Elevated soluble CD8 levels in sera of human immunodeficiency virus-infected populations

Soluble CD8 levels in sera were quantitated in asymptomatic intravenous drug abusers, homosexuals, and patients with lymphadenopathy or acquired immunodeficiency syndrome. Soluble CD8 levels were elevated in human immunodeficiency virus-seronegative intravenous drug abusers and homosexuals, probably reflecting infections like cytomegalovirus. The sera of human immunodeficiency virus-seropositive groups of patients with human immunodeficiency virus infection also had elevated levels of soluble CD8, reflecting infections like cytomegalovirus and human immunodeficiency virus infection.

Virus isolation and immune studies in a cohort of homosexual men

Virus shedding was detected in 77% of homosexual subjects and in only 6% of heterosexual controls. The overall virus isolation rate in homosexual subjects was not significantly different among HIV-seropositive (79%) and HIV-seronegative (74%) individuals. In about 20% of homosexual subjects, virus shedding from multiple sites was observed. The most frequently isolated virus was cytomegalovirus (CMV) (41%), followed by enteroviruses (23%), herpes simplex virus (HSV) (7%), and adenoviruses (6%). In the control group, about 50% of subjects were seronegative for HSV-1 and 2, and about 70% were negative for CMV and Epstein-Barr virus (EBV). Only 2% of homosexuals were seronegative for CMV, about 5% for HSV-1 and 2, and about 20% for EBV. No differences were found in antibody levels against varicella-zoster virus (VZV) among the control and homosexual groups. The proportion of seronegatives for Coxsackie and hepatitis viruses was significantly higher in control than in homosexual subjects. However, no differences in the proportion of seronegatives for measles, mumps, and rubella were observed. No HIV-antibody-negative individual was detected with an OKT4/OKT8 ratio of less than 0.75. On the other hand, only HIV-positive subjects, with a ratio of less than 0.75, had high serum IFN alpha titers. The results suggest that the high rate of virus shedding among HIV-negative homosexual subjects might be a factor in the development of AIDS in this high-risk population.

Lack of a significant independent effect of race on survival in breast cancer

In an analysis of 2033 patients with breast cancer from two population groups presenting to the Combined Breast Clinic of the Johannesburg and Hillbrow Hospitals, black patients were found to present with more advanced stage disease (P much less than 0.0001) and to have a poorer prognosis within each stage than whites (P less than 0.005- less than 0.001). Intrastage inhomogeniety was indicated by the finding that black patients had significantly more advanced T and N categories within stage grouping as compared to white patients (P = 0.013-P less than .001). A multivariate analysis controlling for age, T and N in nonmetastatic showed that when these factors were taken into consideration there was no significant independent effect of race on survival. The data indicate that the poorer prognosis which has been previously reported for black patients probably results from intrastage variability of disease bulk, supporting the use of the TNM rather that the stage grouping system for prognostication. Age differences also were evident when the two population groups were compared, with breast cancer in blacks appearing to present at an earlier age. Further analysis showed that these age differences were related to the age structure of the two populations and that breast cancer probably does not occur at a younger age in black subjects. Ethnic origin, does not appear to play a significant independent role in the prognosis of breast cancer in women.

Open study of AL-721 treatment of HIV-infected subjects with generalized lymphadenopathy syndrome: an eight week open trial and follow-up

AL-721 is a lipid compound composed of neutral lipids, phosphatidylcholine and phosphatidylethanolamine in a 7:2:1 ratio. The objective of this open study was to evaluate the effects of AL-721 in vivo in an 8-week open trial in which 10 g twice daily was administered on a low fat diet to eight HIV-infected subjects with lymphadenopathy syndrome (LAS). Serial lymphocyte cocultivation studies in 7 patients with initial culture positivity appeared to demonstrate reduction of reverse transcriptase peak counts in 5 with the trough noted in 4 at 8 weeks and in one at 4 weeks following termination of therapy. The mean values for all 7 patients revealed a baseline value of 73,419 with decrease to a low of 27418 at 8 weeks. Mean levels of total lymphocytes, T-4, T-8 and T-11 cells were not altered but lymphoproliferative responses to concanavalin A and pokeweed mitogens appeared to be augmented in 4 of the 8 subjects in association with AL-721 treatment. No side effects were noted. In a subsequent follow-up study using a normal diet in the same subjects lymphocyte cocultivation and mitogen-induced responses were less consistently affected when 15 g twice daily AL-721 was readministered. In addition, serum HIV p24 antigen and CD4 levels were not altered during both the 8-week open and subsequent AL-721 readministration. Four of the 8 patients have progressed to AIDS over the subsequent 14 months.

