Immunoglobulin A (IgA) deficiency and alternative celiac disease-associated antibodies in sera submitted to a reference laboratory for endomysial IgA testing.

Immunoglobulin A (IgA) deficiency occurs more frequently in patients with celiac disease (CD) than in the general population and can lead to false-negative results in the best serologic test for CD, endomysial IgA (EMA). To evaluate the impact of IgA deficiency on serologic detection of CD in a reference laboratory setting, IgA levels were measured in 510 consecutive serum specimens submitted for testing for EMA; 510 consecutive serum specimens submitted for Helicobacter pylori IgG testing served as a gastrointestinal symptom control group. The frequency of IgA deficiency was significantly higher among the specimens submitted for testing for EMA (5.1%) than among the specimens from the symptom control group (1.4%). Three subsets of sera from the group of specimens submitted for testing for EMA were then tested by additional serologic assays for CD; these subsets were EMA-positive sera (n = 25), EMA-negative, IgA-deficient sera (n = 26), and control sera (from EMA-negative, IgA-nondeficient patients age matched to IgA-deficient patients; n = 26). The proportions of EMA-positive sera positive by other assays for CD were 92% for transglutaminase IgA (TG-IgA), 80% for gliadin IgA, 84% for gliadin IgG, 60% for endomysial IgG (EMG), and 32% for transglutaminase IgG (TG-IgG). Very low proportions (0 to 8%) of IgA-deficient sera and control sera were positive for TG-IgA, gliadin IgA, EMG, and TG-IgG. Eight of 26 (31%) IgA-deficient serum samples were positive for gliadin IgG, whereas 3 of 26 (12%) control serum samples were positive for gliadin IgG, but this difference was not statistically significant. Physicians supplied clinical data for 18 of 26 patients with IgA deficiency; only 4 patients had undergone small-bowel biopsy, and 0 of 4 patients showed villous atrophy. These findings show that IgA deficiency is found more frequently among sera submitted for testing for EMA in a reference laboratory setting, but there was no clear-cut serologic or clinical evidence of CD in EMA-negative, IgA-deficient patients.

Evaluation of an enzyme immunoassay system for measuring herpes simplex virus (HSV) type 1-specific and HSV type 2-specific IgG antibodies.

MRL Diagnostics has developed a dual enzyme immunoassay (EIA) system that employs the recombinant Herpes Simplex Virus (HSV) type-specific glycoproteins G1 (HSV1) and G2 (HSV2) to detect HSV type-specific IgG antibodies. This system was evaluated using 155 consecutive sera previously tested in a conventional dual EIA system (Zeus) that employs multiple HSV1 and HSV2 proteins to detect type-common as well as type-specific antibodies. Sera were also analyzed by Western blot to determine the true HSV type-specific IgG reactivity pattern. Of 110 sera giving concordant reactivity patterns in the MRL and Zeus EIA systems, 108 (98%) also displayed concordant Western blot patterns; two sera gave false positive HSV2 reactivity in both EIA systems. Of 45 sera giving discordant MRL and Zeus EIA reactivity patterns, 41 (91%) displayed a Western blot reactivity pattern that matched the MRL reactivity pattern. Both the HSV1 IgG component and the HSV2 IgG component of the MRL EIA system were 100% sensitive and > 95% specific. In contrast, the Zeus HSV1 IgG EIA was 98% sensitive and 79% specific, and the Zeus HSV2 IgG EIA was 85% sensitive and 79% specific. An analysis of the distribution of index values in the MRL EIA system showed that low-positive values (1.0-3.0) were rare, but, when detected, often represented false positive results; only 11 MRL low-positive results were observed, but all 6 MRL false positive results were found within this low-positive subgroup. These findings show that the MRL dual EIA system effectively detects HSV type-specific IgG antibodies.

Evaluation of a line immunoblot assay for detection of antibodies recognizing extractable nuclear antigens.

