291
Letters to the Editor
countries, numerous widely prevalent chronic conditions like tuberculosis. malaria. filariasis. Icishmaniasis. hepatitis. worm infestations, chronic renal diseases could also lead to elevated levels of Bcta-2-M [I J. The controls in present study were age matched HIV negative healthy individuals only. The study should have included HIV negative controls, sutTering from aforementioned conditions as well for comparison. Authors have not considered this aspect while recommending Beta-2-M as surrogate marker of HIV disease. It is noteworthy that not long ago, elevated ESR and then CRP levels were considered as surrogate markers of tuberculosis. It was
only when extensive studies revealed non-specific nature of rise of ESR and CRP that these investigations were relegated to their present status. It appears that unless we learn from the past, Beta-2-M another non-specific marker. too will pass through similar phase of upswing till the initial euphoria about it dies down.
P Col Shishir: Gokhale·
Military Hospital. Bereilly CanU (UP) 243001
REFERENCE I. Sharma YV. Clinical Utility of Beta-2-Microglobulin Measurement.
MJAFI 1997; 53: 249-50
AUTHORS REPLY
Lt Col S Gokhale has mentioned conditions in his letter. like malaria, filariasis. leishmaniasis, worm infestations that are not alluded to in the only reference quoted by him. Before undertaking the study we were well aware that Beta-2-M is known to increase in conditions such as Iymphoreticular malignancies. multiple myeloma. Sjogrens syndrome. rheumatoid arthritis. renal dysnfunetion. etc. As for choosing controls for thc study. inclusion of patients sutTering from disparnte conditions mentioned by him. would have diluted the aim of our study. HIV negative healthy controls have been taken by us on a logical basis. Besides. the controls have served to give us normal levels in our population. an important parnmeter in the present as well as future studies ofthis marker. Literature on HIV infection is abound with numerous studies on the significance and proved value of Beta-2-M and CD4 counts as well as neopterin and CD4 counts as co-predictors ofprogression to
MJAH VOl. j-l. NO 3. /991/
AIDS. We aimed at finding whether Beta-2-M level alone can be a surrogate cost etTective marker correlating with the stage of HIV infection or not. and the elicited results were projected in the article after statistical analysis. We have recommended specific situations in the HIV infected where Beta-2-M measurement could help quoting appropriate studies. (References 14-18 of our article). Beta -2-M cannot be compared to markers like ESR and CRP. We quote one reference (I) studying factors influencing Beta-2-M and neopterin in healthy diverse populations. The study has concluded that the two markers correlate very well with each other and not numerous biological markers except IL-2 receptor levels. REFERENCE I. Oiamondstone LS. Tollemd OJ. Fuchs O. et al. Factors influencing
serum neopterin and Beta-2 Microglobulin levels in healthy diverse populations. J Clin Immunology 1994: 14(6): 368-74.
Letters to the Editor
countries, numerous widely prevalent chronic conditions like tuberculosis. malaria. filariasis. Icishmaniasis. hepatitis. worm infestations, chronic renal diseases could also lead to elevated levels of Bcta-2-M [I J. The controls in present study were age matched HIV negative healthy individuals only. The study should have included HIV negative controls, sutTering from aforementioned conditions as well for comparison. Authors have not considered this aspect while recommending Beta-2-M as surrogate marker of HIV disease. It is noteworthy that not long ago, elevated ESR and then CRP levels were considered as surrogate markers of tuberculosis. It was
only when extensive studies revealed non-specific nature of rise of ESR and CRP that these investigations were relegated to their present status. It appears that unless we learn from the past, Beta-2-M another non-specific marker. too will pass through similar phase of upswing till the initial euphoria about it dies down.
P Col Shishir: Gokhale·
Military Hospital. Bereilly CanU (UP) 243001
REFERENCE I. Sharma YV. Clinical Utility of Beta-2-Microglobulin Measurement.
MJAFI 1997; 53: 249-50
AUTHORS REPLY
Lt Col S Gokhale has mentioned conditions in his letter. like malaria, filariasis. leishmaniasis, worm infestations that are not alluded to in the only reference quoted by him. Before undertaking the study we were well aware that Beta-2-M is known to increase in conditions such as Iymphoreticular malignancies. multiple myeloma. Sjogrens syndrome. rheumatoid arthritis. renal dysnfunetion. etc. As for choosing controls for thc study. inclusion of patients sutTering from disparnte conditions mentioned by him. would have diluted the aim of our study. HIV negative healthy controls have been taken by us on a logical basis. Besides. the controls have served to give us normal levels in our population. an important parnmeter in the present as well as future studies ofthis marker. Literature on HIV infection is abound with numerous studies on the significance and proved value of Beta-2-M and CD4 counts as well as neopterin and CD4 counts as co-predictors ofprogression to
MJAH VOl. j-l. NO 3. /991/
AIDS. We aimed at finding whether Beta-2-M level alone can be a surrogate cost etTective marker correlating with the stage of HIV infection or not. and the elicited results were projected in the article after statistical analysis. We have recommended specific situations in the HIV infected where Beta-2-M measurement could help quoting appropriate studies. (References 14-18 of our article). Beta -2-M cannot be compared to markers like ESR and CRP. We quote one reference (I) studying factors influencing Beta-2-M and neopterin in healthy diverse populations. The study has concluded that the two markers correlate very well with each other and not numerous biological markers except IL-2 receptor levels. REFERENCE I. Oiamondstone LS. Tollemd OJ. Fuchs O. et al. Factors influencing
serum neopterin and Beta-2 Microglobulin levels in healthy diverse populations. J Clin Immunology 1994: 14(6): 368-74.
