Evaluation of immune survival factors in pediatric HIV-1 infection.
Peripheral blood CD4+ and CD8+ T cells, CD19+/20+ B cells, and serum immunoglobulins (Igs) have been implicated as survival factors for pediatric HIV-1 infection. To determine which of these immune factors might be important in predicting survival, we studied HIV-1 vertically infected (HIV-1+) children over a 5-year period. Peripheral blood lymphocytes and Igs were measured in 298 HIV-1+ children, who were classified as survivors or nonsurvivors, and in 463 HIV-1 vertically exposed and noninfected (HIV-1-) children. Measurements of other possible survival factors were included in this study: albumin, hemoglobin, lactic dehydrogenase (LDH), and HIV-1 RNA levels. Survivors had significantly higher CD4+ T-cell, CD8+ T-cell, and CD19+/CD20+ B-cell counts and serum IgG levels, but lower serum IgA and IgM levels than nonsurvivors. Serum albumin and blood hemoglobin levels were higher, but serum LDH and HIV-1 RNA levels were lower in the survivors compared to nonsurvivors. In univariable analysis, factors affecting survival were baseline CD4+ T-cell and CD8+ T-cell counts, IgG, albumin, hemoglobin, LDH, and HIV-1 RNA (all p < 0.001). In multivariable analysis, high baseline CD4+ T-cell count, IgG and albumin levels, and low baseline HIV-1 RNA load remained important factors for survival. Serum IgG level has been identified as an immune factor that independently predicts survival, in addition to the already established CD4+ T-cell count. The HIV-1 RNA and serum albumin levels also predicted survival.
Shearer
W T
WT
Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA. wshearer@bcm.tmc.edu
Easley
K A
KA
Goldfarb
J
J
Jenson
H B
HB
Rosenblatt
H M
HM
Kovacs
A
A
McIntosh
K
K
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000401:mortality / Q000635:transmission; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D018655:Lymphocyte Count; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012367:RNA, Viral / Q000097:blood; D044469:Racial Groups; D015996:Survival Rate; D013997:Time Factors; D014481:United States
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral