COMPARISON OF VIRUS BURDEN IN BLOOD AND SEQUENTIAL LYMPH-NODE BIOPSY SPECIMENS FROM CHILDREN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Background: Lymph nodes serve as reservoirs for the replication of hum an immunodeficiency virus (HIV) type 1. Comparison of serial measureme nts of virus burden in lymph nodes and peripheral blood after a change in antiretroviral therapy may provide insights into pathogenic mechan isms and permit a more accurate assessment of a therapeutic response. Study design: Nevirapine was added to the drug regiment of eight child ren with HIV infection treated with the combination of zidovudine and didanosine who had increasing levels of serum p24 antigen. Lymph node biopsies were performed at entry and after 12 weeks of therapy. Result s: Neither CD4 counts nor p24 antigen level correlated with the degree of viremia as measured by ribonucleic acid copy numbers in plasma. Co rrelations were found between HIV DNA copy number in peripheral blood mononuclear cells and HIV DNA copy number in lymph nodes (p=0.02), as well as between peripheral blood CD4 counts and lymph node architectur e. The HIV signals in the lymph nodes conformed to the anatomic organi zation of apical light zones in the germinal centers; however, in more advanced disease stages, organized germinal centers disappeared as ev idenced by a decline in the extent of the follicular dendritic network . Conclusions: Lymph node biopsies in this small number of HIV-infecte d children revealed a progressive loss of an organized architecture, e specially of the follicular dendritic network. This correlated with a progressive loss of CD4(+) cells but not with other measures of diseas e stage, including viral load, as measured by ribonucleic acid copy nu mbers.