Antibodies to human T-lymphotropic virus type III (HTLV-III) in saliva of acquired immunodeficiency syndrome (AIDS) patients and in persons at risk for AIDS

Whole saliva samples collected from available people at risk in Boston for infection with human T-lymphotropic virus type III (HTLV-III/LAV), from late 1984 through early 1985, were analyzed for the presence of antibodies to viral proteins. Fourteen of 20 (70%) acquired immunodeficiency syndrome (AIDS) patients and 14 of 15 (93%) AIDS-related complex (ARC) patients had salivary antibodies that reacted with the virus-encoded glycoproteins gp160 and gp120 of HTLV-III infected cells. All of the AIDS and ARC patients had serum antibodies to the same antigens. Of 20 sex partners of AIDS/ARC patients, nine (45%) showed anti-HTLV-III antibodies, and four of 18 (22%) healthy homosexual males also were positive for such antibodies. Serum and salivary antibody status were the same in these groups. A minority of those patients positive for salivary antibodies to env gene-encoded gp160 and gp120 also had salivary antibodies to gag gene-encoded proteins of 55,000, 24,000, and/or 17,000 daltons. Immunoglobulin A (IgA) class antibodies comprised the majority of the salivary antibody response. The spectrum of HTLV-III proteins detected by the salivary and serum antibodies was similar. The possibility that secretory IgA from the gut-associated lymphoid system may play a role to restrict salivary transmission of HTLV-III should be considered.     

Epidemiology of human T-lymphotropic virus type III and the risk of the acquired immunodeficiency syndrome

The discovery of human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) has opened a window to the understanding of the spectrum of the acquired immunodeficiency syndrome (AIDS) and related clinical syndromes. Analysis of risk factors for seropositivity has shown that HTLV-III is transmitted most efficiently via routes that involve close personal contact or parenteral exposure. Longitudinal studies have shown that HTLV-III infection has a long latent period. The prevalence of AIDS in different geographic areas and among different risk groups appears to depend in part on duration of exposure. Co-factors for AIDS outcome such as manner and route of exposure, underlying immune status, and host susceptibility are also likely to play a role in risk.     

Seroepidemiology of human T-lymphotropic virus type III among homosexual men with the acquired immunodeficiency syndrome or generalized lymphadenopathy and among asymptomatic controls in Boston

We studied a cohort of 45 homosexual men with the acquired immunodeficiency syndrome, 78 with persistent unexplained generalized lymphadenopathy, and 160 asymptomatic homosexual controls for serologic evidence of infection with human T-lymphotropic virus type III (HTLV-III). Study participants were recruited from a community-based health center and a university hospital practice. Ninety-eight percent of men with the syndrome and greater than 90% of men with generalized lymphadenopathy had antibody to HTLV-III, while 21% of the controls were positive (p less than 0.001). Six patients with generalized lymphadenopathy developed the acquired immunodeficiency syndrome over 2 years; all were seropositive for HTLV-III. Thirty-six asymptomatic controls had had sexual contact with a man with the syndrome; receptive anal intercourse in this group was associated with seropositivity for HTLV-III. These data suggest that persistent generalized lymphadenopathy and the acquired immunodeficiency syndrome are part of a clinical spectrum of HTLV-III infection and that most high-risk homosexual men in some regions of the United States have not yet been infected with this virus.     

Antibodies to human T-lymphotropic virus type III and development of the acquired immunodeficiency syndrome in homosexual men presenting with immune thrombocytopenia

In 35 homosexual men with isolated thrombocytopenia at initial presentation, who were evaluated and treated between 1982 and 1984, hematologic studies showed immune destruction. In contrast to findings in other autoimmune conditions, T-lymphocyte subsets in these patients were reversed, with a mean helper to suppressor ratio of 0.4 and with an absolute depletion of helper cells to 390/mm3. An enzyme-linked immunosorbent assay detected antibodies to human T-lymphotropic virus type III in 21 of 25 patients tested; Western blot analysis confirmed seropositivity in the other 4 patients, who had borderline findings. Although 19 of 24 patients treated with steroids responded, only 2 achieved sustained normal platelet counts. Ten of fifteen patients who had splenectomy achieved remissions. Three patients treated with steroids or splenectomy developed diagnoses compatible with the acquired immunodeficiency syndrome 16 to 34 months after their initial presentation with thrombocytopenia. These findings indicate that immune thrombocytopenia is part of the clinical spectrum of the acquired immunodeficiency syndrome.     

