.

Extraordinarily high spider densities on islands: flow of energy from the marine to terrestrial food webs and the absence of predation.

Some islands in the Gulf of California support very high densities of spiders. Spider density is negatively correlated with island size; many small islands support 50-200 spiders per m3 of cactus. Energy for these spiders comes primarily from the ocean and not from in situ productivity by land plants. We explicitly connect the marine and terrestrial systems to show that insular food webs represent one endpoint of the marine web. We describe two conduits for marine energy entering these islands: shore drift and seabird colonies. Both conduits are related to island area, having a much stronger effect on smaller islands. This asymmetric effect helps to explain the exceptionally high spider densities on small islands. Although productivity sets the maximal potential densities, predation (by scorpions) limits realized spider abundance. Thus, prey availability and predation act in concert to set insular spider abundance.