IMPROVING THE PROGNOSTIC VALUE OF CD4(-SEROPOSITIVE IV DRUG-USERS() COUNT USING IGA AND CLINICAL SIGNS IN HIV)

A population of 549 HIV-positive intravenous drug users, 140 of whom w ere women, recruited between June 1985 and June 1991, were studied to determine the usefulness of minor clinical signs and biological parame ters in predicting progression to AIDS at different CD4(+) levels, Nin ety-eight subjects developed AIDS during a median follow-up of 4 years , Oral thrush was predictive of progression to AIDS independently of t he CD4(+) level at enrolment; seborrheic dermatitis was predictive of disease progression only in those with CD4(+) under 500 cells/mm(3), R egarding the predictive value of the biologic parameters examined, sim ilar IgA levels among HIV-seropositive intravenous drug users with CD4 (+) > 500 cells/mm(3) and HIV-negative intravenous drug users were obs erved, while higher median levels were found among HIV-positive partic ipants with CD4(+) level under 500 cells/mm(3). Among intravenous drug users with CD4(+) < 500 cells/mm(3), a level of IgA higher than 200 m g/dl at enrolment was predictive of faster progression to AIDS, Among participants with CD4(1) over 500 cells/mm(3), an IgA level above 400 mg/dl was still predictive of faster progression, but the sensitivity tended to be low, These findings suggest that an elevated level of IgA and presence of oral thrush may be important early markers of disease progression in HIV-infected intravenous drug users, Seborrheic dermat itis is also predictive, but only in later stages.