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Immune activation markers and AIDS prognosis.
D H Osmond1, S Shiboski, P Bacchetti
1Department of Epidemiology and Biostatistics, University of California, San Francisco.
AIDS (London, England)
|May 1, 1991
Summary
Four immune activation markers, including beta 2-microglobulin (beta 2M) and neopterin, effectively predict AIDS progression in HIV-positive men. Combining these markers with CD4 counts aids treatment decisions for asymptomatic HIV infection.
Area of Science:
- Immunology
- Virology
- Clinical Medicine
Background:
- Assessing prognostic markers for Acquired Immunodeficiency Syndrome (AIDS) is crucial for managing asymptomatic Human Immunodeficiency Virus (HIV) infection.
- Cellular products of immune activation are potential indicators of disease progression.
Purpose of the Study:
- To evaluate four serum immune activation markers—beta 2-microglobulin (beta 2M), neopterin, soluble CD8 (sCD8), and soluble interleukin-2 receptor (sIL-2R)—as prognostic indicators for AIDS.
- To determine the predictive value of these markers in asymptomatic HIV-seropositive homosexual men.
Main Methods:
- A prospective study involving 185 asymptomatic HIV-seropositive homosexual men.
- Baseline serum levels of beta 2M, neopterin, sCD8, and sIL-2R were measured.
- Univariate and multivariate analyses were performed to assess the markers' ability to predict AIDS diagnosis over 36 months, considering CD4 lymphocyte count and HIV p24 antigen/antibody status.
Main Results:
- All four immune activation assays correlated highly with each other and were significant univariate predictors of AIDS, comparable to CD4 lymphocyte count.
- Beta 2-microglobulin, neopterin, and sCD8 independently predicted AIDS in multivariate analysis, irrespective of CD4 count or p24 antigen/antibody status.
- Combining immune activation markers with CD4 counts (200-499 x 10(6) cells/l) stratified individuals into distinct risk groups for AIDS development (3-6% vs. 63-86% over 36 months).
Conclusions:
- Serum levels of beta 2M, neopterin, sCD8, and sIL-2R are valuable prognostic markers for AIDS in asymptomatic HIV-infected individuals.
- These markers, particularly when used with CD4 counts, can aid clinicians and patients in making informed treatment decisions regarding zidovudine therapy for asymptomatic HIV infection.