Neopterin concentrations in pediatric human immunodeficiency virus infection as predictor of disease activity

Intravenous gammaglobulin treatment in HIV-1 infection

The two main indications for the use of intravenous gammaglobulin--antibody replacement therapy and immunomodulation--are pertinent only for a few scenarios in HIV-1 infection. The role of gammaglobulin in the treatment of HIV-1 infection has changed significantly with the introduction of highly active antiretroviral therapy. Antiretroviral drugs have not only controlled the progression of disease but also had far-reaching effects on HIV-1-induced immunologic aberrations. Complete or partial immunologic reconstitution and prevention of immunologic damage have been the hallmarks of success for highly active antiretroviral therapy. This article addresses the use of gammaglobulin before and after the era of effective antiretroviral therapies.

Correlation of ribonucleic acid polymerase chain reaction, acid dissociated p24 antigen, and neopterin with progression of disease. A retrospective, longitudinal study of vertically acquired human immunodeficiency virus type 1 infection in children

OBJECTIVE

We investigated the relationship between cell-free viral load, neopterin, age-adjusted CD4+ cell concentration, and clinical events in 49 children with vertically acquired human immunodeficiency virus type 1 infection.

STUDY DESIGN

Viral load was measured by quantitating viral ribonucleic acid in serum by polymerase chain reaction and measurement of immune complex dissociated p24 antigen in serum and plasma. Children were followed for an average of 2 1/2 years, with an average of 6 samples per child. Medical records were reviewed for weight, CD4+ cell count and clinical events.

RESULTS

High virus copy number in serum was predictive of a decrease in weight-for-age zscore during the subsequent 6 months. High viral load, low CD4+ cell count, and high neopterin level were correlated with encephalopathy. High viral load correlated with opportunistic infections. All of these relationships held regardless of treatment status, although viral load decreased significantly after treatment was begun.

CONCLUSIONS

Measurements of viral load were useful prognostic indicators for poor weight gain. Elevated serum virus levels and neopterin values and low CD4+ cell counts were all associated with encephalopathy.

Role of neopterin and 7,8-dihydroneopterin in human immunodeficiency virus infection: marker for disease progression and pathogenic link

Human immunodeficiency virus (HIV) infection is associated with increased concentrations of neopterin derivatives, released in large quantities by human macrophages on stimulation with interferon-gamma (INF-gamma). Neopterin concentrations thus inversely correlate with absolute CD4+ T-cell numbers and strongly predict progression of disease from latency to AIDS. Investigations of hydrogen peroxide-induced chemiluminescence indicated a potential role of neopterin and 7,8-dihydroneopterin in oxygen free radical-mediated processes. Indeed, 7,8-dihydroneopterin is able to enhance tumor necrosis factor alpha (TNF-alpha)-induced apoptosis, accompanied by an increased production of reactive oxygen intermediates (ROIs). In line with this finding, the same combination appears to contribute to the upregulation of HIV replication due to activation of nuclear factor-kappa B (NF-kappa B), a central enhancer element of the HIV LTR promoter. Thus, besides the role of neopterin as sensitive indicator of disease activity in HIV infection, neopterin derivatives apparently are associated with the cascade of events that regulate the HIV production in infected individuals.

Long-term lipid-based total parenteral nutrition activates mononuclear cells and modulates membrane lipid composition in pigs

In previous studies we have found lung granulomas in pigs on long-term soybean-based total parenteral nutrition (TPN). In the present study we have investigated activities and membrane lipids of cells known to participate in a granulomatous process. Pigs were given TPN with soybean emulsion for 7 weeks, controls were given saline intravenously and consumed a similar caloric load in a standard oral diet. Spontaneous nitroblue tetrazolium (NBT) reduction increased 204% in peripheral blood mononuclear cells (MNC) from TPN animals compared to controls (p < 0.05), and 161% (p = 0.05) in alveolar macrophages. The spontaneous lymphocyte mitogen response (LMR) rate in MNC increased 299% (p < 0.05). Endotoxin-stimulated procoagulant activity in MNC tended to increase in TPN animals. Acid phosphatase and lysozyme production in alveolar macrophages were not significantly changed. The serum neopterin level at the end of the observation was 7.0 nmol l-1 in TPN animals compared to 3.9 nmol l-1 in controls (p < 0.01), while interleukin-1 and tumour necrosis factor were not detectable. These findings indicated in vivo activation of peripheral blood monocytes, lymphocytes and alveolar macrophages in pigs on TPN. The membrane lipid contents of linoleic acid (18:2, n-6) increased, while arachidonic acid (20:4, n-6) tended to decrease both in MNC and lung tissue. Thus, linoleic acid conversion did not lead to accumulation of arachidonate in the cell membranes. Direct effects on monocytes, lymphocytes and alveolar macrophages of TPN particles, and altered cell membrane function, due to linoleic acid enrichment, are tentative explanations for the raised cell responses. Such cell activation may have contributed to the formation of granulomas.

