title: Comparison of virus burden in blood and sequential lymph node biopsy specimens from children infected with human immunodeficiency virus.
abstract: BACKGROUND
  Lymph nodes serve as reservoirs for the replication of human immunodeficiency virus (HIV) type 1. Comparison of serial measurements of virus burden in lymph nodes and peripheral blood after a change in antiretroviral therapy may provide insights into pathogenic mechanisms and permit a more accurate assessment of a therapeutic response.
  
  
  METHODS
  Nevirapine was added to the drug regiment of eight children with HIV infection treated with the combination of zidovudine and didanosine who had increasing levels of serum p24 antigen. Lymph node biopsies were performed at entry and after 12 weeks of therapy.
  
  
  RESULTS
  Neither CD4 counts nor p24 antigen level correlated with the degree of viremia as measured by ribonucleic acid copy numbers in plasma. Correlations were found between HIV DNA copy number in peripheral blood mononuclear cells and HIV DNA copy number in lymph nodes (p = 0.02), as well as between peripheral blood CD4 counts and lymph node architecture. The HIV signals in the lymph nodes conformed to the anatomic organization of apical light zones in the germinal centers; however, in more advanced disease stages, organized germinal centers disappeared as evidence by a decline in the extent of the follicular dendritic network.
  
  
  CONCLUSIONS
  Lymph node biopsies in this small number of HIV-infected children revealed a progressive loss of an organized architecture, especially of the follicular dendritic network. This correlated with a progressive loss of CD4+ cells but not with other measures of disease stage, including viral load, as measured by ribonucleic acid copy numbers.
authors.affiliation: Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1928, USA.
authors.forename: B U
authors.initials: BU
authors.lastname: Mueller
authors.forename: S
authors.initials: S
authors.lastname: Sei
authors.forename: B
authors.initials: B
authors.lastname: Anderson
authors.forename: K
authors.initials: K
authors.lastname: Luzuriaga
authors.forename: M
authors.initials: M
authors.lastname: Farley
authors.forename: D J
authors.initials: DJ
authors.lastname: Venzon
authors.forename: G
authors.initials: G
authors.lastname: Tudor-Williams
authors.forename: D J
authors.initials: DJ
authors.lastname: Schwartzentruber
authors.forename: C
authors.initials: C
authors.lastname: Fox
authors.forename: J L
authors.initials: JL
authors.lastname: Sullivan
authors.forename: P A
authors.initials: PA
authors.lastname: Pizzo
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D016049:Didanosine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D017403:In Situ Hybridization; D007223:Infant; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology*; D008297:Male; D019829:Nevirapine; D011725:Pyridines / Q000008:administration & dosage; D014766:Viremia; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D016655:HIV Core Protein p24; D011725:Pyridines; D015215:Zidovudine; D019829:Nevirapine; D016049:Didanosine