Breast cancer in men. Clinical features, hormone receptor status, and response to therapy

Stage, estrogen receptor status, treatment and survival of 29 men with breast cancer attending the Breast Clinic of the Johannesburg Hospital between 1976 and 1985 are reviewed. Most patients had locoregionally advanced disease at presentation. Estrogen receptors (ER) were detected in significant concentration in 15/23 (65%). Local control was achieved in the majority, 19/26 (73%), by either surgery or radiation therapy alone or by combined modality treatment. Fifteen of 23 patients tested (65%) were ER-positive (greater than 10 fmol/mg protein). For patients with metastatic disease hormone receptor status was predictive of response to hormonal manipulation. Tamoxifen was the most acceptable and frequently used form of hormone therapy with 7/12 patients responding. Combination chemotherapy gave a response rate comparable to that seen in women with breast cancer.

Results of surgical treatment in patients with arachnoid cysts

A retrospective study of 35 patients operated upon for arachnoid cysts during the last 10 years was carried out. In 19 patients treated by craniotomy, membrane resection and drainage into the basal cisterns, clinical improvement could be noted in 13 cases. Correspondingly on the CT-controls the cysts were found to have disappeared in two cases and were reduced in size in seven patients. In 11 patients, however, who were initially treated by a shunting procedure, seven patients became free of symptoms. Postoperative CT-controls showed in three cases a significant reduction of the size of the cyst, which remained unchanged in two other cases. In five patients with the combination of a nonspace-occupying arachnoid cyst and subdural effusions, drainage of the latter only was sufficient to relieve the clinical symptoms. The prominent findings were the high complication rate of the primary or secondary shunting procedures (48%), as well as the close correlation between the clinical outcome and the postoperative CT-controls.

Reverse transcriptase activity (RTA) in lymphocyte cultures of AIDS patients treated with HPA-23

HPA-23 was used in a parallel, multiple dose study in patients with Centers for Disease Control (CDC)-defined AIDS. Sixteen patients were divided into four dosage groups, receiving 0.25, 0.5, 1.0, or 2.0 mg/kg HPA-23 respectively, by rapid IV infusion five days/week for eight weeks. Blood was collected before, at weeks 1, 3, and 7 of treatment, and two weeks post-therapy. Patient peripheral blood lymphocytes (PBL) were cultivated in the presence of fresh PBL from a healthy donor for 30 days. Media were changed and reverse transcriptase activity (RTA) was tested every four to five days. The results showed a significant decrease in RTA in patients treated with a dose of 0.5 or 1 mg/kg, but only a slight decrease in patients who received the lowest dose. In the group treated with the 2 mg/kg dose, two patients had toxic reactions and were discontinued; the other two showed a slight decrease in RTA. In 40% of treated patients, RTA did not increase again two weeks after the end of treatment. No significant immunologic and clinical changes were noticed during the observation period. In vitro experiments of Con A stimulated PBL in presence and absence of HPA-23 showed an increase in proliferation in the presence of the drug.

Long-term follow-up of serum-interferon and its acid-stability in a group of homosexual men

For a period of over two years 99 volunteer healthy homosexual men were examined periodically for the presence of interferon (IFN) in their serum. Thirty-nine subjects had either undetectable IFN levels in serum or IFN was detected only once in three to five samples tested. In another 45 subjects low IFN levels were detected throughout the study period. None of these subjects had or developed any disease symptoms. In the remaining 15 subjects high serum IFN levels were detected at their enrollment or during the study period. All these subjects started to manifest clinical symptoms compatible with AIDS. In six subjects the mean time elapsed between the first detection of serum IFN and disease symptoms was 6.5 months. In all subjects but one, the IFN was of type alpha. The acid-stability of serum IFN alpha decreased with time, and when its decrease was abrupt it was associated with a more rapid evolution of AIDS. Sera containing acid-labile IFN alpha can induce IFN alpha synthesis in normal lymphocyte cultures (LC), but do not influence IFN gamma synthesis in LC stimulated with phytohemagglutinin. LC stimulated with viral antigens in the presence of serum with acid-labile IFN alpha synthesized IFN with an increased sensitivity for acid treatment. The results confirm the prognostic value of serum IFN alpha in the development of AIDS, and suggest that the transition to acid-lability may be a gradual process.

