Viro-immunological studies in acute HIV-1 infection.
OBJECTIVE
To monitor a patient who presented with symptomatic HIV-1 infection for virological and immunological parameters in relation to the clinical course.


METHODS
Virological studies included determination of frequency of productively HIV-1-infected peripheral blood mononuclear cells (PBMC) and viral RNA load in plasma and p24 antigenaemia. Immunological studies included the analysis of T-cell subsets, the expression of activation markers, CD45RO and CD45RA antigens, the frequency of cells programmed for death, and T-cell function.


RESULTS
During the first week post onset of primary HIV-1 infection symptoms high plasma titres of p24 and HIV-1 RNA were observed. The number of productively HIV-1-infected PBMC peaked, coinciding with CD4+ T lymphocytopaenia, during week 2 when clinical improvement started. CD8+ T lymphocytosis was observed 10 days post onset of clinical symptoms, the expanded cell population being of the CD8+CD38+, CD8+CD27+ and CD8+CD28- phenotype. CD8+ T lymphocytosis was paralleled by a high percentage of cells undergoing programmed cell death on in vitro culture. In vitro T-cell function was severely depressed during the first 10 days post onset of clinical symptoms. Within about 3 weeks, following resolution of clinical symptoms, phytohaemagglutinin-induced proliferation was restored to normal levels while responses to the CD3 monoclonal antibody only showed a partial restoration. During follow-up, concomitant with the rise of activated CD8+ T cells, p24 antigen levels and viral RNA load in serum as well as the number of HIV-producing PBMC steeply declined after 2 weeks.


CONCLUSIONS
These findings demonstrate HIV-1-induced abnormalities during severe clinical symptoms of primary HIV-1 infection. The subsequent strong immune response, which is believed to be responsible for efficient control of viral replication, appears to precede clinical improvement.
Department of Clinical Viro-Immunology, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam.
M T
MT
Roos
N A
NA
de Leeuw
F A
FA
Claessen
H G
HG
Huisman
N A
NA
Kootstra
L
L
Meyaard
P T
PT
Schellekens
H
H
Schuitemaker
F
F
Miedema
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000276:immunology* / Q000821:virology*; D000328:Adult; D015703:Antigens, CD / Q000097:blood; D017209:Apoptosis; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D015483:HIV Antibodies / Q000097:blood; D016655:HIV Core Protein p24 / Q000097:blood; D015497:HIV-1 / Q000302:isolation & purification*; D018451:Homosexuality, Male; D006801:Humans; D007156:Immunologic Memory; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012016:Reference Values; D012725:Sexual Behavior; D016176:T-Lymphocyte Subsets / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology* / Q000821:virology*; D013997:Time Factors
D015703:Antigens, CD; D015483:HIV Antibodies; D016655:HIV Core Protein p24; D012367:RNA, Viral