SERUM NEOPTERIN LEVEL PREDICTS HIV-RELATED MORTALITY BUT NOT PROGRESSION TO AIDS OR DEVELOPMENT OF NEUROLOGICAL DISEASE IN GAY MEN AND PARENTERAL DRUG-USERS

Objective: To investigate the ability of elevated serum neopterin leve ls to predict independently mortality, progression to acquired immunod eficiency syndrome, and development of neurological disease. Design: C ross-sectional and longitudinal study of gay and/or bisexual men and p arenteral drug users. Setting and Patients: Patients included human im munodeficiency virus (HIV)-negative and -positive gay and/or bisexual men and parenteral drug-using men and women who volunteered for an out patient study of the natural history of HIV infection. Results: Serum neopterin levels were significantly elevated in HIV-positive patients (mean, 18.0 nmol/L; SD, 19.2 nmol/L), compared with those in HIV-negat ive patients (mean, 7.5 nmol/L; SD, 5.5 nmol/L) (P<.001). No differenc es in the serum neopterin levels could be detected between gay men and parenteral drug users. In HIV-positive patients, women had a higher s erum neopterin level than did men (P=.03). The elevated serum neopteri n levels were associated with an advanced clinical stage of HIV infect ion. After adjusting for the CDS lymphocyte count and other potential confounders, the serum neopterin level was a significant independent p redictor of mortality. The elevated serum neopterin levels did not pre dict progression to acquired immunodeficiency syndrome or development of clinically significant neurological disease. Conclusion: An elevate d serum neopterin level predicts mortality, but it does not predict pr ogression to acquired immunodeficiency syndrome or development of neur ological disease among HIV-infected individuals.