Immunologic markers of progression to acquired immunodeficiency syndrome are time-dependent and illness-specific

Krämer A, Biggar RJ, Hampl H, et al. Immunologic markers of progression to acquired immunodeficiency syndrome are time-dependent and illness-specific. American Journal of Epidemiology. 1992;136(1):71-80.Since prevalent cohorts may be biased by the duration of human immunodeficiency virus (HIV) infection (onset bias), it is useful to assess the potential predictive value of markers in incident cohorts of HIV-positive subjects for whom the date of seroconversion is known or can reliably be estimated. Of 131 homosexual men with HIV-1 seroconversion from New York City and Washington, DC, who were evaluated annually beginning in 1982, 60 developed acquired immunodeficiency syndrome (AIDS) by the end of 1989. The prognostic significance of immunologic markers (proportion of CD4+ T-lymphocytes, neopterin, ß2-microglobulin, serum interferon, and anti-p24 antibody) and of a virologic marker (HIV p24 antigen) was determined using measurements made at defined time intervals after the known or estimated date of HIV seroconversion. When measurements made 3 years after seroconversion were used, all markers except anti-p24 antibody were found to be significant estimators of AIDS risk in univariate analyses. In multivariate Cox regression modeling, the maximum information was obtained by including neopterin, interferon, and the CD4+ T-lymphocyte proportion. The predictive value of markers after HIV seroconversion could change considerably from one interval to another. Elevated levels of ß2-microglobulin and neopterin significantly predicted the development of Kaposi‘s sarcoma. These two markers were highly correlated (r=0. 74). The authors conclude that immunologic markers can be important for an HIV staging system for estimating prognosis and facilitating early therapeutic intervention in HIV-positive patients

Non-responsiveness to hepatitis-B vaccination: revaccination and immunogenetic typing

Krämer A, Herth D, von Keyserlingk H, et al. Non-responsiveness to hepatitis-B vaccination: revaccination and immunogenetic typing. Klinische Wochenschrift. 1988;66(15):670-674.The variation in immune responses to standard inoculation of the hepatitis-B virus vaccine suggest that host factors influence response in ways that are not presently understood. We studied 25 low/nonresponding health care workers (anti-HBs titer 10 IU/l. Almost all subjects had normal B-cell and CD-4 and CD-8 counts and ratios. Relative to other European populations HLA-A-10 (P<0.05), B-12 (P<0.025), CW-5 (P<0.05), DR-3 (P<0.025), and DR-5 (P<0.025) were increased, whereas DR-2 (P<0.05) was decreased. However, after correction of theP-values for the number of HLA antigens determined, these differences were no longer significant. Furthermore, these HLA types were not the same as those reported in other studies (except for DR-3). We suggest that larger sample sizes or even not yet available immunogenetic markers will be required to prove an "immunogenetic background" in low/nonresponders, if it exists

Kritische Analyse klinischer und autoptischer Befunde bei Patienten mit AIDS

Krämer A, Sommer D, Ludwig WD, et al. Kritische Analyse klinischer und autoptischer Befunde bei Patienten mit AIDS. AIDS-Forschung. 1987;2(10):576-582

Pulmonale Komplikationen beim erworbenen Immundefektsyndrom: Ergebnisse einer prospektiven Untersuchung

Höffken G, Lode H, Dissmann T, et al. Pulmonale Komplikationen beim erworbenen Immundefektsyndrom: Ergebnisse einer prospektiven Untersuchung. Deutsche medizinische Wochenschrift. 1988;113(19):755-762.Zwischen 1983 und 1987 wurde bei 37 von 100 HIV-Antikörper-positiven Patienten mit 40 bronchopulmonalen Infektionen prospektiv ein abgestuftes diagnostisches Programm durchgeführt, das im wesentlichen aus einer flexiblen Bronchoskopie, verbunden mit einer Lavage, transbronchialen Biopsie und (oder) bronchialem Bürstenabstrich, bestand. Unter Berücksichtigung sämtlicher intravitaler und autoptischer Untersuchungsverfahren hatten 25 der 37 Patienten eine Pneumocystis-carinii-Pneumonie (67,5 %), dreizehn Patienten bakterielle Pneumonien, davon sechs mykobakterielle Infektionen (atypische Mykobakterien n = 4), acht Patienten Neoplasien (pulmonales Kaposi-Sarkom n = 5, Plattenepithelkarzinom n = 2, M. Hodgkin n = 1) und vier Patienten eine Cytomegalievirus-Infektion. Die diagnostische Gesamtausbeute der flexiblen Bronchoskopie betrug 78 %, bezogen auf die Pneumocystis-Pneumonie 91 %.Between 1983 and 1987, a stepwise diagnostic programme was undertaken prospectively in 37 of 100 HIV-positive patients with 40 bronchopulmonary infections. It consisted chiefly of flexible bronchoscopy combined with lavage, transbronchial biopsy and/or removal of bronchial brush cells. Taking into account all examinations performed in life and at autopsy, 25 of the 37 patients had Pneumocystis carinii pneumonia (67.5 %), 13 had bacterial pneumonia, six of these were mycobacterial infections (atypical mycobacteria in four), eight had neoplasms (pulmonary Kaposi's sarcoma in five, squamous-cell carcinoma in two, and Hodgkin's disease in one), and four patients had cytomegalovirus infection. Total diagnostic success of bronchoscopy was 78 %; related to Pneumocystis pneumonia it was 91 %