IMMUNOLOGICAL AND VIROLOGICAL EFFECTS OF GLUCOCORTICOIDS ON HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN CHILDREN - A PRELIMINARY-STUDY

The immune dysfunction in human immunodeficiency virus (HIV) infection is complex and cannot be explained solely on the basis of numerical d epletion of T lymphocytes. Inappropriate, uncontrolled activation of t he immune system may be involved. In a test of this hypothesis, five H IV-infected children were prospectively treated with prednisone and se lected immunologic and virologic indices were analyzed. Subjects had m arked T lymphopenia (CD4+ T lymphocytes < 500 cells/ml) and antigenemi a (serum p24 antigen >30 pg/ml) and were free of opportunistic infecti ons. There was a significant drop in serum p24 antigen concentrations from baseline (60.2 +/- 10.1% SEM; P < 0.005) 4 weeks after initiation of prednisone, which returned to baseline concentrations as the predn isone was tapered. Concomitant with this decrease, there was decreased expression of cell surface activation markers (HLA-DR, CD25 (interleu kin 2 receptor) and CD26 (Ta-1)) in peripheral T lymphocytes. There wa s no significant change in either T lymphocyte subset numbers or mitog en and antigen-specific lymphoproliferation. A regulatory dysfunction of the immune system, allowing inappropriate activation of T lymphocyt es, may be involved in the pathogenesis of HIV disease, and further st udies involving selective immunosuppression in HIV disease are warrant ed.