Shorter survival in advanced human immunodeficiency virus type 1 infection is more closely associated with T lymphocyte activation than with plasma virus burden or virus chemokine coreceptor usage

J Infect Dis. 1999 Apr;179(4):859-70. doi: 10.1086/314660.


To define predictors of survival time in late human immunodeficiency virus type 1 (HIV-1) disease, long- and short-duration survivors were studied after their CD4+ T cells fell to </=50/mm3. Immune activation of CD4+ and CD8+ T cells, as measured by elevated cell surface expression of CD38 antigen, was strongly associated with shorter subsequent survival (P</=.002). The naive CD45RA+CD62L+ T cell reserve was low in all subjects and did not predict survival (P=.34 for CD4+ and.08 for CD8+ cells). Higher virus burden correlated with CD8+ but not CD4+ cell activation and, after correcting for multiple comparisons, was not associated with shorter survival (P=.02). All of the patients' viruses used CCR5, CXCR4, or both, and coreceptor usage did not predict survival (P=. 27). Through mechanisms apparently unrelated to higher virus burden, immune activation is a major determinant of survival in advanced HIV-1 disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • ADP-ribosyl Cyclase
  • ADP-ribosyl Cyclase 1
  • Acquired Immunodeficiency Syndrome / immunology
  • Acquired Immunodeficiency Syndrome / mortality*
  • Acquired Immunodeficiency Syndrome / virology
  • Adult
  • Antigens, CD*
  • Antigens, Differentiation / analysis
  • CD4 Lymphocyte Count
  • HIV-1*
  • HLA-DR Antigens / analysis
  • Humans
  • Lymphocyte Activation*
  • Male
  • Membrane Glycoproteins
  • Middle Aged
  • NAD+ Nucleosidase / analysis
  • RNA, Viral / blood*
  • Receptors, CCR5 / physiology*
  • Receptors, CXCR4 / physiology*
  • T-Lymphocytes / immunology*


  • Antigens, CD
  • Antigens, Differentiation
  • HLA-DR Antigens
  • Membrane Glycoproteins
  • RNA, Viral
  • Receptors, CCR5
  • Receptors, CXCR4
  • ADP-ribosyl Cyclase
  • CD38 protein, human
  • NAD+ Nucleosidase
  • ADP-ribosyl Cyclase 1