Predictive markers for the acquired immunodeficiency syndrome (AIDS) in hemophiliacs: persistence of p24 antigen and low T4 cell count.
OBJECTIVE
To investigate the predictive value of assays for human immunodeficiency virus (HIV) p24 antigen, p24 antibody, and gp120 antibody compared with T4 cell counts.


METHODS
Prospective cohort selected from persons who had HIV-antibody seroconversion.


METHODS
Eighty-seven persons with hemophilia with an actuarial cumulative acquired immunodeficiency syndrome (AIDS) incidence of 26% (CI, 12% to 40%), 8 years after HIV-antibody seroconversion.


METHODS
None.


RESULTS
Human immunodeficiency virus p24 antigen was detected in 8 of 74 (11%) of the patients without AIDS and 7 of 13 (54%) of the patients with AIDS. The 2-year actuarial incidence of AIDS was 24% (CI, 0% to 48%) after detection of p24 antigen, 16% (CI, 0% to 34%) after loss of p24 antibody, 20% (CI, 0% to 45%) after loss of gp120 antibody, 31% (CI, 15% to 47%) after a T4 count of less than 200 cells/microL, and 67% (CI, 31% to 100%) after a T4 count of less than 200 cells/microL among those patients positive for p24 antigen. Very low numbers of T4 and T8 lymphocytes, presence of p24 antigen in serum, and absence of p24 antibody all had some predictive value. However, only p24 antigen (relative hazard 6.0, P = 0.008) and T4 counts (relative hazard 5.3, P = 0.002 with T4 count less than 200 cells/microL) independently predicted AIDS up to 12 months before diagnosis.


CONCLUSIONS
Strong predictors of AIDS are p24 antigenemia or low T4 counts. Detection of p24 antigen is highly specific and complementary to the greater sensitivity of low T4 counts. These findings have important implications regarding prognosis, counseling, and the planning of clinical trials.
Eyster
M E
ME
Pennsylvania State University School of Medicine, Hershey.
Ballard
J O
JO
Gail
M H
MH
Drummond
J E
JE
Goedert
J J
JJ
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology*; D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015483:HIV Antibodies / Q000378:metabolism; D015488:HIV Antigens / Q000276:immunology / Q000378:metabolism*; D016655:HIV Core Protein p24; D015699:HIV Envelope Protein gp120; D006679:HIV Seropositivity / Q000276:immunology*; D006467:Hemophilia A / Q000276:immunology*; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D011237:Predictive Value of Tests; D012191:Retroviridae Proteins / Q000276:immunology / Q000378:metabolism*; D012307:Risk Factors
D015483:HIV Antibodies; D015488:HIV Antigens; D016655:HIV Core Protein p24; D015699:HIV Envelope Protein gp120; D012191:Retroviridae Proteins