Peripherally inserted central catheters in patients with AIDS are associated with a low infection rate.

We reviewed the medical records of all human immunodeficiency virus (HIV)-infected patients who had a peripherally inserted central catheter (PICC) placed during a 1-year period. Ninety-seven PICCs were inserted in 66 patients for 8337 catheter-days. Eighty of 97 catheters were used primarily to treat cytomegalovirus disease. The mean time to any complication was 150 days. The total complication rate was 6.1 per 1000 catheter-days. The total infection rate was 1. 3 per 1000 catheter-days, and the serious infection rate was 0.8 per 1000 catheter-days. The mean time to a serious infection was 310 days. The noninfectious complication rate was 4.6 per 1000 catheter-days. PICCs were associated with a low infection rate and a moderate mechanical complication rate, which compare favorably with historical rates seen in AIDS patients with other types of central venous access devices. PICCs are a reasonable alternative to other central venous access devices in patients with HIV or AIDS.     

Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival.

To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill.     

中心静脉导管的留置时间与其引起的感染之间的关系

为了探讨中心静脉插管留置时间与其引起的感染之间的关系，我们分析了84例中心静脉插管的病人，按导管留置时间不同分为三组，留置6天以内的29例，1例感染，感染率为3．4％，在第6，7，8天时给予拔除或更换的38例，感染2例，感染率5．3％，留置8天以上的17例，感染5例，感染率29.4％。结果表明留置时间8天以上感染率明显升高，最佳留置时间应为7天。     

Subclinical central nervous system infection with JC virus in patients with AIDS.

Immunocompromised patients, particularly those with AIDS, develop progressive multifocal leukoencephalopathy (PML) due to central nervous system infection with JC virus (JCV). It is unknown whether JCV infection in the central nervous system can occur in the absence of PML symptoms. To address this question, autopsy specimens from patients with AIDS were examined. The brains of a group of patients without AIDS or central nervous system disease were also examined. JCV DNA was detected by the polymerase chain reaction in brain tissue from 4 (31%) of 13 human immunodeficiency virus (HIV)-positive patients. JCV was also detected in 1 elderly HIV-negative patient but not in the 11 other control brains. JCV was not detected in 22 myocardial specimens obtained at autopsy from HIV-negative patients nor 10 peripheral blood specimens from HIV-positive patients. The presence of JCV in brains of patients without clinically evident PML suggests that JCV may be present in the central nervous system without clinical disease.     

Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital

OBJECTIVE: The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. DESIGN AND SETTING: A retrospective analysis was used at a large urban teaching hospital. MATERIAL AND METHODS: We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome. RESULTS: The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a prior lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 31 (34%) patients, and 76 patients (84%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49%), and 35 patients (39%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72%) and 53 (59%) of the patients, respectively. Eleven patients (12%) died. Of these patients, 8 (73%) had an underlying infection, whereas only 22% of survivors had an infection (P =.0012). CONCLUSION: Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12%; most patients who died had a central venous catheter and an underlying infection.     

Central airway obstruction due to cytomegalovirus-induced necrotizing tracheitis in a patient with AIDS

Cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) can present as either disseminated disease, pneumonitis, retinitis, gastroenteritis, neuropathy, or a subclinical infection. We report a patient whose initial manifestation of CMV infection was severe central airways obstruction due to necrotizing tracheitis. At bronchoscopy, the lesion appeared deeply ulcerated, distinctly different from previously described airway lesions in patients with AIDS. Mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only CMV. The patient responded partially to ganciclovir, steroids, and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma. CMV infection of the upper airway should be considered in the patient with AIDS presenting with atypical cough or stridor and ulcerated endobronchial lesions.     