42例HIV感染/艾滋病患者的心脏表现

目的　总结 42例人免疫缺陷病毒 ( HIV)感染 /艾滋病患者的心脏表现。方法　对 42例 HIV感染 /艾滋病患者进行回顾性分析。结果　 42例 HIV感染 /艾滋病心脏表现有 :心律失常 5 0 .0 % ( 2 1/ 4 2 ) ,感染性心内膜炎 4.8% ( 2 / 4 2 ) ,心包积液 2 .4% ( 1/ 4 2 ) ,扩张型心肌病合并心功能不全 14 .3% ( 6 / 4 2 )。结论　心脏亦为 HIV感染 /艾滋病的受累器官之一。艾滋病患者可因自身突出的全身症状掩盖而使心脏病变隐匿 ,心电图、胸片、超声心动图有助早期诊断并指导治疗     

Mental disorders in patients infected with the human immunodeficiency virus

The present review aims to offer a concise of information about the diverse mental disorders affecting HIV-infected patients. Although most studies coincide in remarking that HIV-infected patients are frequently burden with psychological distress, the prevalence of the different mental disorders being present at the time of evaluation is widely variable. HIV infection clinical stage, prior psychiatric morbidity, and sociodemographic issues are also related to the type and risk for mental disorders. When planning therapeutic interventions, psychopharmacological or psychological, for HIV-infected patients several peculiarities should be taken into account. The accurate psychosocial evaluation and prompt therapeutic intervention, could help to reduce psychiatric-psychologic morbidity in a population of patients with multifactorial impairment in their quality of life and improve the adherence to treatment.     

Isolation of infectious human T-cell leukemia/lymphotropic virus type III (HTLV-III) from patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) and from healthy carriers: a study of risk groups and tissue sources.

Acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) are thought to be caused by human T-cell leukemia/lymphotropic virus type III (HTLV-III). Since the fall of 1982, independent isolates of HTLV-III have been obtained in this laboratory, in collaboration with several clinical groups, from 101 AIDS and ARC patients and healthy donors at risk for AIDS. Most isolates were from peripheral blood T lymphocytes established in cell culture, but some were obtained from bone marrow, lymph node, brain tissue, and cell-free plasma and from cells associated with saliva, cerebrospinal fluid, and semen. Virus was isolated from approximately 50% of AIDS patients, 85% of ARC patients, and 30% of healthy individuals at risk for AIDS. The risk groups included homosexuals, promiscuous heterosexuals, i.v. drug users, recipients of blood or blood products, and spouses and offspring of AIDS patients and others at risk for AIDS. A high correlation was seen between persistent levels of serum antibody and the ability to isolate virus from patient or donor leukocytes. Immunologic and nucleic acid analysis demonstrated that the virus isolates were highly related, although substantial diversity was observed in the restriction enzyme cleavage patterns of those studied in detail. Biological analysis of cells from infected patients and donors as well as from normal peripheral blood mononuclear cells exposed to virus in vitro demonstrated that OKT4/Leu3a+ (helper/inducer) lymphocytes were preferentially infected and were subjected to a characteristic cytopathic effect. The availability of multiple isolates of virus from a number of different patients and donors will greatly facilitate the characterization of HTLV-III and the study of possible biological and/or biochemical variants of the virus responsible for the development of AIDS, ARC, and related diseases.     

Transient antibody to lymphadenopathy-associated virus/human T-lymphotropic virus type III and T-lymphocyte abnormalities in the wife of a man who developed the acquired immunodeficiency syndrome

We present evidence of transmission of lymphadenopathy-associated virus (LAV)/human T-lymphotropic virus type III (HTLV-III) from a man to his wife, and a return to a normal number of T-helper lymphocytes and loss of antibody after discontinuing sexual exposure to LAV/HTLV-III. The man had hemophilia A, and developed the lymphadenopathy syndrome, antibody to LAV, and a low number of T-helper lymphocytes. His wife, who had no risks for the acquired immunodeficiency syndrome other than sexual contact with him, developed LAV antibody (titer, 1:160) and a mildly decreased number of T-helper cells. The husband subsequently developed the syndrome and lost the LAV antibody. During 10 months of follow-up his wife remained clinically well, discontinued exposure to semen, and then lost the LAV antibody, and regained a normal number of T-helper cells.     

