Antibody-dependent cellular cytotoxicity independently predicts survival in severely immunocompromised human immunodeficiency virus-infected patients.
The exact immune defects leading to human immunodeficiency virus (HIV)-associated opportunistic infections, malignancies, and death are unknown. In this study, the relationship between survival and 2 immune functions, cytomegalovirus-specific antibody-dependent cellular cytotoxicity (ADCC) and natural killer (NK) activity, was determined by using peripheral blood mononuclear cells from 39 severely immunocompromised patients (median CD4 count, 7). Median follow-up was 414 days; 15 subjects died and 24 remained alive. In a Kaplan-Meier analysis, high baseline ADCC (>median) was associated with improved survival (P=.05). A similar trend was observed for NK activity (P=.1). In a multivariate model controlling for baseline CD4 cell count, HIV RNA, and use of protease inhibitors during follow-up, high ADCC, but not high NK activity, remained significantly associated with a lower risk of death (relative risk, 0.18; 95% confidence interval, 0.05-0.75). ADCC may be an important determinant of disease progression independently of anti-retroviral therapy, CD4 cell count, and HIV RNA.
Forthal
D N
DN
Division of Infectious Diseases, Department of Medicine, University of California, Irvine, Orange, CA 92868, USA. dnfortha@uci.edu
Landucci
G
G
Haubrich
R
R
Keenan
B
B
Kuppermann
B D
BD
Tilles
J G
JG
Kaplan
J
J
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology* / Q000401:mortality*; D000328:Adult; D000368:Aged; D000920:Antibody-Dependent Cell Cytotoxicity; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000401:mortality; D017726:Cytomegalovirus Retinitis / Q000276:immunology / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality*; D006801:Humans; D016867:Immunocompromised Host; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood; D015996:Survival Rate; D013997:Time Factors
D012367:RNA, Viral