Soluble tumor necrosis factor alpha receptors (sTNF-Rs) in HIV-1-infected intravenous drug users: Change in circulating sTNF-R type II level and survival for AIDS patients

This study in intravenous drug users (IV-DUs) investigated differences in s erum soluble tumor necrosis factor types I and II (sTNFR-I and II) concentr ations in HIV-1-infected IVDUs and controls. This study also investigated w hether changes of sTNFRs concentration affect the risk of death among patie nts with AIDS. A cross-sectional study of 54 subjects with AIDS, 47 HIV-ser opositive IVDUs, 47 HIV-seronegative IVDUs, and 21 healthy subjects showed that sTNFRs concentration increases from healthy controls to AIDS patients through HIV-seronegative and HIV-seropositive subjects (p < 0.01). sTNFR-I concentration, however, was shown to be similar in HIV-seronegative IVDUs a nd healthy controls. In the longitudinal study, serum concentration of sTNF Rs was determined near AIDS diagnosis in 21 IVDUs and 1 year later (start f or the survival study). Cox proportional hazards regression was performed t o assess the prognostic value of percent change of sTNFR level alone and in combination with T lymphocyte subsets, HIV-p24 antigenemia and opportunist ic infections for death within 240 days. Uni- and multivariate Cox modellin g for dichotomised variables according to its median showed an increase of sTNFR-II by at least 30% to be single significant predictor of death: crude relative risk 3.69, p = 0.03; adjusted relative risk 5.67, p = 0.02. Mean survival was 126 days in 11 patients whose sTNFR-II level increased by at l east 30%, and 176 days in 10 patients with less change in sTNFR-II (p = 0.0 2). Conclusions: sTNFRs concentration is higher in IVDUs than in healthy co ntrols and is highest in AIDS patients. Survival of patients with AIDS is a ssociated with variation in the concentration of sTNFR-II.