Our HIV patients are evaluated for lymphocyte function by mitogen phytohemmagluttinin (PHA) stimulation and those with poor responses are closely monitored. We present a case-series of perinatal acquired HIV patients whose T-cell function declined in the presence of adequate CD4+ T-cell counts.
Mitogen cultures of 23 patients aged 2-17years-old were reviewed in addition to average CD4+ T-cell counts and HIV viral loads(VL) for the one-year period around mitogen testing. Appropriate PHA response was defined as ten times the control. Appropriately responding patients were compared to insufficient responders to examine differences in age, average CD+ count, and average VL. Data excluding patients younger than six years-old was also compared, owing to different cutoffs for normal CD4+ values in this age group.
10 of 23 patients had insufficient mitogen responses. Patients with appropriate mitogen responses were younger (9.6 vs. 12.2years of age), had higher average CD4+ counts (1147 vs. 797cells/mm3) and had a lower average VL (1252 vs. 4114copies/mL) compared to patients with inappropriately low responses. When patients younger than six years-old were excluded, the appropriate mitogen responders were younger (11.1 vs. 13.33years-old), had higher average CD4+ T-cell counts (1026 vs. 736cells/mm3) and a lower VL (240 vs. 7969copies/mL) compared to insufficient responders.
Perinatal acquired HIV patients with insufficient T-cell function measured by PHA mitogen culture were older, had lower CD4+ counts, and higher viral loads than patients with normal T-cell function. This indicates functional decline precedes decrease in absolute count, making mitogen stimulation a useful tool in assessing perinatal HIV patients.