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Skip Navigation LinksHome > June 19, 2013 - Volume 27 - Issue 10 > Older HIV-infected patients on antiretroviral therapy have B...
AIDS:
doi: 10.1097/QAD.0b013e32835fabc2
Clinical Science

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

Kalayjian, Robert C.a; Spritzler, Johnb; Matining, Roy M.b; Fiscus, Susan A.c; Gross, Barry H.d; Francis, Isaac R.d; Pollard, Richard B.e; Lederman, Michael M.f; Landay, Alang

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Abstract

Background: The contribution of immune activation to accelerated HIV-disease progression in older individuals has not been delineated.

Methods: 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.

Results: 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/μl in younger, versus older patients, or with gains of 25.7, 23.4, and 2.1 cells/μl in patients with the largest, intermediate, and smallest thymuses, respectively (P < 0.01 for interactions between activation reduction and age-group or thymic volume).

Conclusion: Older patients had significant B-cell expansion, higher levels of immune activation markers, and significantly attenuated naive CD4 cell gains associated with activation reduction.

© 2013 Lippincott Williams & Wilkins, Inc.

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