In vitro T cell function, delayed-type hypersensitivity skin testing, and CD4+ T cell subset phenotyping independently predict survival time in patients infected with human immunodeficiency virus.
Human immunodeficiency virus type 1 (HIV-1)-infected patients (n = 335) in the US Air Force HIV Natural History Program were followed for 3 years (mean) after skin testing, immunophenotyping of CD4+ cell subsets, and measurement of in vitro interleukin-2 production after stimulation by phytohemagglutinin, alloantigens, tetanus toxoid, and influenza A virus. The T cell functional assay predicted survival time (P < .001) and time for progression to AIDS (P = .014). Skin testing for tetanus, mumps, and Candida antigen and the total number of positive tests (P < .001 for each) stratified patients for survival time. In a multivariable proportional hazards model, the T cell functional assay (P = .008), the absolute number of CD4+ T cells (P = .001), the percentage of CD4+ CD29+ cells (P = .06), and the number of reactive skin tests (P < .001) predicted survival time. Thus, cellular immune functional tests have significant predictive value for survival time in HIV-1-infected patients independent of CD4+ cell count.
Dolan
M J
MJ
Department of Infectious Diseases, Wilford Hall Medical Center, Lackland Air Force Base, TX 78236-5300, USA.
Clerici
M
M
Blatt
S P
SP
Hendrix
C W
CW
Melcher
G P
GP
Boswell
R N
RN
Freeman
T M
TM
Ward
W
W
Hensley
R
R
Shearer
G M
GM
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000401:mortality / Q000503:physiopathology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality*; D006801:Humans; D006968:Hypersensitivity, Delayed; D007111:Immunity, Cellular; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012882:Skin Tests; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*; D013997:Time Factors; D014481:United States