Silent human immunodeficiency virus type 1 infection: a rare occurrence in a high-risk heterosexual population

A group of 58 heterosexual female partners (FP) of human immunodeficiency virus type 1 (HIV-1)-seropositive hemophiliacs was studied by conventional diagnostic methods such as enzyme-linked immunosorbent assay (ELISA) and Western blot analysis to examine whether any had acquired HIV-1 infection through sexual transmission. A subset of 29 FP were asked to answer a detailed questionnaire concerning their health, use of "safer sex" techniques, and other risk factors for HIV-1 infection. They also had additional blood drawn for CD4 cell analysis, viral cultures, nef, gag, and env immunoblots, and polymerase chain reaction (PCR) analysis to assess the occurrence of "silent" HIV-1 infection in a high-risk seronegative population. Among the 58 FP, three were found to be HIV-1-seropositive on first testing, with no new seroconversions occurring with subsequent testing in the remaining 55. Two seropositive FP had the additional testing and were found to have positive viral cultures, as well as positive PCR results. All of the seronegative FP (n = 24) who had additional testing were negative in viral culture, had negative immunoblots, and had no HIV-1 nucleic acid sequences detected by PCR. Thus, in this population, silent HIV-1 infection appears to be a rare occurrence and antibody testing seems to correlate with the more sensitive techniques of PCR and viral cultures.

Factors affecting response of cows to biweekly injections of sometribove

Seventy-eight lactating Holstein cows (18 primiparous and 60 multiparous) were used to study certain factors affecting response in milk yields to biweekly injections of bST. Cows were intramuscularly injected with placebo or with 500 mg of bST every 14 d for 36 wk beginning 60 d postpartum. Primiparous cows responded less to bST than did multiparous cows. Cows were separated into three yield groups within each treatment based on pretreatment yield: low (27.0 kg/d), medium (32.0 kg/d), and high (39.0 kg/d). Response of low yielding cows to bST was numerically greater than that of medium or high yielding cows, but there was no significant interaction between treatment and pretreatment milk yield. Individual cow index for milk yield was used as a measure of genetic potential of cows, which were divided into two index groups: high cow index (greater than -23 kg) and low cow index (less than -23 kg). Cows in the high index group showed significantly higher milk yields than the low index group during treatment, but treatment by cow index interaction was not significant, suggesting that cows of widely ranging genetic potential respond similarly to bST. Response of cows to bST in mid to late lactation was slightly greater than in early lactation (15.9 and 10.6% vs. 17.8%, respectively), but no significant interaction of treatment by days postpartum was noted. Finally, even though cows treated with bST exhibited slightly higher rectal temperatures during the hot summer months, no significant difference in milk yield response to bST was noted during periods of moderate versus high ambient temperatures.

Limiting dilution analysis of cytotoxic T lymphocytes to human immunodeficiency virus gag antigens in infected persons: in vitro quantitation of effector cell populations with p17 and p24 specificities

The presence of cytotoxic T lymphocytes (CTL) to the gag antigens of human immunodeficiency virus (HIV) has been described in infected populations. We found that the majority of this immune response as measured in bulk CTL assays of unstimulated peripheral blood mononuclear cells (PBMC) is directed against the p24 component of the p55 gag precursor protein. Using limiting dilution analysis of this effector cell population we confirm that the majority of activated gag-specific CTL circulating in the PBMC of infected hemophilic patients are directed at p24 determinants and are present at frequencies of 1/36,000 to 1/86,000 lymphocytes. By performing in vitro stimulation after limiting dilution, the precursor population of gag-specific CTL are characterized and quantitated. HIV gag-specific CTL precursors are identified at frequencies of 1/1700 to 1/17,000 lymphocytes and are made up of cells with both p17 and p24 specificities. No HIV gag-specific CTL precursor cells are identified in the PBMC of HIV-uninfected individuals. These studies demonstrate that CTL directed at both p17 and p24 determinants make up the cellular immune repertoire in HIV-infected individuals but that only the p24-specific CTL are routinely found in an activated state in the circulation.

Pregnancy in a cohort of long-term partners of human immunodeficiency virus-seropositive hemophiliacs

Since 1981, there have been 17 pregnancies in 12 long-term female sexual partners of human immunodeficiency virus (HIV-1)-seropositive hemophilic men at the New England Hemophilia Center. Eleven of 12 women were seronegative for HIV antibody and one was seropositive. Six of the women followed a specific antibody testing schedule for nine pregnancies. This involved antibody testing at specific points before, during, and after pregnancy. All of the seronegative women had at least one negative antibody test at the conclusion of each pregnancy. Fourteen of 16 pregnancies in the seronegative women resulted in live-born infants. The children now range in age from 7 months to 7 years and 8 months, and have no significant medical problems. The woman found to be seropositive at 8 weeks' gestation of her first pregnancy subsequently delivered an infected infant. In this small group, 11 of 12 women at risk for HIV transmission were able to become pregnant and remain seronegative for HIV antibody. Antibody testing during pregnancy gave the women information on which to base reproductive choices.

