We quantified T cell proliferation and thymic function in primary HIV infection (PHI; n ؍ 19) and chronic HIV infection (CHI;n
H uman immunodeficiency virus type 1 infection is marked by a progressive loss of CD4ϩ T cells, eventually leading to immunodeficiency and death. The pathogenesis of T cell depletion in HIV infection is complex, and debate continues as to whether T cell depletion is predominantly caused by increased T cell death, enhanced T cell proliferation and subsequent "exhaustion," or an inhibition of de novo T cell production (reviewed in Ref. 1). After effective antiretroviral therapy, this process is reversed in the majority of individuals and there is an increase in both CD4 ϩ naive and memory T cells and partial reconstruction of functional immunity (2).The role of the thymus in T cell homeostasis is critical to our understanding of T cell depletion, T cell turnover, and immune reconstitution. A fraction of recent thymic emigrants carries episomal TCR excision circles (TREC) 5 that do not replicate with cell division (3, 4). The number of TREC per million cells is dependent on thymic output, T cell proliferation, and the rate of death of both TREC-positive and -negative T cells. Hazenberg et al. (5) demonstrated an inverse relationship between the number of TREC per million cells and cell division in the naive T cell population from individuals with chronic HIV infection (CHI), suggesting that the reduction of TREC per million cells in HIV infection is a consequence of increased T cell proliferation and is not due to a reduction in thymic output. As suggested by Hazenberg et al. (5), interpretation of these results is complex because T cell proliferation, T cell death, and thymic function are all altered by HIV infection (6 -8) and, in addition, each of these processes will also affect the quantification of TREC (4, 9).To help unravel these competing processes we quantified TREC in two ways. First, we measured TREC per million T cells (CD4 ϩ and CD4 Ϫ ) and then, to account for changes in T cell number due to either HIV infection or therapy, we calculated TREC per milliliter of blood. Proliferation, for example, is thought to decrease TREC by dilution (5). This is clearly true if one measures TREC per million CD4 ϩ T cells, because division will not increase the number of TREC but will increase the number of cells. However, if one measures TREC per milliliter there will be no change because the number of TREC remains unchanged during cell division. If death occurs simultaneously with proliferation to maintain cell numbers, then TREC per milliliter will decrease as TREC ϩ