Document 3217
 DOCN  M94A3217
 TI    Serum cytokeratin 19 (CK 19) and pulmonary pneumocystosis (PCP) in HIV
       infection.
 DT    9412
 AU    Amiel C; Dousset B; Rabaud C; May T; Canton P; Service de Maladies
       Infectieuses et Tropicales, CHU Nancy,; France.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):126 (abstract no. PA0123). Unique
       Identifier : AIDSLINE ICA10/94369358
 AB    Epithelial cells of the respiratory tract have been shown to express CK
       19, a component of the cytoskeleton now widely considered as a
       characteristic and reliable tissue differentiation marker. As CK19 also
       exists as a secreted form, we measured circulating level in HIV+
       patients, to investigate the usefulness of this assay as marker of
       opportunistic pulmonary infection and prognosis. We studied 81 HIV+
       patients (76 men, 5 women), 22 to 48 years old, at different stages of
       HIV infection, according to the CDC 87 classification: II/III n = 15;
       IVC2 n = 31; IVC1 n = 31; IVD n = 3; IVE = 1. Samples from 30 age and
       sex-matched healthy volunteers were used as controls. The levels of a
       fragment of CK 19, CYFRA 21-1, were measured in serum samples using a
       recently developed radioimmunometric assay. The two monoclonal
       antibodies (KS 19-1 and BM 19-21) used in this assay recognize two
       different epitopes of cytokeratin subunit 19 and are used in a sandwich
       assay for CK 19 measurement. CK 19 serum levels observed in the control
       group were lower than 2.6 ng/mL (mean 1.6 +/- 0.5 ng/mL). Similar value
       were found in 40 HIV+ patients without any pulmonary opportunistic
       infection history (mean 1.8 +/- 0.5 ng/mL). In 19 patients with history
       of cured pulmonary disease (15 PCP, 2 Candidosis, 2 Cytomegalovirus
       infection), CK 19 levels were in the same range than controls (0.06 to
       2.2 ng/mL). 22 patients presenting with acute PCP were tested before
       therapy initiation. CK 19 levels ranged between 0.06 and 16.8 ng/mL.
       Only 7 out of these 22 patients had a dramatic increase of CK 19 ranging
       between 3.4 to 16.8 ng/mL. All these 7 subjects exhibited severe PCP
       with dyspnea (stage III or IV) and severe bilateral interstitial
       syndrome on chest X-ray. In these 7 patients, PO2 pressure was below 50
       mmHg and was negatively correlated with CK 19 level (p < 0.05). These 7
       patients died 2 to 12 weeks later (mean 10 weeks). The 15 other patients
       died 1 to 150 weeks later (mean 56 weeks) (p < 0.01). In conclusion, our
       data suggest that in the course of HIV infection, the increase in CK 19
       concentration is associated with severe forms of PCP and could be a
       biological marker of pejorative prognosis.
 DE    Adult  AIDS-Related Opportunistic Infections/*BLOOD/PHYSIOPATHOLOGY
       Biological Markers/BLOOD  Female  Human  HIV
       Infections/*BLOOD/PHYSIOPATHOLOGY  Keratin/*BLOOD  Lung Diseases,
       Fungal/*BLOOD/PHYSIOPATHOLOGY  Male  Middle Age  Pneumocystis carinii
       Infections/*BLOOD/PHYSIOPATHOLOGY  Predictive Value of Tests  Prognosis
       Reference Values  MEETING ABSTRACT

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