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PubMed2004

Effect of hyperglycemia and hyperinsulinemia on the response of IL-6, TNF-alpha, and FFAs to low-dose endotoxemia in humans.

Insulin therapy to maintain euglycemia increases survival in critically ill patients. To explore possible mechanisms of action, we investigated the effect of endotoxin on circulating cytokines, free fatty acids (FFA), and leukocytes during manipulated plasma glucose and insulin concentrations. Ten volunteers underwent three trials each, receiving an intravenous bolus of endotoxin (0.2 ng/kg) during normoglycemia (trial A, control), during a hyperglycemic clamp at 15 mM (trial B), and during a hyperinsulinemic euglycemic clamp (trial C). Endotoxin induced an increase in neutrophil count, a decrease in lymphocyte count, and an increase in serum levels of TNF-alpha, IL-6, and FFA. There was no difference in the TNF response between the three trials; the IL-6 levels were increased during the late phase of trials B and C compared with trial A. The endotoxin-induced elevation in FFA in trial A was suppressed during trials B and C. Clamping (trials B and C) caused a reduction in lymphocyte count that persisted after endotoxin injection. We conclude that low-dose endotoxemia triggers a subclinical inflammatory response and an elevation in FFA. The finding that high insulin serum concentrations induce a more prolonged increase in the anti-inflammatory cytokine IL-6 and suppress the levels of FFA suggests that insulin treatment of patients with sepsis may exert beneficial effects by inducing anti-inflammation and protection against FFA toxicity, and thereby inhibit FFA-induced insulin resistance.

Adult↗

PubMed1997

[Quantification of viremia in patients infected with human immunodeficiency virus with different degrees of immunosuppression].

BACKGROUND: Many of the therapeutical decisions related to patients infected with human immunodeficiency virus (HIV) are taken considering the CD4+ lymphocyte count. The recent availability of procedures which quantitate the number of viral particles in peripheral blood has disclosed that viremia degree is the best predictor of HIV disease progression. Nevertheless, the proportion of subjects who despite a normal CD4+ lymphocyte count, have a high viremia and a high risk of short term progression to AIDS is not well known. PATIENTS AND METHODS: Plasma viremia was investigated in 120 adults subjects with a known time of HIV infection. Fifty-two patients had a CD4+ lymphocyte count > 500 x 10(6)/l (CDC group 1), 42 had a number of CD4+ lymphocytes ranging from 200 and 500 x 10(6)/l (CDC group 2), and 26 had a count < 200 x 10(6)/l (CDC group 3). None of the patients was receiving antiretroviral treatment or had intercurrent infections at the time of the study. RESULTS: Mean values of viremia showed an inverse significant relationship with the CD4+ lymphocyte count. In CDC group 1 subjects the distribution of viremia was as follows: low (< 3,000 copies of HIV RNA/ml) in 16 (30.8%), intermediate in 20 (38.4%), and high (> 30,000 copies of HIV RNA/ml) in 16 (30.8%). In eight subjects from CDC group 1, the duration of HIV infection was less than 5 years. In contrast, in patients from CDC group 3, viremia was high in 17 (65.4%), intermediate in 9 (34.6%), and none of them had a low degree viremia. In CDC group 2 patients, viremia was high in 14 (33.3%), intermediate in 20 (47.6%), and low in 8 (19.1%). CONCLUSION: There is an inverse correlation between the viremia degree and the CD4+ lymphocyte count among HIV-positive patients. Nevertheless, there can be a high viremia in absence of low CD4+ lymphocyte count, particularly among subjects with HIV infection for less than 5 years, in whom an early therapeutical intervention might be warranted.

Adult↗

PubMed1991

Physical activity and the immune system.