Sera (n = 90) giving positive results in a screening test for antibodies to extractable nuclear antigens (ENAs) were tested in a line immunoblot assay that measures antibody reactivity with individual ENAs in a single test field. Results were then compared to those obtained in monospecific ENA antibody enzyme immunoassays (EIAs). Discordant results were resolved by immunodiffusion. Of 540 result pairs (90 sera tested for 6 ENAs [Sm/RNP, Sm, SSA, SSB, Scl-70, Jo-1]), 509 (94%) showed concordance. Immunodiffusion resolved 28 of 31 discordant result pairs in favor of the immunoblot result. After resolution of discordant data, the immunoblot assay exhibited 100% sensitivity for all ENA antibodies except those recognizing Scl-70, for which the sensitivity was 89%; specificity was over 96% for all 6 ENA antibodies. These findings show that a line immunoblot assay for the characterization of ENA antibodies yields results comparable to those obtained using monospecific ENA antibody EIAs. The immunoblot assay is easier and less expensive to perform due to its utilization of a single test field.

Elevated CD38 antigen expression on CD8+ T cells is a stronger marker for the risk of chronic HIV disease progression to AIDS and death in the Multicenter AIDS Cohort Study than CD4+ cell count, soluble immune activation markers, or combinations of HLA-DR and CD38 expression.

The prognostic value of several immunologic markers were compared in Los Angeles Multicenter AIDS Cohort Study (MACS) participants, most of whom had been infected with HIV for >8 years. Markers studied included CD4+ cell number, flow cytometric measurements of CD8+ cell expression of CD38 and HLA-DR antigens, and serum markers of immune activation including neopterin, beta2-microglobulin, soluble interleukin-2 receptor, soluble CD8, and soluble tumor necrosis factor receptor-alpha (TNF-alpha) type II. Cox proportional hazards models indicated that elevated CD38 on CD8, a flow cytometric measurement of CD8+ T-lymphocyte activation, was the most predictive marker of those studied for development of a clinical AIDS diagnosis and death. As compared with the reference group, who had CD38 on CD8 <2470 molecules per CD8+ cell and in whom 4 of 99 developed clinical AIDS within 3 years, participants with CD38 on CD8 between 2470 and 3899, 3900 and 7250, and >7250 had relative risks (and numbers developing AIDS within 3 years) of 5.0 (15 of 81), 12.3 (24 of 60), and 41.4 (36 of 49), respectively. The strong prognostic value of CD38 on CD8 measurements and the fundamental importance of chronic immune activation in the pathogenesis of HIV disease suggests that this marker might have utility in the clinical management of HIV-infected persons.

Costimulatory effects of T cell proliferation during infection with human T lymphotropic virus types I and II are mediated through CD80 and CD86 ligands.

The modulation of expression of CD80 and CD86 on T cells following infection with human T lymphotropic virus (HTLV)-I/II and its functional importance in T-T cell interactions was examined. Infection with HTLV-I/II leads to constitutive expression of CD80 and CD86, concomitant to down-modulation of CD28 on T cells. The CD80/CD86+ HTLV-infected T cells stimulated proliferation of allogeneic and autologous resting T cells, which could be specifically blocked by a soluble CTLA-4Ig chimeric protein, anti-CD80 or anti-CD86, but not by anti-CD54. It was necessary to inhibit interaction with both ligands (CD80 and CD86) to optimally block HTLV-mediated proliferation of allogeneic and autologous resting T cells. Simultaneous addition of anti-CD8O and anti-CD86 Abs also inhibited production of IFN-gamma, TNF-alpha, and IL-4, with no effect on IL-10 production, for both allo- and autologous T cell proliferation. Further, there was a direct correlation between the spontaneous proliferation of lymphocytes from patients infected with HTLV-II and expression of CD80, which could be blocked by simultaneous addition of anti-CD80 and anti-CD86. Taken together, these results suggest that HTLV-infected CD80/CD86+ T cells serve as APCs, leading to a sustained proliferation of T cells, and that both ligands participate in allostimulation, autologous proliferation, as well as spontaneous proliferation of HTLV-II-infected PBMC.

