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[Prognostic significance of the T4 lymphocyte count in patients infected with CDC Class II and III HIV].

From 1985 to 1987 101 patients infected with the human immunodeficiency virus (HIV) were seen at our outpatient clinic and prospectively analyzed in a cohort study. We evaluated the follow-up in 41 patients of CDC classes II and III with regard to the number of T-helper lymphocytes (T4) and clinical progression. The patients consisted of 24 i.v. drug addicts, 11 homosexuals and 6 persons with other or multiple risk factors for HIV infection. Patients with a T4 count of less than 400/mm3 at the first visit did not differ significantly with regard to development of AIDS from those with a count of greater than 400/mm3 after a mean follow-up of approximately 1 year. The course of the infection for the individual patient was extremely varied and not predictable by the T4 value. We conclude that the number of the T4-lymphocytes is of no help in assessment of prognosis in the individual patient of CDC classes II and III.

Acquired Immunodeficiency Syndrome↗

A biometrical view on normal values of CD4 and CD8 lymphocyte counts in peripheral blood.

Statistical methods have been used to determine an optimal approach to the definition of the reference range for CD4 ("helper") and CD8 ("suppressor/cytotoxic") T cell numbers and the CD4/CD8 ratio in the peripheral blood. A graphical presentation of the absolute values for CD4 and CD8 for 85 healthy blood donors showed that a reference ellipse defined by fitting a gaussian distribution to logarithmically transformed data for absolute counts of CD4 and CD8 cells was superior to the fitting of an ellipse to untransformed data. Further analysis for another 147 subjects showed that the 95% tolerance prediction for the CD4/CD8 ratio in health could be stated with 95% confidence as 0.6 to 5.0. This approach allows clear definition of reference ranges for T cell tests in health and would also be applicable to results for patients with a disease such as HIV 1 infection in which a reference range for "well" patients exists and a change in the T cell ratio is of prognostic significance.

Biometry↗

Alterations of natural killer cell and T-lymphocyte counts in adults infected with human immunodeficiency virus through blood and plasma sold in the past in China and in whom infection has progressed slowly over a long period.

Natural killer (NK) cells, natural killer T (NKT) cells, and T lymphocytes were analyzed by using a flow cytometer in 225 human immunodeficiency virus (HIV)-positive individuals infected through the past sale of blood and plasma without receiving antiretroviral therapy in the People's Republic of China. According to CD4 T-cell counts these HIV-infected adults were stratified into three groups: long-term slow progressors, HIV-infected subjects, and AIDS patients. NK cell counts in long-term slow progressors were higher compared to HIV infection and AIDS patients (P < 0.05) and lower compared to normal controls (P < 0.05), whereas NKT cell counts in slow progressors and the HIV infection group were not different from those of normal controls. NK cell counts in HIV-seropositive subjects were positively correlated with CD4 T-cell counts (P < 0.05), and NKT cell counts were positively correlated with CD4 T-cell and CD8 T-cell counts (P < 0.05). The CD8 T-cell counts were higher in slow progressors compared to those with HIV infection, AIDS patients, and normal controls. These results indicated that HIV infection causes alterations of NK cells and T cells in slow progressors, HIV-infected subjects, and AIDS patient groups, but no difference was found in NKT cell counts and percentages in slow progressors and the HIV-infected group compared to normal controls.

Adult↗

Crossover of human immunodeficiency virus-infected patients from aerosolized pentamidine to trimethoprim-sulfamethoxazole: lack of hematologic toxicity and relationship of side effects to CD4+ lymphocyte count.

Trimethoprim-sulfamethoxazole (TMP/SMZ) was given in a crossover study to 130 human immunodeficiency virus-infected patients who had been receiving aerosolized pentamidine; 86 (66%) successfully crossed over to TMP/SMZ without hypersensitivity reactions or hematologic toxicity. No significant changes occurred in mean hemoglobin concentration, leukocyte count, or platelet count between study enrollment and 12-month follow-up. Predominant side-effects, in 41 patients (33.8%), were fever and maculopapular rashes, which resolved promptly with discontinuation of TMP/SMZ. The mean time to first side effect was 12.3 days, and 86% of side effects developed within 30 days. Three patients experienced toxicity serious enough to warrant hospitalization. Of patients with < or = 200 CD4+ lymphocytes/mm3, 57% developed rashes after the cross-over compared with only 27% of patients with higher CD4+ cell counts. Many patients currently receiving aerosolized pentamidine can be safely crossed over without hematologic toxicity or hypersensitivity reactions.

Adult↗

The effects of altered exercise distribution on lymphocyte subpopulations.

