HIV infection has been shown to affect lymphocyte function and to reduce lymphocyte responsiveness in vitro to mitogenic stimulation, but little is known about lymphocyte metabolism in vivo and how it is affected during the course of the disease. This study investigated the metabolic activity of lymphocytes in vivo through the progression of HIV-associated disease. Lymphocyte protein synthesis was measured with l-[2H5]phenylalanine (45mg/kg body weight) in healthy volunteers (n = 7), in patients who were HIV-positive (n = 7) but asymptomatic, and in patients with AIDS (n = 8). The rates of lymphocyte protein synthesis [expressed as a percentage of lymphocyte protein, i.e. fractional synthesis rate (FSR)] were not altered in HIV-positive patients compared with healthy controls (7.9±1.28% and 9.1±0.53%/day respectively), but were significantly elevated in AIDS patients (14.0±1.16%/day; P < 0.05). The serum concentration of the cytokine tumour necrosis factor-α (TNF-α) increased with the progression of the disease, and TNF-α levels were significantly higher in AIDS patients (6.81±0.88ng/l) than in healthy controls (3.09±0.27ng/l; P < 0.05). Lymphocyte protein FSR was positively correlated with serum TNF-α concentration (r = 0.55, P = 0.009) and negatively correlated with CD4+ lymphocyte count (r =-0.70, P = 0.004). The elevation of lymphocyte protein synthesis in AIDS patients suggests a higher rate of turnover of lymphocytes. This may be associated with a generalized activation of the immune system, which is also reflected by the elevated serum TNF-α concentration in the late stages of HIV-associated disease.

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