Lack of predictive value for progression of dissociated circulating P24 antigen in human immunodeficiency virus type 1-infected black patients.
In human immunodeficiency virus type 1 (HIV)-1-infected Black people, the circulating p24 antigen is hidden frequently in immune complexes, because of high titers of serum anti-p24 antibodies. In order to evaluate the prognostic values for progression of free and dissociated serum p24 antigen in Black people, sera from 45 HIV-1-infected Black patients, all at non-AIDS stages, were evaluated prospectively for p24 antigen by several assays; circulating free p24 antigen was measured by immunocapture ELISA only (method 1) and with ELAST amplification (method 2), and dissociated p24 antigen determined after glycine-HCl pretreatment of serum, by immunocapture ELISA only (method 3) and with ELAST amplification (method 4). Serum CD4 and CD8 cell counts, beta 2-microglobulin, and total IgA were determined also at least twice a year. Clinical events for AIDS were those included in the 1986 CDC classification for HIV infection. At entry, p24 antigen was found in 3 (6.7%) patients by method 1, in 7 (15.6%) by method 2, in 14 (31.1%) by method 3, and in 22 (48.9%) by method 4. Methods 3 and 4 were more sensitive than method 1 (P < 0.001) and method 2 (P < 0.001). The mean follow-up was 30 months. The free symptom survival times (mean +/- SD months) were significantly lower in patients being p24 antigen positive by method 1 [(+) 33 +/- 27 vs. (-) 61 +/- 15, P = 0.03), but they were similar in patients positive and in those negative for p24 antigen determined by method 2 [(+) 71 +/- 17 vs. (-) 74 +/- 9, P = 0.54], method 3 [(+) 76 +/- 12 vs. (-) 69 +/- 13.2, P = 0.80], and method 4 [(+) 79 +/- 9 vs. (-) 63 +/- 7, P = 0.71]. At 24 months, p24 antigen positivity did not correlate either with CD4 or CD4/CD8 slops, nor with beta 2-microglobulin or IgA variations. By contrast, a CD4 cell count below 200/mm3 at entry was significantly associated with disease progression. In conclusion, dissociated p24 antigenemia does not appear as a useful surrogate marker for progression in HIV-1-infected Black people.
Départment des Maladies Infectieuses, Centre Hospitalier Universitaire, Villeneuve St Georges, France.
T
T
Prazuck
D
D
Troisvallets
X
X
Vallantin
O
O
Patey
M
M
Matta
A
A
Fisch
C
C
Lesguiller
A
A
Si Mohammed
M
M
Thomas
C
C
Lafaix
L
L
Bélec
D000328:Adult; D044383:Black People; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D015488:HIV Antigens / Q000097:blood* / Q000276:immunology; D016655:HIV Core Protein p24 / Q000097:blood* / Q000276:immunology; D015658:HIV Infections / Q000097:blood / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D008137:Longitudinal Studies; D011237:Predictive Value of Tests; D011446:Prospective Studies
D015488:HIV Antigens; D016655:HIV Core Protein p24