Efficacy of total parenteral nutrition in a series of end-stage AIDS patients: a case-control study

The aims of this study were to document the risks and benefits of total parenteral nutrition (TPN) by comparing two groups of patients with advanced HIV disease. This case-control study took place from June 1992 through June 1994. Medical Records were the primary source of data. Bailey-Boushay House, a 24-h skilled nursing facility in Seattle, Washington was the resident location of participating patients. TPN was commonly used in this long-term care facility for persons with AIDS. Eighty patients with AIDS, 40 of whom were receiving TPN and 40 of whom were not receiving TPN but who had central venous access (control group) were chosen. No significant differences were found between the two groups in the number of positive blood cultures (10% vs. 3%), however, the number of abnormal lab values was higher in the TPN group (6 vs. 4) (p < 0.05). The TPN group also gained an average of 2.2 kg in weight compared to an average loss of 1.4 kg in the control group (p < 0.05); the control group had a higher number of patients with weight loss > 10% of admit weight (28% vs. 8%) (p < 0.05). The length of stay was similar between groups (91 vs. 77 days), as were several quality of life indicators. The conclusions of the investigators was that TPN did not appear to lead to clinically important positive or negative health effects when compared to a group not receiving TPN but with central venous access. Benefits or detriments to certain sub-groups of AIDS patients may well exist that were not apparent in this study.     

Cytomegalovirus infection of the central nervous system in patients with AIDS: diagnosis by DNA amplification from cerebrospinal fluid.

A nested polymerase chain reaction (PCR) was evaluated for the detection of cytomegalovirus (CMV) DNA in cerebrospinal fluid (CSF). CSF and serum samples from 19 AIDS patients with intracerebral CMV infection diagnosed at autopsy were retrospectively examined. As controls, CSF and serum samples from 15 AIDS patients with only extracerebral CMV involvement at autopsy, from 10 AIDS patients without CMV infection at autopsy, and from 10 anti-human immunodeficiency virus-negative patients without ongoing CMV infection, were studied. CMV DNA was detected from patients with intracerebral CMV infection in 9 of 9, 5 of 6, and 1 of 4 CSF samples collected, respectively, 1-30, 30-90, and 90-300 days before death. Twelve of 13 sera from these patients were CMV PCR-positive. None of the control patients had CMV DNA in CSF. PCR was positive in 6 of 8 sera from AIDS patients with only extracerebral CMV infection and in serum from 1 AIDS patient without CMV involvement at autopsy. CMV PCR on CSF is highly sensitive and specific. It should be considered a rapid and reliable diagnostic method for CMV infection of the central nervous system.     

Contrast venography in young Haemophiliacs with implantable central venous access devices

To assess the risk of deep vein thrombosis in Haemophiliacs with long-term central venous catheters, we studied Haemophiliacs followed at our centre with implantable venous access devices (ports) in place for > 6 months. Medical records were reviewed for a history of catheter-related complications. Each patient was examined for physical stigmata of thrombosis. Patency of the vessels was evaluated by contrast venography. Of 21 males with ports, 19 had factor VIII deficiency and two factor IX deficiency. Nineteen ports were evaluable (i.e. were in place for > 6 months). Seventeen patients have their original ports in place; two ports were replaced for mechanical dysfunction (1) and recurrent infection (1). Difficulty withdrawing or infusing occurred with three ports, two of which were cleared with urokinase. Physical examination was normal on all 19 patients. Venograms were performed in 13 of 19 patients. Parents of the remaining six patients refused venography because of the need for peripheral venipuncture. One patient had a small nonocclusive thrombus on the same side as his functioning catheter, and another had minimal narrowing of the subclavian vein at the site of a prior catheter. The overall prevalence of clinically relevant upper venous system thrombosis identifiable by contrast venography was zero (95% CI, 0–23%). We conclude that Haemophiliacs do not have as high a risk of thrombosis as other populations of patients with central venous catheters. The theoretical risk of thrombosis should not preclude use of central venous catheters in patients with Haemophilia.     

Morbidity associated with long-term use of totally implantable ports in patients with AIDS.

