Abstract
A recently recognized syndrome of acquired immunodeficiency (Acquired Immunodeficiency Syndrome-AIDS) has arisen since June 1981. It has received international attention. The clinical spectrum consists of repeated opportunistic infections, rare malignancies, and autoimmune phenomena, occurring in previously healthy adults with no history of an immunologic disorder. The population subset at risk for this syndrome appears to be predominantly homosexual American males and intravenous drug abusers with rare cases being reported in heterosexuals, hemophiliacs, and foreign patients, especially Haitians. The immunologic aberrancy in all patients described appears limited to T-lymphocyte hyporesponsiveness and imbalance of T-helper and suppressor cells. This disordered immunoregulation is a consistent finding in all reported cases and appears to predispose to the opportunistic infections and malignancies which have been associated with a 40 percent mortality. The underlying factor responsible for the immunoregulatory defect is unknown but possible etiologies include a transmissible infectious agent, drug use, chronic antigen stimulation, and spermatozoa exposure. Treatment of the associated infections and malignancies has been a frustrating endeavor as many patients respond incompletely or relapse soon after successful treatment course. Preventive measures, including patient education, physician awareness, and immunomodulating agents, are discussed.
Full text
PDF









Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Boldogh I., Beth E., Huang E. S., Kyalwazi S. K., Giraldo G. Kaposi's sarcoma. IV. Detection of CMV DNA, CMV RNA and CMNA in tumor biopsies. Int J Cancer. 1981 Oct 15;28(4):469–474. doi: 10.1002/ijc.2910280412. [DOI] [PubMed] [Google Scholar]
- Brown S. M., Stimmel B., Taub R. N., Kochwa S., Rosenfield R. E. Immunologic dysfunction in heroin addicts. Arch Intern Med. 1974 Dec;134(6):1001–1006. [PubMed] [Google Scholar]
- Carney W. P., Rubin R. H., Hoffman R. A., Hansen W. P., Healey K., Hirsch M. S. Analysis of T lymphocyte subsets in cytomegalovirus mononucleosis. J Immunol. 1981 Jun;126(6):2114–2116. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) A cluster of Kaposi's sarcoma and Pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Orange Counties, California. MMWR Morb Mortal Wkly Rep. 1982 Jun 18;31(23):305–307. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs. MMWR Morb Mortal Wkly Rep. 1982 Nov 5;31(43):577–580. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Follow-up on Kaposi's sarcoma and Pneumocystis pneumonia. MMWR Morb Mortal Wkly Rep. 1981 Aug 28;30(33):409–410. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep. 1981 Jul 3;30(25):305–308. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Opportunistic infections and Kaposi's sarcoma among Haitians in the United States. MMWR Morb Mortal Wkly Rep. 1982 Jul 9;31(26):353-4, 360-1. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Persistent, generalized lymphadenopathy among homosexual males. MMWR Morb Mortal Wkly Rep. 1982 May 21;31(19):249–251. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Pneumocystis carinii pneumonia among persons with hemophilia A. MMWR Morb Mortal Wkly Rep. 1982 Jul 16;31(27):365–367. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Pneumocystis pneumonia--Los Angeles. MMWR Morb Mortal Wkly Rep. 1981 Jun 5;30(21):250–252. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Update on Kaposi's sarcoma and opportunistic infections in previously healthy persons--United States. MMWR Morb Mortal Wkly Rep. 1982 Jun 11;31(22):294, 300-1. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Update on acquired immune deficiency syndrome (AIDS)--United States. MMWR Morb Mortal Wkly Rep. 1982 Sep 24;31(37):507-8, 513-4. [PubMed] [Google Scholar]
- DeStefano E., Friedman R. M., Friedman-Kien A. E., Goedert J. J., Henriksen D., Preble O. T., Sonnabend J. A., Vilcek J. Acid-labile human leukocyte interferon in homosexual men with Kaposi's sarcoma and lymphadenopathy. J Infect Dis. 1982 Oct;146(4):451–459. doi: 10.1093/infdis/146.4.451. [DOI] [PubMed] [Google Scholar]
