[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

7789 CLINICAL PROGRESSION OF INFECTION IN FORMER
BLOOD DONORS INFECTED WITH HIV-1
AE Williams, HE Prince, KM Epley, and the American Red
Cross Collaborative HIV Study Group, Jerome H. Holland
Laboratory, Rockville, MD USA
Objective To evaluate the sensitivity of absolute CD4+
lymphocyte count, CD4+/CD8+ ratio, serum soluble IL2
receptor (sIL2R), neopterin (NEOP) and Beta-2
microglobulin (B2M) as predictors of CDC Stage 4 HIV
disease (CDC4).
Methods Clinical and laboratory parameters of 155 HIV-1
seropositive former blood donors were measured at six
month intervals as part of a prospective study of HIV-1
infected former blood donors.
Results After two years of follow-up (1434 personmonths), 10 seropositive donors classified as CDC2 at
time of entry have advanced to CDC4 at a mean interval
of 12.6 months. Laboratory abnormalities which appeared
in advance of CDC4 were evaluated as predictors of
clinical progression. (*Sensitivity as a predictor
variable = a/t = Visits prior to CDC4 at which test
result was abnormal/Total visits prior to CDC4).
Measure Cutoff All HIV+ a/t *Sensitivity
sIL2R 86 units 41% (n=99) 13/14 93% (n=7)
NEOP 10 nmol/l 55% (n=153) 17/19 89% (n=10)
CD4+/CD8+ 1.0 30% (n=155) 17/21 81% (n=10)
B2M 2450 ug/ml 43% (n=149) 16/21 76% (n=10)
CD4+ 400 mm3 30% (n=154) 14/21 67% (n=10)
Conclusion When considered together with cellular
markers, serum levels of sIL2R and neopterin may be
useful predictors of clinical outcome in asymptomatic
individuals infected with HIV-1.

7790 IMMUNOLOGIC AND IMMUNOGENETIC MARKERS THAT
MODEL THE RISK OF AIDS
Alexander Kramer*, D Fuchs**, S Milstien*, DL
Mann*, WA Blattner*, JJ Goedert*
*National Cancer Institute and National Institute of
Mental Health, Bethesda, MD, USA, **University Innsbruck,
Austria
Objective. To define predictors of AIDS in HIV
seropositives.
Methods. T4 counts (n=109), urinary neopterin (n=69) and
HLA markers (n=96) were evaluated on a prospective
cohort of HIV infected white homosexual men to elucidate
their predictive value.
Results. Since 1982 37 of 109 subjects (34%) have
developed AIDS through 1987. The odds ratio (OR) of AIDS
was markedly higher with low T4 counts or high neopterin
levels, slightly higher with HLA type DR1, and
substantially lower with HLA-DR53 (Table). Neopterin
levels determined in
AIDS Marker OR 95% CI 2 different laboraT4<300/ul 10.8 (3.2-38.3) tories were highly
T4 300-449/ul 3.6 (1.1-11.9) correlated (p<0.001).
T4>449/l 1 Logistic regression
High neopterin 14.3 (3.5-670) analysis revealed
HLA-DR1 2.2 (0.7-7.1) that low T4 counts
HLA-DR53 0.3 (0.1-1.0) and high neopterin
levels were independently associated with AIDS outcome (R=-0.24,p=0.017 and
R=0.30,p=0.005, respectively).
Conclusion. Progression from HIV infection to AIDS is a
complex multistep process. Markers of T4 lymphocytes,
monocytes (neopterin) and host genetic (HLA) factors
provide a framework for understanding the natural history
of this process and for predicting lethal outcomes.

Notes:

7791 BETA-2-MICROGLOBULIN IN PRIMARY HIV INFECTION
H Gaines* ***,LV von Stedingk**,M von Sydow*,
H Richardson****,J Wasserman**,O StrannegArd*.
*Vir and **Bact Dept,Central Microbiological Laboratory,
***Dept of Inf Dis,Roslagstull Hospital,Karolinska
Institute,****Pharmacia Diagnostics,Sweden.
Obiective To determine beta-2-microglobulin (B2-M) serum
levels in the early stages of HIV infection.
Method 79 sera from 16 subjects with primary HIV
infection were examined for B2-M by RIA (Pharmacia).
Earlier examined (Bratt,Sandstr6m) HIV-negative
homosexuals were used as controls.
Results Time after onset B2-M (mg/l)
(mean:-SEM) 1-2 weeks (n=17) 2.44+0.188
2-8 weeks (n=22) 3.00+0.293
2-12 months (n=23) 2.20-0.170
1-3 years (n=16) 2.24+0.172
Controls 1.74+0.052
Compared to controls,B2-M was elevated,during the 2
early(p<0.001) as well as the 2 late(p<0.01) periods.
All subjects with initially low(<3.0mg/l) B2-M levels
had low levels on follow-up(81 days-3 years,mean 411
days),whereas 4 out of 6 subjects with initially high
B2-M displayed low levels during the later stage.
However,3 of these 4 had higher levels than all other
"low-level" subjects, during the late period.
Conclusion Beta-2-Microglobulin serum levels are
elevated early during the primary HIV infection. Levels
of B2-M in early stages appear to correlate with levels
observed at later stages and,since B2-M levels have been
shown to correlate with progress of disease,B2-M levels
observed during early primary HIV infection may therefore
possibly have prognostic significance.

7792 BETA-2-MICROGLOBULIN IN THE FOLLOW UP
OF HAEMOPHILIA WITH HIV INFECTION
EH Cooper * MA Forbes*,B A McVerry*
L Hall*, M Howard*, M Helbert*
*Unit for Cancer Research, University of Leeds
**St James's University Hospital, Leeds
***St Mary's Hospital, London
A study has been made of 75 adults with haemophilia and compared to 13 non-haemophiliac
HIV +ve patients, 3 with PGL,10 with AIDS.
Serum B2-m was found to be elevated in haemophiliacs, all were >3 mg/L. There is no
correlation between B2-m and amount of factor
VIII concentrate infused, T cell subset, or
thrombocytopenia. Longitudinal studies were
made over a 2 year period, and the changes of
B2-m level during AZT treatment compared to
those in non-haemophiliac AIDS patients.
82-m levels probably result from a complex
interaction of lymphocyte subset balance,their
number and activity in response to HIV and
opportunistic infection.
Longitudinal studies reveal steady state raised
levels and their acute perturbations during
periods of increased vulnerability to infection
In advanced disease 82-m falls with the severe
lymphopenia.

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