Antibody-dependent cell-mediated cytotoxicity directed by a human monoclonal antibody reactive with gp120 of HIV-1

We used a human monoclonal antibody (MAb; 15e) to identify an antibody-dependent cell-mediated cytotoxicity (ADCC) epitope on HIV-1 gp120. 15e has been shown to recognize a conformation-dependent epitope on gp120 which is important in both CD4 binding and neutralizing of HIV-1 infection. 15e binds to gp120 of HIV-1IIIB but not HIV-1RF. Using a standard ADCC assay, 15e was found to mediate ADCC against cells infected with HIV-1IIIB but not HIV-1RF. 15e did not mediate ADCC against cells with recombinant gp120 bound to surface CD4, indicating that 15e does not mediate innocent bystander ADCC against uninfected CD4 cells. To better define the 15e epitope, we performed ADCC against target cells infected with a vaccinia vector which expresses processed HIV-1IIIB gp160 from which the third variable region was deleted (amino acids, 312-328). MAb 15e efficiently mediated ADCC against cells expressing this altered form of gp120, indicating that this region is not contributing to the conformational epitope defined by 15e. 15e defines an important epitope in the human immune response to HIV-1 infection. Antibodies with 15e-like activity may be useful in immunoprophylaxis or immunotherapy of HIV-1 infection.

Deficient human immunodeficiency virus type 1-specific cytotoxic T cell responses in vertically infected children

Cytotoxic T lymphocyte (CTL) responses to human immunodeficiency virus type 1 (HIV-1) gag proteins were studied prospectively in 17 children (12 infected) born of mothers with HIV-1 seropositivity and in five pediatric patients with hemophilia infected by transfusion of HIV-1-contaminated factor VIII concentrate. B lymphoblastoid cells infected with vaccinia virus vectors expressing HIV-1 gag gene products were combined with autologous peripheral blood mononuclear cells to detect circulating CTLs. Effector cells were defined by monoclonal antibody-mediated, complement-dependent cytolysis. Circulating HIV-1 gag-specific cytotoxic responses were detectable in 4 of 5 HIV-1-infected pediatric hemophilic patients, and were similar in magnitude to those previously described in adults. In contrast, circulating HIV-1 gag-specific cytolysis was detectible in only 3 of 12 vertically infected children. Depletion data revealed that the majority of detectible gag-specific cytolysis was CD8 T cell-mediated. No apparent relationships between CD4 T cell counts, CD8 T cells counts, or serum p24 antigen levels and CTL responses were seen. Deficient CTL development may, in part, explain the more rapid onset of symptomatic disease following vertical HIV infection.

Quantitation of human immunodeficiency virus in vertically infected infants and children

We used a quantitative human immunodeficiency virus, type 1 (HIV-1) culture method to determine whether there is a relationship between the amount of replicating virus in the blood of vertically infected children and the relatively short latency period before development of symptomatic disease in these children. HIV-1 titers were determined by end point dilution in the peripheral blood mononuclear cells and the plasma of 30 infected (CDC class P1 and P2), 36 indeterminate (CDC class PO), and 19 uninfected (CDC class P3) infants and children born to HIV-1 seropositive mothers. HIV-1 was recovered from 35 (90%) of 39 PBMC cultures and 23 (60%) of 38 plasma cultures of infected patients not receiving antiretroviral therapy. The mean HIV-1 titers tended to be higher in patients with more advanced disease (P2, D, E, or F: 1760 TCID/10(6) PBMC, 460 TCID/ml plasma) than in asymptomatic or mildly symptomatic patients (P1; P2, A or C: 90 TCID/10(6) PBMC; 60 TCID/ml plasma). A poor correlation between HIV-1 titers and serum p24 antigen levels was found. No correlation was observed between viral titers and relative or absolute numbers of CD4 lymphocytes. Plasma virus titers were lower in 9 patients receiving zidovudine (ZDV) therapy (mean 2 TCID/ml) than in untreated patients of similar clinical status. The viral titers measured in the blood of vertically infected infants and children were on the same order of magnitude as the viral titers measured in HIV-infected adults. We conclude that the relatively rapid progression to symptomatic disease of the majority of vertically infected patients is not due to a higher load of replicating virus in blood.

