Peters V B, Mayer L, Sperber K E
Department of Pediatrics, Mount Sinai School of Medicine, New York, New York 10029, USA. Vicki
Viral Immunol. 1999;12(2):139-48. doi: 10.1089/vim.1999.12.139.
Studies of immune function in human immunodeficiency virus (HIV)-infected children are important, because functional abnormalities can precede CD4+ T-cell loss and are associated with the development of opportunistic and bacterial infections. We sought to correlate clinical parameters and immunological function with HIV RNA plasma levels in 20 children. HIV RNA levels were measured by a polymerase chain reaction assay. We analyzed T-cell responses to mitogens (phytohemagglutinin, concanavalin A, and pokeweed [PWM]) and antigens (tetanus toxoid and Candida albicans); T-cell suppressor activity; and humoral immunity to Haemophilus influenzae, hepatitis B, tetanus, and diphtheria vaccines. The median age of the children was 6 years. Eight children had HIV RNA levels less than 200 to 9621 copies per milliliter (group I). Four children had 37,970 to 82,630 copies per milliliter (group II). Eight children had 102,100 to 191,200 copies per milliliter (group III). There were no differences in the HIV-related complications between group I and II children. Group I/II children had significantly higher CD4+ T-cell counts (P = 0.02), less symptomatic HIV disease (P = 0.005), and more detectable protective vaccine immunity (P = 0.014) compared with group III children. Responses to mitogens were conserved in most children. Group I children tended to have higher responses to tetanus toxoid than group II children and significantly higher responses than group III children (P = 0.01). Group I had significantly higher responses to C. albicans than groups II (P = 0.016) and III (P = 0.001). Group I/II children tended to have lower suppressor activity compared with group III children (median, 0 vs 64%). We demonstrated that humoral and cellular immune dysfunction exists at all stages of disease in HIV-infected children but was most severe in children with greater than or equal to 100,000 HIV RNA copies per milliliter. Function was the most intact in children with less than 10,000 copies per milliliter.
对感染人类免疫缺陷病毒（HIV）的儿童的免疫功能进行研究很重要，因为功能异常可能先于CD4 + T细胞减少出现，并且与机会性感染和细菌感染的发生有关。我们试图将20名儿童的临床参数和免疫功能与HIV RNA血浆水平进行关联。通过聚合酶链反应测定法测量HIV RNA水平。我们分析了T细胞对丝裂原（植物血凝素、刀豆球蛋白A和商陆[PWM]）和抗原（破伤风类毒素和白色念珠菌）的反应；T细胞抑制活性；以及对流感嗜血杆菌、乙型肝炎、破伤风和白喉疫苗的体液免疫。这些儿童的中位年龄为6岁。8名儿童的HIV RNA水平低于每毫升200至9621拷贝（第一组）。4名儿童的HIV RNA水平为每毫升37,970至82,630拷贝（第二组）。8名儿童的HIV RNA水平为每毫升102,100至191,200拷贝（第三组）。第一组和第二组儿童在HIV相关并发症方面没有差异。与第三组儿童相比，第一组/第二组儿童的CD4 + T细胞计数显著更高（P = 0.02），有症状的HIV疾病更少（P = 0.005），并且可检测到的保护性疫苗免疫更多（P = 0.014）。大多数儿童对丝裂原的反应保持不变。第一组儿童对破伤风类毒素 的反应往往高于第二组儿童，且显著高于第三组儿童（P = 0.01）。第一组对白色念珠菌的反应显著高于第二组（P = 0.016）和第三组（P = 0.001）。与第三组儿童相比，第一组/第二组儿童的抑制活性往往较低（中位数，0对64%）。我们证明，HIV感染儿童在疾病的所有阶段都存在体液和细胞免疫功能障碍，但在HIV RNA每毫升大于或等于100,000拷贝的儿童中最为严重。在每毫升低于10,000拷贝的儿童中功能最完整。
