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Beta‐2 microglobulin as a predictor of prognosis in HIV‐infected men with haemophilia: a proposed strategy for use in clinical care
Author(s) -
Sabin Caroline A.,
Phillips Andrew N.,
Lee Christine A.,
Elford Jonathan,
Timms Anthony,
Bofill Margarita,
Janossy George
Publication year - 1994
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1994.tb04741.x
Subject(s) - medicine , beta 2 microglobulin , haemophilia , beta (programming language) , cohort , antiretroviral therapy , gastroenterology , human immunodeficiency virus (hiv) , surgery , immunology , viral load , computer science , programming language
Summary Whilst the prognostic value of serum beta‐2 microglobulin (s‐β 2 m) is well documented, the lack of a simple strategy for its use means that it is rarely ever measured in clinical practice. The prognosis associated with s‐β 2 m at two different points in HIV infection, as defined by the CD4 count, was studied in a cohort of 111 men with haemophilia registered at the Royal Free Hospital School of Medicine, London. At CD4 counts of 0·5 and 0·2 × 10 9 /1, a raised s‐β 2 m level was significantly associated with an increased risk of developing AIDS ( P = 0·002 and 0·022 respectively, adjusted for the patient's age). Kaplan‐Meier progression rates to AIDS by 4·5 years after a CD4 count of 0·5 × 10 9 /1 were 57% (95% CI 32–82%) in those with s‐β 2 m levels of 3 mg/1 or more, but 20% (95% CI 4–36%) in those with s‐β 2 m levels of less than 3 mg/1. By 3·5 years after a CD4 count of 0·2 × 10 9 /1, Kaplan‐Meier progression rates to AIDS were 75% (95% CI 52–98%) in those with s‐β 2 m levels of 3·8 mg/1 or more, and 47% (95% CI 29–66%) in those with s‐β 2 m levels of less than 3·8 mg/1. In the absence of acute viral infections, a raised s‐β 2 m indicates those who will tend to progress to AIDS more rapidly than those with lower s‐β 2 m levels and the same CD4 count. S‐β 2 m levels in general are likely to be higher in haemophilia patients than in other, nonhaemophilic risk groups. Whilst care should be taken, therefore, when applying our chosen cut‐off values to nonhaemophilic patients, our findings support the introduction of prophylaxis and antiviral therapies at a higher CD4 count in those with raised s‐β 2 m levels relative to other patients in the same risk group whilst delaying treatment in those with lower CD4 counts, but relatively normal s‐β 2 m levels.