TUMOR-NECROSIS-FACTOR-ALPHA IN PEDIATRIC HIV-1 INFECTION

Objective: To evaluate the diagnostic and prognostic value of serum tumor necrosis factor-alpha (TNF-alpha) levels in HIV-1-infected children. Design: Serum levels of TNF-alpha were evaluated in 57 HIV-1-infected symptomatic children aged between 7 months and 8 years. Methods: TNF-alpha levels were determined by enzyme immunoassay. The sensitivity of the assay was 10 pg/ml. Results: TNF-alpha levels (mean +/- s.d.) were significantly elevated in HIV-1-infected patients (285 +/- 390 pg/ml), compared with HIV-1-uninfected age-matched controls (22.7 +/- 4.9 pg/ml). Among HIV-1-infected children the highest levels of TNF-alpha were noted in those with Mycobacterium avium intracellulare (MAI) infection and those with interstitial lymphoid pneumonitis (LIP). In contrast, patients with Pneumocystis carinii pneumonia, progressive encephalopathy or cachexia did not have markedly elevated TNF-alpha levels. Conclusions: Serum TNF-alpha is increased in symptomatic HIV-1-infected children, with higher levels in children with LIP or MAI. Serum TNF-alpha levels are not diagnostic for cachexia or progressive encephalopathy.