Methods of examining immune function include a charting of susceptibility to infections, differential blood counts or lymphocyte counts, and measures of cell proliferation and immunoglobulin synthesis in response to external mitogens. The reported acute response to exercise is transient and quite variable, depending upon the type of exercise, the immunological methodology used, the intensity of effort relative to the fitness of the individual, and the timing of observation. A leucocytosis, a granulocytosis, a small lymphocytosis, and a decrease in the proportion of T to B cells reflect mainly changes of blood volume, demargination, and migration of cells. Lymphocyte subsets show a decreased helper/suppressor cell ratio and an increase of natural killer cells. Because of the lymphocytosis, mitogens induce an increased overall cell proliferation, but proliferation for a given number of cells is decreased. Prolonged exercise leads to a decrease of serum and salivary immunoglobulin levels. Soluble factors such as interleukin-1 and interferon are increased by a bout of exercise. Cross-sectional comparisons and training experiments suggest that under resting conditions well-conditioned individuals show some lymphocytosis, increased natural killer cell activity, higher levels of interleukin-1, and possibly an enhanced reaction to mitogens. Moderate training does not greatly change exercise responses at a given fraction of maximal effort. Excessive training suppresses immune function, but the changes are small, variable, and thus difficult to relate to overtraining. Moreover, because of their transient nature, they have only a limited influence upon the risks of infection or cancer.

Exercise↗

PubMed1987

Immunological profile after splenectomy in children with beta-thalassaemia major.

The in vitro immune functions of peripheral blood lymphocytes have been studied in 12 children with beta-thalassaemia major and hypersplenism. The study was performed prior to splenectomy and on the 2nd, 6th, 15th and 30th day after splenectomy. It was found that before splenectomy, patients had low numbers of blood leucocytes, normal rosette and T3 lymphocyte counts, low T4 and normal T8 lymphocyte counts with a T4/T8 ratio below 2, impaired T lymphocyte mitogenic responses induced by PHA, increased numbers of polyvalent and monovalent B lymphocytes and normal immunoglobulin levels of IgG and IgA. After splenectomy, especially on the 2nd day, leucocytosis, a significant decrease of T cells and their subsets and a reduction of the IgM levels were found. These parameters, except the IgM levels, increased until the 30th day after splenectomy and reached presplenectomy values. On the 2nd day after splenectomy, large mononuclear cells behaving like immunocytes appeared in the peripheral blood. They had the phenotype of T3, T4, T8, B lymphocytes and OKM1 monocytes. All the large mononuclear cells increased significantly on the 6th day after splenectomy and remained elevated during the whole study (30 days). The T4/T8 ratio was increased, but no increase was found in the functional responses of T lymphocytes.

Adolescent↗

PubMed2000

Current antipsychotic dose correlates to mononuclear cell counts in the cerebrospinal fluid of psychotic patients.

Elevated cerebrospinal fluid (CSF) angiotensin I-converting enzyme (ACE) levels have been evidenced in patients with schizophrenia who have been treated with antipsychotics. In order to explore a possible mononuclear cell origin of CSF ACE, the authors determined CSF ACE and CSF mononuclear cell counts from 25 acutely psychotic patients, who had been drug-free for at least 4 months but started on conventional antipsychotic medication within a few days before sampling. No correlations were found between CSF to serum ACE ratio and CSF mononuclear cell counts. However, CSF total mononuclear cell count, CSF lymphocyte count, and CSF mononuclear phagocyte count evidenced significant positive correlations with current dose of antipsychotic medication expressed as chlorpromazine equivalents. The authors conclude that no indication of a relationship between mononuclear cells and CSF ACE activity was found. Surprisingly, a relationship between chlorpromazine dose and CSF mononuclear cell counts was found, which may indicate drug-related changes in cell-mediated immunity. This finding needs replication and further corroboration in well-designed studies.

Acute Disease↗

PubMed1994

[Non-Hodgkin's lymphomas in patients with human immunodeficiency virus infections. Clinicopathologic characteristics, treatment response and prognosis in 40 patients].

