title: Immunological markers of disease progression in patients infected with the human immunodeficiency virus.
abstract: Identification of inexpensive and technically simple immunological tests useful in predicting the progression to AIDS in human immunodeficiency virus (HIV)-infected patients would be especially welcome in developing countries, in which 80% of HIV-infected patients reside and health budgets are low. In the current study, we evaluated CD4+ and total lymphocyte counts and the concentrations in serum of beta 2-microglobulin, p24 antigen, and immunoglobulin A (IgA) as predictors of disease progression in 74 Panamanian HIV-positive patients and 50 HIV-negative healthy individuals. Total lymphocyte and CD4(+)-cell counts for AIDS patients (1,451 +/- 811 cells/microliters, P < 0.001, and 238 +/- 392 cells/microliters, P < 0.0001, respectively and asymptomatic patients (2,393 +/- 664 cells/microliters, P > 0.05, and 784 +/- 475 cells/microliters, P < 0.001, respectively) were lower than those observed for healthy subjects (2,596 +/- 631 cells/microliters and 1,120 +/- 296 cells/microliters, respectively). The levels of beta 2-microglobulin and IgA in serum were significantly elevated in patients with AIDS (5.7 +/- 3.6mg/liter, P < 0.001, and 541 +/- 265 mg/dl, P < 0.0002, respectively) and asymptomatic infected subjects (3.4 +/- 2.1 mg/liter, P = 0.001, and 436 +/- 216 mg/dl, P < 0.0001, respectively) compared with the levels in healthy subjects (2.2 +/- 0.7 mg/liter and 204 +/- 113 mg/dl, respectively). Nonstatistically significant differences (P > 0.05) for concentrations of p24 antigen between asymptomatic infected patients (29 +/- 13 pg/ml) and AIDS patients (40 +/- 23 pg/ml) were observed. Total lymphocyte counts of 1,750 cells/microliters or less, CD4 counts of 200 cells/microliters or less, beta 2-microglobulin concentrations in serum of 4 mg/liter or higher, concentrations of IgA in serum of 450 mg/dl or higher, and the presence in serum of p24 antigen were correlated with elevated risks for developing AIDS. Monitoring both total lymphocytes and beta 2-microglobulin identified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4(+)-cell evaluations and the costs associated with monitoring both total lymphocytes and beta 2-microglobulin identified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4(+)-cell evaluations and the costs associated with monitoring the immune status of HIV-positive patients.
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Panama, Panama City.
authors.forename: J M
authors.initials: JM
authors.lastname: Pascale
authors.forename: M D
authors.initials: MD
authors.lastname: Isaacs
authors.forename: P
authors.initials: P
authors.lastname: Contreras
authors.forename: B
authors.initials: B
authors.lastname: Gomez
authors.forename: L
authors.initials: L
authors.lastname: Lozano
authors.forename: E
authors.initials: E
authors.lastname: Austin
authors.forename: M C
authors.initials: MC
authors.lastname: De Martin
authors.forename: R L
authors.initials: RL
authors.lastname: Gregory
authors.forename: G L
authors.initials: GL
authors.lastname: McLaughlin
authors.forename: A
authors.initials: A
authors.lastname: Amador
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood* / Q000453:epidemiology / Q000276:immunology*; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology; D018450:Disease Progression; D005260:Female; D016655:HIV Core Protein p24 / Q000097:blood; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D012307:Risk Factors; D001613:beta 2-Microglobulin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D016655:HIV Core Protein p24; D007070:Immunoglobulin A; D001613:beta 2-Microglobulin