Lung CD4 lymphocytes predict survival in asymptomatic HIV infection.

BACKGROUND Plasma viral load and blood CD4 counts are accepted indicators of severity of illness in patients with HIV-1. Lung CD4 counts have not been evaluated in asymptomatic HIV-1 patients as indicators of disease severity. OBJECTIVE To determine if lung lymphocyte counts in asymptomatic subjects with HIV compare with plasma viral loads and blood CD4 counts in predicting survival. DESIGN Retrospective, cross-sectional analysis. SETTING Midwestern urban community, December 1996 to August 1998. PARTICIPANTS HIV-seropositive subjects (n = 95) without AIDS-related pulmonary complications. MEASUREMENTS Plasma viral load, blood hemoglobin and blood lymphocyte subtypes, lung lymphocyte subtypes from BAL, body mass index, and mortality. RESULTS Eight of the 95 subjects (8.4%) had died at the 4-year follow-up. Lung CD4 counts were significantly related to mortality by univariable analysis (2.5 x 10(3)/mL vs 0.9 x 10(3)/mL, median values for survivors vs nonsurvivors, respectively, p = 0.010). Modeling using exact methods further showed lung CD4 counts to be a significant predictor of survival after individually adjusting for potential confounders, including plasma viral load and blood CD4 count. CONCLUSIONS Lung CD4 counts in patients with HIV-1 infection may provide an independent predictor of survival.