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Blood, 15 August 2004, Vol. 104, No. 4, pp. 942-947.
Prepublished online as a Blood First Edition Paper on April 29, 2004; DOI 10.1182/blood-2003-09-3333.


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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Immune activation set point during early HIV infection predicts subsequent CD4+ T-cell changes independent of viral load

Steven G. Deeks, Christina M. R. Kitchen, Lea Liu, Hua Guo, Ron Gascon, Amy B. Narváez, Peter Hunt, Jeffrey N. Martin, James O. Kahn, Jay Levy, Michael S. McGrath, and Frederick M. Hecht

From the Positive Health Program, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA; the Department of Biostatistics, School of Public Health, University of California, Los Angeles, CA; and the Department of Medicine, University of California, San Francisco, CA.

Although generalized T-cell activation is an important factor in chronic HIV disease pathogenesis, its role in primary infection remains poorly defined. To investigate the effect of immune activation on T-cell changes in subjects with early HIV infection, and to test the hypothesis that an immunologic activation "set point" is established early in the natural history of HIV disease, a prospective cohort of acutely infected adults was performed. The median density of CD38 molecules on CD4+ and CD8+ T cells was measured longitudinally in 68 antiretroviral-untreated individuals and 83 antiretroviral-treated individuals. At study entry, T-cell activation was positively associated with viremia, with CD8+ T-cell activation levels increasing exponentially at plasma HIV RNA levels more than 10 000 copies/mL. Among untreated patients, the level of CD8+ T-cell activation varied widely among individuals but often remained stable within a given individual. CD8+ T-cell activation and plasma HIV RNA levels over time were independently associated with the rate of CD4+ T-cell loss in untreated individuals. These data indicate that immunologic activation set point is established early in HIV infection, and that this set point determines the rate at which CD4+ T cells are lost over time.


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