The initial immune response to HIV and immune system activation determine the outcome of HIV disease

Article Abstract:

Cell-mediated immune responses are deficient in individuals infected with the human immunodeficiency virus (HIV), and the deficiency is progressive. Two clinical markers of the progression of HIV disease, antibody to the p24 core protein of HIV and neopterin concentrations in the blood, were studied in terms of their relationship to the outcome of HIV disease. Using data from a large population-based survey, 238 HIV-seropositive homosexual men were studied. Antibody levels to p24 core protein were determined, levels of CD4 cells were measured, and the concentration of neopterin in the blood was determined. Both antibody to p24 and the concentration of neopterin in the blood were found to be predictive of the development of AIDS as long as 54 months prior to its development. Specifically, low antibody levels and high levels of neopterin were independently and strongly related to poor outcome. This is consistent with the hypothesis that the intensity of the initial immune response to HIV (as measured by antibody levels) and the degree of immune response over time (measured by concentration of neopterin in the blood) are both important factors in determining disease outcome, independent of each other. About 60 percent of those with low antibody levels and high levels of neopterin developed AIDS over the 54 months, as compared with only 34 percent of patients who had either low antibody levels or high concentrations of neopterin in the blood. Fewer than 10 percent of those with high antibody levels and low neopterin concentrations developed AIDS during the period. It is suggested therefore that antibody and neopterin levels are independent measures that predict the outcome of HIV infection, but that they affect outcome in an interactive way. (Consumer Summary produced by Reliance Medical Information, Inc.)

Immune response

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Use of beta 2-microglobulin level and CD4 lymphocyte count to predict development of acquired immunodeficiency syndrome in persons with human immunodeficiency virus infection

Article Abstract:

Beta 2-microglobulins (B2M), half of which are produced by lymphocytes (specialized white blood cells), are thought to be involved in the immune response. High numbers of beta 2-microglobulins have been reported in patients with kidney disease (because the microglobulins are cleared by the kidneys), autoimmune disorders (the immune system's failure to recognize the body's own cells) and infectious diseases, including the human immunodeficiency virus (HIV). It is not known if the microglobulin is high during infectious diseases because of increased production or increased release because of destruction of lymphocytes. Specialized white blood cells, CD4 lymphocytes, increase as HIV-infected patients become more ill with the disease AIDS (acquired immunodeficiency syndrome). To see if B2M and CD4 lymphocyte measurements can predict the development of AIDS, 962 unmarried men were studied in San Francisco. AIDS developed in 65 out of 388 men infected by the HIV. The average level of B2M in uninfected men was 170 (measured in nanomoles per liter), compared with 254 in HIV-infected men without AIDS and 347 in HIV-infected men with AIDS. Three year later, 34 percent of the men with B2M of 322 developed AIDS, 21 percent of the men with B2M between 246 and 322 developed AIDS and 7.3 percent of the men with B2M levels below 246 developed AIDS. When the two measurements were combined, 65 percent of men with a B2M of greater than 322 and CD4 lymphocytes of less than 550 developed AIDS within three years. The probability of HIV-infected individuals developing AIDS can be predicted by using B2M and CD4 measurements. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, HIV (Viruses), HIV, Lymphocytes

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Use of T-lymphocyte subset analysis in the case definition for AIDS

Article Abstract:

An expanded case definition for AIDS may more than double the number of HIV-positive individuals who are classified as having AIDS. The 1987 Centers for Disease Control (CDC) AIDS case definition may be expanded to include HIV-positive individuals with less that 200 CD4 T-cells per cubic millimeter of blood. The expanded case definition and two other expanded definitions of AIDS involving other T-cell subsets were used to classify 762 HIV-positive homosexual and bisexual men who were HIV-positive in 1984. Implementation of any one of the expanded definitions of AIDS in mid-1991 would have more than doubled the number of living HIV-positive individuals with AIDS. The proposed CDC definition would have increased the number of living HIV-positive individuals with AIDS in mid-1991 by 212%. The other two expanded case definitions would have increased this number by 266% and 272%.

Development and progression, CD4 lymphocytes

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