Influence of specimen age and anticoagulant on flow cytometric evaluation of granulocyte oxidative burst generation.

The oxidative burst generation capacity of granulocytes can be reliably detected by a flow cytometric procedure using lysed whole blood, dihydrorhodamine 123 (DHR), and phorbol myristate acetate (PMA). This assay is used to detect chronic granulomatous disease (CGD) and the CGD carrier state. To assess the feasibility of performing this assay in a reference laboratory setting, we investigated the influence of anticoagulant and specimen age on flow cytometric detection of granulocyte oxidative burst generation. Peripheral blood from 20 healthy controls was collected in acid citrate dextrose (ACD), ethylenediaminetetraacetate (EDTA), or sodium heparin (HEP) and held at room temperature. At 4, 24, 48, 72, and 96 h after collection, red cells were lysed, the white cells loaded with DHR, and then activated by PMA. Granulocyte-associated fluorescence, indicative of oxidative burst generation, was assessed by flow cytometry. Blood in any of the three anticoagulants tested gave reliable results (> 90% of granulocytes positive for fluorescence) at 4 h after collection; at 24 h after collection, HEP and ACD specimens performed slightly better than EDTA specimens. At later time points, HEP proved superior to ACD and EDTA for maintaining granulocyte oxidative burst capacity. As a demonstration of the practical utility of the assay, both CGD and the CGD carrier state were accurately detected using heparinized blood specimens analyzed 72 h after collection. These results show that heparinized blood specimens up to 72 h old can be used to reliably assess granulocyte oxidative burst generation.

Spontaneous proliferation of memory (CD45RO+) and naive (CD45RO-) subsets of CD4 cells and CD8 cells in human T lymphotropic virus (HTLV) infection: distinctive patterns for HTLV-I versus HTLV-II.

Spontaneous lymphocyte proliferation (SLP) in vitro is a characteristic feature of about 50% of individuals infected with HTLV-I or HTLV-II. Both CD4 cells and CD8 cells contribute to SLP in HTLV-I infection, whereas SLP in HTLV-II infection is usually restricted to CD8 cells. In this study, we asked if SLP was restricted to the memory (CD45RO+) cell subset of CD4 and CD8 cells in HTLV infection. Purified CD4 and CD8 cells were separated into CD45RO+ and CD45RO- populations by a modified panning technique, and spontaneous proliferation (SP) of the cell subsets was assessed. For all five HTLV-I-infected persons whose mononuclear cell cultures were SLP+, only CD45RO+ cells, but not CD45RO- cells, within CD4 and CD8 subsets showed SP. In contrast, five of six SLP+ HTLV-II+ individuals showed SP in both the CD45RO+ and the CD45RO- subsets of CD4 cells, and 10 of 12 SLP+ HTLV-II+ individuals showed SP of both the CD45RO+ and CD45RO- subsets of CD8 cells. Polymerase chain reaction studies showed that proviral genome was generally present in both CD45RO+ and CD45RO- subsets of CD4 and CD8 cells, regardless of HTLV type and SP activity. These findings show that SP of both CD4 and CD8 cells in HTLV-I infection is usually restricted to CD45RO+ memory cells, whereas in HTLV-II infection, both CD45RO+ memory and CD45RO- naive subsets of CD4 and CD8 cells may exhibit SP. It thus appears that HTLV-I infection and HTLV-II infection exhibit distinctive dysregulatory effects on memory and naive T cell subpopulations.

Spontaneous lymphocyte proliferation in human T-cell lymphotropic virus type I (HTLV-I) and HTLV-II infection: T-cell subset responses and their relationships to the presence of provirus and viral antigen production.

