Acquired immunodeficiency syndrome in a heterosexual population in Zaire

Immunopathology of AIDS (acquired immune deficiency syndrome) observations in 75 patients with pre-AIDS and AIDS

Sequential changes in the morphology of immunocompetent and other organs, in the accompanying immunocytological and immunovirological measurements are described in 75 patients with lymphadenopathy syndrome and with AIDS. The data presented demonstrate a stepwise development of the disease from a hyperimmunization syndrome to T-cell immune deficiency. Excessive antigenic stimulation by a large number of infectious organisms or by transfusion of blood and blood products account for antigenic overloading and hyperimmunization. Among such infectious organisms are certain viruses which per se interfere with cells of the immune system as for instance Epstein-Barr virus, cytomegalovirus, and HTLV3. Developing immunological incompetence will favor the persistence of these and other infectious organisms enhancing the damage of the immune reactivity and finally allow lethal infections or malignant tumors to occur.

Slim disease: a new disease in Uganda and its association with HTLV-III infection

A new disease has recently been recognised in rural Uganda. Because the major symptoms are weight loss and diarrhoea, it is known locally as slim disease. It is strongly associated with HTLV-III infection (63 out of 71 patients) and affects females nearly as frequently as males. The clinical features are similar to those of enteropathic acquired immunodeficiency syndrome as seen in neighbouring Zaire. However, the syndrome is rarely associated with Kaposi's sarcoma (KS), although KS is endemic in this area of Uganda. Slim disease occurs predominantly in the heterosexually promiscuous population and there is no clear evidence to implicate other possible means of transmission, such as by insect vectors or re-used injection needles. The site and timing of the first reported cases suggest that the disease arose in Tanzania.

Human T-lymphotropic retroviruses

The first human retroviruses have been discovered during the past six years. They cause two diseases which involve disturbances of the growth of the T4 lymphocyte, a remarkably specific target cell type. This cell, which is central to the regulation of the immune system, is induced by human T-lymphotropic virus type I (HTLV-I) to excessive proliferation (leukaemia) and by HTLV-III to premature death (acquired immune deficiency syndrome, AIDS). Both also seem to be indirectly involved in several other disorders. The genetic structures of these retroviruses and the mechanisms by which they usurp host-cell functions are novel among retroviruses.

A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome in Africa

A prospective study of ophthalmologic findings in 20 African patients with the acquired immunodeficiency syndrome (Group 1) and nine patients with acquired immune deficiency syndrome related complex (Group 2) disclosed that 11 patients in Group 1 and two patients in Group 2 had ocular involvement. Cotton-wool spots, Roth spots, and hemorrhages were frequent features in Group 1. In this series, unlike most others, perivasculitis occurred in five patients whereas cytomegalovirus retinitis and ocular involvement of Kaposi's sarcoma were not observed. These African patients also differed from those previously described in the high proportion of women (11 of 29) and the lack of the usual risk factors (homosexuality, intravenous drug abuse, and hemophilia).

Endemic African Kaposi's sarcoma is not associated with immunodeficiency

Twenty-seven histologically confirmed Kaposi sarcoma (KS) patients resident in the Kivu Lake area of eastern Zaire were examined for immune competence. Only KS cases of the endemic African type have been observed in this high-incidence area. The median duration of the symptoms was 6 years and ranged from 1 to 38 years. Forty-one controls matched for age, sex and tribe and unrelated to the KS patients were selected from the community. Thirteen additional controls were first-degree relatives of the KS patients. No evidence of immune suppression among KS patients was found and there were no significant differences in the immune status between KS patients and controls. Total lymphocytes, B and T cells, and OKT4+ and OKT8+ cells varied within the normal range. Grouping of the KS patients in categories according to duration and disease extent did not reveal significant differences in their immune status. The number of KS patients reacting positively in a skin test to 5 recall antigens and I mitogen was similar to that of controls, except in the case of candidin, to which a higher number of KS patients were negative. The serum levels of immunoglobulins, complement factors and circulating immune complexes were comparable in KS patients and controls. Indicators of inflammatory processes [white blood cells (WBC), complement-reactive protein (CRP)] were positive in 27% of the KS patients. The prevalence and mean titer of antibody against cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B virus (HBV) and syphilis were similar in KS patients and in controls.

Regional variation in prevalence of antibody against human T-lymphotropic virus types I and III in Kenya, East Africa

The prevalence of antibodies against HTLV-III and -I was studied among populations of 6 distinctly different regions of Kenya, an equatorial African country in which AIDS has rarely been observed. Overall, 21% of subjects had ELISA reactions suggesting the presence of antibody against HTLV-III. The frequency of HTLV-III antibodies was highest among the Turkana people (50%) and lowest among the Masai (8%). Prevalence increased with age but was not related to sex. The pattern of ELISA-detected antibody against HTLV-I was similar. The specificity of these antibodies was supported by Western blot analysis of a subset of sera with high and low ELISA ratios, in which 66% and 73% of those with ELISA ratios considered positive (= greater than 5.0 in this study) also had a profile of bands consistent with HTLV-III and HTLV-I respectively. The antibodies detected were not cross-reactive between HTLV-III and HTLV-I on Western blot analysis. In a series of subjects with various parasitic and infectious diseases, patients with idiopathic splenomegaly and with schistosomiasis had a high proportion of antibodies against both HTLV-III and HTLV-I. This survey shows that reactivity in the ELISA HTLV-III and HTLV-I assays are common among Kenyans but vary considerably by region.

