PROGNOSTIC VALUE OF COMBINED RESPONSE MARKERS AMONG HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PERSONS - POSSIBLE AID IN THE DECISION TO CHANGE ZIDOVUDINE MONOTHERAPY

To clarify useful clinical parameters for determining the need for cha nges in antiretroviral regimens, 586 persons who were seropositive for the human immunodeficiency virus (HIV) and who had intermediate-stage HIV disease underwent follow-up semiannually for a median of 3.1 year s after zidovudine monotherapy was instituted, The strongest predictor s of time to the development of AIDS and of survival were an increased CD4 lymphocyte count (>50/mu L), a decreased neopterin level (>2,4 nm ol/L), and no increase in the number of symptoms after 7-12 months of zidovudine therapy, Men who had the best quartile CD4 lymphocyte and n eopterin responses and who also had no increase in the number of sympt oms were 23 times less likely to die (reflecting a 96% increase in sur vival) than were men who had the worst responses in these variable cat egories, After 7-12 months of zidovudine therapy, 5-year survival rate s were 63% for men with good responses in all three variable categorie s, 47%-49% for those with good CD4 lymphocyte responses and good respo nses in one other variable category, 31% for those with only a good CD 4 lymphocyte response, and 0 for those with poor responses in all thre e variable categories.