[Relation between erythrocyte sedimentation rate, clinical and immune status and virus load in non-hospitalized HIV-infected patients].

The objective of this study was to analyze the clinical, immunitary and virological implications of an elevated erythrocyte sedimentation rate (ESR) in HIV-positive patients. A retrospective crossover study of 350 HIV-positive patients undergoing periodic evaluations (942 follow-ups) at the outpatient service of the Division of Infectious Diseases of the Fundación Jiménez Díaz in Madrid was carried out from January 1993 to July 1998. The relationship between the ESR (cut-off point: 20 mm/h), the clinical status (symptomatic or asymptomatic), the immune status (CD4, cut-off point: 200 cells/microl), and viral status (viral load, cut-off point: 3 log) of the patients was analyzed. Information on other possible confounding factors was also collected. It was found that in 667 cases (71%), the ESR was normal and in 275 (29%) it was >20 mm/h. In the univariate analysis, a statistically significant relation was found between the ESR and the clinical, immune and viral status of the patients: a normal ESR was associated with a CD4 >200 cells/ml, viral load <3 log, and an asymptomatic clinical status (p <0.05). A significant inverse relation was found between ESR and hematocrit (p <0.05, CI 95%: 3.87-5.1) and between ESR and gammaglobulin (p <0.05). The multivariate analysis did not show a significant relation between ESR and clinical status (OR: 1.98, IC95%: 1-3.9), nor between ESR and the CD4 level (in the case of hematocrit 42-43%, OR: 0.755, p >0.005). However, in patients with low hematocrit the risk of having CD4 < or = 200 cells/microl when the ESR was >20 mm/h was significant (OR: 9.34, IC95%: 4.56-11.35). When adjusting for clinical factors such as age, sex, gammaglobulin, hematocrit and co-infection with hepatitis C or B virus, we did not find a relation between the ESR and the clinical, immune or viral status of the seropositive patients. We believe that it is not necessary to determine the ESR when monitoring HIV-positive patients, since it does not appear to be a good marker for a deterioration in clinical, immune or viral status.