Viral Burden and Disease Progression in HIV‐1–Infected Patients with Sickle Cell Anemia

• Published in: American journal of hematology 1998-11, Vol.59 (3), p.199-207
• Main Authors: Bagasra, Omar, Steiner, Robert M., Ballas, Samir K., Castro, Oswaldo, Dornadula, Geethanjali, Embury, Stephen, Jungkind, Donald, Bobroski, Lisa, Kutlar, Abdullah, Burchott, Sandra
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; AIDS/HIV; anemia; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - virology; Atrophy - etiology; Atrophy - physiopathology; Biological and medical sciences; Disease Progression; DNA; DNA, Viral - blood; Female; HIV Antibodies - blood; HIV Infections - complications; HIV Infections - physiopathology; HIV Seropositivity - blood; HIV Seropositivity - complications; HIV-1 - genetics; HIV-1 - immunology; HIV‐1 sickle cell; Human viral diseases; Humans; Infectious diseases; Leukocytes, Mononuclear - virology; Male; Medical sciences; Proviruses - genetics; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; RNA; RNA, Viral - blood; Spleen - pathology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/(SICI)1096-8652(199811)59:3<199::AID-AJH4>3.0.CO;2-L

The spleen and lymph nodes are major sites of human immunodeficiency virus type 1 (HIV‐1) replication, mutation, and genetic variation in vivo. If a major portion of the lymphatic tissue, such as the spleen, is removed or otherwise is unavailable for invasion by the HIV‐1 virus, will the course of the infection be altered, resulting in a prolonged symptom‐free interval or even increased survival? The spleen of most adults with sickle cell anemia (SS) is nonfunctional due to recurrent episodes of microinfarction. If autosplenectomized SS patients are exposed to HIV‐1, they may be ideal candidates to examine the question of whether absence of splenic function at the time of infection will positively alter the course of HIV‐1‐related disease. All SS patients with a diagnosis of HIV‐1 infection at five university sickle cell centers were included in the patient cohort. Patients in active treatment or in follow‐up (group A, n = 11) underwent a series of quantitative viral studies to determine their HIV‐1 viral burden. The studies included the branched‐DNA signal amplification assay, quantitative DNA‐polymerase chain reaction (PCR), quantitative reverse transcription (RT)‐initiated–PCR, and in situ PCR. All patients who died of the complications of the acquired immunodeficiency syndrome (AIDS) or of SS, lost to follow‐up, or were otherwise unavailable for study (Group B: n = 7) were included in the total patient group. None of the patients in group B underwent quantitative viral studies. In addition, a control population (group C, n = 36) of HIV‐1–infected African Americans without SS, of similar age and gender to the SS patients, were compared with the study population for outcomes. In eight of 11 active patients (group A), the CD4+ T‐lymphocyte counts were normal and viral burdens were low for an average of 10.25 years following diagnosis. These eight patients all from group A were the only long‐term nonprogressors (44%) among a total of 18 SS patients (groups A and B). In group C (control), only five patients of 36 were long‐term nonprogressors (13.9%). Five patients (28%) of the total SS group (groups A and B) succumbed to AIDS. One of the five was from Group A. The evaluation of a limited number of adult individuals suggests that a significant proportion of HIV‐1–seropositive SS patients (44%) may be asymptomatic long‐term nonprogressors. In these patients, the CD4+ T‐lymphocyte counts remained high and their viral burdens were remarkably lower than in non‐