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Reid Michael J.; Goetz, David W.; Zajac, Robert A.; Houk, Richard W.; Boswell, R. Neal
Journal of Acquired Immune Deficiency Syndromes: October 1988

We prospectively studied 157 HIV antibody-positive U.S. Air Force personnel identified by universal ELISA screening and confirmed by Western blot. They were initially evaluated and then re-evaluated at least once at approximately 1 year intervals. In order to determine which if any demographic and serologic cofactors were significantly related to progression of immunodeficiency early in the course of disease, we compared these variables with the mean change in CD4 cells per month and with progression in Walter Reed stage. Upon entry into the study, the subjects were classified as follows: sex: 153 (97.5%) male, 4 (2.5%) female; race: 84 (53.5%) white, 63 (40.1%) black, 8 (5.1%) Hispanic, and 2 (1.3%) Oriental; age: mean of 28.6 years (63.0% between 20 and 32 years); and Walter Reed stage: 108 (68.8%) Walter Reed 1,26 (16.6%) Walter Reed 2, 9 (5.7%) Walter Reed 3, 6 (3.8%) Walter Reed 4, 5 (3.2%) Watler Reed 5, and 3 (1.9%) Walter Reed 6. The mean follow-up period was 12.2 months (range of 2 to 35 months). The mean change in CD4 cells per month was −0.072 (range of −94.75 to +67.58). Factors at entry that are significantly related to loss of CD4 cells included serum IgA over 300 mg/dl (p = 0.0450) and anergy (p = 0.0093). Factors at entry significantly related to progression in Walter Reed stage included serum IgA over 300 mg/dl (p = 0.0001), low absolute CD4 count (p = 0.0001), and low CD4/CD8 ratio (p = 0.0001). Sixty percent of subjects who had a serum IgA over 300 mg/dl and a CD4/CD8 ratio of less than 0.5 progressed in Walter Reed stage in the first 12 months of this study, 44% when excluding progression of Walter Reed 1 to Walter Reed 2. These data indicate that in this cohort of individuals who were relatively early in disease progression, depletion of CD4 cells was slow and that progression in Walter Reed stage may be predicted from high serum IgA and low CD4/CD8 ratio.

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