SOLUBLE RECEPTORS FOR TUMOR-NECROSIS-FACTOR AS PREDICTORS OF PROGRESSION TO AIDS IN ASYMPTOMATIC HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 INFECTION

Serum concentrations of soluble receptors for tumor necrosis factor-al pha (sTNF alpha R) types I and II, beta(2)-microglobulin, and CD4 cell counts were determined at entry and 3-5 months before AIDS diagnosis in 20 untreated, asymptomatic human immunodeficiency virus type 1 (HIV -1)-seropositive subjects, who progressed to AIDS within 5.5 years of study entry, and in an equal number of HIV-seronegative and untreated seropositive controls, who remained asymptomatic. At entry, concentrat ions of sTNF alpha R type II and beta(2)-microglobulin were elevated a nd increased further in progressors. The odds ratio (OR) for sTNF alph a R type II concentrations greater than or equal to 6.5 ng/mL was 18.4 and for beta(2)-microglobulin concentrations greater than or equal to 3 mg/L was 6.6; CD4 cell counts were not predictive. Five months befo re diagnosis, the OR was 102.0 for sTNF alpha R type II concentrations greater than or equal to 7.5 ng/mL, 13.5 for beta 2-microglobulin con centrations greater than or equal to 4 mg/L, and 6.9 for CD4 cell coun ts <250/mm(3) (counts <500/mm(3) were not predictive). Of the three va riables, sTNF alpha R type II was proved by bivariate analysis to be t he strongest and earliest predictor of disease progression.