Prospective 5-year study of peripheral blood CD4, CD8, and CD19/CD20 lymphocytes and serum Igs in children born to HIV-1 women. The P(2)C(2) HIV Study Group.
BACKGROUND
Peripheral blood CD4(+) and CD8(+) T cells, CD19(+)/20(+) B cells, and serum Igs are known to be altered by the progression of pediatric HIV-1 infection, but their evaluation as predictors of survival needs further definition.


OBJECTIVE
To determine the natural history of these immune factors and their importance in predicting survival, we studied 298 HIV-1 vertically infected (HIV-1(+)) children over a 5-year period.


METHODS
These immune factors and serum HIV-1 RNA levels were measured in two groups: (1) a birth cohort of children enrolled up to age 28 days postnatally, including 93 HIV-1(+) and 463 HIV-1 uninfected infants (HIV-1(-)), and (2) an older cohort of 205 HIV-1(+) children enrolled after the age of 28 days, who were classified as survivors or nonsurvivors.


RESULTS
In the birth cohort HIV-1(+) children had significantly lower CD4(+) T-cell counts, higher CD8(+) T-cell counts, and lower CD19(+)/20(+) B-cell counts and higher IgG, IgA, and IgM levels than HIV-1(-) children. In the older cohort survivors had significantly higher CD4(+) and CD8(+) T-cell and CD19(+)/CD20(+) B-cell counts and higher IgG, lower IgA, and lower IgM levels than did nonsurvivors. In univariable analysis factors affecting survival in the older cohort were baseline CD4(+) and CD8(+) T-cell and CD19(+)/20(+) B-cell counts and IgG and HIV-1 RNA levels (all P <.05). In multivariable analysis high baseline CD4(+) T-cell count and low baseline HIV-1 RNA load remained important.


CONCLUSIONS
The longitudinal mean profiles of CD4 and CD8 T-cell and CD19/20 B-cell counts and serum IgG levels helped to describe the natural progression of HIV-1 disease in children. However, only baseline CD4 T-cell count independently predicted survival.
Shearer
W T
WT
Baylor College of Medicine, Houston.
Easley
K A
KA
Goldfarb
J
J
Rosenblatt
H M
HM
Jenson
H B
HB
Kovacs
A
A
McIntosh
K
K
D018941:Antigens, CD19 / Q000097:blood*; D018951:Antigens, CD20 / Q000097:blood*; D016175:B-Lymphocyte Subsets / Q000473:pathology; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology*; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000401:mortality / Q000473:pathology*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007136:Immunoglobulins / Q000097:blood*; D007223:Infant; D007231:Infant, Newborn; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral; D015996:Survival Rate; D019562:Viral Load
D018941:Antigens, CD19; D018951:Antigens, CD20; D007136:Immunoglobulins; D012367:RNA, Viral