Document 2380
 DOCN  M94A2380
 TI    Viral burden, antiviral immune response, and nonspecific immune
       activation in predicting progression of HIV disease.
 DT    9412
 AU    Ascher MS; Sheppard HW; Lang W; Busch MP; Lee TH; Calif. Dept. Health
       Serv. Berkeley 94704.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):317 (abstract no. PC0200). Unique
       Identifier : AIDSLINE ICA10/94370195
 AB    OBJECTIVE: To assess the predictive value of serial measurements of
       viral burden, immune response and markers of immune activation on HIV
       disease progression in the San Francisco Men's Health Study cohort.
       METHODS: A balanced sample of 26 individuals representing four patterns
       of risk of progression based on previous studies of immune activation
       and immune response was selected. Blood samples from study entry in 1984
       and the five year followup visit in 1989 were tested for levels of
       anti-p24 immune response by a serial dilution ELISA method, for serum
       neopterin and beta-2 microglobulin and for levels of virus by
       quantitative DNA PCR. These results were analyzed and correlated with
       the slope of CD4 cell decline and the incidence of AIDS defining
       conditions as the endpoints. RESULTS: As previously noted, the initial
       levels of anti-p24 antibody and neopterin were highly predictive of
       progression at five years of followup and showed no differential change
       over time in progressors and nonprogressors. Viral burden was a somewhat
       stronger predictor compared to its inverse, the p24 antibody titer.
       Beta-2 microglobulin levels were not different (or predictive) at study
       onset, but increased dramatically in progressed individuals, resulting
       in this marker being the strongest correlate of progression. The
       multivariate discriminant model combining these variables correctly
       classified 87% of individuals' disease outcome. DISCUSSION AND
       CONCLUSIONS: Two major variables in the HIV disease process, the viral
       burden and degree of immune activation, appear to be determined shortly
       after infection and change very little thereafter. Initial levels are
       strongly predictive of disease progression. Direct measurement of viral
       burden is slightly more predictive than the inversely related antiviral
       immune response, but has far greater cost and complexity. One immune
       activation marker, neopterin, was a better predictor than a second
       marker, beta-2 microglobulin, which in turn was the strongest correlate
       of the progressed state.
 DE    beta 2-Microglobulin/ANALYSIS  Biological Markers/BLOOD
       Biopterin/ANALOGS & DERIVATIVES/BLOOD  Enzyme-Linked Immunosorbent Assay
       Human  HIV/ISOLATION & PURIF  HIV Core Protein p24/ANALYSIS  HIV
       Infections/IMMUNOLOGY/MICROBIOLOGY/*PATHOLOGY  Male  Polymerase Chain
       Reaction  Prognosis  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).