To determine the morbidity associated with long-term use of a totally implantable central venous access device (Port-A-Cath [PAC]) in patients with AIDS, we studied 68 consecutive patients with AIDS requiring 79 such devices for long-term use, inserted over a period of 5 years. The total number of PAC-days was 20,159. At least one PAC-related complication occurred with 40 of 79 PACs (50.6% [95% confidence interval (CI): 39.6%-61.6%]), and 16 devices (20.2% [95% CI, 11.4%-29.0%]) had to be removed because of complications. Device-related infection occurred with 33 of 79 PACs (41.7% [95 CI, 30.8%-52.6%]). The predominant infection occurring with PACs was chamber infection, with an incidence of 0.16 per 100 PAC-days. The predominant organisms isolated from patients with chamber infections but also from those with device-related bacteremia were gram-positive cocci (79.4%). The presence of neutropenia (odds ratio [OR] = 9.72; 95% CI, 3.0-31.3; P < .001) and a CD4 cell count lower than 0.025 x 10(9)/L (OR = 6.14; 95% CI, 1.9-19.2; P = .002) were independent predictors of infection. The antibiotic lock technique was associated with decreased device loss when compared with isolated systemic antibiotic therapy (OR = 0.05; 95% CI, 0.0-0.59; P = .008). This technique may be useful to treat PAC infection in patients with AIDS, for whom the risk of PAC-related complications is very high.     

Risk factors and microbial profile of central venous catheter related blood stream infection in medical cardiac care units,National Heart Institute,Egypt

Introduction

Catheter related blood stream infection (CRBSI) is the main complication of central venous catheter (CVC) use. The aim of the study is to improve the safety of patients with central venous catheter in National Heart Institute (NHI) medical cardiac care units.

艾滋病病人脑组织细胞凋亡及HIV核心蛋白p24的原位检测

为研究细胞凋亡与艾滋病两者之间的关系及探讨艾滋病的发病机理，采用细胞ＤＮＡ片段特异性标记法及免疫组织化学方法对艾滋病病人及对照组病人脑组织中的凋亡细胞及ＨＩＶ核心蛋白Ｐ２４（ＨＩＶ－Ｐ２４）进行原位检测。观察组２３例艾滋病病人，其中有８例合并艾滋病脑病，另１５例无脑病。８例（８／８）艾滋病脑病的脑组织标本及１３例（１３／１５）无脑病艾滋病脑组织标本中均可检出凋亡细胞及ＨＩＶ－Ｐ２４。对照组１９例非艾滋病病人，仅３例（３／１９）脑组织中可检出凋亡细胞。无脑病艾滋病病人的脑组织凋亡细胞阳性率（８６．７％）高于ＨＩＶ－Ｐ２４的阳性率（６０．０％），并且艾滋病人神经原细胞ＨＩＶ－Ｐ２４阳性率较低。实验结果揭示艾滋病脑病的发生与细胞凋亡具有一定的关系，ＨＩＶ可能通过某些中间环节而诱导神经组织发生细胞凋亡。     

Esophageal candidiasis associated with acute infection due to human immunodeficiency virus: case report and review

Esophageal candidiasis, an opportunistic infection that generally occurs in the latest phases of infection due to the human immunodeficiency virus (HIV), is currently a diagnostic criterion for acquired immunodeficiency syndrome (AIDS). We recently treated one patient for esophageal candidiasis associated not with AIDS but with acute HIV infection. At follow-up 19 months later, he was well and had no symptoms related to infection with HIV. We reviewed nine previously reported cases of esophageal candidiasis associated with acute HIV infection. None of the patients involved had other predisposing illnesses or risk factors for candidiasis. The case described herein, together with those reviewed, supports a revision of the Centers for Disease Control's clinical definition of primary HIV infection to include esophageal candidiasis in the clinical spectrum. Moreover, the value of esophageal candidiasis as a diagnostic criterion for AIDS should be reassessed.     

