IMMUNOLOGICAL CHARACTERISTICS OF HIV-INFECTED CHILDREN - RELATIONSHIPTO AGE, CD4 COUNTS, DISEASE PROGRESSION, AND SURVIVAL

We have evaluated immunologic markers of disease progression in 79 chi ldren perinatally infected with HIV. Laboratory testing included T lym phocyte subsets and lymphoproliferative responses (LPR) to mitogens (P HA, Con A, and PWM), antigens (Candida, Tetanus), and alloantigens (ML C). Patients were graded into grades I, II, and III based on results o f CD4 counts, and into grades A, B, and C based on results of LPR, wit h grades I and grades A being normal, III and C being the lowest, and II and B falling in-between. CD4 counts, CD4/CD8 ratio, and lymphoprol iferative responses were markedly decreased in a majority of children. Grade III CD4 counts were almost always associated with decreased LPR . A majority of the children with grade I CD4 numbers, however, also h ad abnormal lymphoproliferative responses. Results of laboratory testi ng were analyzed in relation to clinical disease progression and survi val. The first AIDS defining illnesses (ADI), especially opportunistic infections (OI), was usually associated with Grade III/C results in i mmunologic assays. Survival was significantly decreased in children wi th grade III CD4 cell counts, and grade C LPR, and was poorest if thes e abnormalities developed within the first year of life. In this latte r age group, if the CD4 counts fell to grade III, the risk for dying w as at least five times greater than those children with higher CD4 cou nts (grades II and I); if the proliferative responses to PHA and MLC w ere in Grade C, the survival was 22 months. Severe immune defects in t he first year of life in children with HIV infection, as assessed by C D4 counts and a battery of functional tests, predicted rapid disease p rogression.