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.