Staphylococcus aureus bacteremia and recurrent staphylococcal infection in patients with acquired immunodeficiency syndrome and AIDS-related complex

PURPOSE: An increased incidence of Staphylococcus aureus bacteremia has recently been described in patients with the acquired immunodeficiency syndrome (AIDS). However, other risk factors for community-acquired S. aureus bacteremia (including intravenous drug abuse and lymphedema) were present in nearly all these AIDS-related cases of S. aureus infection. Our purpose was to review cases of S. aureus bacteremia that occurred in patients with AIDS or AIDS-related complex (ARC) who did not have a recent history of intravenous drug use, lymphatic obstruction, or neutropenia. PATIENTS AND METHODS: Patients at San Francisco General Hospital between October 1984 and October 1987 with blood culture results positive for S. aureus were identified. A review of this group revealed 22 cases of S. aureus bacteremia that occurred in 18 patients with an underlying diagnosis of AIDS or ARC, none of whom had a recent history of intravenous drug use, lymphedema secondary to Kaposi's sarcoma, or neutropenia. RESULTS: An intravenous catheter was the single most important risk factor for S. aureus bacteremia and was identified as the source for bacteremia in 16 (73 percent) of the 22 episodes. Based on 1986 outpatient clinic records, we calculated an incidence of S. aureus bacteremia occurring in non-intravenous-drug-using male AIDS or ARC patients, 18 to 44 years old, that was 5.4 episodes/1,000 patients. Although the mean duration of appropriate antibiotic therapy was 18 days, late metastatic complications of S. aureus bacteremia occurred in six (35 percent) of 17 AIDS/ARC patients who survived initial antibiotic therapy. CONCLUSION: Non-intravenous-drug-using AIDS and ARC patients (especially those with indwelling venous catheters) appear to be at high risk for S. aureus bacteremia, with a higher late metastatic complication rate than that reported for recent historical control subjects.     

Disseminated toxoplasmosis presenting as symptomatic orchitis and nephrotic syndrome

Toxoplasma gondii is a common pathogen in patients with acquired immune deficiency syndrome (AIDS). The most common modes of presentation are related to the central nervous system (CNS), usually with headache, fever, and focal neurological signs. Extra-neural manifestations are unusual in patients with AIDS. The authors present a patient with AIDS who had disseminated toxoplasmosis whose initial clinical presentation was symptomatic orchitis and the nephrotic syndrome (NS). Testicular involvement with toxoplasmosis has been described only rarely, predominantly as an incidental finding at autopsy. Toxoplasmosis is a rare cause of nephrotic syndrome, with the majority of cases associated with congenital infection. In this case, the nephrotic syndrome remitted only after orchiectomy and chemotherapy for toxoplasmosis, but recurred when the patient had a relapse of his CNS disease. Toxoplasmosis in AIDS may present with extra-neural manifestations and may be an etiologic agent for NS in some patients with AIDS.     

Low prevalence of Helicobacter pylori but high prevalence of cytomegalovirus-associated peptic ulcer disease in AIDS patients: Comparative study of symptomatic subjects evaluated by endoscopy and CD4 counts

BACKGROUND AND AIMS: The role of Helicobacter pylori infection in gastroduodenal lesions might be different between the general population and AIDS patients. The aim of the present study was to compare the prevalence of H. pylori and cytomegalovirus (CMV) infection in AIDS patients and HIV-negative controls. The impact of CD4 lymphocyte counts on H. pylori and CMV infection in the same subjects was also assessed. METHODS: One hundred and fifty-six patients (52 HIV-positive, 104 HIV-negative) with gastrointestinal symptoms were evaluated with upper gastrointestinal endoscopy and biopsy. Comparison of the prevalence of H. pylori and CMV infection was made by dividing AIDS patients into two groups: those with CD4 counts >100/mm3 and those with CD4 counts <100/mm3, and ulcer and non-ulcer patients. RESULTS: In comparison with HIV-negative controls, AIDS patients had a lower prevalence of H. pylori infection (P < 0.0001) but a higher prevalence of CMV infection (P < 0.0001). Cytomegalovirus infection was frequently found in AIDS patients with CD4 count <100/mm3, in comparison with those with a CD4 count >100/mm3. In AIDS patients, CMV was more frequently detected in subjects with peptic ulcers (P = 0.0125). Conversely, the prevalence of H. pylori infection in AIDS patients was not different between those with and without peptic ulcers. CONCLUSIONS: The low prevalence of H. pylori infection and peptic ulcer in AIDS patients suggests a different role of H. pylori infection in peptic ulcer or even a different mechanism of peptic ulcerogenesis in HIV-positive subjects. Cytomegalovirus, rather than H. pylori, may be the main causative pathogen of peptic ulcers in AIDS patients.     

