The decline in CD4+ T lymphocytes as a function of the duration of HIV infection, age at seroconversion, and viral load.

BACKGROUND

The rate of CD4+ T-lymphocyte decline seen in HIV-infected patients is very variable. Although older patients, a longer duration of HIV infection, and a high level of plasma viraemia, have been associated with a faster fall in CD4+ T-cells, the relationship between these variables is still not well known.

PATIENTS AND

METHODS

In a cross-sectional study that included a total of 107 patients of known age and date at HIV seroconversion, the current CD4+ T-cell count and plasma viraemia were examined. Patients were not taking antiretroviral drugs, nor had received immunizations nor were suffering any intercurrent infections at the time of the study.

RESULTS

The mean duration of HIV infection was 8.6+/-2.9 years. The mean CD4+ T-lymphocyte count was 367+/-264 x 10(6)/l. Mean plasma viraemia was 4.3+/-0.9 logs. In a linear regression model, the current CD4+ T-cell count was explained in 21.7% by the duration of HIV infection, while the level of plasma viraemia justified separately up to 37.0%. When both parameters were combined, they explained 58.8%. of the CD4+ lymphocyte values. In this model, a variation of one logarithm in the plasma viraemia had six times greater effect on the number of CD4+ lymphocytes than each year of HIV infection. When the age at seroconversion was added to the model, the CD4+ cell count allowed the explanation of up to 62.2% of cases.

CONCLUSIONS

The age at seroconversion, the duration of HIV infection, and the level of plasma viraemia independently and substantially influence the current CD4+ lymphocyte count in HIV-infected subjects. However, other variables should exist (e.g. virus syncytium-inducing phenotype, host immunogenetic repertoire, etc.), contributing to explaining the different rate of CD4+ T-cell decline seen in HIV-infected subjects.