Ferritin levels in pediatric HIV-1 infection

Ferritin is an acute phase protein which is often elevated in acute and chronic inflammation, as well as in neoplastic disease. In adults with human immunodeficiency virus (HIV) infection, elevated serum ferritin levels indicate advanced or progressive disease. In the present study, ferritin levels were evaluated in 88 HIV-infected children. Ferritin levels greater than 100 ng/ml were found in 93% of patients with advanced disease. Increasing levels always accompanied or closely preceded rapid disease progression. Serum ferritin levels may prove to be a useful marker to monitor disease progression and therapeutic efficacy in HIV-infected children.

HIV-1 reverse transcriptase codon 215 mutation and clinical outcome in children treated with zidovudine

OBJECTIVE

In HIV-infected adults prolonged monotherapy with zidovudine may be associated with the appearance of HIV strains with decreased zidovudine sensitivity, owing to specific mutations in the reverse transcriptase (RT) gene, and this has been suggested to be a reason for reduced zidovudine efficacy. This study was undertaken to determine the appearance of mutation at codon 215 of the RT gene in proviral DNA from PBMCs in HIV-infected children.

DESIGN

A prospective, open study.

SETTING

A University Pediatric Department.

PATIENTS AND METHODS

Nineteen HIV-infected symptomatic children were treated with zidovudine for a median of 24 months. Clinical and laboratory controls for HIV infection status were performed monthly. Mutant proviral sequences were evaluated at the start of therapy, every 3 months during the first 6 months of therapy, and every 6 months thereafter. Clinical outcome was defined as stable or deteriorating.

RESULTS

No child had proviral sequences mutant at codon 215 before starting zidovudine. Ten of 13 children who had received zidovudine for more than 6 months developed mutant proviral sequences. All the children (10 of 10) with mutant proviral sequences had a deteriorating clinical condition, compared to none of those (0 of 9) without mutation at codon 215.

CONCLUSION

The appearance of HIV-1 codon 215 mutation seems to be strongly associated with zidovudine therapy and with clinical progression of HIV disease in children.

Neopterin and human immunodeficiency virus infection

Neopterin concentrations increase in serum and urine within the first week of infection with HIV and remain increased throughout the infection. In particular, changes in neopterin concentration precede decreases in CD4 T cell numbers and the development of clinical disease, and they can be used to predict the later development of AIDS. The increased neopterin concentrations show that the immune system is activated in HIV infection and demonstrate the presence of an interaction between the virus and the immune system. The most important future use of neopterin measurements may be in fast evaluation of new drugs in HIV infection.

The role of neopterin as a monitor of cellular immune activation in transplantation, inflammatory, infectious, and malignant diseases

The accumulated knowledge about the organization and function of the human immune system contributes to a better understanding of the pathogenesis of most diverse disorders and is opening new avenues for therapeutic regimens. To gain further insight into the complex interactions within the components of the immune system, it has become increasingly necessary to develop rapid and simple methods to monitor the status of the immune system in patients. The determination of neopterin concentrations in human body fluids allows to investigate sensitively the cell-mediated immune status to be investigated with considerable sensitivity. In recent years it was shown that production and release of neopterin is inducible in human monocytes/macrophages by interferon gamma. Increased neopterin levels indicate endogenous formation of gamma interferon, and monitoring of neopterin levels therefore permits the activation status of the cell-mediated immune system to be examined. Neopterin concentrations in serum and in urine increase in parallel to the clinical course of infections with viruses, intracellular bacteria, and parasites. In patients with human immunodeficiency virus infection neopterin concentration in serum and urine is a significant predictor of disease progression, the statistical power being similar to CD4+ T-cell numbers. In patients with autoimmune disorders, neopterin levels correlate with the extent and the activity of the disease. Neopterin concentrations are also sensitive indicators of immunological complications in allograft recipients. In certain malignant diseases neopterin concentrations correlate with the stage of the disease and bear prognostic information. Results of neopterin measurements agree with the important role that the cellular immune system plays in these disorders.