Antibodies to HIV in Israeli hemophiliacs: relationship between serological profile and disease development

Markers predicting progression of human immunodeficiency virus-related disease

Human immunodeficiency virus (HIV) interacts with the immune system throughout the course of infection. For most of the disease process, HIV activates the immune system, and the degree of activation can be assessed by measuring serum levels of molecules such as beta 2-microglobulin and neopterin, as well as other serum and cell surface phenotype markers. The levels of some of these markers correlate with clinical progression of HIV disease, and these markers may be useful as surrogate markers for development of clinical AIDS. Because the likelihood and timing of development of clinical AIDS following seroconversion, for any particular individual, are not readily predictable, the use of nonclinical disease markers has become critically important to patient management. Surrogate markers of HIV infection are, by definition, measurable traits that correlate with disease progression. An ideal marker should identify patients at highest risk of disease progression, provide information on how long an individual has been infected, help in staging HIV disease, predict development of opportunistic infections associated with AIDS, monitor the therapeutic efficacy of immunomodulating or antiviral treatments, and the easily quantifiable, reliable, clinically available, and affordable. This review examines the current state of knowledge and the role of surrogate markers in the natural history and treatment of HIV infection. The clinical usefulness of each marker is assessed with respect to the criteria outlined for the ideal surrogate marker for HIV disease progression.

Potential use of globins and their derivatives of abnormal red blood cells in the treatment of cancer and related immune disorders

One of the most important 'antibodies' that nature has developed for malarial parasites can be used for treating cancer as well as diseases like AIDS. The globins and their derivatives of abnormal red blood cells (sickle cells and thalassemia), have evolved as a selective resistance to malarial infections. Plasmodium species of sporozoa, which parasitize red blood cells and proliferate at their cost are inhibited by these abnormal red blood cells. To test the validity of this hypothesis, the author carried out a preliminary Medline search from 1974 to 1991 to find out if persons suffering from sickle cell or thalassemia diseases are 'immune' to HIV infections and malignancies. Clinical investigations lend support to the hypothesis. A research scheme is suggested for the study of the role of these globulin derivatives as they effect the synthesis of genetic material related to cell proliferation.

Antigenic characterization of the human immunodeficiency viruses

As more is learned about the human immunodeficiency viruses HIV-1 and HIV-2, increasingly sophisticated methods of acquired immunodeficiency syndrome (AIDS) treatment and prevention may be implemented. Integral to an understanding of these viruses is an analysis of both the viral antigens and the host-immune responses to these antigens, which may differ from HIV-1 to HIV-2. Because levels of both antigen and antibody vary throughout disease development, knowledge of how and why such changes occur will lend insight into viral pathogenic mechanisms and will facilitate the development of differential diagnostic tests for classifying AIDS patients and their disease states. This task becomes very complex when dealing with HIV viruses because they possess an unprecedented number of regulatory genes for members of the retrovirus family.

Two-year evaluation of clinical and laboratory variables of immune function in 117 hemophiliacs seropositive or seronegative for HIV-1

Fifty-nine HIV-1 antibody positive and 58 antibody negative hemophiliacs were evaluated over a 2 year study period to gain insight into the natural history and prognosis of HIV-1 disease in members of this risk group. Mean CD4 (Leu 3+) cell counts calculated at 6 month intervals decreased gradually in seropositive patients (from 403 to 311/microliters) whereas CD8 (Leu 2+) counts remained stable but above the normal range. CD4 cell counts correlated closely with advancing CDC clinical stage; CD8 numbers showed no such association, but were markedly lower in the six patients with overt AIDS. Serum P24 antigenemia was associated with low CD4 cell counts and with advanced clinical stage (58% of antigenemic and 14% of non-antigenemic seropositive patients were in stage IV). In addition to CD4 cell counts, significant reductions in Leu 11+ natural killer cell (NK) subsets and in Leu 3 + 8 - cells occurred in seropositive patients over the study period; Leu 2 + DR + cells increased significantly. When expressed as a percentage of lymphocytes, the reduction in Leu 19 + NK cells was also significant, as were the increases in Leu 4 + DR + cells and Leu 12 + 8 + B cells. In summary, declining CD4 cell numbers and percentages are valuable markers of progressive HIV-1 disease in hemophiliacs, but may not always accurately reflect the degree of disease activity. Progressive changes in additional variables such as serum P24 antigen, and numbers and percentages of NK cell subsets and (as AIDS supervenes) CD8 cell numbers, may allow more precise monitoring of HIV-1 disease. This will, in turn, facilitate the design of optimal individualized strategies for therapeutic intervention.

The clinical prognosis of HIV-1 infection: a review of 32 follow-up studies

Thirty-two follow-up studies of patients with HIV-1 infection, but without AIDS at baseline, were examined for information on the risk of developing AIDS or other conditions. Disease progression in asymptomatic groups was similar to that found in patients with persistent generalized lymphadenopathy (PGL) without other symptoms. Among these asymptomatic and PGL groups, the risk of developing AIDS reached 10% to 15% between 24 and 36 months of follow up. The risk of progression to AIDS continued to increase in the studies with longer follow-up periods, reaching 36% at 88 months. However, more than 40% of "high-risk" groups (characterized by the presence of constitutional symptoms, oral thrush, herpes zoster, and/or low T4 counts) developed AIDS after only 36 months of follow-up. Reliable information about progression to other states (e.g., AIDS-related complex) has not been consistently provided.