Analysis of the interferon system in African patients with acquired immunodeficiency syndrome

Serum interferon and in vitro production of alpha and gamma interferon by peripheral blood leucocytes were examined in 21 African patients with acquired immunodeficiency syndrome (AIDS) and in 15 African patients with AIDS-related complex. Interferon was detected in the serum of 44% of the patients with AIDS-related complex and in 70% of the patients with full-blown AIDS, and was characterized as an acid-labile alpha interferon. When compared to healthy blood donors, the interferon response of peripheral blood leucocytes to Newcastle Disease virus was impaired in 7 of 12 patients with AIDS-related complex and in 16 of 20 AIDS patients (p less than 0.005). Also, production of gamma interferon following stimulation with phytohaemagglutinin was diminished in 5 of 11 patients with AIDS-related complex and in 13 of 17 patients with AIDS (p less than 0.005). A high correlation was observed between the presence of circulating interferon and decreased in vitro production of gamma interferon, but not of alpha interferon. These results suggest that the impairment of in vitro production of gamma interferon can be used as a preclinical marker of AIDS.

Nucleotide sequence of the AIDS virus, LAV

The complete 9193-nucleotide sequence of the probable causative agent of AIDS, lymphadenopathy-associated virus (LAV), has been determined. The deduced genetic structure is unique: it shows, in addition to the retroviral gag, pol, and env genes, two novel open reading frames we call Q and F. Remarkably, Q is located between pol and env and F is half-encoded by the U3 element of the LTR. These data place LAV apart from the previously characterized family of human T cell leukemia/lymphoma viruses.

Etiology of AIDS: biological and biochemical characteristics of HTLV-III

The newly identified human HTLV-III virus, the etiologic agent for AIDS, shares many of the biological and physicochemical properties common to a family of retroviruses named human T-cell leukemia (lymphotropic) viruses, or HTLV. Because of the similarities, and because of the uniform nomenclature for human T-cell leukemia (lymphotropic) viruses adopted at the first Cold Spring Harbor Meeting on HTLV (19, 79), this newly discovered virus associated with AIDS as HTLV-III was named HTLV-III. Other investigators making independent isolations of virus have suggested naming the virus lymphadenopathy virus or LAV (3, 16), immunodeficiency associated virus or IADV (48), AIDS-related virus (41). Immunological and nucleic acid comparison has now demonstrated that these viruses are, not surprisingly, very similar to HTLV-III (55, 63, 78). In view of the wide range of disease manifestations caused by the virus, and previous discussions concerning a uniform nomenclature for human T-lymphotropic retroviruses, it would seem ill-advised to restrict the name of this virus to one clinical manifestation of one disease. The frequent isolation of HTLV-III from patients with AIDS and ARC, the detection of antibodies specific for HTLV-III in nearly all patients with these diseases and in a high proportion of individuals at risk, and finally its effect on cells in vitro, leaves little doubt that HTLV-III is causatively involved in the development of these diseases. This etiologic association is further strengthened by the detection of HTLV-III infection in many instances where a direct cause-and-effect association can be made, e.g., hemophiliacs and children with AIDS, and blood from HTLV-III infected donors and the otherwise normal recipients of this blood who subsequently develop AIDS.

Ribavirin suppresses replication of lymphadenopathy-associated virus in cultures of human adult T lymphocytes

The in-vitro effect of ribavirin on the replication of lymphadenopathy-associated virus (LAV), one of the prototype viruses aetiologically associated with lymphadenopathy syndrome and acquired immunodeficiency syndrome, was tested. Ribavirin, a nucleoside, suppressed the replication of LAV in cultures of human adult T lymphocytes. Suppression occurred at ribavirin concentrations of 50 micrograms/ml or higher.

The epidemic of acquired immunodeficiency syndrome (AIDS) and suggestions for its control in drug abusers

Intravenous (IV) users of illicit drugs have accounted for 17% of AIDS cases seen in the United States. Previous research has shown that more than half of IV drug abusers entering a drug detoxification program in New York City had serologic evidence of exposure to the virus believed to cause AIDS. Spread of AIDS among drug abusers presumably occurs by transmission of the virus via shared needles, works, or drug-containing solutions. Secondary spread of AIDS from IV drug abusers to others may occur by venereal transmission or by perinatal transmission to infants. In this article, relevant characteristics of the AIDS epidemic are presented to assist the staff of drug treatment programs in their work with IV drug abusers. Suggestions regarding the education of drug treatment personnel and the dissemination of information about AIDS to drug abusers and their families are offered. Fact sheets on AIDS for drug treatment and prison staff, and for drug abusers with and without the disease are presented. Finally, possible approaches to the prevention of AIDS in drug users are discussed.