Pascale J M, Isaacs M D, Contreras P, Gomez B, Lozano L, Austin E, De Martin M C, Gregory R L, McLaughlin G L, Amador A
Department of Microbiology, Faculty of Medicine, University of Panama, Panama City.
Clin Diagn Lab Immunol. 1997 Jul;4(4):474-7. doi: 10.1128/cdli.4.4.474-477.1997.
Identification of inexpensive and technically simple immunological tests useful in predicting the progression to AIDS in human immunodeficiency virus (HIV)-infected patients would be especially welcome in developing countries, in which 80% of HIV-infected patients reside and health budgets are low. In the current study, we evaluated CD4+ and total lymphocyte counts and the concentrations in serum of beta 2-microglobulin, p24 antigen, and immunoglobulin A (IgA) as predictors of disease progression in 74 Panamanian HIV-positive patients and 50 HIV-negative healthy individuals. Total lymphocyte and CD4(+)-cell counts for AIDS patients (1,451 +/- 811 cells/microliters, P < 0.001, and 238 +/- 392 cells/microliters, P < 0.0001, respectively and asymptomatic patients (2,393 +/- 664 cells/microliters, P > 0.05, and 784 +/- 475 cells/microliters, P < 0.001, respectively) were lower than those observed for healthy subjects (2,596 +/- 631 cells/microliters and 1,120 +/- 296 cells/microliters, respectively). The levels of beta 2-microglobulin and IgA in serum were significantly elevated in patients with AIDS (5.7 +/- 3.6mg/liter, P < 0.001, and 541 +/- 265 mg/dl, P < 0.0002, respectively) and asymptomatic infected subjects (3.4 +/- 2.1 mg/liter, P = 0.001, and 436 +/- 216 mg/dl, P < 0.0001, respectively) compared with the levels in healthy subjects (2.2 +/- 0.7 mg/liter and 204 +/- 113 mg/dl, respectively). Nonstatistically significant differences (P > 0.05) for concentrations of p24 antigen between asymptomatic infected patients (29 +/- 13 pg/ml) and AIDS patients (40 +/- 23 pg/ml) were observed. Total lymphocyte counts of 1,750 cells/microliters or less, CD4 counts of 200 cells/microliters or less, beta 2-microglobulin concentrations in serum of 4 mg/liter or higher, concentrations of IgA in serum of 450 mg/dl or higher, and the presence in serum of p24 antigen were correlated with elevated risks for developing AIDS. Monitoring both total lymphocytes and beta 2-microglobulin identified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4(+)-cell evaluations and the costs associated with monitoring both total lymphocytes and beta 2-microglobulin identified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4(+)-cell evaluations and the costs associated with monitoring the immune status of HIV-positive patients.
在发展中国家，80%的人类免疫缺陷病毒（HIV）感染患者居住于此且卫生预算较低，因此，识别出廉价且技术操作简单的免疫检测方法以预测HIV感染患者病情进展至艾滋病，将备受欢迎。在本研究中，我们评估了74名巴拿马HIV阳性患者和50名HIV阴性健康个体的CD4+和总淋巴细胞计数，以及血清中β2-微球蛋白、p24抗原和免疫球蛋白A（IgA）的浓度，以作为疾病进展的预测指标。艾滋病患者的总淋巴细胞计数（1451±811个/微升，P<0.001）和CD4+细胞计数（238±392个/微升，P<0.0001）以及无症状患者的总淋巴细胞计数（2393±664个/微升，P>0.05）和CD4+细胞计数（784±475个/微升，P<0.001）均低于健康受试者（分别为2596±631个/微升和1120±296个/微升）。艾滋病患者（分别为5.7±3.6毫克/升，P<0.001和541±265毫克/分升，P<0.0002）和无症状感染受试者（分别为3.4±2.1毫克/升，P = 0.001和436±216毫克/分升，P<0.0001）血清中β2-微球蛋白和IgA的水平显著高于健康受试者（分别为2.2±0.7毫克/升和204±113毫克/分升）。无症状感染患者（29±13皮克/毫升）和艾滋病患者（40±23皮克/毫升）之间p24抗原浓度的差异无统计学意义（P>0.05）。总淋巴细胞计数为1750个/微升或更低、CD4计数为200个/微升或更低、血清中β2-微球蛋白浓度为4毫克/升或更高、血清中IgA浓度为450毫克/分升或更高以及血清中存在p24抗原均与患艾滋病风险升高相关。同时监测总淋巴细胞和β2-微球蛋白可识别出91%的艾滋病患者；这些检测方法可能会减少每年CD4+细胞评估的次数以及与监测HIV阳性患者免疫状态相关的费用。