Inhibition of human immunodeficiency virus type 1 (HIV-1) replication by the dipyridodiazepinone BI-RG-587

The dipyridodiazepinone human immunodeficiency virus type 1 (HIV-1)-specific reverse transcriptase (RT) inhibitor BI-RG-587 was tested for its ability to inhibit HIV-1 replication in both acutely and chronically infected cell lines. The ability of BI-RG-587 to inhibit steps in the virus replicative cycle other than reverse transcription was also assessed. BI-RG-587 was found to be a potent inhibitor of HIV-1 replication in acutely infected cells (50% inhibitory concentration [IC50] = 37.2 nM), and the sensitivity and kinetics of that inhibition was similar to the known RT inhibitor zidovudine (AZT). Even at 100x IC50, BI-RG-587 had no effect on gp120/CD4 interaction, syncytia formation, or envelope glycoprotein processing. In addition, no inhibition of viral replication or protein production was noted in a chronically infected cell line that produces viral products in an RT-independent manner. Finally, no inhibition of acute HIV-2 replication was noted, even with very high (2500x IC50 for HIV-1) concentrations of BI-RG-587. These results demonstrate that BI-RG-587 is a potent inhibitor of HIV-1 replication and that this inhibition occurs at the point of reverse transcription.

Broadly reactive antibody-dependent cellular cytotoxic response to HIV-1 envelope glycoproteins precedes broad neutralizing response in human infection

To determine if and when the antibody-dependent cell-mediated cytotoxic (ADCC) response of human serum exhibits broad reactivity across HIV-1 strains, multiple sera were tested for their ability to mediate ADCC against target cells infected with recombinant vaccinia vectors expressing envelope genes of HTLV-IIIB or HTLV-IIIRF. These vectors were found to express the envelope glycoproteins of the two HIV-1 strains and so were appropriate targets for ADCC assays. All the HIV-1-positive sera were able to mediate ADCC against both HTLV-IIIB and HTLV-IIIRF envelope-expressing targets at similar titer. In sera from early seroconverters, the ADCC response was again broadly reactive, even in those sera that exhibited strain-specific neutralizing antibody responses. The ADCC response to natural infection with HIV-1 is therefore broadly reactive and precedes the development of a broad neutralizing antibody response. The broad reactivity of HIV-1-specific ADCC responses may be important for protection against cell-associated virus in vaccine development.

Racial/ethnic differences in HIV-1 seroprevalence and risky behaviors among intravenous drug users in a multisite study

Differences in human immunodeficiency virus type 1 (HIV-1) seroprevalence and patterns of drug-use and sexual behaviors were examined among Hispanic, black, and white intravenous drug users recruited at multiple sites in Worcester, Massachusetts. A total of 1,092 (786 males, 306 females) intravenous drug users were interviewed, and HIV-1 antibody test results were available for 874 (80.0%). After adjustment for demographic differences, black males were significantly less likely to report risky drug-use behaviors (ever sharing needles and recently visiting shooting galleries) compared with white males. In contrast, Hispanic males were significantly more likely to report recent risky drug-use behaviors (sharing needles in New York City, daily needle-sharing, and visiting shooting galleries). Both groups were less likely to report risky sexual behaviors compared with whites. The odds ratios for HIV-1 seropositivity remained significantly greater than 1 for Hispanics compared with whites (odds ratio = 4.5) and maintained marginal significance for blacks compared with whites (odds ratio = 2.1) when adjusted for risky behaviors and demographic variables. The different patterns of drug-use and sexual behaviors by race/ethnicity indicate the need for interventions targeted to specific populations.

A chronic "postinfectious" fatigue syndrome associated with benign lymphoproliferation, B-cell proliferation, and active replication of human herpesvirus-6

A 17-year-old, previously healthy woman developed an acute "mononucleosis-like" illness with an associated "atypical" pneumonitis, followed by years of debilitating chronic fatigue, fevers, a 10-kg weight loss, night sweats, and neurocognitive symptoms. Thereafter, her sister developed a similar but less severe illness. The patient developed marked, chronic lymphadenopathy and splenomegaly, with associated persistent relative lymphocytosis and atypical lymphocytosis and with thrombocytopenia. After 3 years of illness, a splenectomy was performed, which resulted in some symptomatic improvement, prompt weight gain, and resolution of all hematologic abnormalities. Serial immunologic studies revealed a strikingly elevated number of activated B lymphocytes and a T lymphopenia, which improved but did not return to normal postsplenectomy. No causal association was found with any of several infectious agents that could produce such a lymphoproliferative illness. However, both the patient and her sister had evidence of active infection with the recently discovered human herpesvirus-6. Seven years after the onset of the illness, the patient and her sister remain chronically ill.

