Serum neopterin level predicts HIV-related mortality but not progression to AIDS or development of neurological disease in gay men and parenteral drug users

N. Sacktor, X. Liu, M. Popescu, K. Marder, Y. Stern and R. Mayeux
Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, USA.

OBJECTIVE: To investigate the ability of elevated serum neopterin levels to predict independently mortality, progression to acquired immunodeficiency syndrome, and development of neurological disease. DESIGN: Cross-sectional and longitudinal study of gay and/or bisexual men and parenteral drug users. SETTING AND PATIENTS: Patients included human immunodeficiency virus (HIV)-negative and -positive gay and/or bisexual men and parenteral drug-using men and women who volunteered for an outpatient study of the natural history of HIV infection. RESULTS: Serum neopterin levels were significantly elevated in HIV-positive patients (mean, 18.0 nmol/L; SD, 19.2 nmol/L), compared with those in HIV-negative patients (mean, 7.5 nmol/L; SD, 5.5 nmol/L) (P < .001). No differences in the serum neopterin levels could be detected between gay men and parenteral drug users. In HIV-positive patients, women had a higher serum neopterin level than did men (P = .03). The elevated serum neopterin levels were associated with an advanced clinical stage of HIV infection. After adjusting for the CD4 lymphocyte count and other potential confounders, the serum neopterin level was a significant independent predictor of mortality. The elevated serum neopterin levels did not predict progression to acquired immunodeficiency syndrome or development of clinically significant neurological disease. CONCLUSION: An elevated serum neopterin level predicts mortality, but it does not predict progression to acquired immunodeficiency syndrome or development of neurological disease among HIV-infected individuals.