Predicting progression to AIDS: combined usefulness of CD4 lymphocyte counts and p24 antigenemia

Article Abstract:

One to one and a half million people in the United States are infected with the human immunodeficiency virus (HIV), and most HIV-infected persons will have no symptoms of the disease for prolonged periods. Certain clinical symptoms are useful in predicting progression of HIV infection, such as: the development of thrush, a yeast infection of the mouth or throat; hairy leukoplakia, the formation of white spots or patches on the mucous membrane of the tongue or cheek; persistent diarrhea; or weight loss. However, these symptoms may develop at a relatively late stage of the disease, when the immune system has already undergone extensive deterioration. Hence, laboratory markers that could predict disease progression at an early stage of HIV infection would be very valuable. Certain factors have been shown to be useful in predicting disease progression, and these include: the numbers of CD4 lymphocytes, a type of immune cell; HIV-1 p24 core antigen, a protein of HIV; beta 2-microglobulin, an immune factor that reflects the levels of lymphocytes; and neopterin, a metabolic product that reflects the activity of the immune system. The usefulness of HIV-1 p24 antigen and CD4 lymphocyte counts in predicting progression of HIV infection to AIDS was assessed in 518 homosexual men over a four-year period. The presence of p24 antigen was detected in 134 men (26 percent) during the study, and they showed a more rapid decrease in CD4 lymphocyte counts than men without p24 antigen. The antigen was detected in 63 of 103 men who developed AIDS and in 71 of 415 men who did not. The prevalence of AIDS was 86, 63, and 21 percent in men with CD4 counts at study entry of less than 200, 200 to 399, and 400 or more cells per microliter, respectively. The presence of p24 antigens was strongly associated with a decline in CD4 lymphocyte counts. These results show that the presence of p24 antigens can first be identified with a moderate decrease in CD4 lymphocyte count, and p24 antigen is associated with a more rapid reduction in CD4 lymphocyte counts. The combined use of p24 antigen detection and CD4 lymphocyte counts is effective in predicting the risk for progression of HIV infection to AIDS over a four-year time period. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Development and progression, T cells, HIV antigens

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The era of aerosol pentamidine prophylaxis: the beginning or the end?

Article Abstract:

Pneumocystis pneumonia was recognized early on as a frequent and severe complication resulting for human immunodeficiency virus (HIV) infection. It is often the cause of death in AIDS patients, who may have multiple bouts with the pulmonary disease. Pentamidine was known to be useful in preventing and treating this pneumonia in pediatric cancer patients when given in an oral form. When given to AIDS patients in this form, a large number of the patients had severe reactions to the drug. It was consequently decided to try to give the drug in an aerosol form, to diminish the side effects. Initial results indicated that aerosol was safer and more effective than oral delivery. However, whether the method for delivering the drug by aerosol was the best method for providing the optimal dose was not studied. A study reported in the April 1991 issue of The American Journal of Medicine compares the present method of delivering pentamidine with a newly developed one. The currently accepted method delivers a continuous flow of drug at the rate of 300 mg per four weeks. A new method uses a hand-held device, the Fisons ultrajet nebulizer, which delivers the drug on demand. This delivery system was evaluated for giving three different dosages (5 mg, 60 mg, and 120 mg) every two weeks. The 5 mg group was dropped when it was found to be ineffective. Results were comparable between those receiving 60 mg and those receiving 120 mg. Relapse rates were as good as or better than with the continuous flow method. The new nebulizer appears to be easier and less expensive to use, but direct trials comparing the two need to be done. A question remains whether aerosol delivery is the best method after all. Recent studies have indicated that oral administration of pentamidine and related drugs is much more effective and does not cause as many side effects as originally thought. Only well controlled studies will determine if aerosol pentamidine is the best method for preventing and treating pneumonia in AIDS patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Pneumocystis carinii pneumonia, Dosage and administration, Pneumocystis carinii, Pentamidine isethionate, Pentamidine

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Predicting the progression to AIDS

Article Abstract:

Factors that can predict the prognosis, or expected outcome, of infection with the human immunodeficiency virus (HIV) provide valuable information to HIV-infected patients, health care professionals, and agencies that allocate health care resources. It has been estimated that 65 to 100 percent of HIV-infected patients develop AIDS within 16 years of HIV infection. The CD4 T lymphocyte, a type of immune cell, is a specific target of HIV and serves as a marker of the deterioration of the immune system. Knowledge of CD4 lymphocyte counts can help to predict the occurrence of certain opportunistic infections, and is used to plan treatment regimens (such as therapy with the antiviral drug, zidovudine, which prolongs survival of HIV-infected patients with CD4 lymphocyte counts of less than 500 cells per microliter). Another potential marker of disease progression may be the p24 antigen, an HIV protein that reflects the multiplication, or replication, of the virus. HIV antigenemia, or the presence of HIV antigens in the blood, occurs at two stages of HIV disease: (1) immediately after infection with HIV and before the production of HIV antibodies, immune proteins that specifically act against HIV; and (2) when the amount of HIV exceeds the production of HIV antibodies by the patient. Studies show that antigenemia is a specific but insensitive marker of disease progression. Pretreatment of HIV-infected blood with acid may improve detection of HIV antigens and thereby increase the sensitivity of p24 antigen in predicting disease progression. Other factors that may be useful in predicting HIV disease progression and in monitoring the effectiveness of AIDS treatment include beta 2-microglobulin, neopterin, immunoglobulin A and interleukin-2 receptors, quantity of HIV, and DNA of HIV. The costs and benefits of each diagnostic test must be considered before any such tests are selected for routine use in assessing the prognosis of HIV-infected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

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