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< .01) cumulative decrease of CIC occurred (9,10,14). Similarly,

< unity) are characteristic for B-cell

Indirect Effects A reduced rate of infections may reduce lymphocyte activation and thereby decrease viral replication. Similarly, the removal of CIC by IVIG may decrease cellular activation as well as immunosuppression by CIC in antigen excess, both of which are present in HIV -infected children. These indirect effects may be responsible for the observed preservation of CD4 cell counts, the decrease in serum LDH levels, the decrease in HIV serum antigens, and improvement in suppressor T -cell function. In one study, the CD4 sparing effect of IVIG treatment persisted even in patients experiencing serious infections (20). We have also reported reductions in serum ~2 microglobulin (39), neopterin (40), and tumor necrosis factor levels (41)-all markers of lymphocyte activation and HIV disease activity. These fmdings suggest that IVIG may act by inhibition of the effector functions of activated T cells, ultimately reducing the release of injurious cytokines.