Breast carcinoma metastatic to endometrial polyp

An elderly woman presented with an enlarged uterus without uterine bleeding. The hysterectomy specimen contained a large, solitary intrauterine mass. Microscopic examination revealed metastatic poorly differentiated adenocarcinoma infiltrating an endometrial polyp. This metastatic tumor appeared histologically identical to the patient's ductal carcinoma of the breast removed by modified radical mastectomy 6 years earlier. An extrapelvic primary carcinoma metastatic to tan endometrial polyp is a very rare event but should be included in the differential diagnosis of endometrial carcinomas.

Immune responses to Herpesvirus sylvilagus infection in cottontail rabbits

Immunologic changes produced by Herpesvirus sylvilagus infection of cottontail rabbits were investigated to evaluate this virus infection system as an animal model for EBV infection in humans. H. sylvilagus neutralizing antibodies appeared as early as 7 days after infection, peaked 2 to 4 wk postinfection and decreased to low levels by 8 to 10 wk postinfection. Complement-dependent antibodies mediating the protection of in vitro infection of monocytes and Con A-stimulated lymphoblasts with H. sylvilagus were observed as were complement-dependent cytotoxic antibodies against H. sylvilagus-infected cells. No cytolytic activity was present in sera taken either before or 3 days after infection; cytolysis was first observed 7 days after infection. The development of cytolytic antibodies appeared to be biphasic during an infection course of 12 to 16 wk. In vivo induction of a primary cytotoxic lymphocyte response to H. sylvilagus was also investigated. Splenic lymphocytes from infected animals lysed H. sylvilagus-infected skin fibroblasts; however, similar activity was not observed when PBMC or mesenteric lymph node lymphocytes were used as effector cells. H. sylvilagus-infected autologous skin fibroblasts were preferentially lysed as compared to heterologous skin fibroblasts. This virus-specific cytotoxic activity appeared 5 days postinfection and peaked 7 days postinfection. By 28 days postinfection, only low levels of cytotoxic activity were detected in spleen cells. Herpesvirus sylvilagus infection of cottontail rabbits provides an animal model for the study of lymphoproliferative disorders induced by herpesviruses.

Immune responses to Herpesvirus sylvilagus infection in cottontail rabbits

Immunologic changes produced by Herpesvirus sylvilagus infection of cottontail rabbits were investigated to evaluate this virus infection system as an animal model for EBV infection in humans. H. sylvilagus neutralizing antibodies appeared as early as 7 days after infection, peaked 2 to 4 wk postinfection and decreased to low levels by 8 to 10 wk postinfection. Complement-dependent antibodies mediating the protection of in vitro infection of monocytes and Con A-stimulated lymphoblasts with H. sylvilagus were observed as were complement-dependent cytotoxic antibodies against H. sylvilagus-infected cells. No cytolytic activity was present in sera taken either before or 3 days after infection; cytolysis was first observed 7 days after infection. The development of cytolytic antibodies appeared to be biphasic during an infection course of 12 to 16 wk. In vivo induction of a primary cytotoxic lymphocyte response to H. sylvilagus was also investigated. Splenic lymphocytes from infected animals lysed H. sylvilagus-infected skin fibroblasts; however, similar activity was not observed when PBMC or mesenteric lymph node lymphocytes were used as effector cells. H. sylvilagus-infected autologous skin fibroblasts were preferentially lysed as compared to heterologous skin fibroblasts. This virus-specific cytotoxic activity appeared 5 days postinfection and peaked 7 days postinfection. By 28 days postinfection, only low levels of cytotoxic activity were detected in spleen cells. Herpesvirus sylvilagus infection of cottontail rabbits provides an animal model for the study of lymphoproliferative disorders induced by herpesviruses.

Subcellular localization of low-abundance human immunodeficiency virus nucleic acid sequences visualized by fluorescence in situ hybridization

Detection and subcellular localization of human immunodeficiency virus (HIV) were investigated using sensitive high-resolution in situ hybridization methodology. Lymphocytes infected with HIV in vitro or in vivo were detected by fluorescence after hybridization with either biotin or digoxigenin-labeled probes. At 12 hr after infection in vitro, a single intense signal appeared in the nuclei of individual cells. Later in infection, when cytoplasmic fluorescence became intense, multiple nuclear foci frequently appeared. The nuclear focus consisted of newly synthesized HIV RNA as shown by hybridization in the absence of denaturation and by susceptibility to RNase and actinomycin D. Virus was detected in patient lymphocytes and it was shown that a singular nuclear focus also characterizes cells infected in vivo. The cell line 8E5/LAV containing one defective integrated provirus revealed a similar focus of nuclear RNA, and the single integrated HIV genome was unequivocally visualized on a D-group chromosome. This demonstrates an extremely sensitive single-cell assay for the presence of a single site of HIV transcription in vitro and in vivo and suggests that it derives from one (or very few) viral genomes per cell. In contrast, productive Epstein-Barr virus infection exhibited many foci of nuclear RNA per cell.