CD8 apoptosis may be a predictor of T cell number normalization after immune reconstitution in HIV

• Main Authors: Martinez Maria L, Diez Martine M, Gross Kimber L, Lewis Dorothy E, Lukefahr Helen N, Kozinetz Claudia A, Arduino Roberto C
• Format: Article
• Language: English
• Published: BMC 2007-01-01
• Series: Journal of Translational Medicine
• Online Access: http://www.translational-medicine.com/content/5/1/9
• ISSN: 1479-5876

<p>Abstract</p> <p>Background</p> <p>As part of the Houston Vanguard study, a subset of 10 patients randomized to receive IL-2 therapy were compared to 4 patients randomized to not receive IL-2, for markers of T cell activation and death during the first three cycles of IL-2. All patients were treated with combination antiretroviral therapy (ART) and were virally suppressed. The purpose of the study was to examine the role of CD8+ T cell death in responses to ART and IL-2 therapy.</p> <p>Methods</p> <p>Lymphocytes were examined at Day 0, 5 and 30 days during three cycles of IL-2 therapy. CD25, CD38, HLA-DR expression and annexin (cell death) were examined on CD4 and CD8 subpopulations. Follow up studies examined CD4 levels and CD4:CD8 reconstitution after 6 years using both univariant and multivariate analyses.</p> <p>Results</p> <p>Human lymphocytes responded to IL-2 therapy by upregulation of CD25 on CD4⁺T cells, leading to an increase in CD4 cell counts. CD8⁺T cells did not increase CD25 expression, but upregulated activation antigens (CD38 and DR) and had increased death. At baseline, 7 of the 14 patients had high CD8⁺T cell apoptosis (mean 17.0% ± 6.0). We did an exploratory analysis of immune status after six years, and found that baseline CD8⁺T cell apoptosis was correlated with CD4 cell count gain beginning two years post enrollment. Patients with low levels of CD8⁺T cell apoptosis at baseline (mean 2.2% ± 2.1) had significantly higher CD4 cell counts and more normalized CD4:CD8 ratios than patients with high CD8⁺T cell apoptosis (mean CD4 cell counts 1,209 ± 164 vs 754 ± 320 cells/mm³; CD4:CD8 ratios 1.55 vs. 0.70, respectively).</p> <p>Conclusion</p> <p>We postulate that CD8⁺T cell apoptosis may reflect inherent activation status, which continues in some patients even though viral replication is suppressed which influences the ability of CD4⁺T cells to rebound. Levels of CD8⁺T cell apoptosis may therefore be an independent predictor of immune status, which should be shown in a prospective study.</p>