- Drew W. L., Mintz L., Miner R. C., Sands M., Ketterer B. Prevalence of cytomegalovirus infection in homosexual men. J Infect Dis. 1981 Feb;143(2):188–192. doi: 10.1093/infdis/143.2.188. [DOI] [PubMed] [Google Scholar]
- Durack D. T. Opportunistic infections and Kaposi's sarcoma in homosexual men. N Engl J Med. 1981 Dec 10;305(24):1465–1467. doi: 10.1056/NEJM198112103052408. [DOI] [PubMed] [Google Scholar]
- Fauci A. S. The syndrome of Kaposi's sarcoma and opportunistic infections: an epidemiologically restricted disorder of immunoregulation. Ann Intern Med. 1982 Jun;96(6 Pt 1):777–779. doi: 10.7326/0003-4819-96-6-777. [DOI] [PubMed] [Google Scholar]
- Friedman-Kien A. E., Laubenstein L. J., Rubinstein P., Buimovici-Klein E., Marmor M., Stahl R., Spigland I., Kim K. S., Zolla-Pazner S. Disseminated Kaposi's sarcoma in homosexual men. Ann Intern Med. 1982 Jun;96(6 Pt 1):693–700. doi: 10.7326/0003-4819-96-6-693. [DOI] [PubMed] [Google Scholar]
- Goedert J. J., Neuland C. Y., Wallen W. C., Greene M. H., Mann D. L., Murray C., Strong D. M., Fraumeni J. F., Jr, Blattner W. A. Amyl nitrite may alter T lymphocytes in homosexual men. Lancet. 1982 Feb 20;1(8269):412–416. doi: 10.1016/s0140-6736(82)91617-8. [DOI] [PubMed] [Google Scholar]
- Goode E., Troiden R. R. Amyl nitrite use among homosexual men. Am J Psychiatry. 1979 Aug;136(8):1067–1069. doi: 10.1176/ajp.136.8.1067. [DOI] [PubMed] [Google Scholar]
- Gottlieb M. S., Schroff R., Schanker H. M., Weisman J. D., Fan P. T., Wolf R. A., Saxon A. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981 Dec 10;305(24):1425–1431. doi: 10.1056/NEJM198112103052401. [DOI] [PubMed] [Google Scholar]
- Harwood A. R., Osoba D., Hofstader S. L., Goldstein M. B., Cardella C. J., Holecek M. J., Kunynetz R., Giammarco R. A. Kaposi's sarcoma in recipients of renal transplants. Am J Med. 1979 Nov;67(5):759–765. doi: 10.1016/0002-9343(79)90731-9. [DOI] [PubMed] [Google Scholar]
- Ho M. The lymphocyte in infections with Epstein-Barr virus and cytomegalovirus. J Infect Dis. 1981 Jun;143(6):857–862. doi: 10.1093/infdis/143.6.857. [DOI] [PubMed] [Google Scholar]
- Hurtenbach U., Morgenstern F., Bennett D. Induction of tolerance in vitro by autologous murine testicular cells. J Exp Med. 1980 Apr 1;151(4):827–838. doi: 10.1084/jem.151.4.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hurtenbach U., Shearer G. M. Germ cell-induced immune suppression in mice. Effect of inoculation of syngeneic spermatozoa on cell-mediated immune responses. J Exp Med. 1982 Jun 1;155(6):1719–1729. doi: 10.1084/jem.155.6.1719. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hymes K. B., Cheung T., Greene J. B., Prose N. S., Marcus A., Ballard H., William D. C., Laubenstein L. J. Kaposi's sarcoma in homosexual men-a report of eight cases. Lancet. 1981 Sep 19;2(8247):598–600. doi: 10.1016/s0140-6736(81)92740-9. [DOI] [PubMed] [Google Scholar]
- Jorizzo J. L., Sams W. M., Jr, Jegasothy B. V., Olansky A. J. Cimetidine as an immunomodulator: chronic mucocutaneous candidiasis as a model. Ann Intern Med. 1980 Feb;92(2 Pt 1):192–195. doi: 10.7326/0003-4819-92-2-192. [DOI] [PubMed] [Google Scholar]
- Kazal H. L., Sohn N., Carrasco J. I., Robilotti J. G., Delaney W. E. The gay bowel syndrome: clinico-pathologic correlation in 260 cases. Ann Clin Lab Sci. 1976 Mar-Apr;6(2):184–192. [PubMed] [Google Scholar]
- Kornfeld H., Vande Stouwe R. A., Lange M., Reddy M. M., Grieco M. H. T-lymphocyte subpopulations in homosexual men. N Engl J Med. 1982 Sep 16;307(12):729–731. doi: 10.1056/NEJM198209163071206. [DOI] [PubMed] [Google Scholar]
- Kung P., Goldstein G., Reinherz E. L., Schlossman S. F. Monoclonal antibodies defining distinctive human T cell surface antigens. Science. 1979 Oct 19;206(4416):347–349. doi: 10.1126/science.314668. [DOI] [PubMed] [Google Scholar]
