A prospective study of the association of serum neopterin, beta 2-microglobulin, and hepatitis B surface antigenemia with death in infants and children with HIV-1 disease.
A high percentage of HIV-1-infected infants and children in Romania are coinfected with hepatitis B virus. Little information is available on the impact of concurrent hepatitis B infection on the course of HIV-1 infection. We conducted a prospective cohort study over 1 year in a group of 68 HIV-1-infected infants and children to determine whether hepatitis B surface antigenemia, neopterin, and beta 2-microglobulin (B2M) predicted death. Among the 44 hepatitis B surface antigen-positive (HBsAg+) subjects at enrollment, 13 (30%) died during 1 year of follow-up. In comparison, two of 24 (8%) HBsAg-negative subjects died (RR = 7.7; p = 0.05). Higher initial serum concentrations of neopterin and B2M were negatively associated with survival. After stratifying by baseline clinical evidence of HIV-related disease, survival was negatively associated with HBsAg+ status (p = 0.04) in 33 children in stage P-2, adjusting for age, serum neopterin, and serum B2M levels. The results of this study suggest that serum neopterin is a marker for severity of clinical illness and that HBsAg+ status increases the mortality rate among children with clinical evidence of HIV infection.
Di Franco
M J
MJ
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115.
Zaknun
D
D
Zaknun
J
J
Vuja
E
E
Oswald
H P
HP
Mayersbach
P
P
Hunter
D
D
Tosteson
T D
TD
Trichopoulos
D
D
Schmitzberger
R
R
D001708:Biopterins / Q000031:analogs & derivatives* / Q000097:blood; D001798:Blood Proteins / Q000032:analysis; D002675:Child, Preschool; D015331:Cohort Studies; D003644:Death Certificates; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000401:mortality*; D015497:HIV-1; D006509:Hepatitis B / Q000150:complications; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D019798:Neopterin; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012383:Romania / Q000453:epidemiology; D016019:Survival Analysis; D001613:beta 2-Microglobulin / Q000032:analysis*
D001798:Blood Proteins; D006514:Hepatitis B Surface Antigens; D001613:beta 2-Microglobulin; D001708:Biopterins; D019798:Neopterin