Nonrandom development of immunologic abnormalities after infection with human immunodeficiency virus: implications for immunologic classification of the disease.

Abstract

Blood specimens from 165 intravenous drug users who were seropositive for the human immunodeficiency virus (HIV), from 158 seropositive homosexual men with lymphadenopathy, and from 77 patients with acquired immunodeficiency syndrome (AIDS) were assessed immunologically. Immunologic parameters were analyzed by the Guttman scalogram technique to determine if immunologic abnormalities occurred in a nonrandom pattern. The following four patterns emerged: (i) seropositivity for HIV with no immunologic abnormalities; (ii) seropositivity for HIV with a depressed T4/T8 cell ratio; (iii) seropositivity with a depressed T4/T8 cell ratio and T4-cell depletion; and (iv) seropositivity with a depressed T4/T8 cell ratio, T4-cell depletion, and lymphopenia. Ninety-two to 100% of subjects in each of the three groups of patients were found "to scale" because the abnormalities occurred in the cumulative, ordered fashion described. This nonrandom occurrence of abnormalities indicates an ordered progression of immunologic abnormalities in individuals infected with HIV, a finding useful in the staging of both symptomatic and asymptomatic HIV-seropositive subjects.Various studies have shown that different manifestations of infection with the human immunodeficiency virus (HIV, ref.

Human immunodeficiency virus infection of helper T cell clones. Early proliferative defects despite intact antigen-specific recognition and interleukin 4 secretion.

“…However, much greater numbers of cells may undergo low level chronic or latent infection, from which HIV may only be recognized after appropriate stimulation (14). Our findings do parallel proliferative abnormalities seen using T lymphocytes from early HIV-infected individuals (1), and may help to explain the lack of in vitro and in vivo efficacy of IL-2. In addition, our documentation of intact CD23 induction and IL-4 secretion despite other T cell defects may be relevant to the hyperstimulation of B lymphocytes characteristic of AIDS ( 14).…”

“…Absolute numbers of CD4+ cells and the CD4:CD8 helper/inducer to suppressor/cytotoxic T lymphocyte ratio may be within normal limits, yet certain measures of cellular immunity are markedly perturbed (1). These early events following HIV infection, particularly qualitative changes in immune reactivity, are poorly understood.…”

Presence of monoclonal T-cell populations in B-cell post-transplant lymphoproliferative disorders

“…During the early course of HIV-1 infection, CD8-positive T cells show a moderate rise, which is transient in most cases, and then decline in parallel with the depletion of CD4-positive T cells. 29 However, persistent elevation of circulating CD8-positive T cells with visceral involvement, mainly salivary glands and lung, in response to HIV-1 infection, has been described in certain group of patients. 30 These are manifested as clonally expanded T-cell populations in the peripheral blood and in the viscera.…”

Tissue infiltration in a CD8 lymphocytosis syndrome associated with human immunodeficiency virus-1 infection has the phenotypic appearance of an antigenically driven response.

“…In contrast, T cells of the CD8 lineage are generally not infected with HIV-1 and have been implicated in both potentially protective anti-HIV responses (2,3) as well as in mechanisms causing the depletion of autologous CD4 T cells (4). CD8 lineage T cells are often moderately elevated early in the course of HIV-1 infection, however, in most cases, this is usually a transient phenomenon and CD8 T cell numbers tend to subsequently decline in parallel with CD4 T cell depletion (5).…”