The effects of exercise distribution on lymphocyte count, lymphocyte subpopulations and plasma cortisol concentration in peripheral blood were assessed in 19 healthy subjects. The subjects were randomly divided into group A (n = 10) or group B (n = 9) according to exercise distribution. Both groups underwent a 10-week programme involving 5 x 2-week blocks: baseline (B), training period 1 (TP1), stabilisation 1 (S1), training period 2 (TP2), and stabilisation 2 (S2). During B, S1 and S2 normal training was undertaken. During TP1 and TP2 the subjects increased the amount of training by 50% in week 1 and by 100% in week 2. During TP1 subjects in group A exercised 6 days.week-1, while during TP2 these subjects exercised on 3 alternate days.week-1, but doubled the duration of each training session. The subjects in group B reversed this training order. Blood was collected 36-42 h following exercise period B, and at the end of periods TP1, S1, TP2 and S2, and also 12-18 h following completion of exercise at the end of TP1 and TP2. There were no significant differences (P > 0.05) between the 6 day.week-1 programme and the 3 alternate day.week-1 programme in total lymphocyte count, CD3+, CD4+, CD8+, CD16+, or CD19+ cells, the CD4:CD8 ratio, HLA-DR+ (activated) T cells or plasma cortisol concentrations. Following both TP1 and TP2 there was a nonsignificant decrease in lymphocyte subpopulations. However following both S1 and S2 (baseline training) there was a significant increase in total lymphocyte count, CD3+, CD4+ and CD8+ lymphocytes. The S2 variables statistically significant from B were: total lymphocyte count (P < 0.01), CD3+ T-cells and percentage of circulating lymphocytes (P < 0.01), CD4+ cells (P < or = 0.0001), CD8+ cells (P < 0.05), and HLA-DR+ (activated) T-cells (P < 0.05). The results indicated that provided the amount of exercise is constant for a given period, then exercise distribution is not a critical variable in the alteration of lymphocyte subpopulations that may occur in response to overload training. However 2 weeks of overload training followed by 2 weeks of active recovery (baseline) training may induce an increase in the lymphocyte count.

Adult↗

Alterations in spliced and unspliced HIV-1-specific RNA detection in peripheral blood mononuclear cells of individuals with varying CD4-positive lymphocyte counts.

Reverse transcriptase-polymerase chain amplification reactions (RT-PCR) were used to identify transcripts for HIV-1 structural and regulatory proteins in peripheral blood mononuclear cells of a cohort of 48 patients. At least one set of PCR primers was capable of detecting HIV-1 transcripts in 94% of patients. Unspliced gag-pol transcripts were detected with gag or pol primer sets in 60 and 63% of samples, respectively. A significant inverse correlation was noted between transcript identification with the gag primer set and the number of CD4-positive lymphocytes in the blood sample and the clinical stage of infection. Single-spliced env transcripts were identified in 44% of individuals. Multiple-spliced tat or nef transcripts were detected in 6.2 and 53% of individuals, respectively. These findings indicate that viral transcripts are expressed throughout the course of HIV-1 infection.

Base Sequence↗

CD4 lymphocyte counts and serum p24 antigen of no diagnostic value in monitoring HIV-infected patients with pulmonary symptoms.

The diagnostic value of the CD4 cell counts and the HIV p24 antigen were evaluated in a consecutive series of 105 HIV-infected patients experiencing 128 episodes of pulmonary symptoms which required bronchoscopy. One-third of patients with opportunistic infection (OI) had CD4 counts greater than 0.200 x 10(9)/l, and 60% of patients without OI had CD4 counts less than 0.200 x 10(9)/l; 47 and 42% of patients with and without OI, respectively, had detectable p24 antigen in serum. Only 36% of the patients with OI presented the combination of CD4 cells less than 0.200 x 10(9)/l and p24 in serum. In conclusion, the CD4 cell counts and the presence of p24 antigen in serum had a very limited predictive value for the presence of OI in HIV-infected patients with pulmonary symptoms.

Acquired Immunodeficiency Syndrome↗

Radiation-induced immune changes in patients with cancer of the cervix.

Immunological methods were used to estimate the therapeutic effect of irradiation and its influence on the immune capacity of patients with cervical cancer. Patients were examined during and following radiotherapy by means of lymphocyte counts, lymphocytic response to phytohaemagglutinin (PHA), and the depressive effect of their sera on the response of normal lymphocytes PHA stimulation. Lymphocyte counts and lymphocyte responses during radiotherapy were depressed to 20 to 50 per cent and 10 to 33 per cent respectively of the values found before treatment. Lymphopenia and depressed T-cell function persisted for years in many patients. The highest values for both lymphocyte counts and reactivities were found in those patients who had unexpectedly good responses to radiotherapy. The immunodepressive effect of patients' sera on normal lymphocyte reactivity decreased and disappeared during therapy and was not present in previously treated patients showing a good prognosis, whereas it showed no change or even increased during therapy in patients with a poor prognosis. The results suggest that not only does immune capacity influence the effect of radiation and the prognosis of the patient, but also that study of the serum-depressive effect could give important information about both the dosage and therapeutic effects of irradiation.

Adult↗