Lung CD4 lymphocytes predict survival in asymptomatic HIV infection.

Abstract

BACKGROUND: Plasma viral load and blood CD4 counts are accepted indicators of severity of illness in patients with HIV-1. Lung CD4 counts have not been evaluated in asymptomatic HIV-1 patients as indicators of disease severity. OBJECTIVE: To determine if lung lymphocyte counts in asymptomatic subjects with HIV compare with plasma viral loads and blood CD4 counts in predicting survival. DESIGN: Retrospective, cross-sectional analysis. SETTING: Midwestern urban community, December 1996 to August 1998. PARTICIPANTS: HIV-seropositive subjects (n = 95) without AIDS-related pulmonary complications. MEASUREMENTS: Plasma viral load, blood hemoglobin and blood lymphocyte subtypes, lung lymphocyte subtypes from BAL, body mass index, and mortality. RESULTS: Eight of the 95 subjects (8.4%) had died at the 4-year follow-up. Lung CD4 counts were significantly related to mortality by univariable analysis (2.5 x 10(3)/mL vs 0.9 x 10(3)/mL, median values for survivors vs nonsurvivors, respectively, p = 0.010). Modeling using exact methods further showed lung CD4 counts to be a significant predictor of survival after individually adjusting for potential confounders, including plasma viral load and blood CD4 count. CONCLUSIONS: Lung CD4 counts in patients with HIV-1 infection may provide an independent predictor of survival.