Clinical Infections and Bloodstream Isolates Associated with Fever in Patients Undergoing Chemotherapy for Acute Myeloid Leukemia

Summary Background: Patients with acute myeloid leukemia (AML) are at high risk for infections. The aim of this study was to identify the sources of fever and the type of pathogens that cause bloodstream infection in patients with AML undergoing cytotoxic chemotherapy and antibiotic prophylaxis. Patients and Methods: The source of fever and the type of pathogens causing bloodstream infection were identified for 129 febrile episodes experienced by 42 patients with AML receiving cytotoxic chemotherapy and antibiotic prophylaxis. Results: A source of fever was identified in 81% of all febrile episodes. Mucositis (21.7%), pneumonia (13.2%), central venous catheter infection (12.4%), neutrophenic enterocolitis (9.3%) and invasive fungal disease (9.3%) were the most common sources of fever. Of 16 central venous catheter infections, seven (43.8%) were not associated with local signs. 49 febrile episodes (37.9%) were associated with bloodstream infections, of which 14 (28.6%) were polymicrobic and seven (14.3%) had an undefined source of infection. Bloodstream infection was commonly associated with cellulitis (60%), mucositis (57.1%), central venous catheter infection (55.6%), neutropenic enterocolitis (41.7%) and invasive fungal disease (41.7%). Gram-positive microorganisms were the most common blood isolates (75.8%). Gram-negative bacteremic infections occurred in eight episodes (12.1%) experienced by patients who were nor receiving ciprofloxacin prophylaxes at the time of bacteremia. Noninfectious sources of fever accounted for 23 (17.8%) of the 129 febrile episodes. Conclusion: Although the spectrum of pathogens that cause infection in this group of patients has shifted from gram-negative to gram-positive bacteria, the most common sources of infection remain the same as previously described and they mainly involve integumental surfaces. Received: December 5, 1999 · Revision accepted: August 8, 2000     

艾滋病恐惧症46例临床分析

目的 总结艾滋病恐惧症患者临床特征,初步提出艾滋病恐惧症的临床诊断依据.方法 收集艾滋病恐惧症患者临床资料,分析研究对象的一般人口学、临床表现及实验室检测结果.结果 艾滋病恐惧症患者临床特点包括:(1)可存在或不存在感染HIV的高危行为;(2)反复要求进行实验窒相关检查验证,怀疑或坚信感染HIV,影响正常工作与生活;(3)临床主诉繁多,主诉症状多以头痛、咽痛等流感样症状(15例)及肌肉震颤、皮肤蚁走感、关节疼痛(12例)、乏力(12例)、发热(但测量体温正常,12例)为主,体检除舌苔发白厚腻外未见明显阳性体征;(4)症状大多出现在高危行为后的0～3个月,期间重复HIV抗体检测呈阴性;(5)23例患者进行了T淋巴细胞哑群的检测,其中19例(82.6%)CD4+T淋巴细胞计数大于50个/μl,其余4例患者在300～500个/μl,最低者307个/μl,个别有CD4+/CD8+T淋巴细胞比例倒置情况,但CD8+T淋巴细胞均无异常激活表现.结论 艾滋病恐惧症是一种复杂的躯体心理疾病,其诊断与治疗还需进一步探讨.

