Early lymphocyte transformation abnormalities in human immunodeficiency virus infection

Two hundred twelve patients with enzyme immunoassay and Western blot confirmation of human immunodeficiency virus (HIV) infection were evaluated with anergy panel, lymphocyte cell surface phenotyping, lymphocyte transformation, and serum immunoglobulins. Mitogen responses were used to develop a lymphocyte transformation index (LTI) comparing the summation of each individual's response to its normal control. By multiple regression, anergy panel, absolute CD4 level, and LTI show a progressive decline and IgA shows a progressive increase when correlated with a worsening Walter Reed (WR) classification (R = 0.84). Lymphocyte transformation is first abnormal in WR class 1, absolute CD4 in WR class 3, and anergy and serum IgA in WR class 4. The above markers are useful to assess immunologic function in HIV infection. Lymphocyte transformation abnormalities precede other immunologic deficits in HIV positive patients. Serial evaluation of these markers may help define the immunologic response and natural history of HIV infection.