T-Cell Function Declines before CD4+ T-Cell Count Reaches Critical Level in Patients with Perinatal Acquired HIV
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Naveen Nannapaneni, M.D., Pavadee Poowuttikul, MD, Elizabeth A. Secord, MD FAAAAI

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.