CD4+ T cell depletion in an untreated HIV type 1-infected human leukocyte antigen-B*5801-positive patient with an undetectable viral load

Abstract

We report a case of a patient infected with human immunodeficiency virus type 1 (HIV-1) for 20 years who has experienced CD4(+) T cell depletion in spite of maintaining undetectable viral loads. Our data suggest that immune activation can cause CD4(+) T cell depletion even when HIV-1 replication appears to be controlled by host factors.

Figure 1

CD4⁺ T cell count and viral loads of the study subject over the past 10 years. Standard viral load testing with a limit of detection of 400 copies/mL was performed until 2000. Ultrasensitive viral load testing (limit of detection, 50 copies/mL) was performed after that time point. The unshaded points listed at 400 or 50 copies/mL were less than the limit of detection of the respective assays. The boxes above the graph denote the medications the patient was prescribed at a given time. He reports very poor adherence with all his medications. AZT, zidovudine; ddI, didanosine; RTV, ritonavir; 3TC, lamivudine.

Figure 2

Comparison of activation markers on CD8⁺ T cells (A) and CD4⁺ T cells (B) isolated from HIV-1-seronegative controls, HIV-1-infected elite suppressors (ES) and the study subject. A 2 sided t-test was used to compare the values obtained from HIV-seronegative controls and ES. Levels of plasma lipopolysaccharide (LPS; C), LPS-binding protein (LBP; D), soluble CD14 (sCD14; E) and endotoxin-core antibody (EndoCAb; F) in ES and the study subject. The horizontal lines depict the median values of the 10 ES studied.