Progression to AIDS in HIV-infected patients is predicted most accurately by the level of CD4+ T lymphocytes in combination with the serum level of neopterin or beta-2-microglobulin, according to a study by John L. Fahey and colleagues of the UCLA Schools of Medicine and Public Health. In a four-year prospective study, the researchers monitored eight cellular and serologic markers of immune activation to evaluate the usefulness of these measures as indicators of the progression to AIDS in 395 HIV-positive men. The researchers report that the CD4+ T cell count expressed as an absolute number or as a ratio of CD4+ to CD8+ was the best single predictor; serum neopterin and beta-2-microglobulin levels had nearly as much predictive power. Fahey and colleagues recommend that at least one of these two serum markers, which reflect immune activation, be used with CD4+ count in disease classification and in the evaluation of response to therapy.

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