Immunologic and virologic effects of glucocorticoids on human immunodeficiency virus infection in children: a preliminary study.
The immune dysfunction in human immunodeficiency virus (HIV) infection is complex and cannot be explained solely on the basis of numerical depletion of T lymphocytes. Inappropriate, uncontrolled activation of the immune system may be involved. In a test of this hypothesis, five HIV-infected children were prospectively treated with prednisone and selected immunologic and virologic indices were analyzed. Subjects had marked T lymphopenia (CD4+ T lymphocytes < 500 cells/ml) and antigenemia (serum p24 antigen > 30 pg/ml) and were free of opportunistic infections. There was a significant drop in serum p24 antigen concentrations from baseline (60.2 +/- 10.1% SEM; P < 0.005) 4 weeks after initiation of prednisone, which returned to baseline concentrations as the prednisone was tapered. Concomitant with this decrease, there was decreased expression of cell surface activation markers (HLA-DR, CD25 (interleukin 2 receptor) and CD26 (Ta-1)) in peripheral T lymphocytes. There was no significant change in either T lymphocyte subset numbers or mitogen and antigen-specific lymphoproliferation. A regulatory dysfunction of the immune system, allowing inappropriate activation of T lymphocytes, may be involved in the pathogenesis of HIV disease, and further studies involving selective immunosuppression in HIV disease are warranted.
Ferdman
R M
RM
Childrens AIDS Center, Childrens Hospital Los Angeles, CA.
Church
J A
JA
D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D016655:HIV Core Protein p24 / Q000097:blood*; D015658:HIV Infections / Q000276:immunology* / Q000382:microbiology; D006801:Humans; D007958:Leukocyte Count; D008213:Lymphocyte Activation; D010641:Phenotype; D011241:Prednisone / Q000494:pharmacology*; D011446:Prospective Studies; D016176:T-Lymphocyte Subsets / Q000276:immunology*
D016655:HIV Core Protein p24; D011241:Prednisone