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Original Article
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Volume 337:1267-1274 October 30, 1997 Number 18
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Cytotoxic-T-Cell Responses, Viral Load, and Disease Progression in Early Human Immunodeficiency Virus Type 1 Infection
Luwy Musey, M.D., James Hughes, Ph.D., Timothy Schacker, M.D., Theresa Shea, P.A.C., Lawrence Corey, M.D., and M. Juliana McElrath, M.D., Ph.D.

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ABSTRACT

Background Early in human immunodeficiency virus type 1 (HIV-1) infection there is a decline in viral replication that has been attributed to host immunity, but the components of this response, particularly the ability of cytotoxic T lymphocytes to control viral burden and influence the outcome of disease, are poorly understood.

Methods We prospectively studied 33 patients with primary HIV-1 infection for HIV-specific activated cytotoxic T lymphocytes and memory cytotoxic T lymphocytes and compared these lymphocyte responses with changes in viral load and clinical status over the subsequent 18 to 24 months.

Results Soon after infection, activated HIV-specific cytotoxic T lymphocytes, mediated primarily by CD8+ cells, were detected in 17 of 23 patients (74 percent). Memory cytotoxic T lymphocytes were found in 6 of 6 patients tested (100 percent) during the first three months of infection and in 17 of 21 patients (81 percent) tested during the first six months. The frequencies of memory cytotoxic T lymphocytes varied markedly over time, but overall they declined over the first 6 to 8 months and then stabilized over the next 12 to 18 months. The patients with higher frequencies of Env-specific memory cytotoxic T lymphocytes had a median level of plasma HIV-1 RNA about one third that of the patients with lower frequencies (median number of RNA copies per milliliter, 22,000 vs. 62,000; P = 0.006). Patients with low frequencies of Env-specific memory cytotoxic T lymphocytes (or none) in early infection had a more rapid decline to less than 300 CD4+ cells per cubic millimeter (P = 0.05).

Conclusions In early HIV-1 infection, the induction of memory cytotoxic T lymphocytes, particularly those specific for Env, helps control viral replication and is associated with slower declines in CD4+ cell counts. Host cytolytic effector responses appear to delay the progression of HIV-1 disease.


Source Information

From the Departments of Medicine (L.M., T. Schacker, T. Shea, L.C., M.J.M.) and Laboratory Medicine (L.C.), School of Medicine, and the Department of Biostatistics, School of Public Health (J.H.), University of Washington; and the Division of Clinical Research, Fred Hutchinson Cancer Research Center (L.C., M.J.M.) — all in Seattle.

Address reprint requests to Dr. McElrath at the Fred Hutchinson Cancer Research Center, Program in Infectious Diseases, M115, 1124 Columbia St., Seattle, WA 98104.

Full Text of this Article


Related Letters:

Cytotoxic-T-Cell Responses in Early HIV-1 Infection
Phillips A. N., McElrath M. J., Hughes J., Musey L.
Extract | Full Text  
N Engl J Med 1998; 338:622-623, Feb 26, 1998. Correspondence

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