BASIS: Non-Hodgkin lymphoma (NHL) is one of the commonest neoplasms appearing in subjects infected by the human immunodeficiency virus (HIV). The purpose of this work was to analyse the clinical and laboratory characteristics, along with the clinical course, response to therapy and prognosis in a series of 40 patients with NHL and HIV infection treated in a single institution between 1985 and 1993. METHODS: The following variables at onset were analysed: age, sex, risky behaviour, NHL location, presence of "B" symptoms, haemoglobin value, platelet count, total number of lymphocytes and CD4-positive lymphocyte count, erythrocyte sedimentation rate, LDH levels, serum albumin, beta 2-microglobulin, NHL type and staging. The following variables during follow-up were also examined: treatment administered, achievement of remission and remission duration, date of relapse and death or date of the last control, relapse-free survival (RFS) and overall survival (OS). A multivariate study of the prognostic factors associated to the achievement of remission, RFS and OS were carried out as well. RESULTS: The frequency of NHL amongst the HIV-positive subjects was 4.4%. Thirty cases had high-grade lymphoma, 20 were stage IV and 33 had extranodal locations. Anaemia was the commonest blood impairment and CD4-positive lymphocyte count was below 0.2 x 10(9)/L in 72% of the cases. Twenty-eight patients with systemic NHL received chemotherapy (CHOP in 25 instances, MACOP-B in 3), and of them 6 were alive, 5 in maintained remission, as for this paper's writing. The median RFS was 7 months and the median OS was 11 months. Increased serum LDH was associated with lesser probability of attaining both remission (p = 0.03) and RFS (p = 0.03). Response to therapy was the main factor in determining survival (p = 0.002); after excluding such factor, increased serum LDH and low serum albumin rates correlated negatively with OS (p = 0.004 and p = 0.007, respectively). CONCLUSIONS: HIV-positive patients, when affected by NHL, usually have high-grade lymphoma, frequently in advanced stages and with extra-nodal involvement. They show poor response to therapy. Increased serum LDH level is the main prognostic factor.

Adult↗

PubMed1997

Distribution of lymphocyte subsets in bone marrow and peripheral blood is associated with haptoglobin type. Binding of haptoglobin to the B-cell lectin CD22.

Haptoglobin is an acute phase protein showing a genetic polymorphism with 3 major types: Hp 1-1, Hp 2-1, and Hp 2-2. In this study, flow cytometric analysis demonstrated that all three haptoglobin types bind to CD22 on human B-lymphocytes with equal affinity. Comparison of reference values for lymphocyte subsets in peripheral blood and bone marrow showed significant differences between haptoglobin types. Haptoglobin 2-2 is associated with higher peripheral B-lymphocyte counts (P < 0.001) and CD4+ T-lymphocyte counts (P < 0.05). In bone marrow, CD4+ T-cell percentages were highest (P < 0.001) but B-cell percentages were lowest (P < 0.001) in haptoglobin 2-2 type. A negative correlation between serum haptoglobin 1-1 concentration and peripheral B-cell counts was observed (r = -0.663). Our results suggest that haptoglobin is involved in lymphocyte distribution. The present findings are a potential cause of over- or underestimation of lymphocyte subset counts in the clinical staging of immunodeficiency diseases.

Adult↗

PubMed1995

Sequential phenotyping of myeloma patients on chemotherapy: persistence of activated T-cells and natural killer cells.

To better detail the status of functional T cell subsets and natural killer cells in multiple myeloma, we undertook a detailed immunophenotypic study of circulating mononuclear cells in myeloma. We studied myeloma patients entered on a large prospective, randomized ECOG chemotherapy trial EST 9486 for patients with newly diagnosed multiple myeloma. All patients were studied prior to entry and then two months after initiation of therapy (e.g. post two cycles of Vincristine, BCNU, melphalan, cyclophosphamide and prednisone (VBMCP)). The chemotherapy protocol was a three-arm protocol utilizing either VBMCP, VBMCP alternating with interferon, or VBMCP with intermittent high dose cyclophosphamide. The major findings in this analysis include significant reductions in the white blood cell count, total lymphocytes, T cell (CD3+), T helper (CD4+), and T suppressor (CD8+) cells, after 2 cycles of VBMCP. However, there was a relative sparing of Natural killer (CD16+) and activated T cell (CD2+, HLADR+) reduction in these same patients. In summary, only two cycles of combination chemotherapy resulted in significant reductions in white blood cell and lymphocyte counts in multiple myeloma patients. All cell types appear to have been reduced by chemotherapy except for activated T cells and natural killer cells. The impact of selective modulation of functional T cells subsets during therapy for patients with multiple myeloma is an important parameter which needs to be addressed in the overall approach to these patients.