- Lang D. J., Kummer J. F., Hartley D. P. Cytomegalovirus in semen. Persistence and demonstration in extracellular fluids. N Engl J Med. 1974 Jul 18;291(3):121–123. doi: 10.1056/NEJM197407182910303. [DOI] [PubMed] [Google Scholar]
- Leung F., Fam A. G., Osoba D. Kaposi's sarcoma complicating corticosteroid therapy for temporal arteritis. Am J Med. 1981 Aug;71(2):320–322. doi: 10.1016/0002-9343(81)90135-2. [DOI] [PubMed] [Google Scholar]
- Marmor M., Friedman-Kien A. E., Laubenstein L., Byrum R. D., William D. C., D'onofrio S., Dubin N. Risk factors for Kaposi's sarcoma in homosexual men. Lancet. 1982 May 15;1(8281):1083–1087. doi: 10.1016/s0140-6736(82)92275-9. [DOI] [PubMed] [Google Scholar]
- Marx J. L. New disease baffles medical community. Science. 1982 Aug 13;217(4560):618–621. doi: 10.1126/science.7089584. [DOI] [PubMed] [Google Scholar]
- Masur H., Michelis M. A., Greene J. B., Onorato I., Stouwe R. A., Holzman R. S., Wormser G., Brettman L., Lange M., Murray H. W. An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. N Engl J Med. 1981 Dec 10;305(24):1431–1438. doi: 10.1056/NEJM198112103052402. [DOI] [PubMed] [Google Scholar]
- Masur H., Michelis M. A., Wormser G. P., Lewin S., Gold J., Tapper M. L., Giron J., Lerner C. W., Armstrong D., Setia U. Opportunistic infection in previously healthy women. Initial manifestations of a community-acquired cellular immunodeficiency. Ann Intern Med. 1982 Oct;97(4):533–539. doi: 10.7326/0003-4819-97-4-533. [DOI] [PubMed] [Google Scholar]
- McDonough R. J., Madden J. J., Falek A., Shafer D. A., Pline M., Gordon D., Bokos P., Kuehnle J. C., Mendelson J. Alteration of T and null lymphocyte frequencies in the peripheral blood of human opiate addicts: in vivo evidence for opiate receptor sites on T lymphocytes. J Immunol. 1980 Dec;125(6):2539–2543. [PubMed] [Google Scholar]
- Morris L., Distenfeld A., Amorosi E., Karpatkin S. Autoimmune thrombocytopenic purpura in homosexual men. Ann Intern Med. 1982 Jun;96(6 Pt 1):714–717. doi: 10.7326/0003-4819-96-6-714. [DOI] [PubMed] [Google Scholar]
- Owen W. F., Jr Sexually transmitted diseases and traumatic problems in homosexual men. Ann Intern Med. 1980 Jun;92(6):805–808. doi: 10.7326/0003-4819-92-6-805. [DOI] [PubMed] [Google Scholar]
- Phillips S. C., Mildvan D., William D. C., Gelb A. M., White M. C. Sexual transmission of enteric protozoa and helminths in a venereal-disease-clinic population. N Engl J Med. 1981 Sep 10;305(11):603–606. doi: 10.1056/NEJM198109103051102. [DOI] [PubMed] [Google Scholar]
- Rand K. H., Pollard R. B., Merigan T. C. Increased pulmonary superinfections in cardiac-transplant patients undergoing primary cytomegalovirus infection. N Engl J Med. 1978 Apr 27;298(17):951–953. doi: 10.1056/NEJM197804272981705. [DOI] [PubMed] [Google Scholar]
- Reinherz E. L., Kung P. C., Goldstein G., Schlossman S. F. Separation of functional subsets of human T cells by a monoclonal antibody. Proc Natl Acad Sci U S A. 1979 Aug;76(8):4061–4065. doi: 10.1073/pnas.76.8.4061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Reinherz E. L., Schlossman S. F. The differentiation and function of human T lymphocytes. Cell. 1980 Apr;19(4):821–827. doi: 10.1016/0092-8674(80)90072-0. [DOI] [PubMed] [Google Scholar]
- Rinaldo C. R., Jr, Carney W. P., Richter B. S., Black P. H., Hirsch M. S. Mechanisms of immunosuppression in cytomegaloviral mononucleosis. J Infect Dis. 1980 Apr;141(4):488–495. doi: 10.1093/infdis/141.4.488. [DOI] [PubMed] [Google Scholar]
- Shanley J. D., Pesanti E. L. Replication of murine cytomegalovirus in lung macrophages: effect of phagocytosis of bacteria. Infect Immun. 1980 Sep;29(3):1152–1159. doi: 10.1128/iai.29.3.1152-1159.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Siegal F. P., Lopez C., Hammer G. S., Brown A. E., Kornfeld S. J., Gold J., Hassett J., Hirschman S. Z., Cunningham-Rundles C., Adelsberg B. R. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med. 1981 Dec 10;305(24):1439–1444. doi: 10.1056/NEJM198112103052403. [DOI] [PubMed] [Google Scholar]