Meningococcal infection in patients with the human immunodeficiency virus and acquired immunodeficiency syndrome

Meningococcal infection is believed to be rare in HIV-positive individuals. We present 2 cases from our reference caseload within the last 10 years.     

Septic arthritis in patients with acquired immunodeficiency syndrome with human immunodeficiency virus infection.

We have evaluated the presence and characteristics of septic arthritis in intravenous (iv) drug users with human immunodeficiency virus (HIV) infection. Sixteen patients with both HIV infection and septic arthritis were studied and compared with 5 patients with septic arthritis but no HIV infection. Clinical profile, laboratory findings at the time of onset, localization, causative organisms, mean hospitalization time and presence of complications were the same in HIV positive and HIV negative patients. Staphylococcus aureus was the most commonly isolated organism in both groups. We conclude that septic arthritis in HIV infected iv drug users is not uncommon, it is produced by the same organisms and presents similar characteristics to the ones found in iv drug users without HIV infection. Therefore, the presence of HIV infection does not appear to modify the characteristics of septic arthritis.     

Antibody to human T-lymphotropic virus in a patient with Guillain-Barré syndrome (case report)

Serum sample obtained from a male, 12 year old patient suffering from Guillain-Barré syndrome (GBS) was positive for human T-lymphotropic virus (HTLV-I) antibody by the enzyme-linked immunosorbent assay (ELISA) and the Western Blot analysis (WB). Attempts to isolate enteroviruses (including poliovirus) from faecal material in both tissue culture and suckling mice were unsuccessful; in addition, acute and convalescent paired serum samples did not show any evidence of recent poliovirus infection when tested against the three serotypes. Specific tests for detection of Epstein-Barr virus infection were not performed; however, the Paul-Bunnel test yielded negative results. ELISA for detection of anti-cytomegalovirus IgM was also negative. The concomitant occurrence of either adult T cell leukemia (ATL) or lymphoma was not recorded in this case.     

Management of psychiatric disorders in patients infected with human immunodeficiency virus.

Psychiatric disorders increase the risk of acquiring human immunodeficiency virus (HIV) and increase morbidity from HIV-related illness by impeding treatment. The response to highly active antiretroviral therapies is impaired by poor patient adherence, a substantial component of which is related to mental illness and substance use disorders. The recognition of psychiatric disorders in most HIV clinics is an issue of utmost importance. We outline diagnostic and treatment issues for major depression, bipolar disorder, personality disorder, substance use disorders, and demoralization as seen in patients with HIV. Our experience at the Johns Hopkins Moore (HIV) Clinic has led us to conclude that treatment of these disorders greatly improves patient adherence to treatment and outcomes of HIV infection.     

Apparent transmission of human T-cell leukemia virus type III to a heterosexual woman with the acquired immunodeficiency syndrome

A 24-year-old woman developed the acquired immunodeficiency syndrome with lymphadenopathy, oral candidiasis, and Kaposi's sarcoma. Her only known risk factor for the syndrome was sexual contact with an asymptomatic Haitian man. The woman had serologic evidence for infection with human T-cell lymphotropic virus type III, and this virus was recovered from the saliva of her sexual partner. Epidemiologic and virologic studies of the cases of such patients provide further evidence of a primary pathogenetic role for this retrovirus in the acquired immunodeficiency syndrome.     