Hematologic correlates and the role of erythrocyte CR1 (C3b receptor) in the development of AIDS

Circulating immune complexes (CICs) are common in patients with the acquired immunodeficiency syndrome (AIDS) as in anemia. In our previous reports, we observed that the deposition of CICs on erythrocytes via C3b receptors (CR1) resulted in a defective CIC clearing system of erythrocytes and in high membrane osmotic fragility of such erythrocytes. We investigated the functional activity of erythrocyte CR1 in 89 patients with AIDS, 41 with AIDS related complex (ARC), 102 healthy homosexual volunteers, and 37 heterosexual males, in relation to the presence of CICs, antibody to lymphadenopathy associated virus/human T lymphotropic virus-III (LAV/HTLV-III), anemia, and the direct and indirect Coombs' tests. CICs were frequently found in all groups except heterosexual males. Absence of CR1 activity was observed in 85% of patients with AIDS, and in 59% with ARC. Impaired CR1 activity also occurred in the homosexual volunteer group. Positive direct Coombs' test and the presence of CICs correlated inversely with CR1 activity while a lowered hematocrit and the presence of antibody to LAV/HTLV-III correlated directly. Neither the sera nor the eluates from erythrocytes with a positive IgG Coombs' test contained IgG antibody against erythrocytes. This suggests decremental loss of CR1 activity progressing from asymptomatic LAV/HTLV-III antibody positive homosexual volunteers to the prodromal spectrum of ARC and finally progressing to a total disappearance in overt AIDS. Of 8 homosexuals volunteers demonstrating the composite of impaired CR1 activity, positive antibody to LAV/HTLV-III, and polyvalent positive direct Coombs' test (with gamma, mu, and C3b), all developed ARC or overt AIDS within 2 years of these observations.

Neurogenic bladder. New clinical finding in Legionnaires' disease

Legionnaires' disease presents with a spectrum of organ involvement including pulmonary, hepatic, gastrointestinal, metabolic, and renal dysfunction. Known neurologic manifestations include hallucinations, delirium, cerebral and cerebellar disturbance, and encephalomyelitis. Clinical and subclinical peripheral neuropathy has been described. This report describes a 51-year-old man with legionnaires' disease complicated by cerebral and persistent cerebellar and brainstem dysfunction, without evidence of direct bacterial invasion of the nervous system. Of particular interest was the development of a flaccid neurogenic bladder, a clinical manifestation not previously described.

Kaposi's sarcoma in heterosexual intravenous drug users

Kaposi's sarcoma is a feature of the acquired immunodeficiency syndrome (AIDS) in male homosexuals and Haitians. In this report the authors describe six heterosexual intravenous drug users who developed Kaposi's sarcoma. They had other characteristics of AIDS including opportunistic infections (oral candidiasis, six patients; Pneumocystis carinii pneumonia, two patients; genital herpes simplex, two patients; disseminated cytomegalovirus, one patient; Mycobacterium avium, one patient) and inversion of the normal ratio of helper-suppressor T-cell subsets in peripheral blood lymphocytes in the two patients in whom it was determined. These observations indicate that intravenous drug users as well as Haitians and homosexual men are at risk for developing Kaposi's sarcoma as part of the acquired immunodeficiency syndrome.

Defective B-lymphocyte function in homosexual men in relation to the acquired immunodeficiency syndrome

Patients with the acquired immunodeficiency syndrome manifest a wide spectrum of immunologic abnormalities. Polyclonal and antigen-specific differentiation of B lymphocytes into immunoglobulin- and antibody-secreting cells was studied in vitro in three groups of homosexual volunteers: asymptomatic men; men who were symptomatic but lacked clinical criteria for the acquired immunodeficiency syndrome; and those having the syndrome. Although mean responses of all three groups were significantly lower than those of healthy heterosexual male controls, those of the asymptomatic group were least affected. Abnormalities in the symptomatic group were equal to or greater than those of patients with the syndrome, but responses of the latter group were the least augmentable by in vitro manipulations. Severe impairment of B-cell function appeared to favor clinical deterioration. Antibody replenishment might be of value as adjunctive therapy in persons with the acquired immunodeficiency syndrome or as prophylaxis in certain at-risk persons.

