The identification of the human T cell lymphotropic virus (HTLV-III) as the presumed etiologic agent for AIDS has stimulated a re-examination and allowed better understanding of many of the immunologic abnormalities described in high risk individuals with and without clinical disease. Currently needed are useful predictors of clinical progression which will allow better counselling, earlier diagnosis and effective treatment of high risk individuals. We have examined the principles of test selection including sensitivity, specificity, predictive value and overall test efficiency for serum β2 microglobulin (β2M), serum interferon (IFN) and antibody to HTLV-III (HTLV-III Ab) in a group of 113 homosexual men and 62 controls. The presence of HTLV-III Ab and elevated serum β2M appear to be the most sensitive markers of immune dysregulation in the study group but also proved to be the least specific. Rising levels of serum β2M correlated with clinical severity where HTLV-III Ab positivity did not. The detection of elevated levels of acid labile serum IFN alpha was most speicific for full-blown AIDS and was overall the most efficient test when compared with HTLV-III Ab, serum β2M and lymphocyte subpopulations. We believe that further examinations of the principles of test selection for immunologic abnormalities in AIDS may lead to potential applications for these tests in patient management.
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