Cytomegalovirus (CMV) antigenemia was evaluated in 174 patients positive for human immunodeficiency virus. Antigenemia could be detected in 96.7% of patients with CMV disease, 76.9% of patients suffering from a relapse of the disease, and 11.4% of asymptomatic patients with CD4 levels of <100 cells per l. No antigenemia was detected in patients with CD4 levels of 250 to 500 cells per l. Specificity and the positive predictive value for CMV disease were increased only if more than 5 positive cells per slide were considered. However, CMV disease may also occur in patients with low-grade antigenemia.
for the multicentre cohort study group t Objective: To evaluate whether the use of immunological markers in addition to CD4+ Iymphocyte count can improve the prediction of the probability of developing AIDS within a given period. Design and setting:Prospective multicentre cohort study of homosexual men. Patients:A total of 447 HIV-positive homosexual men followed prospectively at 6-month intervals (median time of observation, 47 months). Methods:Estimation of AIDS-free time using lifetable plots by Cutler and Ederer and Weibull parametric models. A stepwise multivariate regression analysis was used to calculate the optimal combination of the parameters studied. Results:In general CD4+ Iymphocyte counts are most important for the prediction of AIDS-free time. The use of serum levels of ß2-microglobulin (ß2M), immunoglobulin A (lgA) and erythrocyte sedimentation rate (ESR) can significantly improve the predictive value of CD4 + Iymphocyte counts. However, the usefulness of these parameters depends on the stage of HIV disease. In patients with a CD4 + Iymphocyte count > 500 x 10 6 /1 , only IgA level had a significant predictive value; none of the other parameters significantly improved the model. In patients with a CD4 + Iymphocyte count< 500 x 10 6 /1 , the absolute number of CD4+ cells itself was the most important single predictive parameter, but the prediction of AIDS was significantly improved by the addition of the other parameters investigated. The most powerful combination of parameters in this group was CD4 + count, ß2M and ESR. Conclusion:Determination of serum IgA, ß2M and ESR in addition to CD4 + Iymphocyte count may aid the choice of specific therapeutic regimens or systems of care for HIV-positive individuals. AIDS 1993, 7:813-821
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