OBJECTIVES: To compare the value of procalcitonin,
C-reactive protein (CRP) and neopterin as indicators of
immune deficiency, co-infection, efficacy of treatment,
and disease progression, in patients with advanced HIV-1
DESIGN: Cross-sectional, investigating baseline blood
measurements and clinical observations in 82 HIV-positive
patients divided into an antiretroviral treatment (ART)
group and an ART-naïve group.
SETTING: Secondary general hospital in Pretoria.
RESULTS: Procalcitonin and CRP levels showed no
significant differences between the ART and ART-naïve
groups, and no correlations with CD4 counts or viral loads.
CRP levels were significantly higher with TB co-infection
(p<0.05). Neopterin levels were raised above normal in 92%
of the ART-naïve group and in 75% of the ART group. The
levels were significantly higher (p<0.05) in the ART- naïve
group. Negative correlations were found between neopterin
and CD4 counts for the total patient group (r=-0.482;
p<0.001). Neopterin was significantly (p<0.05) higher in
the HIV/TB co-infection group than in those without TB.
Higher neopterin levels at baseline were associated with a
decline in CD4 counts over the ensuing 6-month period,
and patients with higher baseline neopterin levels developed
more complications over the 6-month period.
CONCLUSIONS: Compared with procalcitonin and CRP,
neopterin appears to be associated with the degree of
immunodeficiency and of co-infection with TB. Neopterin
levels may be investigated further as a measure of disease
progression or treatment response.