In vitro enhancement of T-cell receptor-targeted lysis after IL-2 treatment of PBL from HIV-seropositive individuals.

Individuals with advanced HIV infection have a greater proportion of T-cells that are activated when compared to uninfected individuals. These activated cells are not able to lyse specific targets. The reason for this dysfunction is not well known. In this study we demonstrate that there are CD8+ T-cells from HIV-seropositive individuals that can be targeted to lyse targets with OKT3 (anti-CD3 antibody) but are unable to lyse targets with WT31 (anti-alphabeta antibody). Treatment of peripheral blood lymphocytes with IL-2 results in an enhancement of WT31-targeted lysis in 9 of 13 individuals evaluated. These findings demonstrate a differential response, in vitro, of CD8+ T-cells to IL-2 treatment. Future work evaluating clinical responses after IL-2 therapy with recovery of targeted lysis in vitro could provide information on screening of individuals for therapeutic intervention.

Primary lymphoma of the liver in AIDS. Report of one new case and review of the literature.

A case of primary lymphoma of the liver in a patient with acquired immunodeficiency syndrome (AIDS) is presented. Persistent fever, tender hepatomegaly, and mildly abnormal liver function tests combined with an elevated lactate dehydrogenase level gave the clue for the diagnosis. High-grade, non-Hodgkin's lymphoma of B-cell phenotype was demonstrated by percutaneous liver biopsy. Primary hepatic lymphoma is a rare event among patients with AIDS. We reviewed the cases in the literature and noted that a preponderance of these patients presented with multiple lesions (a rather rare occurrence in primary lymphoma of the liver in patients not infected with the human immunodeficiency virus).

Clinical presentation and outcome of patients with HIV infection and tuberculosis caused by multiple-drug-resistant bacilli.

OBJECTIVE: To determine the clinical manifestations of patients with human immunodeficiency virus (HIV) infection and tuberculosis caused by multiple-drug-resistant bacilli compared with those with single-drug-resistant or susceptible bacilli. DESIGN: Descriptive, case-control, and cohort studies. SETTING: A large urban teaching hospital. PATIENTS: Sixty-two patients with tuberculosis caused by multiple-drug-resistant bacilli (cases) and 55 patients with tuberculosis caused by single-drug-resistant or susceptible bacilli (controls). MEASUREMENTS: Characteristics of clinical presentation, radiographs, pathologic abnormalities, antituberculosis treatment, and clinical course. RESULTS: Twenty cases (32%) had concomitant pulmonary and extrapulmonary disease at presentation compared with 9 controls (16%; odds ratio, 2.4; 95% CI, 1.0 to 5.9). More cases had alveolar infiltrates (76%; odds ratio, 3.6; CI, 1.2 to 11.4), interstitial infiltrates with a reticular pattern (67%; odds ratio, 7.8; CI, 1.0 to 83.5), and cavitations (18%; odds ratio, 6.6; CI, 0.8 to 315.3) on initial chest radiographs compared with controls (49%, 19%, and 3%, respectively). Pathologic specimens from cases showed extensive necrosis, poor granuloma formation, marked inflammatory changes with a predominance of neutrophils, and abundant acid-fast bacilli. Twenty-five cases received two or more effective antituberculosis drugs for more than 2 months. Only 2 cases had three consecutive negative cultures for Mycobacterium tuberculosis; one patient died within 1 day of the last negative culture, and the other had positive cultures 496 days later. The remaining 23 cases had persistently or intermittently positive cultures despite therapy. The clinical course of these cases suggested overwhelming miliary tuberculosis with involvement of the lungs (77%), pleura (15%), stool (34%), meninges (13%), bone marrow (16%), blood (10%), lymph nodes (10%), and skin (8%). The median survival time was 2.1 months for cases compared with 14.6 months for controls (P = 0.001, log-rank test). CONCLUSIONS: Tuberculosis caused by multiple-drug-resistant bacilli in patients with HIV infection is associated with widely disseminated disease, poor treatment response with an inability to eradicate the organism, and substantial mortality.