Work

The CD4 cell count 3 months after acute retroviral syndrome is associated with the presence of AIDS in the source individual

Year: 2002

Type: article

Abstract: A source individual with AIDS was associated with a higher rate of HIV transmission [1], but the impact of the HIV stage of the source individual on the early events in the recipient individual is unclear. Whereas the CD4 cell count remains a valid prognostic marker independently of the HIV viral load [2,3], we explored the relationship between the presence of AIDS in the source individual at the time of transmission and the CD4 cell count 3 months after a documented acute retroviral syndrome (ARS) in a recipient individual. A low level of CD4 cells might signify transmission of a virus with an increased virulence as shown with SIV [4]. A total of 19 pairs of source individuals and recipient individuals were analysed. Each of these recipient individuals was enrolled at the time of ARS in three prospective cohorts (Geneva, Switzerland, Montreal, Canada and Sydney, Australia) for studying the rate of HIV disease progression [5,6]. Data collection forms and follow-up were similar in the three centres [5,6]. At enrolment, the symptoms of ARS were recorded, and completed by biological data. The recipient individuals were invited to provide information on the most likely source individual [7]. The following anonymous information on the source individual were recorded: (i) HIV status of the source individual; (ii) if HIV positive, the presence or absence of AIDS at the time of transmission; and (iii) if the source individual was known to receive antiretroviral drugs at the time of HIV transmission to the recipient individual. A multiple linear regression was used to identify the variables associated with the CD4 cell level (in absolute numbers and in percentages) 3 months after the onset of ARS in the recipient individual. The population consisted of 17 men (90%), and the routes of infection were homosexual intercourse for 16 patients and heterosexual intercourse for 3 patients. The CD4 cell count was measured at 3 months after onset (88.2 ± 11.0 days on average) and the average cell count was 603.7 cells/ml (± 240.2). A total of eight recipient individuals (42%) received antiretroviral treatment at ARS on average 40 days (± 49) after onset. The results of the linear regression with CD4 cells in absolute numbers or as a percentage of total lymphocytes, as dependent variables are reported in Table 1. The presence of AIDS in the source individual was an independent predictor of the CD4 cell level 3 months after ARS in the source individual.Table 1: Variables associated with the CD4 cell count in the absolute number or percentage 3 months after acute retroviral syndrome using multiple linear regression.Carre et al. [8] and Ashton et al. [9] found a faster progression to AIDS in recipient individuals after infection by sex and by contaminated blood products when the source individuals progressed faster to AIDS. Our findings show that a difference in progression is already apparent 3 months after acute infection. Advanced HIV disease in the source individual correlates with immunodepression in the recipient individual soon after infection. That can intuitively be related to the quantity (i.e. size of inoculum or a high viral load) or the virulence (i.e. phenotype) of HIV transmitted. In summary, a low CD4 cell count shortly after acute HIV infection through the sexual route might depend on the HIV stage of the source individual at transmission. That completes viral investigations showing that HIV strains became more virulent with time in the host [4] and then could influence early events in individuals newly infected with such HIV strains. The members of the Swiss HIV Cohort Study are M. Bateguay (Co-chair of the Scientific Board), E. Bernasconi, Ph. Bürgisser, M. Egger, P. Erb (Chairman of the ‘Laboratories’ Group), W. Fierz, M. Flepp (Chairman of the ‘Clinics’ Group), P. Francioli (President of SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne), H.J. Furrer, P. Grob, B. Hirschel (Co-chair of the Scientific Board), L. Kaiser, B. Ledergerber, R. Lüthy, R. Malinverni, L. Matter, M. Opravil, F. Paccaud, G. Pantaleo, L. Perrin, W. Pichler, J-C. Piffaretti, M. Rickenbach, P. Sudre, J. Schupbach, A. Telenti, P. Vernazza.

Source: AIDS

DOI: 10.1097/00002030-200211080-00022