Flow Cytometry↗

PubMed2002

Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi.

BACKGROUND: Human immunodeficiency virus (HIV) seropositive patients frequently experience upper gastrointestinal tract (GIT) symptoms that cause considerable morbidity and are due to multiple aetiologies. The role of Helicobacter pylori gastric mucosal infection in HIV related upper GIT morbidity is unclear. No data exist on the prevalence of H. pylori gastric mucosal infection and upper gastrointestinal endoscopic findings in HIV seropositive patients at the Kenyatta National Hospital. OBJECTIVES: The aim of the study was to determine the prevalence of H. pylori gastric mucosal infection and the pattern of upper gastrointestinal endoscopic findings in HIV seropositive patients. DESIGN: A hospital-based prospective case-control study. SETTING: Kenyatta National Hospital, Endoscopy Unit. SUBJECTS: Fifty two HIV seropositive patients with upper GIT symptoms were recruited (as well as 52 HIV seronegative age and gender matched controls). INTERVENTION: Both cases and control subjects underwent upper GIT endoscopy and biopsies were taken according to a standard protocol. H. pylori detection was done by the rapid urease test and histology, and H. pylori gastric mucosal infection was considered to be present in the presence of a positive detection by both tests; biopsies were also taken for tissue diagnosis and CD4+ peripheral lymphocyte counts were determined using flow cytometry. RESULTS: H. pylori prevalence was 73.1% [95% CI 59.9-83.8] in HIV positive subjects and 84.6% [95% CI 72.9-92.6] in HIV negative controls (p=0.230). Prevalence of H. pylori decreased with decreasing peripheral CD4+ lymphocyte counts. Median CD4+ lymphocyte count was 67 cells per cubic millimetre in HIV positive patients. On endoscopy, the most common lesion in HIV positive patients was oesophageal candidiasis (occurring in 51.9%), which was often associated with presence of oral candidiasis and, together with erosions, ulcers and nodules in the oesophagus, occurred exclusively in these patients. A few cases of cytomegalovirus and herpes simplex oesophagitis were seen, as were cases of upper GIT Kaposi's sarcoma, and one gastric lymphoma. CONCLUSIONS: H. pylori prevalence was not significantly different between HIV positive and HIV negative subjects, and decreased in HIV positive subjects with decreasing CD4+ cell counts. Oesophageal candidiasis was the most important endoscopic finding in HIV positive patients and was often associated with oral thrush.

AIDS-Related Opportunistic Infections↗

PubMed1997

Antilymphocytic and immunosuppressive effects of Lantana camara leaves in rats.

Once daily administration of Lantana camara leaves juice at different dose levels (60, 300, 600 and 1500 mg/kg/day) for 14 days in rats resulted in alterations in various haemato- and biochemical parameters. Significant increase in blood urea nitrogen was observed with the doses of 600 and 1500 mg while significant increase in the relative weights of adrenals was observed at all the four dose levels. Total proteins, globulins, absolute lymphocyte count and per cent lymphocyte count were significantly decreased with 60, 600 and 1500 mg doses while a significant hypoglycemic effect was observed with 1500 mg only. Rats treated with 1500 mg dose did not exhibit any increase in alanine aminotransferase and aspartate aminotransferase activities or the alterations in relative kidney and liver weights. In another set of experiment, once daily oral administration of 1500 mg/kg/day for 14 days significantly inhibited the granulomatous tissue formation in rats and this effect was comparable to that of cyclophosphamide (10 mg/kg/day).

Animals↗

PubMed1982

Survival in Hodgkin's disease: the role of immunocompetence and other major risk factors.