Spontaneous lymphocyte proliferation (SLP) during in vitro culture of mononuclear cells (MCs) characterizes over half of asymptomatic individuals infected with human T-cell lymphotropic virus type I (HTLV-I) or HTLV-II. Both CD4 and CD8 T-cell subsets within MC cultures are activated during SLP, as judged by high-density CD25 (CD25bright) expression; it is unclear, however, whether both cell subsets can directly undergo SLP. In the present investigation, the SLP capacities of purified CD8 and CD4 cells were examined in subjects infected with HTLV-I (n = 19) or HTLV-II (n = 54) in relation to the SLP status of MCs from each subject. No increase in SLP was observed for CD8 or CD4 cells from SLP-negative (SLP-) HTLV-infected subjects, whereas robust SLP characterized CD8 cells from all SLP-positive (SLP+) individuals, regardless of HTLV type. In contrast, SLP+ CD4 cells characterized only 23% (7 of 31) of HTLV-II+ SLP+ individuals, whereas SLP+ CD4 cells characterized 100% of HTLV-I+ SLP+ individuals. In cocultures of HTLV-II+ SLP+ CD8 cells and autologous SLP- CD4 cells, sizable proportions of both CD8 cells and CD4 cells coexpressed CD25bright, suggesting that SLP- CD4 cells were activated in the presence of SLP+ CD8 cells. PCR analysis for tax sequences detected provirus in most CD4- and CD8-cell preparations from HTLV-seropositive individuals, regardless of type and the SLP status of cell subsets. To determine whether SLP was associated with activation of viral genes, levels of HTLV-I and HTLV-II core antigen (Ag) in supernatants were measured. Viral Ag production and SLP responses were significantly correlated for both CD4 and CD8 cells in both HTLV-I and HTLV-II infections. However, inhibition of CD8- or CD4-cell SLP by cyclosporin A or anti-Tac (anti-CD25) did not reduce Ag production, indicating that Ag production is not coupled to SLP. These findings show that CD4 cells from SLP+ HTLV-I+ and SLP+ HTLV-II+ individuals differ in SLP capacity, that the absence of SLP does not indicate a lack of infection, and that production of viral Ag is associated with, but not dependent on, SLP.

Unaltered lymphocyte subsets in hepatitis C virus-seropositive blood donors.

Lymphocyte subsets were evaluated by dual-color flow cytometry in whole blood specimens from 35 blood donors who were seropositive on enzyme-linked immunosorbent assay (ELISA) for hepatitis C virus (HCV) and whose sera reacted in a four-antigen recombinant immunoblot assay (RIBA) (referred to as the HCV+R group), 15 donors who were seropositive on ELISA for HCV with indeterminate or negative RIBA results (the HCV+I/N group), and 25 HCV-seronegative controls (HCV-group). The cell subsets assessed included natural killer cells, B cells, T cells, CD4 and CD8 subsets of T cells, and T-cell subsets defined by the coexpression of markers that appear (HLA-DR, CD25, CD38) or disappear (CD45RA) after activation. A one-way analysis of variance revealed no significant differences among the three study groups. These findings show that, unlike cytomegalovirus- and human immunodeficiency virus-positive individuals, HCV-positive individuals do not exhibit lymphocyte alterations indicative of the immune activation caused by chronic viral infection.

Immunologic correlates of spontaneous lymphocyte proliferation in human T-lymphotropic virus infection.

Previously we showed that mononuclear cells from about half of human T-lymphotropic virus (HTLV)-seropositive persons exhibit spontaneous proliferation in vitro. We sought to determine if proliferation was associated with other immunologic changes characteristic of HTLV infection. The parameters assessed were (1) percentages of lymphocytes expressing CD4 and/or CD25 (interleukin-2 receptor), (2) serum levels of soluble CD25, (3) serostatus for other viruses, (4) anti-HTLV antibody levels, and (5) HTLV type determined by polymerase chain reaction or serologic reactivity with type-specific peptides. The proliferation+ HTLV (PROL+) group, proliferation HTLV (PROL-) group, and control group showed similar percentages of CD4+, CD25+, and CD4+CD25+ lymphocytes; serum levels of soluble CD25 were also similar. Antibodies to cytomegalovirus, hepatitis B core, and hepatitis C were present in similar proportions of PROL+ and PROL+ groups. However, a significant association was found between spontaneous proliferation and anti-HTLV antibody levels; sera from 67% of PROL+ persons, but only 18% of PROL- persons, required dilution to yield absorbance values within the linear range of the anti-HTLV antibody assay. In the PROL+ group, persons whose sera required the most dilution had proliferative responses significantly higher than those whose sera required no dilution. The PROL+ and PROL groups were similar with regard to the relative distribution of HTLV-I and HTLV-II infection. These findings indicate that HTLV-related spontaneous lymphocyte proliferation is related to levels of circulating anti-HTLV antibodies, and characterizes both HTLV-I and HTLV-II infection.

