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Older HIV-infected patients on antiretroviral therapy have B-cell expansion and attenuated CD4 cell increases with immune activation reduction.

ABSTRACT: The contribution of immune activation to accelerated HIV-disease progression in older individuals has not been delineated.Prospective multicenter cohort of older (?45 years) and younger (18-30 years) HIV-infected adults initiating 192 weeks of antiretroviral therapy (ART). Longitudinal models of CD4 cell restoration examined associations with age-group, thymic volume, immune activation, and viral load.Forty-five older and 45 younger adults (median age 50 and 26 years, respectively) were studied. Older patients had fewer naive CD4 cells (P<0.001) and higher HLA-DR/CD38 expression on CD4 (P=0.05) and CD8 cells (P=0.07) than younger patients at any time on ART. The rate of naive and total CD4 cell increase was similar between age groups, but older patients had a faster mean rate of B-cell increase (by +0.7 cells/week; P=0.01), to higher counts than healthy controls after 192 weeks (P=0.003). Naive CD4 increases from baseline were associated with immune activation reductions (as declines from baseline of %CD8 cells expressing HLA-DR/CD38; P<0.0001), but these increases were attenuated in older patients, or in those with small thymuses. A 15% reduction in activation was associated with naive gains of 29.9 and 6.2 cells/?l in younger, versus older patients, or with gains of 25.7, 23.4, and 2.1 cells/?l in patients with the largest, intermediate, and smallest thymuses, respectively (P<0.01 for interactions between activation reduction and age-group or thymic volume).Older patients had significant B-cell expansion, higher levels of immune activation markers, and significantly attenuated naive CD4 cell gains associated with activation reduction.

SUBMITTER: Kalayjian RC

PROVIDER: S-EPMC3805132 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Older HIV-infected patients on antiretroviral therapy have B-cell expansion and attenuated CD4 cell increases with immune activation reduction.

Kalayjian Robert C RC Spritzler John J Matining Roy M RM Fiscus Susan A SA Gross Barry H BH Francis Isaac R IR Pollard Richard B RB Lederman Michael M MM Landay Alan A

AIDS (London, England) 20130601 10

<h4>Background</h4>The contribution of immune activation to accelerated HIV-disease progression in older individuals has not been delineated.<h4>Methods</h4>Prospective multicenter cohort of older (≥45 years) and younger (18-30 years) HIV-infected adults initiating 192 weeks of antiretroviral therapy (ART). Longitudinal models of CD4 cell restoration examined associations with age-group, thymic volume, immune activation, and viral load.<h4>Results</h4>Forty-five older and 45 younger adults (medi ...[more]

PMID: 24047762

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Older HIV-infected patients on antiretroviral therapy have B-cell expansion and attenuated CD4 cell increases with immune activation reduction.

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Older HIV-infected patients on antiretroviral therapy have B-cell expansion and attenuated CD4 cell increases with immune activation reduction.

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