Increased levels of immune activation among HIV patients from developing countries are believed to accelerate and/or enhance the shift to a Th2 cytokine environment, which in turn may result in a more rapid progression to AIDS. In support of this hypothesis, we present data from a cohort of 35 HIV+ individuals in southern India. Among asymptomatic individuals in this cohort, a dramatic increase in plasma interleukin (IL)-10 coincided with rapid decrease in CD4 counts and progression to AIDS. Serum IL-10 levels were significantly higher after 6 months of follow up (P=0.01), while CD4 counts declined at a rate of 280 cells/ul per year, roughly 3 times the rate of decline reported for HIV+ asymptomatic subjects in developed countries. Changes in serum IL-10 levels and CD4 counts fell short of statistically significant correlation (P=0.1). Among AIDS patients in this cohort, the mean period from diagnosis of AIDS to death was <5 months and is in agreement with an earlier report of rapid progression in India.
PIP: This paper presents data on the increase of plasma interleukin-10 (IL-10) levels and rapid loss of CD4+ T cells among HIV-infected individuals in southern India. A cohort of 35 HIV-positive individuals were evaluated and classified into 3 categories based on the US Centers for Disease Control (CDC) clinical classification: 9 asymptomatic, 11 symptomatic with a non-AIDS defining illness, and 15 AIDS cases. Results revealed that asymptomatic individuals experienced rapid declines in CD4 counts (280 cells/mcl/year), which is 3 times lower than the rate of HIV-positive asymptomatic subjects in developed countries. It has been estimated that progression to AIDS would occur within 2 years for the average Indian patient. On the other hand, symptomatic patients were observed to have a stable CD4 count during the 6 months of study, which could be attributable to anti-tuberculosis treatment and trimethoprim-sulfamethoxazole. The shifts in serum IL-10 levels and CD4 counts were lower for a statistically significant correlation (p = 0.1). Several factors were identified that may have caused the differing rates of disease progression, which include infectious agents and malnutrition. Among the patients, the mean period from AIDS diagnosis to death was 5 months, which is similar to reports of rapid progression in India.