Role of Serum Adenosine Deaminase Activity as a Prognostic Marker in HIV Patients on Antiretroviral Therapy: A Prospective Study

Abstract

Background: HIV infection is characterized by replication by aberrant immune activation and persistent inflammation. HIV infection is associated with loss of CD4 T cells, resulting in dysfunction of immune system. Adenosine Deaminase (ADA) has a cytokine-like costimulatory role in T cell proliferation. Materials and Methods: The study included 150 HIV-positive patients between age group of 20-50 years from ICTC (Integrated Counseling and Testing Centre) and ART centre of Belagavi Institute of Medical Sciences, Hospital, Belagavi, Karnataka, India. ADAactivity and CD4 cell count were estimated before starting any treatment and after 3 months interval of ART up to 9 months. Serum ADA activity was estimated by using colorimetric method of Giusti and Galanti. Results and Discussion: The study showed increased ADA activity before ART, which was gradually decreasing after 3, 6 and 9 months of ART (p<0.001). We observed low CD4 cell count before ART, there was steady rise of CD4 cell count after 3, 6 and 9 months of ART (p<0.001). After 3, 6 and 9 months of ART adenosine deaminase activity decreases as the CD4 count increases. Elevated serum adenosine deaminase activity in HIV patients is an indicator of T-cell activation. With antiretroviral therapy, there is reduction in viral load and T-cell activation, which may explain the gradual decrease in ADA activity. Conclusion: Estimation of serum ADA activity is a simple, rapid and inexpensive test. In this study ADA activity decreased gradually with ART. Thus, the study concludes that serum ADAactivity may be used as a prognostic marker to monitor response to antiretroviral therapy in HIV patients in limited resource and high incidence areas.

Keywords

• HIV
• ART
• ADA