Use of HIV-1 p24 as a sensitive, precise and inexpensive marker for infection, disease progression and treatment failure

HIV RNA is an acknowledged marker of disease activity and predictive of pro gression, while the p24 antigen is considered unsuitable. This is at odds w ith the fact that viral pathogenesis is usually mediated by proteins. One m ight expect that p24, if analyzed properly, might even be superior to RNA. This hypothesis was investigated in clinical studies using a sensitive and precise p24 test (heat-mediated immune complex dissociation with signal amp lification-boosted ELISA). This test was as sensitive and specific as the p olymerase chain reaction (PCR) for viral RNA (200-400 copy detection), an o verall better predictor of CD4 decline and survival, while RNA prevailed in predicting AIDS. The lower costs of p24 testing also permit a closer monit oring of patients with an earlier detection of anti-retroviral treatment fa ilures. (C) 2000 Elsevier Science B.V. and International Society of Chemoth erapy. All rights reserved.