PROGNOSTIC VALUE OF ADENOSINE-DEAMINASE COMPARED TO OTHER MARKERS FOR PROGRESSION TO ACQUIRED-IMMUNODEFICIENCY-SYNDROME AMONG INTRAVENOUS-DRUG-USERS

This study was designed to determine the prognostic value of erythrocyte adenosine deaminase (ADA) as a possible indicator of progression to AIDS, and compare this with other known cellular and serological markers. At the end of a 3-year study, a cohort of 114 human immunodeficiency virus-1 (HIV-1) seropositive intravenous drug users (IVDUs) from the five different Center for Disease Control (CDC) groups was examined in order to estimate the prognostic relevance with respect to the progression to acquired immunodeficiency syndrome (AIDS) of each of the following markers at baseline value: number and percentage of CD4(+) T cells, number of CD8(+) T cells, CD4(+)/CD8(+) ratio, IgA and beta(2) microglobulin and ADA levels, and the presence of HIV antigens. Moreover, 57 IVDUs belonging to II and III CDC groups were analyzed in a follow-up study at 6-month intervals, in order to evaluate and compare the behavior of each marker over time. The prognostic significance of each marker was assessed by computing the survival distribution and the Cox analysis in a multivariate model providing the set of markers with greatest predictive value. The revels of ADA and the CD4(+)/CD8(+) ratio showed a linear association with disease staging, whereas beta(2) microglobulin and CD4(+)/CD8(+) ratio were the best predictors for AIDS progression. A highly significant increase in ADA and beta(2) microglobulin was observed during follow-up. The results obtained among HIV-positive IVDUs clearly indicate that the erythrocyte ADA may be considered a reliable marker of the development of HIV infection from the intermediate stages of the disease onwards. The measurement of beta(2) microglobulin should be regarded as a particularly useful parameter in the assessment of HIV infection in drug users. (C) 1995 Wiley-Liss, Inc.