The prognostic value of age, sex, symptoms, histopathology, lymphocyte count, skin tests, immunocompetence (lymphocyte response profile to a spectrum of PHA concentrations), and stage was evaluated in 35 previously untreated patients with Hodgkin's disease by multiple linear regression and logistic analysis. Immunocompetence exhibited the highest correlation (R = 0.537) with survival status and was required as a common denominator for deriving best sets of two or more variables. In addition, immunocompetence contributed to all other variables combined (p = 0.023), whereas stage did not (p = 0.116). Immunocompetence, age, symptoms, and histopathology generated a highly discriminant (R = 0.784) model not improved by stage or by other variables (p greater than or equal to 0.159). The utility and generalizability of this model are shown by a correct classification of 91.2% of cases according to expected versus actual survival status and by a predicted correlation (R) of 0.71, respectively, neither improved by sex, lymphocyte count, skin tests, or stage. In comparison, the conventional triad of stage, symptoms, and histopathology correctly classified only 70.6% of cases and showed actual and predicted correlations with survival status of R = 0.550 and R = 0.51. We conclude that immunocompetence is a powerful discriminant risk factor in Hodgkin's disease that exerts a pivotal role on survival and serves as a basis for models of greater discriminant power and generalizability than the conventional stage-based evaluation triad. Immunocompetence-based models are expected to provide a more discriminating basis for clinical evaluation, prediction of prognosis, and treatment selection for patients with Hodgkin's disease.

Adult↗

PubMed1989

[Selective effect of personality markers and psychosocial stress on T lymphocyte subpopulations].

Measurements were made of cellular immune system parameters in a group of healthy medical students. On the basis of psychosocial stress encountered during a five-day topic-centered self-awareness course, we investigated modulation in immunity in relation to personality characteristics. 6 days before the beginning of the seminar personality profiles were drawn and blood samples taken. Further immunological measurements were made on day four of the seminar and three weeks after its conclusion. On the fourth day of the seminar we observed throughout the group higher lymphocyte and suppressor/cytotoxic T lymphocyte counts in comparison with counts one week earlier, and likewise a heightened responsiveness to PHA- and IL-2 stimulation. The T lymphocyte counts had dropped. In subjects with a higher need for succorance/nurturance, the depression of the immune system was manifested in a drop in the helper/inducer T lymphocyte counts, and in the more achievement- and order-oriented subjects in a downregulation as observed by higher suppressor/cytotoxic T lymphocyte counts. Our results show that under psychosocial stress, healthy people experience on the one hand an activation of the immune system, and on the other hand an immunodepression bearing a specific relation to personality characteristics.

Adult↗

PubMed1995

Predictive ability of acute physiology and chronic health evaluation II scoring applied to human immunodeficiency virus-positive patients.

OBJECTIVE: To evaluate the predictive ability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) prognostic scoring system when applied to human immunodeficiency virus (HIV) seropositive patients in the medical intensive care unit (ICU). DESIGN: A retrospective chart review. SETTING: An urban university hospital serving the local community population and also functioning as a tertiary care referral center. PATIENTS: All HIV-positive patients who were discharged from the Yale-New Haven Hospital medical ICU between October 1, 1986 and September 30, 1991. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: APACHE II scoring significantly underestimated the mortality rate in our patient population (n = 161) (35.5% estimated vs. 44.1% observed, p < .025). When patients were evaluated according to total lymphocyte count, APACHE II scores accurately predicted the mortality rate of all patients with a total lymphocyte count of > or = 201 cells/mm3 (n = 112) (32.6% estimated vs. 33.0% observed). However, APACHE II scoring significantly underestimated the mortality rate in the group of patients with a total lymphocyte count of < or = 200 cells/mm3 (n = 36) (44.2% expected vs. 61.1% observed, p < .05), particularly those patients with pneumonia or sepsis (n = 14) (50.5% expected vs. 85.7% observed, p < .01). CONCLUSION: APACHE II scoring significantly underestimates mortality risk in HIV-positive patients admitted to the medical ICU with a total lymphocyte count of < or = 200 cells/mm3. This finding is particularly true regarding patients admitted due to pneumonia or sepsis.

AIDS-Related Complex↗

PubMed1991

Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications.

