THE PREDICTIVE VALUE OF SEVERAL MARKERS IN THE PROGRESSION TO ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Serum beta(2)-microglobulin, neopterin, immunoglobulins A, G and M, ad enosine deaminase and CD4+ lymphocyte count were evaluated as predicto rs of progression of HIV-1 infection to AIDS. A population of HIV-1 se ropositive, initially asymptomatic men (n=213) and women (n=101) was f ollowed up quarterly. We estimated the AIDS-free time using the actuar ial method (median survival time 47.2 months). Cox proportional hazard analysis revealed that all markers studied were significant (p<0.05) in relation to progression to AIDS. The best markers for predicting pr ogression to AIDS were, in descending order, CD4+ lymphocyte count, be ta(2)-microglobulin, IgA, neopterin, IgG, IgM and adenosine deaminase. On stratifying population into four groups (devided at percentiles 25 , 50 and 75 - from group 1, with values nearest to reference ranges, t o group 4, with most abnormal values) we observed statistically signif icant differences (p<0.05) for all markers except for adenosine deamin ase. The relative risk from the Cox proportional hazards model were us ed to quantify the effects of the best markers and compared to the ris k obtained in group 1. CD4+ lymphocyte count was the best predictor of progression to AIDS. When considering beta(2)-microglobulin and CD4together, the relative risk in the group with lowest CD4+ cell count ( group 4) ranged from 25.6% (with lower beta(2)-microglobulin values) t o 41.1% (with higher beta(2)-microglobulin values). Similar results we re obtained when considering neopterin and CD4+ together. The addition of beta(2)-microglobulin or neopterin values to CD4+ lymphocyte count improved the predictive value of CD4+ lymphocyte count.