Visceral leishmaniasis in patients infected with human immunodeficiency virus (HIV)

In an 8-month period nine patients with human immunodeficiency virus (HIV) infection were diagnosed as having visceral leishmaniasis; all diagnoses were based on cultures (eight from bone marrow and one from the skin). Visceral leishmaniasis developed before full-blown acquired immunodeficiency syndrome (AIDS) in seven patients and at the same time as or after AIDS in the other two patients. Three patients had a history of leishmaniasis. Clinical manifestations and laboratory findings were atypical. Leishmania species were cultured from samples taken from all patients; however, six patients had an insignificant antileishmanial antibody titer and Leishmania amastigotes were not seen in their bone marrow smears. Four isolates were identified by isoenzyme analysis as Leishmania donovani infantum. Five patients died, including two patients who had completed at least one 3-week course of therapy with N-methylglucamine antimoniate. Screening should be done for visceral leishmaniasis in patients with HIV infection who live or travel in areas where the disease is endemic. The diagnosis of visceral leishmaniasis may frequently be missed if cultures are not done.     

Retroviral sequences related to human T-lymphotropic virus type II in patients with chronic fatigue immune dysfunction syndrome.

Chronic fatigue immune dysfunction syndrome (CFIDS) is a recently recognized illness characterized by debilitating fatigue as well as immunological and neurological abnormalities [Straus, S.E. (1988) J. Inf. Dis. 157, 405-412]. Once thought to be caused by Epstein-Barr virus, it is now thought to have a different but unknown etiology. We evaluated 30 adult and pediatric CFIDS patients from six eastern states for the presence of human T-lymphotropic virus (HTLV) types I and II by Western immunoblotting, polymearse chain reaction, and in situ hybridization of blood samples. The majority of patients were positive for HTLV antibodies by Western blotting and for HTLV-II gag sequences by polymerase chain reaction and in situ hybridization. Twenty nonexposure healthy controls were negative in all assays. These data support an association between an HTLV-II-like virus and CFIDS.     

Antibody to human T-lymphotropic virus type III in wives of hemophiliacs. Evidence for heterosexual transmission

To evaluate the risk of heterosexual transmission of the acquired immunodeficiency syndrome, lymphadenopathy, and infection with human T-lymphotropic virus type III (HTLV-III), we studied 42 hemophiliacs and their wives. By early 1984, 9 of the hemophiliacs had asymptomatic lymphadenopathy and 1 had the acquired immunodeficiency syndrome. Twenty-one hemophiliacs, including all 10 with clinically overt disease, had antibody to HTLV-III. None of the 42 wives had lymphadenopathy or the acquired immunodeficiency syndrome but 2 had HTLV-III antibody. One of these women had evidence of immunologic dysfunction with a markedly reduced T-helper/suppressor cell ratio. The husbands of these 2 women both had HTLV-III antibody, but neither had overt acquired immunodeficiency syndrome-related disease. Thus, as of early 1984, the prevalence of HTLV-III antibody in wives of hemophiliacs seropositive for HTLV-III was 9.5% (2 of 21). We conclude that transmission of HTLV-III occurs between hemophiliacs and their heterosexual partners.     

Long-term seropositivity for human T-lymphotropic virus type III in homosexual men without the acquired immunodeficiency syndrome: development of immunologic and clinical abnormalities. A longitudinal study

The long-term effects of seropositivity for human T-lymphotropic virus type III (HTLV-III) on T-lymphocyte subsets and health status were evaluated in longitudinal studies of 250 initially healthy homosexual men. The relative risk of having an inverted T-lymphocyte helper-to-suppressor ratio rose from 14.3-fold among short-term seropositive subjects (less than 19 months) to 46.9-fold among long-term seropositive subjects (greater than 29 months) in comparison with the risk among seronegative subjects. Overall, 91.7% of long-term seropositive men had inverted ratios, compared with 12.9% of seronegative men. None of the seropositive men who developed an inverted ratio later reestablished a normal ratio. Both decreased T-helper cell number and percentage (p = 0.003) and increased T-suppressor cell number and percentage (p = 0.03) were significantly correlated with duration of seropositivity. Among seropositive persons, lymphadenopathy was a highly significant short-term as well as long-term consequence, whereas diarrhea, oral thrush, and herpes zoster were correlated with long-term seropositivity. Overall, 50% of long-term seropositive men compared with 16% of seronegative men developed at least one of five clinical symptoms (p less than 0.003). We conclude that a high proportion of persons infected with HTLV-III will develop measurable immunologic and clinical abnormalities.