THRUSH AND FEVER AS MEASURES OF IMMUNOCOMPETENCE IN HIV-1-INFECTED MEN

The occurrence of Pneumocystis carinii pneumonia (PCP) in human immuno deficiency virus type 1 (HIV-1)-infected individuals with high CD4(+) counts indicates poor immunologic function. Thrush and persistent feve r, easily recognized clinically, are potential measures of immunocompe tence. This analysis establishes the complex interactions of CD4(+) co unt, thrush, and persistent fever to predict the occurrence of PCP. An alyses used 20,632 person visits from 2,568 HIV-1-seropositive homosex ual or bisexual men participating in the Multicenter AIDS Cohort Study (MACS). Comprehensive examinations were conducted semiannually, while occurrences of PCP were assessed continuously. The occurrence of thru sh and fever increase in frequency as CD4(+) levels decrease. The rela tive hazard of PCP in the presence of thrush compared with the absence of thrush rises (p < 0.05) from 1 for the lowest CD4(+) category to a pproximately 5 in the highest categories. The relative hazard of PCP i n the presence of fever compared with the absence of fever is above on e (p < 0.05) in all CD4(+) categories. No cases of PCP occurred in ind ividuals on PCP prophylaxis with CD4(+) counts >200/mm(3). These resul ts suggest that HIV-1-related symptoms provide a measure of failing im mune function that is not reflected by enumeration of CD4(+) lymphocyt es alone and support the United States Public Health Service recommend ation that symptomatic individuals with CD4(+) counts >200/mm(3) shoul d be considered for PCP prophylaxis.