DIFFERENTIAL EFFECT ON SERUM NEOPTERIN AND SERUM BETA(2)-MICROGLOBULIN IS INDUCED BY TREATMENT IN PNEUMOCYSTIS-CARINII PNEUMONIA

Forty-three human immunodeficiency virus-infected patients with Pneumocystis carinii pneumonia (PCP) were enrolled in a study of adjunctive corticosteroid treatment for 10 days versus placebo, in addition to antimicrobial treatment. Levels of neopterin and beta(2)-microglobulin (beta(2)M) were determined in consecutive serum samples. Initiation of antimicrobial treatment resulted in significantly increased neopterin levels, whereas beta(2)M levels slightly decreased from pretreatment levels. In patients treated with corticosteroid, both neopterin and beta(2)M decreased, by similar to 50% and similar to 30%, respectively, and returned to baseline after discontinuation of corticosteroid treatment. Antimicrobial treatment alone did not affect either neopterin or beta(2)M in healthy controls. Results indicate that treatment has a differential effect on the immune response: increased macrophage activation leading to neopterin production and decreased production of beta(2)M by lymphocytes. Further, addition of corticosteroids modified and decreased this immune activation and may explain the earlier demonstrated beneficial effect of corticosteroids in PCP treatment.