IMMUNOLOGICAL MARKERS OF DISEASE PROGRESSION IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Identification of inexpensive and technically simple immunological tes ts useful in predicting the progression to AIDS in human immunodeficie ncy virus (HIV)-infected patients would be especially welcome in devel oping countries, in which 80% of the HIV-infected patients reside and health budgets are low, In the current study, we evaluated CD4(+) and total lymphocyte counts and the concentrations in serum of beta(2)-mic roglobulin, p24 antigen, and immunoglobulin A (IgA) as predictors of d isease progression in 74 Panamanian HIV-positive patients and 50 HIV-n egative healthy individuals, Total lymphocyte and CD4(+)-cell counts f or AIDS patients (1,451 +/- 811 cells/mu l, P < 0.001, and 238 +/- 392 cells/mu l, P < 0.0001, respectively) and asymptomatic patients (2,39 3 +/- 664 cells/mu l, P > 0.05, and 784 +/- 475 cells/mu l, P < 0.001, respectively) were lower than those observed for healthy subjects (2, 596 +/- 631 cells/mu l and 1,120 +/- 296 cells/mu l, respectively), Th e levels of beta(2)-microglobulin and IgA in serum were significantly elevated in patients with AIDS (5.7 +/- 3.6 mg/liter, P < 0.0001, and 541 +/- 265 mg/dl, P < 0.0001, respectively) and asymptomatic infected subjects (3.4 +/- 2.1 mg/liter, P = 0.001, and 436 +/- 216 mg/dl, P < 0.0001, respectively) compared with the levels in healthy subjects (2 .2 +/- 0.7 mg/liter and 204 +/- 113 mg/dl, respectively). Nonstatistic ally significant differences (P > 0.05) for concentrations of p24 anti gen between asymptomatic infected patients (29 +/- 13 pg/ml) and AIDS patients (40 +/- 23 mu g/ml) were observed, Total lymphocyte counts of 1,750 cells/mu l or less, CD4 counts of 200 cells/mu l or less, beta( 2)-microglobulin concentrations in serum of 4 mg/liter or higher, conc entrations of IgA in serum of 450 mg/dl or higher, and the presence in serum of p24 antigen were correlated with elevated risks for developi ng AIDS, monitoring both total lymphocytes and beta(2)-microglobulin i dentified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4(+)-cell evaluations and the costs associat ed with monitoring the immune status of HIV-positive patients.