Seropositivity for HIV and the development of AIDS or AIDS related condition: three year follow up of the San Francisco General Hospital cohort

Abstract

The three year actuarial progression rate to the acquired immune deficiency syndrome (AIDS) in a cohort of men in San Francisco who were seropositive for the human immunodeficiency virus (HIV) was 22%. An additional 26 (19%) developed AIDS related conditions. 12 Microglobulin concentration, packed cell volume, HIV p24 antigenaemia, and the proportion and number of T4 lymphocytes each independently predicted progression to AIDS. 12 Microglobulin was the most powerful predictor. The 111 subjects tested who were normal by all predictors (40%) had a three year progression rate of 7%, and the 68 subjects who were abnormal by two or more predictors (24%) had a progression rate of 57%. Two thirds of all men who progressed to AIDS were in the last group. The median T4 lymphocyte count in subjects who did not progress to AIDS

Rheumatic symptoms and human immunodeficiency virus infection. The influence of clinical and laboratory variables in a longitudinal cohort study

“…Clinically, despite the facts that progression of HIV infection occurred independently of the onset of articular symptoms (Table 5 ) and that, at baseline, the prognostic variable of the number of CD4+ lymphocytes (17) was similar in patients with articular symptoms and those who were "not affected," there was a preponderance of patients with class IV HIV disease in the articular symptom groups at the first visit. Thus, it is difficult to determine whether clinical deterioration was affected by the articular symptoms per se or whether it merely reflected a selection for those patients who initially had more severe disease.…”

Improvement of the predictive value of CD4 + lymphocyte count by β2-microglobulin, immunoglobulin A and erythrocyte sedimentation rate

“…p24 antigen and antip24 antibodies are HN-specific markers; neopterin and ß2M levels may be elevated because of other infec-tions or autoimmune and neoplastic diseases [22,23]. Progression to AIDS is also reported to be assoeiated with increased levels of immunoglobulin (Ig) G [24] and IgA [17,19,24] and an increased erythrocyte sedimentation rate (ESR) [17].…”

“…In addition, the progression of HN disease in individuals who at one point had the same Co4 + lymphocyte count may differ substantially. Because of these limitations many studies have investigated other or additional potential prognostic parameters, including presence of free p24 antigen in serum [9][10][11], loss of anti-p24 antibodies [5,12], serum neopterin [13][14][15][16], serum ß2-rnicroglobulin (ß2M) [10,12,[17][18][19][20] and serum interferon [21] levels. p24 antigen and antip24 antibodies are HN-specific markers; neopterin and ß2M levels may be elevated because of other infec-tions or autoimmune and neoplastic diseases [22,23].…”

“…None of these additional parameters has the predictive potential of CD4 + lymphocyte count; their predictive value in combination with CD4 + lymphocyte count is confroversial [13,14,17,20,21,[25][26][27].…”

Can repeated plasma donation by asymptomatic HIV–infected individuals delay the onset of AIDS?

“…The prognostic value of the CD4 count is generally recognized (Choi et al 1993 ;Ellenberg 1993 ;Moss et al 1988 ;Graham et al 1993), although some doubt about its use as a surrogate marker for clinical outcome in therapeutic trials has been raised, particularly by the recent Concorde trial of zidovudine in asymptomatic HIV : persistent, though minor, differences in median CD4 counts between immediate (Imm) and deferred (Def) users of zidovudine occurred without an donating plasma dela the onset of AIDS ? D. Bainbridge and others significant differences in the three-year survival or progression to AIDS or death (Concorde Coordinating Committee 1994).…”