Recent Thymus Emigrant CD4+ T Cells Predict HIV Disease Progression in Patients With Perinatally Acquired HIV

• Published in: Clinical infectious diseases 2016-04, Vol.62 (8), p.1029-1035
• Main Authors: Zakhour, Ramia, Tran, Dat Q, Degaffe, Guenet, Bell, Cynthia S, Donnachie, Elizabeth, Zhang, Weihe, Pérez, Norma, Benjamins, Laura J, Del Bianco, Gabriela, Rodriguez, Gilhen, Murphy, James R, Heresi, Gloria P
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; AIDS; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Child; Child, Preschool; Disease Progression; Female; HIV; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - immunology; HIV-1 - physiology; HIV/AIDS; Human immunodeficiency virus; Humans; Immune system; Infectious Disease Transmission, Vertical; Longitudinal Studies; Lymphocytes; Male; Platelet Endothelial Cell Adhesion Molecule-1 - immunology; Pregnancy; Prospective Studies; Regression analysis; Texas - epidemiology; Thymus Gland - cytology; Thymus Gland - immunology; Viral Load; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciw030

Robust immune restoration in human immunodeficiency virus (HIV)-positive patients is dependent on thymic function. However, few studies have investigated thymic function and its correlation with disease progression over time in HIV-positive patients. In this longitudinal prospective study, we followed 69 HIV-positive patients who were perinatally infected. Peripheral blood mononuclear cells were stained with monoclonal anti-CD4 and anti-CD31 and recent thymic emigrants (CD4+recently emigrated from the thymus (RTE), CD4+CD31+) quantified by flow cytometry. Statistical analysis used Wilcoxon rank sum test, Kruskal-Wallis, Spearman correlation, and Kaplan-Meier estimates; Cox regression models were performed for the longitudinal analysis. Median age of HIV positive patients enrolled was 13 years (interquartile range [IQR], 8.6). CD4+RTE% decreased with age and was higher in females. Median CD4+RTE% was 53.5%, IQR, 22.9. CD4+RTE% was closely related to CD4+% and absolute counts but independent of viral load and CD8+CD38+%. Antiretroviral compliance as well as higher nadir CD4+% were associated with higher CD4+RTE%. Low CD4+RTE% predicted poor progression of VL and CD4+% over time. CD4+RTE% predicts disease progression and may reflect history of disease in HIV-positive patients and adolescents. They are easy to measure in the clinical setting and may be helpful markers in guiding treatment decisions.