HIV-related alterations in CD8 cell subsets defined by in vitro survival characteristics.

Previously we showed that over 50% of CD8 cells from HIV-infected persons do not survive in 3-day cultures of mononuclear cells; this loss occurred preferentially in subsets with phenotypes indicative of in vivo activation. In the studies reported here, we asked if cytokines enhanced CD8 cell survival. Of IL1, IL2, IL4, IL6, tumor necrosis factor, and interferon-gamma only IL2 specifically enhanced CD8 survival in the HIV group, compared to the control group. Further studies thus focused on characterizing CD8 cell survival in the presence of IL2. In both study groups, three subsets of CD8 cells were identified based on in vitro survival: (a) those surviving in culture medium alone (survivors), (b) those surviving only when IL2 was included in the culture medium (IL2-dependent survivors), and (c) those failing to survive even in the presence of IL2 (nonsurvivors). By dual-color cytofluorometry, the CD8 survivor subset was similar in the two study groups, and expressed nonactivated phenotypes (Leu8+, CD45RA+, HLA-DR-). The IL2-dependent survivor subset was also similar in the two study groups and expressed the phenotypes Leu8-, CD45RA+, CD57+, HLA-DR+, and CD38+, suggesting prior activation. The CD8 nonsurvivor subset, in contrast, was markedly different in the study groups: compared to the control group, the HIV group contained significantly higher proportions of CD8 cells expressing the phenotypes Leu8-, CD57+, and HLA-DR+, also suggesting activation. These findings indicate that, in HIV infection, the activated CD8 cell subsets that do not survive in medium alone consist of a "normal" component that requires IL2 for survival and an "abnormal" component that does not survive even in IL2.

Spontaneous lymphocyte proliferation in HTLV-I/II infection reflects preferential activation of CD8 and CD16/56 cell subsets.

Previous studies have shown that lymphocytes from HTLV-infected persons spontaneously proliferate when cultured in vitro. We investigated which cell subsets become activated in this response. Mononuclear cells from 16 HTLV-seropositive former blood donors and 9 seronegative controls were cultured for 7 days; activation was then assessed by measuring DNA synthesis in cultured cells and by monitoring CD25 expression by CD3, CD4, CD8, CD19, and CD16/56 lymphocyte subsets. Of the 16 cultures of HTLV + donor cells, 10 showed spontaneous proliferation (Prol + group) and 6 did not (Prol - group). Cytofluorometric analysis revealed a significant increase in the fractions of CD8 cells and CD16/56 cells expressing CD25 for the Prol + group, compared to the Prol- and control groups. Similarly, the fractions of CD25 cells expressing CD8 or CD16/56 were significantly increased in the Prol + group. Although neither the fraction of CD4 cells expressing CD25 nor the fraction of CD25 cells expressing CD4 were increased for the Prol + group, the modal fluorescence intensity value for CD25 expression by CD4 cells was increased, suggesting some CD4 cell activation occurred as well. Blastoid cells were, on average, 79% CD25 +, whereas the sum of CD4 + CD25 + (27%), CD8 + CD25 + (30%), CD19 + CD25 + (3%), and CD16/56 + CD25 + (35%) subsets was 95%; the presence of 17% CD8 + CD16/56 + cells accounted for most of this discrepancy. These findings indicate that spontaneous lymphocyte proliferation in HTLV infection reflects preferential activation of CD8 and CD16/56 cell subsets, apparently including the minor CD8 + CD16/56 + subset.

