Prospective 5-year study of peripheral blood CD4(+), CD8(+), and CD19(+)/CD20(+) lymphocytes and serum Igs in children born to HIV-1(+) women

Background: Peripheral blood CD4(+) and CD8(+) T cells, CD19(+)/20(+) B cel ls, and serum Igs are known to be altered by the progression of pediatric H IV-1 infection, but their evaluation as predictors of survival needs furthe r definition. Objective: To determine the natural history of these immune factors and the ir importance in predicting survival, we studied 298 HIV-1 vertically infec ted (HIV-1(+)) children over a 5-year period. Methods: These immune factors and serum HIV-1 RNA levels were measured in t wo groups: (1) a birth cohort of children enrolled up to age 28 days postna tally, including 93 HIV-1(+) and 463 HIV-1 uninfected infants (HIV-1(-)), a nd (2) an older cohort of 205 HIV-1(+) children enrolled after the age of 2 8 days, who were classified as survivors or nonsurvivors. Results: In the birth cohort HIV-1(+) children had significantly lower CD4( +) T-cell counts, higher CD8(+) T-cell counts, and lower CD19(+)/20(+) B-ce ll counts and higher IgG, IgA, and IgM levels than HIV-1(-) children. In th e older cohort survivors had significantly higher CD4(+) and CD8(+) T-cell and CD19(+)/CD20(+) B-cell counts and higher IgG, lower IgA, and lower IgM levels than did nonsurvivors. In univariable analysis factors affecting sur vival in the older cohort were baseline CD4(+) and CD8(+) T-cell and CD19()/20(+) B-cell counts and IgG and HIV-1 RNA levels tall P < .05). In multiv ariable analysis high baseline CD4(+) T-cell count and low baseline HIV-1 R NA load remained important. Conclusion: The longitudinal mean profiles of CD4 and CD8 T-cell and CD19/2 0 B-cell counts and serum IgG levels helped to describe the natural progres sion of HIV-1 disease in children. However, only baseline CD4 T-cell count independently predicted survival.