Fifth International Congress Drug Therapy in HIV Infection 22-26 October, 2000 Glasgow, UK

THE CORRELATION BETWEEN THE DEVELOPMENT OF CYTOMEGALOVIRUS RETINITIS AND THE CYTOMEGALOVIRUS-SPECIFIC IMMUNOLOGIC REACTIVITY OF T-CELLS

Sung-Chin Pan, Szu-Min Hsieh, Chien-Ching Hung, Hsing-Chun Tsai, Mao-Yuan Chen and Shan-Chwen Chang
Department of Internal Medicine, National Taiwan University Hospital, No.7 Chung-Shan South Road, Taipei, Taiwan, Republic of China

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL5.5
AIDS 2000, Oct 22-26;14(Suppl. 4);S6

Cytomegalovirus retinitis (CR) remains an important cause of morbidity in AIDS patients. To develop a clinically relevant method to identify the highrisk patients for CR, we assessed the immunological reactivity of T-cells against CMV in CMV-seropositive patients with CD4⁺ count < 50/mm³, and evaluated the correlation between the immune reactivity and the development of CR.

Eligible patients were screened for CR at enrollment and at 8 weeks following HAART by an experienced ophthalmologist who was blinded to the results of immune evaluation. The T-cells reactivity against CMV was assessed at enrollment by determining the frequency of CD69 expression on CD4⁺ and CD8⁺ subsets of T-cells by flow cytometry analysis after 24 h coculture with CMV or control antigen. The CMV-specific reactivity of T cells was defined as [the reactivity against CMV] - [the reactivity against control antigen].

A total of 18 patients were enrolled. Among them, six patients were diagnosed with CR (four at enrollment, and two shortly after initiation of HAART). CMV-specific frequency of CD69 expression on CD8⁺ T-cells is similar between patients with and without CR (median, 1.05% [95% CI: 0.32% ~ 2.73%] versus 0.93% [95% CI: 0.44% ~1.86%], (P = 0.43 by Mann– Whitney test). However, CMV-specific frequency of CD69 expression on CD4⁺ T-cells in patients with CR was much lower than that in those without CR (median, 0.26% [95% CI: –0.02% ~ 0.62%] versus 2.3% [95% CI: 1.32% ~ 3.97%], (P = 0.01). The CMV-specific CD4⁺ T-cells reactivity in the two cases with post-HAART CR was still extremely low when CR was diagnosed even though their CD4⁺ count had increased markedly.

Thus, the development of CR may be associated with poor reactivity of CD4⁺ T-cells, but not with that of CD8⁺ T-cells, against CMV. Post-HAART CR may be due to poorly reconstituted immune response to CMV, rather than immune rebound. This evaluation of CMV-specific immune reactivity may help select high-risk patients who may benefit from pre-emptive CMV therapy.

Presenting author: Sung-Chin Pan

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2000-10-22
PL5-5

Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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