Three-color cytofluorometric analysis of CD8 cell subsets in HIV-1 infection.

Previous studies have shown that CD8 cell subsets, some expressing activation markers, are elevated in human immunodeficiency virus (HIV) infection. To assess the overlap of these subsets, we used three-color flow cytometry to phenotype CD8 cells in cryopreserved mononuclear cells from uninfected controls and from people infected with HIV, in CDC classes II, III, and IV (n = 12 per group). There were several CD8 subset changes observed in association with HIV infection. A shift from a naive (CD45RA+CD45RO-) to a memory (CD45RA-CD45RO+) phenotype occurred in the CD8 subset, but the intermediate phenotype (CD45RA+CD45RO+) was unchanged. Increases in DR+CD8 and CD38+CD8 cells were noted in both naive and memory CD8 subsets, defined by CD45RA or CD45RO expression. Both the CD57+ and CD57- subsets of DR+CD8 cells were increased, whereas only the CD57+ subset of CD38+CD8 cells was elevated. The increase in CD57+CD8 cells reflected a selective rise in CD57+CD8 cells coexpressing CD38, DR, and CD45RO. The CD38+ DR+ CD8 subset was markedly increased and was apparently derived from both the CD38-DR-CD8 and CD38+DR-CD8 subsets. Compared with classes II and III, the CDC class IV group showed an increased proportion of CD8 cells expressing CD38; higher percentages of CD38+DR+CD8, CD38+CD45RA-CD8, and DR+CD45RO+CD8 subsets; and decreased percentages of CD38-CD45RA+CD8 and CD38-CD57-CD8 cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Normal expression of p55 interleukin 2 receptor (CD25) by lymphocytes from former blood donors seropositive for human T lymphotropic virus.

Dysregulated expression of the p55 interleukin 2 receptor (CD25) is characteristic of adult T cell leukemia (ATL) associated with human T lymphotropic virus (HTLV) infection. In order to determine if similar changes characterize HTLV infection in the apparent absence of ATL, CD25 expression by peripheral blood lymphocytes from HTLV-seropositive former blood donors was measured using a sensitive dual-color cytofluorometric assay. When comparing the HTLV-seropositive group (N = 19) and a seronegative control group (N = 20), no significant differences were observed in either the proportions of the major lymphocyte subsets (CD3, CD4, CD8, CD19, CD16/56) coexpressing CD25 or the phenotypic distribution of CD25+ cells among these lymphocyte subsets. Similarly, the total percentages of CD3, CD4, CD8, and CD19 cell subsets were unchanged; however, the percentage of CD16/56+ cells was significantly decreased in the HTLV group and reflected a decrease in the percentage of CD16/56 cells lacking CD25. These findings indicate that HTLV infection without ATL is characterized by normal CD25 expression by lymphocytes and a decreased percentage of lymphocytes with a phenotype characteristic of natural killer cells.

American blood donors seropositive for human T-lymphotropic virus types I/II exhibit normal lymphocyte subsets.

Recent reports have demonstrated that some lymphocyte subsets are abnormal in Japanese blood donors who are seropositive for human T-lymphotropic virus type I (HTLV-I). To determine if similar changes characterize American blood donors who are seropositive for HTLV-I/II, lymphocyte subsets were measured in 42 HTLV-seropositive and 42 HTLV-seronegative blood donors. The seronegative individuals were matched by age, race, and gender to the seropositive individuals. Peripheral blood mononuclear cells were treated with a panel of 12 monoclonal antibody pairs and then analyzed by two-color flow cytometry. No significant differences were observed between the seropositive and seronegative groups with respect to the absolute number of circulating lymphocytes or the percentages of lymphocytes belonging to the subsets assessed. These subsets included B, T, CD4, and CD8 cells and subpopulations of CD4 and CD8 cells defined by the coexpression of markers that appear (CD25, HLA-DR, CD38) or disappear (Leu 8, CD45RA) after activation. These findings indicate that HTLV-seropositive persons in the American blood donor pool do not exhibit the lymphocyte subset alterations reported for HTLV-I-seropositive blood donors in Japan.

