THE USEFULNESS OF DIFFERENT MARKERS IN TH E DIAGNOSIS OF ADVANCED HIV-INFECTION

Background: The aim of this study was to evaluate the usefulness of di fferent markers to diagnose advanced infection by the human immunodefi ciency virus (VIH) (AIDS or CD4 lymphocyte < 0.2 x 10(9)/L), establish the degree of correlation and define markers of advanced infection in primary health care. Methods: Clinical, hematological, biochemical, c ellular, serological and immunological variables were analyzed in 146 patients diagnosed for the first time with HIV infection. The patients were classified into three stages: A (II, III, CDC-1987), B (IV-A, IV -C2) and C or advanced (IV-C1, IV-D). The following data were compared : the results in the three stages, the degree of correlation, the spec ificity and sensitivity to the diagnosis of AIDS. Two multiple logisti c regression models were established: the first for all the variables and the second for only those available in primary health care. Result s: All the markes except the triglycerides, IgG, IgM, and beta2-microg lobulin presented significant differences in the stages (p < 0.05). Wi th the exception of the CD3+, CD4+ and CD8+ lymphocytes (r greater-tha n-or-equal-to 0.6 or -0.6) the remaining variables were independent. T he decrease in CD4+ and the increase in neopterine were very sensitive markers (> 95%) but only hyperamylasemia demonstrated a specificity g reater than 95% for the diagnosis of advanced infection. Oropharyngeal candidiasis (OR =4.80) and the CD4+ lymphocyte (OR = 0.99) had the gr eatest weight in the first model. In the second model the most signifi cant markers were weight loss (OR = 4.41), a decrease in lymphocytes ( OR = 7.65) and an increase in IgA (OR = 5.82) with p < 0.01 and a pred ictive value of 85.16%. Conclusions: The presence of weight loss, lymp hocyte count < 1 x 10(9)/L and an increase in IgA may be used in prima ry health care to diagnose advanced infection by the human immunodefic iency virus. Asymptomatic hyperamylasemia with no apparent cause sugge sts advanced infection.