The Prognostic Factors in Human Immunodeficiency Virus Infected Patients

Kim, Nam Joong; Park, Sang Won; Kim, Hong Bin; Choi, Hee Jung; Oh, Myoung Don; Choe, Kang Won

Abstract

BACKGROUND: Human Immunodeficiency Virus (HIV) primarily infects CD4 lymphocyte, resulting in quantitative and qualitative defect of CD4 lymphocyte and eventually AIDS. This study was designed to determine the epidemiologic, cellular, and immunologic markers as possible indicator, of progression to AIDS.
METHODS
A total of 115 HIV infected patients enrolled between September 1987 and July 1996 was analyzed. AIDS was defined according to criteria presented by Centers for Disease Control in 1993. The variables considered in the analysis were age, sex, route of transmission, delayed hypersensitivity skin test, WBC counts, hemoglobin, ESR, lymphocyte counts, platelet counts, CD4 lymphocyte counts, CD8 lymphocyte counts, and serum beta2-microglobulin. Predictors of AIDS were determined by multiple logistic regression analysis.
RESULTS
Median follow-up duration of study was 12.05 months. Thirty-one subjects were diagnosed as AIDS during the study period. AIDS-defining illness included tuberculosis (23 cases), Pneumocystis carinii pneumonia (6 cases), esophageal candidiasis (6 cases), cytomegalovirus disease (6 cases), cryptococcal meningitis (2 cases), cryptosporidiosis (2 cases), isosporiosis (2 cases), primary central nervous system lymphoma (1 case). On univariate analysis, low hemoglobin, low lymphocyte counts, high platelet counts, high ESR, low CD4 lymphocyte counts, low CD8 lymphocyte counts, and high serum beta2-microglobulin level are associated with progression to AIDS. On multivariate analysis, only the low CD4 lymphocyte counts is associated with increased AIDS hazard. In a group treated with zidovudine, any changes of celluar and immunologic markers during four months following treatment are not associated with progression to AIDS.
CONCLUSION
In HIV infected persons, several laboratory markers might predict AIDS when analyzed individually. However, in multivariate analysis, only low CD4 lymphocyte count is an independent predictor of progression to AIDS