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Surrogate markers of disease progression in HIV-infected children in Rio de Janeiro, Brazil
M B Ortigão-de-Sampaio1, T F Abreu, M I Linhares-de-Carvalho
1Departamento de Imunologia, IOC-FIOCRUZ, Rio de Janeiro, Brazil.
Insights
Immune complex-dissociated p24 antigenaemia (ICD-p24Ag), beta 2 microglobulin (beta 2-M), and neopterin do not reliably predict HIV-1 disease progression in children. CD4 lymphocyte counts remain the most effective prognostic marker.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- HIV-1 infection in children poses significant challenges for monitoring disease progression.
- Accurate prognostic markers are crucial for timely clinical intervention and management.
- Existing markers require validation for their predictive value in pediatric HIV cohorts.
Purpose of the Study:
- To evaluate the predictive value of immune complex-dissociated p24 antigenaemia (ICD-p24Ag), beta 2 microglobulin (beta 2-M), and neopterin for HIV-1 disease progression in children.
- To compare the efficacy of these markers against CD4-lymphocyte counts in predicting clinical outcomes.
- To assess the correlation of these biomarkers with clinical staging (CDC-1994) and CD4-lymphocyte counts.
Main Methods:
- Prospective study of 53 HIV-1 infected children and 9 HIV-negative controls over 9 months.
- Regular blood sampling (mean interval 61 days) for ICD-p24Ag, beta 2 microglobulin, and neopterin assays.
- Correlation analysis of biomarker results with clinical outcomes and CD4-lymphocyte counts.
Main Results:
- ICD-p24Ag showed similar positivity rates across symptomatic HIV-1 groups (A, B, C) but was negative in asymptomatic group E.
- Beta 2 microglobulin and neopterin levels did not correlate with clinical stages of HIV-1 infection.
- No significant correlation was found between ICD-p24Ag, beta 2-M, neopterin, and age-matched CD4-lymphocyte counts.
Conclusions:
- The evaluated markers (ICD-p24Ag, beta 2-M, neopterin) demonstrate limited value in predicting HIV-1 disease progression or correlating with CD4 counts in children.
- CD4-lymphocyte count emerged as the most reliable predictor of disease prognosis in this pediatric HIV cohort.
- Further research may be needed to identify more robust biomarkers for pediatric HIV management.
Abstract:
In order to test the predictive value of immune complex-dissociated p24 antigenaemia (ICD-p24Ag), beta 2 microglobulin (beta 2-M), and neopterin as markers of disease progression, 53 HIV-1 infected children (mean age 68 months) and nine HIV-negative controls (mean age 65 months) were studied prospectively for 9 months. Five were classified in category E (CDC-1994) and seroreverted during the study, 14 in category A, nine in category B, and 25 in category C (CDC-1994). Blood samples were taken at medium intervals of 61 days and tested for ICD-p24Ag, beta 2 microglobulin, and neopterin. The results were correlated with clinical outcome and CD4-lymphocyte counts. All three groups (A, B, C) of symptomatic children had similar positivity in an ICD-p24Ag test (48.1, 58.8, and 51.0 per cent, respectively), and all in group E had negative p24 antigenaemia. beta 2 microglobulin and neopterin tests showed no correlation with clinical stages of HIV-1 infection. There was no significant correlation between these three tests with age-matched CD4 lymphocyte counts (p > 0.05). In contrast, the CD4 lymphocyte count correlated well with disease stages. These data suggest that the markers evaluated in the present study do not correlate well with clinical findings or with CD4 lymphocyte counts. Of all the markers tested, CD4 count was the best to predict prognosis of HIV disease in this cohort.