Evaluation of Immune Survival Factors in Pediatric HIV-1 Infection

• Type of Material: Article
• Authors: William T. Shearer, Baylor College; Kirk Easley, Emory University; Johanna Goldfarb, Cleveland Clinic Foundation; Hal B. Jenson, University of Texas; Howard M. Rosenblatt, Baylor College; Andrea Kovacs, University of Southern California, Los Angeles; Kenneth Mcintosh, Harvard University
• Language: English
• Date: 2000-11-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 1999 - 2016 John Wiley & Sons, Inc. All Rights Reserved
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1749-6632.2000.tb05499.x
• Title of Journal or Parent Work: Annals of the New York Academy of Sciences
• ISSN: 0077-8923
• Volume: 918
• Issue: 1
• Start Page: 298
• End Page: 312
• Grant/Funding Information: This work was supported by National Heart, Lung, and Blood Institute Grants N01-HR-96037, N01-HR-96038, N01-HR-96039, N01-HR-96040, N01-HR-96041, N01-HR-96042, and N01-HR-960043 and in part by NIH General Clinical Research Center Grants RR-00071, RR-00188, RR-00533, RR-00643, RR-00645, RR-00865, and RR-02172.
• Research Categories: Health Sciences, Immunology; Health Sciences, Epidemiology

Abstract

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 non-survivors. 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.