The records of 217 consecutive patients who underwent a primary total hip or total knee arthroplasty were reviewed for preoperative and postoperative nutritional status. Fifty-seven patients had a lymphocyte count of less than 1,500 cells/mm3, four patients had an albumin level of less than 3.5 g/dL, and two patients had both, giving a 27% incidence of indices indicative of preoperative nutritional depletion. Patients without wound complications had an average preoperative lymphocyte count of 1,995 (+/- 631), compared to 1,638 (+/- 491) for those with persistent serous drainage from their wounds, and 1,553 (+/- 419) for those patients with a major wound complication (P = .002). The average albumin levels were 4.30 (+/- 0.33), 4.22 (+/- 0.31), and 4.13 (+/- 0.54), respectively. Patients with rheumatoid arthritis were compared to those with osteoarthritis and were found to have significantly lower preoperative albumin levels. They were three times as likely to develop a major wound complication. Patients on immunosuppressive medications had significantly lower preoperative lymphocyte counts, lower albumin levels, and higher complication rates (P = .04). After operation, lymphocyte counts of all patients dropped to an average of 57% of their preoperative values, and albumin levels dropped to 72% of their preoperative values. No nutritional parameters had returned to their preoperative levels by 10 postoperative days. For all patients, a preoperative lymphocyte count of less than 1,500 cells/mm was associated with a five times greater frequency of developing a major wound complication, and an albumin level of less than 3.5 g/dL had a seven times greater frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Clinical forms and outcome of tuberculosis in HIV-infected patients in a tertiary hospital in São Paulo - Brazil.

UNLABELLED: Tuberculosis (TB)/HIV co-infection significantly changes the natural history of both diseases. Proper comprehension and clinical management of co-infected TB/HIV patients is still a challenge, particularly in places like Brazil, where both types of infection are prevalent. OBJECTIVES: Evaluate the frequency of the clinical forms of TB in HIV-infected patients; correlate the clinical forms of TB with the level of immunodeficiency; evaluate the response to therapy with different regimens for the treatment of TB; identify potential prognostic factors in TB/HIV patients. MATERIAL AND METHODS: The following data were collected at the beginning of the study: medical history, epidemiological background, physical examination, and laboratory evaluation (complete blood cell count, T lymphocyte subsets, viral load and tuberculin test). Monthly clinical follow-up was performed, with attention to adverse reactions to tuberculostatic drugs. TCD4+/CD8+ lymphocyte counts and quantification of the viral load were performed after 2, 4, 6, 10 and 15 months of follow-up. RESULTS: The study population consisted of 78 patients (45 males and 33 females) and their mean age was 36.4 +/- 7.9 years The mean TCD4+ count values were higher in patients with the cavitary pulmonary form and lower in patients with disseminated forms. There were no significant differences in the mean TCD8+ cells counts . in the different clinical forms of TB. However, the mean laboratory values for hemoglobin, hematocrit and leucocytes at study entry did differ significantly among the various clinical forms of TB. At the end of the trial, the Tb recovery rate was of 78%, with four cases (5%) of treatment failure, eight (11%) treatment discontinuations and five deaths (6.4%). The highest rate of treatment failure (75%) was observed among patients with the disseminated form. Lower TCD4+ mean values were observed in cases of treatment failure and death. There was a correlation between the TCD4+ cell values and the TB outcome at the six time points. TCD8+ (cells/mm(3)) mean values assessed at the six time points in relation to the TB outcome indicated (non-significantly) lower values in patients who progressed to treatment failure. Considering the different TB outcomes, there was a significant correlation between TCD8+ values at the first and third assessments. Lower mean values of hemoglobin, hematocrit, platelet and leukocytes were observed among the cases of treatment failure than in patients who recovered. The variables hemoglobin, hematocrit, leukocytes and platelets were significantly different among the groups. CONCLUSIONS: The pulmonary forms of TB were most frequent in HIV infected patients; the extrapulmonary, associated and disseminated forms were predominantly seen in patients with a more severe level of immunosuppression. The TB recovery rate in HIV infected patients was similar to the expected rate in non-infected individuals. The best results were obtained when regimens containing rifampicin were used. Pancytopenia and low levels of TCD4+ and TCD8+ lymphocytes at the initial time point of the study were correlated with an unfavorable outcome of TB, and therefore they can be considered potential prognostic factors. However, the of TCD8+ lymphocyte values were the most important variable assessed.

