Early lymphocyte transformation abnormalities in human immunodeficiency virus infection.

Two hundred twelve patients with enzyme immunoassay and Western blot confirmation of human immunodeficiency virus (HIV) infection were evaluated with anergy panel, lymphocyte cell surface phenotyping, lymphocyte transformation, and serum immunoglobulins. Mitogen responses were used to develop a lymphocyte transformation index (LTI) comparing the summation of each individual's response to its normal control. By multiple regression, anergy panel, absolute CD4 level, and LTI show a progressive decline and IgA shows a progressive increase when correlated with a worsening Walter Reed (WR) classification (R = 0.84). Lymphocyte transformation is first abnormal in WR class 1, absolute CD4 in WR class 3, and anergy and serum IgA in WR class 4. The above markers are useful to assess immunologic function in HIV infection. Lymphocyte transformation abnormalities precede other immunologic deficits in HIV positive patients. Serial evaluation of these markers may help define the immunologic response and natural history of HIV infection.

Spectrum of cerebrospinal fluid findings in various stages of human immunodeficiency virus infection.

This report summarizes the results of neurologic and cerebrospinal fluid (CSF) study findings in over 400 of the 649 human immunodeficiency virus-infected US Air Force personnel, evaluated as of Dec 31, 1987. Eighty percent of these patients were entirely asymptomatic and immunologically normal, 13% had low T-helper lymphocyte counts and/or cutaneous anergy, and only 7% had opportunistic infection. Sixty-three percent of all patients had some CSF abnormality. Sixty percent of the asymptomatic group had at least one abnormal result, over 25% had three or four CSF abnormalities, and over 7% had five or six abnormal values. When patients with evidence of blood-brain barrier leak were excluded, significant differences were seen between disease groups with regard to CSF glucose, CSF IgG levels, and CSF IgG synthesis. No human immunodeficiency virus-related central nervous system abnormalities were found on neurologic examination in immunologically intact asymptomatic patients regardless of CSF findings. No clear-cut predictor of impending central nervous system complications has, as yet, been identified from the CSF parameters studied.

Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging.

To determine whether magnetic resonance (MR) imaging can demonstrate the early stages of osteonecrosis that are not detectable radiographically, the authors compared radiologic findings with histologic results in seven patients at high risk for osteonecrosis of the femoral head. Radiography and MR imaging were performed, and proximal femoral intramedullary pressures were measured in all patients, even if results from imaging studies were normal. If the pressures were elevated, core decompression with biopsy was performed. Seven patients had elevated pressures in 11 hips. Of 11 hips from which biopsy specimens were taken, all had histologic evidence of osteonecrosis. However, in only five were the MR imaging findings consistent with osteonecrosis. In the remaining six hips with osteonecrosis, MR imaging findings were normal. Sensitivity of MR imaging in detection of osteonecrosis was 46%. The authors conclude that normal MR imaging results in high-risk patients do not rule out the presence of osteonecrosis.

Goodpasture's syndrome associated with pulmonary eosinophilic vasculitis.

Lung hemorrhage and antiglomerular basement membrane (anti-GBM) antibody mediated nephritis define Goodpasture's syndrome. We present the case of a 19-year-old Caucasian woman with unique clinical findings of Goodpasture's syndrome. Our patient initially presented with leukocytoclastic vasculitis of the skin followed by the development of nephritis and lung hemorrhage. An open lung biopsy done prior to diagnosing anti-GBM antibody disease demonstrated an intense eosinophilic vasculitis. Skin vasculitis has only been rarely reported, and to our knowledge this is the first reported case of pulmonary eosinophilic vasculitis associated with Goodpasture's syndrome.

Cerebrospinal fluid abnormalities in patients without AIDS who are seropositive for the human immunodeficiency virus.

Lumbar punctures were done on 114 consecutive active duty patients referred for evaluation of positive tests for antibodies to the human immunodeficiency virus (HIV). Eighty-eight percent of these patients appeared to have early HIV infections, as evidenced by intact delayed hypersensitivity, T helper lymphocyte counts greater than 400/mm3, and lack of constitutional symptoms. Forty-four (38.6%) of the patients met our criteria for abnormal cerebrospinal fluid (CSF); another 13 (11.4%) had borderline elevations of nucleated cells or protein and could not be definitely classified as having normal or abnormal CSF. No significant differences existed between the patients with normal and abnormal CSF with regard to age; sex; race; serum FTA-Abs; clinical staging; absolute T helper lymphocyte counts; or cytomegalovirus, Toxoplasma, or Epstein-Barr virus serologies. Seventy-two percent of the patients with abnormal CSF had evidence of possible viral infection of the central nervous system (CNS), as evidenced by increased CSF IgG, increased IgG synthesis rates, or the presence of oligoclonal bands. We found that a significant percentage of asymptomatic patients with apparent early HIV infections have abnormal CSF that is possibly due to CNS involvement by HIV.

The natural history of human immunodeficiency virus infection in screened HIV positive U.S. Air Force personnel: a preliminary report.

We prospectively studied 157 HIV antibody-positive U.S. Air Force personnel identified by universal ELISA screening and confirmed by Western blot. They were initially evaluated and then re-evaluated at least once at approximately 1 year intervals. In order to determine which if any demographic and serologic cofactors were significantly related to progression of immunodeficiency early in the course of disease, we compared these variables with the mean change in CD4 cells per month and with progression in Walter Reed stage. Upon entry into the study, the subjects were classified as follows: sex: 153 (97.5%) male, 4 (2.5%) female; race: 84 (53.5%) white, 63 (40.1%) black, 8 (5.1%) Hispanic, and 2 (1.3%) Oriental; age: mean of 28.6 years (63.0% between 20 and 32 years); and Walter Reed stage: 108 (68.8%) Walter Reed 1, 26 (16.6%) Walter Reed 2, 9 (5.7%) Walter Reed 3, 6 (3.8%) Walter Reed 4, 5 (3.2%) Walter Reed 5, and 3 (1.9%) Walter Reed 6. The mean follow-up period was 12.2 months (range of 2 to 35 months). The mean change in CD4 cells per month was -0.072 (range of -94.75 to +67.58). Factors at entry that are significantly related to loss of CD4 cells included serum IgA over 300 mg/dl (p = 0.0450) and anergy (p = 0.0093). Factors at entry significantly related to progression in Walter Reed stage included serum IgA over 300 mg/dl (p = 0.0001), low absolute CD4 count (p = 0.0001), and low CD4/CD8 ratio (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical usefulness of radionuclide scintigraphy in suspected sacro-iliitis: a prospective study.

The ability of quantitative sacro-iliac scintigraphy (QSS) to detect sacro-iliac joint (SIJ) disease was compared to that of standard radiographs in a prospective study of 26 patients with low back pain suggestive of spondylitis. Of 52 SIJs studied, QSS was abnormal in 21 (40%) and radiographs positive in 23 (44%) (p = 0.47). QSS was abnormal in only 11 of the 23 (48%) radiographically abnormal SIJs. Conversely, 29 radiographically equivocal or negative SIJs yielded positive scintigraphs in ten (34%). Although QSS in general is no more sensitive than standard radiographs, it may allow detection of radiographically inapparent sacro-iliitis in carefully selected patients.