The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Increasing Viral Burden in CD4+ T Cells from Patients with Human Immunodeficiency Virus (HIV) Infection Reflects Rapidly Progressive Immunosuppression and Clinical Disease

Steven M. Schnittman, MD; Jack J. Greenhouse, BS; Miltiades C. Psallidopoulos, PhD; Michael Baseler, PhD; Norman P. Salzman, PhD; Anthony S. Fauci, MD; and H. Clifford Lane, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by federal funds from the Department of Health and Human Services under contract number N01-CO-74102.

Requests for Reprints: Steven M. Schnittman, MD, Building 10, Room 11B-13, National Institutes of Health, Bethesda, MD 20892.

Current Author Addresses: Dr. Schnittman and Mr. Greenhouse: Building 10, Room 11B-13, National Institutes of Health, Bethesda, MD 20892.

Drs. Psallidopoulos and Salzman: Department of Microbiology, Preclinical Science Building, Room LM-12, Georgetown University, Washington, DC 20007.

Dr. Baseler: Building 469, Room 6, NCI-Frederick Cancer Research Facility, PO Box B, Frederick, MD 21701.

Dr. Fauci: Building 31, Room 7A03, National Institutes of Health, Bethesda, MD 20892.

Dr. Lane: Building 10, Room 11B-09, National Institutes of Health, Bethesda, MD 20892.

Ann Intern Med. 1990;113(6):438-443. doi:10.7326/0003-4819-113-6-438
Text Size: A A A

Objective: To determine over time the relation between viral burden and immunologic decline in patients with asymptomatic human immunodeficiency virus (HIV) infection.

Design: Blind analysis of cell samples from matched cohorts for HIV proviral DNA by polymerase chain reaction, retrospective analysis of clinical data on patients, and prospective follow-up of patients seropositive for the human immunodeficiency virus type 1 (HIV-I).

Setting: National research clinic and academic medical centers.

Patients: Cohort 1 included 12 healthy HIV-1-seropositive patients (average follow-up, 14 months): Six patients had stable disease and 6 developed rapidly progressive disease. Cohort 2 included 15 healthy HIV-1-seropositive patients from the Multicenter AIDS Cohort Study (average follow-up, 32 months): Eight patients had stable disease and 7 developed rapidly progressive disease.

Laboratory Studies: Quantitative polymerase chain reaction was done to determine the HIV-I viral burden in sort-purified CD4+ T cells obtained from patients at various timepoints.

Measurements and Main Results: In patients who remained asymptomatic, frequencies of HIV-infected CD4+ T cells were low (< 1/10 000 to 1/1000) at study entry and increased only minimally (none higher than 1/1000). In contrast, among patients who developed HIV-related symptoms including the acquired immunodeficiency syndrome (AIDS) despite having similar CD4 counts, frequencies of HIV-infected CD4+ T cells were higher at entry (> 1/1000) and increased substantially (> 1/100) in most within 3 months of developing progressive disease. This increase in HIV burden coincided with a significant decline over time in the percent of T4 cells (31% to 16%), whereas the percent of T4 cells was unchanged in persons who remained asymptomatic (33% to 34%).

Conclusions: Increasing viral burden in peripheral blood CD4+ T-cells is directly associated with a progressive decline in CD4+ T cells and deteriorating clinical course in HIV-infected patients.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.