There's nothing like hearing the results of studies directly from those who actually conducted the research. It is these women and men who are transforming HIV treatment and care. In this interview, you'll meet one of these impressive HIV researchers and read an explanation of the study he is presenting at CROI 2008. Accompanying me on this interview is Gerald Pierone, M.D., an HIV clinician/researcher and the founder and executive director of the AIDS Research and Treatment Center of the Treasure Coast in Fort Pierce, Fla.

Roksana Karim, M.D., Ph.D.

Roksana Karim: I am Roksana Karim, with the research group at Maternal, Child & Adolescent Center for Infectious Disease and Virology at the University of Southern California . Here, my work is looking at the association between early T-cell activation and CD4+ depletion among HIV and HCV [hepatitis C virus] coinfected women who are not on HAART.¹

Initially, we looked at the levels of T-cell activation across three groups of women: those who [had] HIV only; [those who were] coinfected with HCV [but were] non-[HCV-]viremic; and [HIV/HCV-] coinfected, [HCV-]viremic women. We see a significant correlation between CD8+ T-cell activation across the HCV-coinfected groups, compared to the HIV-only group.

Then we looked among the coinfected groups and examined the relationship between HCV RNA levels and T-cell activation levels. We see a significant, increasing trend in both CD4+ and CD8+ activation across higher HCV RNA levels. Then we looked further, to see if these high levels of activation markers in coinfected women were having an impact on CD4+ depletion. We do see that there is a significant impact of higher activation marker levels on CD4+ decline in these coinfected women, adjusted for the potential covariates, which are age, HIV RNA load, IV [intravenous] drug use, and antiretroviral therapy.

Gerald Pierone: What are some of your recommendations for these women?

Roksana Karim: Coinfected women may need early attention in terms of their viral load control. And, of course, they should be screened for their [T-cell] activation levels.

Gerald Pierone: There have been other studies that have looked at levels of immune activation as predicting more rapid decline in CD4+ count.^2,3,4 How is your study different from other studies that have been done?

Roksana Karim: Those are actually done in patients treated with HAART whose viral loads have been suppressed for a long time. They looked at their activation level and CD4+ gain. What I'm doing here is a much earlier stage of disease, and [I'm] looking at CD4+ loss, which may have a better clinical impact.

Gerald Pierone: Just to clarify, was there a difference between the women who were HCV viremic versus not [HCV] viremic, in terms of their levels of immune activation?

Roksana Karim: Yes, there was. These two groups were different in terms of CD8+ T-cell activation, not CD4+. [Editor's note: As noted in the poster, there appeared to be a bit more T-cell activation in the viremic group.]

Gerald Pierone: And how about CD38+?

Roksana Karim: We didn't look at that.

Gerald Pierone: Do you have follow-up studies planned with this data set?

Roksana Karim: At this time, I want to look at the na?ve and memory T-cell markers, which is our next step. We'll probably do that. We also have data on these women when they go on HAART. We can, of course, redo what's been published and see if that holds up.

Gerald Pierone: Great. Thank you.

This transcript has been lightly edited for clarity.

Footnotes

1. Karim R, Mack W, Neuman G, Spencer L, Al-Harthi L, and Kovacs A. Immune activation is not associated with annual rate of CD4 decline in HIV/HCV-co-infected women. In: Program and abstracts of the 15th Conference on Retroviruses and Opportunistic Infections; February 3-6, 2008; Boston, Mass. Abstract 1042.
   View poster: Download PDF
2. Hazenberg MD, Otto SA, van Benthem BH, et al. Persistent immune activation in HIV-1 infection is associated with progression to AIDS. AIDS. September 5, 2003;17(3):1881-1888.
3. Deeks SG, Kitchen CM, Liu L, et al. Immune activation set point during early HIV infection predicts subsequent CD4+ T cell changes independent of viral load. Blood. August 15, 2004;104(4): 942-947.
4. Wilson CM, Ellenberg JH, Douglas SD, Moscicki AB, Holland CA, for The Reach Project Of The Adolescent Medicine Hiv/Aids Research Network. CD8+ CD38+ T cells but not HIV type 1 RNA viral load predict CD4+ T cell loss in a predominantly minority female HIV+ adolescent population. AIDS Res Hum Retroviruses. March 1, 2004;20(3):263-269.