Predictive markers of AIDS dementia complex: CD4 cell count and cerebrospinal fluid concentrations of beta(2),-microglobulin and neopterin

A predictive marker for AIDS dementia complex (ADC) in a cohort of neurologically asymptomatic human immunodeficiency virus type 1 (HIV-1)-infected patients with <200 CD4 cells/mu L was sought. Patients were assessed neurologically and neuropsychologically at entry. Blood and cerebrospinal fluid (CSF) were taken for assay of beta(2)-microglobulin (beta(2)M), and neopterin and T cell subsets were assessed from blood. Patients were evaluated every 4 months. Of 37 patients recruited, 35 had sufficient follow-up data. Seventeen patients progressed to ADC stage greater than or equal to 1. In univariate analyses, concentrations of CSF beta(2)M and neopterin and CD4 cell count were each significantly associated with ADC development. In a multivariate analysis, concentrations of CSF beta(2)M remained significant, with levels >5 mg/L carrying similar to 17 times the risk of ADC. CSF beta(2)M and neopterin levels and CD4 cell count are useful in identifying patients at risk of ADC and as such can be used to target high-risk patients so therapy can be optimized.