Cytomegalovirus isolation from healthy homosexual men

The acquired immune deficiency syndrome (AIDS) has focused renewed interest on cytomegalovirus (CMV) both as an infectious complication of the syndrome and as a potential etiologic agent in the pathogenesis of the immunosuppression. We studied 30 healthy homosexual men in New York City to determine the prevalence of virus excretion and its relationship to CMV-IgM antibodies and to T-lymphocyte subsets. Cytomegalovirus was detected in the urine and/or semen of 11 subjects. Eight of 11 CMV shedders were CMV-IgM positive, but CMV IgM was found in only one of 19 not shedding the virus. While homosexuals as a group had lower OKT4/OKT8 ratios (0.8 +/- 0.4, mean +/- SD) than heterosexual controls (1.8 +/- 0.4, mean +/- SD), there was no significant difference in ratios between homosexuals excreting virus and those not excreting virus. Cytomegalovirus excretion by homosexual men seems to be more prevalent than previously appreciated and may pose a significant risk for sexual transmission.

Enteropathy associated with the acquired immunodeficiency syndrome

To explore the effect of the acquired immunodeficiency syndrome on gastrointestinal structure and absorption, the cases of 12 homosexual men with the syndrome and 11 homosexual controls were studied. Seven patients had diarrhea with weight loss. Bacterial or parasitic infections were not detected. All patients were malnourished; had significantly fewer T-lymphocyte helper and suppressor cells; and had significantly lower body weights, midarm circumferences, serum albumin concentrations, and iron binding capacities than homosexual controls. D-Xylose malabsorption and steatorrhea were present in patients, especially those with diarrhea. Jejunal and rectal biopsy samples were histologically abnormal in all patients with diarrhea. Jejunal abnormalities included partial villus atrophy with crypt hyperplasia and increased numbers of intraepithelial lymphocytes. Rectal abnormalities included intranuclear viral inclusions, mast cell infiltration in the lamina propria, and focal cell degeneration near the crypt base. The histologic findings suggest that a specific pathologic process occurs in the lamina propria of the small intestine and colon in some patients with the syndrome.

Treatment of advanced breast cancer with aminoglutethimide--response after previous tamoxifen treatment

Thirty-one postmenopausal patients with advanced breast cancer either unresponsive to tamoxifen or progressing after responding to tamoxifen were treated with aminoglutethimide (1 000 - 1 250 mg/d) plus hydrocortisone replacement. The response rate was 33% in patients who had never responded to tamoxifen and 47% in patients who had previously responded to tamoxifen. The overall response rate was 42%. These results show that aminoglutethimide is an effective second-line hormonal treatment for patients with advanced breast cancer.

Elevated beta 2-microglobulin and lysozyme levels in patients with acquired immune deficiency syndrome

beta 2-Microglobulin (beta 2-M) levels in sera and urines, and lysozyme levels in sera, were quantitated in healthy heterosexual men and several groups of homosexual males. The mean beta 2-M levels in sera and urines and lysozyme levels in sera of healthy heterosexual and homosexual men were not significantly different. However, beta 2-M levels in patients with lymphadenopathy syndrome and AIDS were elevated. The mean beta 2-M level in sera of 11 patients with the lymphadenopathy syndrome was 4016 +/- 473 micrograms/l (SEM) (P less than 0.001) and 5409 +/- 462 micrograms/l (P less than 0.001) in 27 patients with AIDS. Similarly, beta 2-M levels in the urines of patients with chronic diarrheal syndrome, lymphadenopathy syndrome, and those meeting the CDC surveillance definition of AIDS were also significantly elevated (P less than 0.025). The mean lysozyme levels in the sera of 11 patients with the lymphadenopathy syndrome was 16.58 +/- 0.04 microgram/ml, and in 27 patients with AIDS 15.40 +/- 1.16 microgram/ml, compared to the mean level obtained in normal heterosexual men of 6.67 +/- 0.42 microgram/ml (P less than 0.001). The results of this study suggest that measuring beta 2-M in serum and urine and lysozyme levels in serum might provide additional useful parameters for the evaluation of patients with AIDS and prodromal syndromes.