LOSS OF CD4 T-LYMPHOCYTES IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 IS MORE PRONOUNCED IN THE DUODENAL MUCOSA THAN IN THE PERIPHERAL-BLOOD

Although changes in T lymphocyte subset distribution in the peripheral blood of patients infected with human immunodeficiency virus (HIV) ar e well defined it is not known whether these changes reflect changes i n lymphoid compartments clearly involved in HIV related disease like t he intestinal mucosa. This study analysed lymphocytes isolated simulta neously from the peripheral blood and duodenal biopsy specimens by thr ee colour flow cytometry in eight asymptomatic HIV infected patients, 26 AIDS patients, and 23 controls. The proportion of CD4, CD8, CD4(-)C D8(-), or gamma delta T cells did not correlate between circulating an d duodenal T cells. CD4 T cells were reduced in the peripheral blood ( 7.5% (25th-75th percentile, 2-16%) v 52% (41-63%), p<0.0005) and even more reduced in the duodenum (1% (1-2%) v 36% (23-57%), p<0.0005) of A IDS patients compared with controls. Patients with asymptomatic HIV in fection had intermediate CD4 T cells in the peripheral blood (24% (22- 35%); p<0.002 v controls; p<0.01 v AIDS) but like AIDS patients very l ow CD4 T cells in the duodenum (3% (1-6%); p<0.002 v controls). The ra tio of duodenal to circulating CD4(+) T cells was significantly reduce d to 0.2 (0-1) in AIDS patients (p<0.001) and even to 0.1 (0.44-0.95) in asymptomatic HIV infected patients (p<0.002) compared with 0.72 (0. 44-0.95) in controls. These findings show an early and preferential lo ss of duodenal CD4 T cells in HIV infection. Immunological abnormaliti es in HIV infection are distinct between lymphoid compartments, and pr ofound immunodeficiency may occur in the intestinal immune system alth ough circulating T cells are largely preserved.