[The usefulness of different markers in the diagnosis of advanced HIV infection].
BACKGROUND
The aim of this study was to evaluate the usefulness of different markers to diagnose advanced infection by the human immunodeficiency virus (HIV) (AIDS or CD4 lymphocyte < 0.2 x 10(9)/L), establish the degree of correlation and define markers of advanced infection in primary health care.


METHODS
Clinical, hematological, biochemical, cellular, serological and immunological variables were analyzed in 146 patients diagnosed for the first time with HIV infection. The patients were classified into three stages: A (II, III, CDC-1987), B (IV-A, IV-C2) and C or advanced (IV-C1, IV-D). The following data were compared: the results in the three stages, the degree of correlation, the specificity and sensitivity to the diagnosis of AIDS. Two multiple logistic regression models were established: the first for all the variables and the second for only those available in primary health care.


RESULTS
All the markers except the triglycerides, IgG, IgM, and beta 2-microglobulin presented significant differences in the stages (p < 0.05). With the exception of the CD3+, CD4+ and CD8+ lymphocytes (r > or = 0.6 or -0.6) the remaining variables were independent. The decrease in CD4+ and the increase in neopterin were very sensitive markers (> 95%) but only hyperamylasemia demonstrated a specificity greater than 95% for the diagnosis of advanced infection. Oropharyngeal candidiasis (OR = 4.80) and the CD4+ lymphocyte (OR = 0.99) had the greatest weight in the first model. In the second model the most significant markers were weight loss (OR = 4.41), a decrease in lymphocytes (OR = 7.65) and an increase in IgA (OR = 5.82) with p < 0.01 and a predictive value of 85.16%.


CONCLUSIONS
The presence of weight loss, lymphocyte count < 1 x 10(9)/L and an increase in IgA may be used in primary health care to diagnose advanced infection by the human immunodeficiency virus. Asymptomatic hyperamylasemia with no apparent cause suggests advanced infection.
Portilla
J
J
Unidad de Enfermedades Infecciosas (Servicio de Medicina Interna), Hospital General Universitario de Alicante.
Sánchez Paya
J
J
Boix
V
V
Muñoz
C
C
Tamarit
J
J
Merino
J
J
Pérez-Mateo
M
M
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000276:immunology; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002180:Candidiasis, Oral; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D018655:Lymphocyte Count; D008297:Male; D011237:Predictive Value of Tests; D015431:Weight Loss
D015415:Biomarkers; D007136:Immunoglobulins
Utilidad de diferentes marcadores para el diagnóstico de la infección avanzada por el virus de la inmunodeficiencia humana.