Preferential loss of Leu 8-, CD45R, HLA-DR+ CD8 cell subsets during in vitro culture of mononuclear cells from human immunodeficiency virus type I (HIV)-seropositive former blood donors.

Recent data from our laboratory showed that the CD4:CD8 cell ratio increased significantly during in vitro culture of unstimulated mononuclear cells (MC) from HIV-infected persons. To test the hypothesis that this increase reflected a decline in CD8 cell levels, changes in CD4 and CD8 cell levels during culture of MC were assessed quantitatively. These analyses were accomplished using a Spectrum III flow cytometer, which analyzes a constant volume (0.02 ml) of cell suspension. The number of cells counted within this volume (termed the sip count) thus reflects the cell number in the suspension. To establish day 0 sip counts, aliquots consisting of 200,000 lymphocytes were treated with monoclonal antibodies, resuspended in 1 ml of buffer, and analyzed. Also on day 0, identical cell aliquots were placed in microtiter wells and cultured for 3 days. Cells retrieved from individual wells were then analyzed as on day 0. The mean relative recoveries (RR) of lymphocytes, CD4 cells, and CD8 cells were significantly lower in the HIV group (N = 28) than in the control group (N = 26). For the HIV group, CD8 cell RR was significantly lower than CD4 cell RR. Dual-color analyses showed that CD4 cell loss in the HIV group did not occur preferentially within CD4 subsets defined by Leu 8 or CD45R expression. Similarly, CD8 cell loss did not occur preferentially within CD8 subsets defined by Leu 7 expression. In contrast, CD8 cell loss did preferentially affect Leu 8-, CD45R-, and HLA-DR+ CD8 subsets, compared to the reciprocal CD8 subsets.(ABSTRACT TRUNCATED AT 250 WORDS)

Human T cell leukemia virus type III antibody, lymphadenopathy, and acquired immune deficiency syndrome in hemophiliac subjects. Results of a prospective study.

A cohort of 63 hemophiliac subjects was followed for clinical and immunologic abnormalities related to the acquired immune deficiency syndrome (AIDS). When evaluated in early 1984, antibody to human T cell leukemia virus type III (HTLV-III) was detected in the serum of 59 percent (24 of 41) of factor VIII or IX concentrate recipients, but in none (0 of six) of the cryoprecipitate/fresh frozen plasma recipients. HTLV-III-seropositive hemophiliac subjects, on average, had been exposed to twice as much concentrate during the previous year as seronegative hemophiliac subjects. The seropositive group had a significantly lower mean helper/suppressor T cell ratio and absolute helper T cell level than the seronegative group. By early 1984, 13 hemophiliac subjects in the study population had lymphadenopathy and one had AIDS. Antibody to HTLV-III was detected in the serum of 13 of these 14 hemophiliac subjects with overt clinical disease. The prevalence of lymphadenopathy or AIDS among HTLV-III-seropositive hemophiliac subjects was 54 percent (13 of 24). It is concluded that HTLV-III antibody occurs with high frequency in hemophiliac subjects, and is related to the amount of factor VIII or IX concentrate infused. Over half of HTLV-III-seropositive hemophiliac subjects in this population had overt clinical disease with either lymphadenopathy or AIDS.

Anti-HTLV III ELISA and Western blot testing in a blood donor population: implications for donor notification.

We have evaluated the western blot (WB) test for distinguishing anti-HTLV III ELISA-positive donors who have likely been exposed to HTLV III from those that are false positives. Of 1,955 donors, 26 were positive for anti-HTLV III by ELISA testing. Only 6 (23%) were positive by WB: 5 of these 6 were male homosexuals with multiple partners and 5 of 6 had low Th/Ts ratios. The WB-positive donors gave the highest absorbance values in the anti-HTLV III ELISA assay. The immunologic abnormalities in the WB-positive donors suggest that they should be notified of their test results. We conclude that basing a donor notification policy on WB results is the optimum public health strategy for blood banks at the present time.