Initial Low CD4 Lymphocyte Counts in Recent Human Immunodeficiency Virus Infection and Lack of Association with Identified Coinfections Peter J. Weiss, Stephanie K. Brodine, Ronald R. Goforth, Charles A. Kennedy, Mark R. Wallace, Patrick E. Olson, Frank C. Garland, F. Wesley Hall, Stanley I. Ito, and Edward C. Oldfield III
Departments of Internal Medicine (Infectious Disease Division). Laboratory. and Clinical Investigation. Naval Hospital. and Health Sciences and Epidemiology (Epidemiology Division). Naval Health Research Center. San Diego. California; Department of Computer Systems Engineering. University ofArkansas. Fayetteville
The estimated average time to the development of AIDS after acquiring human immunodeficiency virus (HIV) infection is 8-10 years in the US population [I]. However, a subpopulation of Hl V-infected patients may have much more rapid progression of infection, and AIDS has developed as early as 2 months after HIV infection . CD4 lymphocyte counts accurately predict the risk of progression to AIDS and death . Hutchinson et al.  recently showed that a substantial proportion of newly identified HIV-infected patients had low CD4 lymphocyte counts at initial presentation, the cause of which was not known. However, the duration of HIV infection, a critical factor in CD4 lymphocyte depletion, was not known for this population. Because mandatory Navy screening for HIV infection was begun in 1986, virtually all new HIV-positive patients at Naval Hospital, San Diego (NHSD), since 1987 have previously been negative for HIV by ELISA. We reviewed clinical, demographic, and laboratory data for newly HIV -positive patients seen at NHSD over a 3Y2-year period. Initial CD4 cell counts were analyzed with respect to demographic data and
Received 20 April 1992; revised 15 June 1992. The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Navy. Department of Defense. or the US Government. Financial support: Chief, Navy Bureau ofMedicine and Surgery. Washington. DC, Clinical Investigation Program (study S-92-030). as required by HSETCINST 6000.41. Reprints or correspondence: LCDR P. J. Weiss. MC, USN, c/o Clinical Investigation Department, Naval Hospital, San Diego. CA 92134-5000. The Journal of Infectious Diseases 1992;166:1149-53 © 1992 by The University of Chicago. All rights reserved. 0022-1899/92(6605-0028$01.00
serologic evidence of coinfections. Follow-up data were collected for the 10% of patients constituting the highest and lowest deciles of CD4 cell counts.
Patients and Methods All Navy personnel undergo routine HIV testing at 1- to 4year intervals and may have additional HIV testing in special circumstances such as before ship deployment or after diagnosis ofother sexually transmitted diseases . Positive ELISA results are confirmed by Western blot testing. Results of all HIV antibody testing are entered into individual files in the Navy HIV Central Registry. All HIV-positive individuals are referred to a designated regional HIV evaluation unit. The standard evaluation consists of medical history, physical examination, and laboratory testing including complete blood count, lymphocyte subset analysis, chemistry panel, and serologic testing for syphilis, hepatitis A and B. toxoplasmosis, and cytomegalovirus infection. Varicella-zoster virus IgG assay was done in the last 14 months of the study period. The Navy HIV Central Registry was used to identify patients seen at NHSD during initial evaluation for HIV seropositivity who were previously negative for HIV by ELISA within 24 months of hospital admission. Two hundred forty-four patients meeting those criteria were identified over a 3Y2-year period (January 1988 through June 1991). Demographic, clinical, and laboratory data were obtained through the registry and individual medical records. From January 1989 to December 1991, blood samples for lymphocyte subset analysis were drawn in undiluted EDTA tubes between 8:00 A.M. and noon and processed within 4 h. Two-color flow cytometric evaluation was done on a FACSCAN (Becton Dickinson, Mountain View, CA) flow cytometer. The samples were prepared with Facslyse whole blood lysis and labeled with monoclonal antibodies (Becton Dickin-
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Initial CD4 lymphocyte counts were studied in 244 patients with human immunodeficiency virus (HIV) seroconversion. The CD4 cell counts at initial presentation after seroconversion were normally distributed (mean, 579/mm3 ; SD, 252). The mean percentage of CD4 cells was 26.1% (SD,5.6). CD4 cell counts were