Abstract：

objective To summarize the clinical characteristics of AIDS phobia patients and establish the preliminary clinical diagnostic criteria.Methods The clinical information of 46 AIDS phobia patients was collected and summarized.General demographic data,clinical manifestations and laboratory results were analyzed.Results The clinical characteristics of AIDS phobia patients include:(1)With or without high-risk behavior of HIV-1 infection;(2)Patients repeatedly demanded HIV/AIDS related laboratory tests,suspected or believed in HIV-1 infection with daily life affected;(3)The main complaints were non-specific including influenza-like symptoms(headache,sore throat and so on),fasciculation,formication,arthrodynia,fatigue and complaint of fever with normal body temperature;physical examination did not reveal any positive physical sign except white coated tongue;(4)Symptoms mainly appeared 0-3 months after the high-risk behavior while HIV-1 antibody kept negative;(5)T lymphocyte subsets test was carried out in 23 patients and showed 19(82.6%)with CD4+ T lymphocyte count>500/μl,the remaining 4 were 300-500/μl,with the lowest count of 307/μl.Few patients had inversed CD4+/CD8+ ratio but without excessive CD8+T lymphocyte activation.Conclusion AIDS phobia is a complicated physical and mental disease,whose diagnosis and treatment still need further investigation.     

Experience with a totally implantable venous access device (Port-A-Cath) in patients with AIDS.

OBJECTIVE: To determine the complication rate of a totally implantable central venous access device [Port-A-Cath (PAC)] in AIDS patients, used mainly for home infusion therapy. DESIGN: A retrospective study. SETTING: The study was performed at the AIDS Unit of the Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands. PATIENTS, PARTICIPANTS: Forty-seven consecutive AIDS patients who had a PAC device implanted to receive either drug maintenance therapy (42 patients) or total parenteral nutrition (TPN; five patients). RESULTS: Fifty-one devices were implanted between June 1987 and October 1990. Mean puncture frequency was five times per week. The total number of catheter days was 9069. The total complication rate was 0.43 per 100 catheter days. Complications occurred in 17 (36%) patients: three implantation-related bleedings (0.03 per 100 catheter days), three puncture-related bleedings (0.03 per 100), two infections (0.17 per 100), seven occlusions (0.08 per 100), four flow problems (0.04 per 100) and one central vein thrombosis (0.011 per 100). Imminent skin necrosis at puncture site occurred in one case (0.01 per 100) and drug extravasation in two cases (0.02 per 100). Eight devices (17%) had to be removed. Primary septicaemias were resolved using antibiotics in three out of six patients in whom they occurred. Occlusions were almost exclusively caused by TPN. CONCLUSION: A totally implantable venous access device appears to be safe and convenient in (home) infusion therapy in AIDS patients, without risk of additional infection.     

Correlation of spontaneous suppressor cell activity with progression of human immunodeficiency virus infection.

The immune system has been extensively evaluated in the acquired immunodeficiency syndrome (AIDS). The central role of the T-helper (CD4) cell in the immunopathogenesis of AIDS and the immunologic markers that can predict human immunodeficiency virus (HIV) disease progression have been described. However, the potential influence of suppressor cells in this disease process has not been clearly addressed. Spontaneous suppressor cell activity (SSCA) was evaluated in 78 patients with documented HIV infection at different clinical stages of disease progression. Higher levels of SSCA were found in patients with clinical AIDS less than 6 months and those dying of AIDS when compared with controls. Significant elevations (p less than 0.05) of SSCA were seen in patients newly diagnosed with AIDS, and those having AIDS greater than 6 months and less than one year. Patients surviving AIDS for greater than one year had depressed levels of SSCA compared to controls. Furthermore, SSCA appears to predict disease progression as patients with AIDS-related complex (ARC) with elevations in SSCA progressed to AIDS while those with blunted SSCA did not progress. The level of SSCA in these patients was able to predict disease progression (p = 0.00016, Pearson correlation coefficient = 0.739). Patients with documented AIDS were also followed prospectively, and the level of SSCA was shown to be predictive of mortality (p = 0.009, Pearson correlation coefficient = 0.746). It is concluded that SSCA is a valid predictor of disease progression, and can serve as a prognostic indicator of disease outcome.