HIV-1 and HIV-2 double infection in French homosexual male with AIDS-related complex (Paris, 1985)
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Biomedical subjects
Publications and source records attributed to M Harzic.
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Cytomegalovirus (CMV) infection is a major cause of morbidity in immunodepressed patients: the diagnosis is based on the demonstration of CMV viraemia and/or specific IgM and/or a significant rise in antibody titres. This study was undertaken to compare the diagnostic value of these parameters. Eighteen patients with the AIDS and CMV infection were investigated; CMV viraemia was demonstrated in 87 p. 100 and specific IgM in 23 p. 100 of cases; in 24 patients followed up for 4 months after bone marrow transplantation viraemia was demonstrated in 70 p. 100 and IgM in 54 p. 100 of cases; however, the detection of IgM was often late. In contrast, specific IgM is frequently detected in CMV infection of non-immunodepressed patients.
The detection of CMV antibodies is the only routine method available for differentiating seronegative donors who cannot transmit CMV infection from seropositive donors who are latent carriers and who may transmit the infection by blood transfusion or transplant operations. The validity of this selection depends on the sensitivity and specificity of the method used. We compared the results of 46 serums by the following five tests known for their sensitivity: the indirect haemagglutination test, the latex agglutination test (CMV Scan, Becton-Dickinson); two ELISA tests (Enzygnost anti-Cytomegalovirus-Behring; the Abbott CMV total AB EIA), and the IgG CMV Immunocapture Wellcome. The causes of the discrepancies observed in 7 sera are discussed.
We report 31 cases of AIDS-Kaposi's sarcoma (KS) studied at the Hôpital Saint-Louis, Paris, France, from January 1983 to January 1986. Twenty-nine cases were cutaneous KS and 2 were lymph-node KS. Twenty-eight patients were homosexual or bisexual males, 1 was a woman with transfusion-AIDS and 1 was an intravenous drug-addict; one male had no known risk factor. Thirty were male and 1 female, mean age 35.5 years (+/- 8.4). All were Caucasian and positive for LAV antibodies (Elavia). 17/30 (56.6 p. 100) had a history of syphilis, 16/30 (53.3 p. 100) had a positive TPHA test, 12/30 (40 p. 100) had a history of urethral discharge, 26/31 (87 p. 100) had a history of sexually transmitted disease. 27/30 had antibodies against HBs or HBc. 14/31 (45 p. 100) presented with mild symptoms (fever, loss of weight). 10/28 (36 p. 100) had lymph node enlargement before the first cutaneous lesions of KS developed. Initial involvement included the trunk (32 p. 100), the legs (25 p. 100), the face (21 p. 100) and the lower limbs (11 p. 100). Seventy-one p. 100 of the patients had more than 10 lesions at the initial assessment. The palate was involved in 50 p. 100 of patients, the lymph nodes in 74 p. 100, the stomach in 38 p. 100, the colon in 31 p. 100. In 8 cases pulmonary involvement was present. Altogether, 55 p. 100 of the patients had visceral involvement. Enlargement of the spleen (16 p. 100) and liver (13 p. 100) was also noted. Nineteen p. 100 of the patients had chronic dermatophytic cutaneous infection, 39 p. 100 had oral candidiasis, 32 p. 100 had seborrheic dermatitis, 6 p. 100 had oral hairy leukoplakia and 26 p. 100 had trimethoprim-sulfamethoxazole eruption. Fifty-five p. 100 developed opportunistic infection (OI) (Pneumocystis carinii 8 cases, intestinal cryptosporidiosis 6 cases, cerebral toxoplasmosis 4 cases, CMV pulmonary infection 3 cases). In 14 cases KS preceded OI and in 3 cases OI preceded KS. Biological results are shown in tables II and III. Main findings were: mild inflammatory syndrome (ESR 33 +/- 24 mm, first hour), polyclonal hypergammaglobulinemia (18.6 g/l +/- 5.8), elevation of plasma factor VIII related antigen (191 +/- 66 U/dl), elevation of serum activity of angiotensin-converting enzyme (23.8 +/- 5 nmol/ml/min), low plasmatic cholesterol (3.77 +/- 1.1 mmol/l).(ABSTRACT TRUNCATED AT 400 WORDS)
Five male patients with the persistent generalized lymphadenopathy syndrome also had a sicca complex. Salivary gland biopsy specimens showed diffuse lymphocytic infiltration of the glandular parenchyma. Serum autoantibodies and rheumatoid factor were not detected. All patients had IgG antibodies to human immunodeficiency virus and IgG to the viral capsid antigen of Epstein-Barr virus. These five patients had benign lymphocytic infiltrates in other organs (lung, liver, and kidneys). Sicca complex may be one of the various manifestations of the lymphoid hyperplasia noted in human immunodeficiency virus-infected patients. In these patients, the sicca complex showed specific features related to male predominance, lack of serum autoantibodies, and peripheral-blood T-lymphocyte subset distribution.
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Cytomegalovirus infections are severe and frequent after BMT. This study included 34 bone marrow transplant recipients (23 aplastic anaemias and 11 leukaemias), their marrow donors and 125 related or non related normal controls. Assays were performed before transplantation and every 30 days between D 0 and D 90, and then every six months. They included detection of CMV induced lymphocyte proliferation in vitro, CMV antibody determinations by complement fixation and reverse haemagglutination, viraemia and/or viruria. Similarly, cellular immunity to mitogens and to other specific antigens was evaluated. During the period of study, 22 patients developed CMV infection. The diagnostic was confirmed by virus isolation from the 12th to the 96th day after the graft. Development of positive CMV proliferation test occurred from the 9th to the 84th day after virus isolation (30 to 120th day after the graft). In one case, the CMV infection was only proved by the lymphocyte proliferation to CMV in vitro and only 60 days later by viruria and 105 days later by detection of CMV antibodies. For the other 12 patients (7 aplasies and 5 leukaemias) and 10 of their bone marrow donors, no CMV infection was proved, before or after transplant, by any of the assays performed. By selecting a donor without previous CMV infection, we hope to reduce the incidence of CM infection in recipients.
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In deep seated candidiasis, only 40% of blood cultures are positive. The aim of the study was to investigate circulating Candida albicans mannan and anti-mannan antibodies as a possible help for the diagnosis of deep seated candidiasis. We have compared the results to the detection of IgM by Elisa and antibodies by immunoflourescence. The best tests, in accord to their sensitivity and specificity, are the mannan antigenemia (43% and 100%) and IgM (86% and 100%) and have to be used together.
Intestinal flora was explored in twelve patients affected with alpha-chain disease at different stages (stage A: 2 cases; stage B: 6 cases; stage C: 4 cases). Bacterial overgrowth in the jejunum was observed in 11 cases, but intestinal flora was diverse and no one species was always present; although a 3-month oral antibiotic treatment induced complete remission in one patient (stage A) it was not possible to demonstrate any pathogenic bacterial species. Intestinal lambliasis was present in 40 p. 100 of cases. Virologic studies were negative. At stages A and B of the disease, antibiotic treatment was able to improve malabsorption and/or plasma protein digestive losses in 62 p. 100 of cases; this effect seemed related to the reduction of the bacterial flora and to giardiasis eradication.