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To define predictors of survival time in late human immunodeficiency virus type 1 (HIV-1) disease, long- and short-duration survivors were studied after their CD4+ T cells fell to </=50/mm3. Immune activation of CD4+ and CD8+ T cells, as measured by elevated cell surface expression of CD38 antigen, was strongly associated with shorter subsequent survival (P</=.002). The naive CD45RA+CD62L+ T cell reserve was low in all subjects and did not predict survival (P=.34 for CD4+ and.08 for CD8+ cells). Higher virus burden correlated with CD8+ but not CD4+ cell activation and, after correcting for multiple comparisons, was not associated with shorter survival (P=.02). All of the patients' viruses used CCR5, CXCR4, or both, and coreceptor usage did not predict survival (P=. 27). Through mechanisms apparently unrelated to higher virus burden, immune activation is a major determinant of survival in advanced HIV-1 disease.

Original publication




Journal article


J Infect Dis

Publication Date





859 - 870


ADP-ribosyl Cyclase, ADP-ribosyl Cyclase 1, Acquired Immunodeficiency Syndrome, Adult, Antigens, CD, Antigens, Differentiation, CD4 Lymphocyte Count, HIV-1, HLA-DR Antigens, Humans, Lymphocyte Activation, Male, Membrane Glycoproteins, Middle Aged, NAD+ Nucleosidase, RNA, Viral, Receptors, CCR5, Receptors, CXCR4, T-Lymphocytes