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The availability of a marker that could predict the course of disease progression in HIV‐infected individuals would be of considerable relevance during the asymptomatic stage in order to undertake timely prophylactic measures. A prospective study was undertaken in a group of 42 children suffering from thalassemia major with HIV‐1 infection to assess the status of immune parameters, such as peripheral CD4 +  T lymphocyte (CD4 +  cell) percentage, delayed type of hypersensitivity (DTH) response to recall antigens, detection rate and levels of p24 antigen, and levels of β‐2 microglobulin and cytokines in serum. All were assessed at an interval of 2 years during the asymptomatic period, (baseline and follow‐up assessments) in relation to the development of AIDS defining illness within a follow‐up period of 3 years. No difference could be observed in the mean CD4 +  cell percentage at baseline between those who progressed subsequently to develop AIDS within the follow‐up period (progressors) and those who did not (non‐progressors). However, at the point of follow‐up assessment the progressor group showed significantly lower CD4 +  cell percentage compared to the non‐progressor group (33 ± 4.9 vs. 22 ± 5.6;  p  &lt; 0.05), although in the progressor group there was no correlation of the baseline and follow‐up CD4 +  cell percentage with the duration of the AIDS‐free interval. However, in the progressor group there was a strong negative correlation between the rate of decline in CD4 +  cell percentage and subsequent duration of the AIDS‐free interval ( r  = −0.859). Analysis of additional immune parameters at baseline revealed that the progressor group, despite having CD4 +  cell values comparable to non‐progressors, showed impaired DTH response (number and total induration of positive responses being 2.0 ± 1.23 and 6.2 ± 1.4 in the former group vs. 3.2 ± 0.76 and 12.6 ± 3.80 in the later group;  p  &lt; 0.05 for both the parameters), and elevated levels (mg/l) of serum β‐2 microglobulin (2.92 ± 0.89 vs. 1.38 ± 0.43;  p  &lt; 0.05). The serum cytokine profile at baseline in the progressor group showed a T helper type‐2 (Th 2 ) dominant pattern, i.e. elevation of interleukin‐4 (IL‐4) and interleukin‐10 (IL‐10) levels with decreased levels of interleukin‐2 (IL‐2) and gamma interferon (γ‐IFN) compared to the non‐progressor group that showed a T helper type‐1 (Th 1 ) dominant profile, i.e., elevation of IL‐1 and γ‐IFN level with decreased levels of IL‐4 and IL‐10 ( p  &lt; 0.05 for all four cytokines). The present study points out that rate of decline rather than single point of assessment of CD4 +  cell values is a more reliable predictor for disease progression in HIV‐1 infected children. In addition, parameters such as DTH response, serum levels of β‐2 microglobulin and serum cytokine profile, may provide valuable predictors of subsequent fall in CD4 +  cell value.

journal of tropical pediatrics

Disease Progression Markers during Asymptomatic Phase of HIV‐1 Infected Children with Unimpaired CD4 +  Cell Values: Evaluation of Repeat CD4 +  Cell Evaluation vs. Other Immunological Parameters