AIDS-Related Opportunistic Infections↗

PubMed1990

Serum triiodothyronine values. Prognostic indicators of acute mortality due to Pneumocystis carinii pneumonia associated with the acquired immunodeficiency syndrome.

A feasibility study was undertaken prospectively to identify early clinical and laboratory factors predictive of acute hospital mortality in patients with the acquired immunodeficiency syndrome and concurrent Pneumocystis carinii pneumonia. Twenty-six patients hospitalized with bronchoscopy-proved P carinii pneumonia were studied. Nineteen patients survived their episode of P carinii pneumonia, while 7 subjects did not. The only clinical factor associated with mortality was a history of a shorter duration of pulmonary symptoms. Univariate analysis showed decreased total CD8 cell count, total lymphocyte count, serum hemoglobin, serum albumin, total thyroxine, and total triiodothyronine values consistent with a poor outcome. Multivariate logistic regression analysis showed that the single best prognostic indicator of acute mortality appeared to be a total serum triiodothyronine value less than 0.70 nmol/L obtained early in the hospital course, and that the combination of serum triiodothyronine and hemoglobin values provided a better indication for survival. These preliminary observations would appear to justify the further exploration of serial serum triiodothyronine measurements as a potentially valuable prognostic indicator for the treatment of patients with acquired immunodeficiency syndrome infected with P carinii and possibly other intercurrent infectious illnesses.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Quantitative neurologic and neurobehavioral testing of persons infected with human immunodeficiency virus type 1.

Assessment of neurobehavioral and peripheral neurologic performance among homosexual men was made on two occasions, using a computer-administered neurobehavioral instrument and quantitative vibration threshold testing, respectively. Persons studied included high-risk human immunodeficiency virus (HIV)-negative men (n = 13), asymptomatic HIV-positive men (n = 30), and patients with acquired immunodeficiency syndrome (AIDS)-related complex of AIDS (n = 17). In addition, subjects were characterized immunologically at the time of neurologic and neuropsychologic assessment via determination of circulating lymphocyte counts (total lymphocytes, helper T cells, suppressor T cells, total T cells, activated T cells) and markers of HIV type 1 (HIV-1) infection. At the first cycle of testing, the results of asymptomatic HIV-positive men were indistinguishable from those of HIV-negative men, while persons with AIDS-related complex or AIDS tended to have lower mean performance. These differences did not achieve statistical significance on any single test, but the group with AIDS-related complex or AIDS had the worst mean performance on 12 of 13 individual performance tests. Thirty-seven men underwent repeated testing after a mean interval of approximately 4.5 months. There was little change in mean neurobehavioral performance and vibratory thresholds among all three groups. Measures of neurobehavioral performance and vibrotactile thresholds were not correlated with measures of immunological status. These results are consistent with the concept that asymptomatic infection with HIV-1 does not imply the presence of measurable or significant neurologic or neurobehavioral impairment.

AIDS-Related Complex↗

PubMed1986

Suppression of cellular immunity by head and neck irradiation. Precipitating factors and reparative mechanisms in an experimental model.

A model was developed in C3H mice to investigate the immunosuppressive effects of head and neck irradiation and to explore mechanisms for repair of the defects. Mice receiving 1200 rad (12 Gy) of head and neck irradiation showed significant depression of delayed-type hypersensitivity, peripheral blood lymphocyte counts, spleen cell counts, and spleen cell production of interleukin-2. Treatment with optimal dosages of thymosin alpha 1 (T alpha-1) produced significant increases in all of these values, in some instances to levels higher than in the nonirradiated controls. In identical experiments with mice irradiated to a portal limited to the pelvic region, T alpha-1 induced only partial remission of the abnormalities. The dose response of T alpha-1 with head and neck irradiation showed a relatively limited dose range for immune restoration, a finding that warrants similar determinations in clinical trials with immunomodulating agents. The results suggest a potential clinical usefulness of T alpha-1 and also interleukin-2 in restoring cellular immunity after irradiation for head and neck cancers. The model appears to be useful for investigating immunomodulating agents before they are clinically evaluated as adjuvants with head and neck irradiation regimens.

Animals↗