In Vitro T Cell Function, Delayed-Type Hypersensitivity Skin Testing, and CD4+ T Cell Subset Phenotyping Independently Predict Survival Time in Patients Infected with Human Immunodeficiency Virus

Authors:
  • SBStephen P. Blatt
    Stephen P. Blatt
  • CHCraig W. Hendrix
    Craig W. Hendrix
  • GMGregory P. Melcher
    Gregory P. Melcher
  • RBR. Neal Boswell
    R. Neal Boswell
  • TFTheodore M. Freeman
    Theodore M. Freeman
  • WWWilliam Ward
    William Ward
  • RHRex Hensley
    Rex Hensley
  • GSGene M. Shearer
    Gene M. Shearer
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Abstract
Human immunodeficiency virus type 1 (HIV-1)-infected patients (n = 335) in the US Air Force HIV Natural History Program were followed for 3 years (mean) after skin testing, immunophenotyping of CD4+ cell subsets, and measurement of in vitro interleukin-2 production after stimulation by phytohemagglutinin, alloantigens, tetanus toxoid, and influenza A virus. The T cell functional assay predicted survival time (P < .001) and time for progression to AIDS (P = .014). Skin testing for tetanus, mumps, and Candida antigen and the total number of positive tests (P < .001 for each) stratified patients for survival time. In a multivariable proportional hazards model, the T cell functional assay (P = .008), the absolute number of CD4+ T cells (P = .001), the percentage of CD4+CD29+ cells (P = .06), and the number of reactive skin tests (P < .001) predicted survival time. Thus, cellular immune functional tests have significant predictive value for survival time in HIV-1-infected patients independent of CD4+ cell count.