HIV-1-infected patients are in chronic oxidative stress and clastogenic factors (CFs) are present in their plasma. CFs from patients with HIV are formed via
superoxide anion radical and stimulate further
superoxide production. The pathophysiolgic significance and the exact composition of the circulating clastogenic material in patients with HIV is unknown.
Cytokines, such as
tumor necrosis factor-alpha (
TNF-alpha), are increased in the plasma of patients with HIV and
TNF-alpha shows clastogenic activity in vitro. The aim of this clinical study was to compare levels of CF in HIV-1-positive patients with
asymptomatic disease,
opportunistic infections, and
malignancies with those in HIV-1-negative control groups and to correlate CF activity with CD4+ T cell numbers, the
cytokines (
TNF-alpha,
interleukin-2 [IL-2], IL-6), and the inflammatory markers (
C-reactive protein [CRP],
neopterin,
granulocyte elastase). CFs were significantly increased in all HIV-1-positive patients and in HIV-1-negative patients with malignant
tumors. HIV-1-positive patients with
Kaposi's sarcoma showed the highest CF activity in their plasma (p < 0.08). CFs appear very early in
HIV infection, and they correlate negatively with CD4+ T cells, which are an
indicator of disease activity. The presence of CF in the plasma of HIV-infected patients is not a general response to a
viral infection because these factors are not increased in HIV-1-negative patients with
viral infection (
zoster). CFs are not specific for the HIV-1
infection; they also occur in HIV-1-negative patients with malignant
tumors. There was a tendency towards a positive correlation (p < 0.14) between CF and
TNF-alpha but there was no positive correlation of CF with
IL-2,
IL-6, CRP,
elastase, and
neopterin levels. This indicates that
TNF-alpha may be among the components of CF in HIV-1-infected patients. In addition, other unidentified components may contribute to the clastogenic activity of the plasma or the composition of CF may vary from patient to patient. Further clinical studies with larger sample populations are necessary to analyze the composition of CF in HIV-1-positive patients.