Functional versus phenotypic analysis of t cells in subjects seropositive for the human immunodeficiency virus: A prospective study of in vitro responses to cryptococcus neoformans

We performed a prospective study of 50 subjects at high risk for human immunodeficiency virus (HIV) infection to determine if assays of antigen-specific T cell function provide an earlier indication of future progression to AIDS or a better assessment of immune function than do current methods of evaluation. We measured in vitro T cell responses to Cryptococcus neoformans and tetanus toxoid, response to mitogens, HIV p24 antigene-mia, and clinical parameters. Progression to AIDS was significantly associated with loss of T cell response to cryptococci (P =.015), HIV antigenemia (P =.001), and low CD4⁺ cell numbers (P =.001). Most importantly, we found that loss of antigen-specific responses to cryptococci and tetanus can occur before changes in CD4 cell number. Abnormal response to mitogens and marked depletion of CD4⁺ cells were late signs of progressive HIV infection. Measurement of antigen-specific T cell function may be useful for assessing the efficacy of antiviral therapy in HIV infection before onset of symptoms.