Reports on HIV/AIDS: 1990

NOVEMBER 30, 1990, MMWR, Vol. 39, RR-16 [inclusive page numbers]
Because there is inherent variability in CD4+ cell counts, other parameters (e.g.,
CD4+/CD8+ ratio, percentage of total lymphocytes that are CD4+, clinical signs and
symptoms) may ultimately be more reliable and valid indicators of immune status,
alone or in combination. Also, because different specimens are required for CD4+
cell counting than for serum antibody testing, and since the technology for CD4 + cell
counting is not currently widely available, the workshop participants concluded that
it would be desirable to identify an alternative indicator of immune dysfunction that
is measurable in serum and is also highly correlated with stage of disease. Serologic
markers (e.g., beta-2 microglobulin and neopterin levels) should be further explored.
Recommendations
1. Ongoing and planned PHS-sponsored studies of demographically, geographically, and behaviorally defined subgroups of the infected population (e.g.,
homosexual and bisexual men, IVDUs, women, children, adolescents, and
racial/ethnic minorities) should be supplemented to identify markers of immune
status for all stages of disease. Studies should also be designed or augmented
to a) measure rates of decline in CD4+ cell counts, b) identify surrogate markers
of immune status that can be measured in serum, and c) measure the effects of
various types of therapy on rates of decline of CD4+ cell counts and on changes
in other indicators of immune status.
2. Surveys should be conducted to describe the spectrum of immune deficiency
among infected persons.
3. CDC's HIV-infection classification system should be modified or appended with
a system based on indicators of immune status, including CD4+ cell measures
(e.g., count, ratio, percentage).
4. Surveys designed to measure seroprevalence should, when possible, include
CD4+ cell counts for persons identified as being infected with HIV. If CD4+ cell
assays are not feasible, the use of markers of immune status that can be
measured in serum should be evaluated for use in survey designs.
5. Modeling methods designed to project distributions of immune status among
infected populations should be further developed. These should include methods to model a) the decline of CD4+ cell counts, b) the progression of other
markers of infection, and c) the effects of treatment on the rates of change of
CD4+ cell counts and other markers.
Actions taken since meeting
1. The CDC HIV classification system is being revised to include indicators of
immune status (i.e., CD4+ cell counts or percent) as well as clinical symptoms.
This will fulfill recommendation 3.
2. Programs to facilitate the,standardization of CD4+ cell testing, evaluate the
effects of CD4+ cell-count variability and measurement error, and make
recommendations regarding specific quality-control procedures have been put
in place under the aegis of PHS agencies.
3. Plans have been made to supplement serosurveys at chosen sentinel locations
with assessments of immune status within the next year. This is related to
recommendations 2 and 4.

157