Document 3042
 DOCN  M94A3042
 TI    Comparison of surrogate markers predictive for rapid progression of HIV
       disease in patients with initial CD4 counts of 200 to 500.
 DT    9412
 AU    Lange M; Klein EB; Inada Y; Maitra US; Mohan VP; St. Luke's-Roosevelt
       Hosp. Ctr., Columbia University, NY, NY; 10025.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):167 (abstract no. PB0094). Unique
       Identifier : AIDSLINE ICA10/94369533
 AB    OBJECTIVE: HIV positive patients with CD4 counts 200 to 500 are at
       increased risk for AIDS. The optimal time to begin antiretroviral
       therapy remains controversial. A reliable method to sort out rapid
       progressors versus slow progressors could permit a more individualized
       therapeutic approach. We previously reported on a significant
       association between progressive HIV disease and elevated serum
       acid-labile alpha interferon(AL-Ifn) levels together with reduced
       erythrocyte complement 3b receptor binding activity (E-CR1 BA). We now
       compared the relationship of these two markers to p24 Ag, immune complex
       dissociated p24 Ag (ICD-p24) and dilutional plasma virus culture.
       METHODS: 39 HIV positive patients with initial CD4 counts between 200
       and 500 were recruited. Study surrogate markers were measured every 6 to
       8 wks. 13 patients were followed for 24 wks and 26 patients were
       followed for 50 to 58 wks. RESULTS: 7 patients demonstrated an AL-Ifn of
       12 dilutional titer together with E-CR1 BA of zero percent. Of these,
       one developed wasting syndrome, one lymphoma and another two showed
       unidirectional rapid CD4 decline (150 over 6 months). In contrast, of
       the remaining 32 patients with AL-Ifn 12, one became symptomatic. Of
       these 6(19%) had positive p24 Ag, 17(53%) had positive ICD-p24 Ag and 18
       (56%) had plasma viremia, whereas of the 7 with the Al-Ifn, 2(29%),
       5(71%) and 4(57%) had the above markers respectively. CONCLUSIONS: The
       combination of positive serum AL-Ifn with low E-CR1 BA predicted
       clinical illness and CD4 decline more accurately than the virologic
       markers tested. Differential therapies maybe warranted for patients with
       CD4 200-500 demonstrating AL-Ifn and decreased E-CR1 binding activity.
 DE    Acquired Immunodeficiency Syndrome/DIAGNOSIS/IMMUNOLOGY  Biological
       Markers/*BLOOD  Comparative Study  Follow-Up Studies  Human  HIV Core
       Protein p24/BLOOD  HIV Infections/DIAGNOSIS/*IMMUNOLOGY  HIV
       Seropositivity/DIAGNOSIS/IMMUNOLOGY  Interferon-alpha/BLOOD  *Leukocyte
       Count  Receptors, Complement 3b/METABOLISM  T4 Lymphocytes/*IMMUNOLOGY
       Virus Cultivation  MEETING ABSTRACT

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