Sequential Clinical and Immunologic Abnormalities in Hemophiliacs

Goldsmith, J.; Kalish, Steve B.; Chmiel, Joan S.; Wallemark, Carl B.; Phair, John P.

doi:10.1001/archinte.1985.00360030063013

Cited by 11 publications

(4 citation statements)

References 28 publications

(1 reference statement)

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“…The disturbed immune function, in both HIV-seropositive and HIV-seronegative hemophilia patients, is in agreement with previous reports and supports the hypothesis that factors other than HIV infection are responsible for the impaired immunity in hemophilic patients [Goldsmith et al, 1985;Blumberg et al, 1989;Brettler et al, 1986;Medhok et al, 19861. The response of the HIV-seronegative hemophiliacs to polio vaccination, both a t 4 weeks and a t 1 year, in the present study does not appear to differ from that described in young normal controls [Rotem et al, 19881. Of note is the observation that HIV-seropositive patients, as a group, had detectable baseline levels of antibodies to the three viral types and responded to immunization with increased titers of these antibodies. As would be expected, both pre-and post-immunization antibody titers in this group were lower than those observed in the HIV-seronegative patients.…”

Section: Discussionsupporting

confidence: 89%

“…Recent studies have demonstrated that immunological dysfunction in hemophilia might arise from factors other than HIV infection. In fact, other viral infections (like hepatitis B and C, Epstein-Barr and cytomegaloviruses) and impure FVIII concentrates have been suggested as possible causes for this phenomenon [Goldsmith et al, 1985;Blumberg et al, 1989;Brettler et al, 1986;Medhok et al, 19863. A recent outbreak of poliomyelitis in Israel, resulting in 15 cases of paralysis [Slater et al, 19901, allowed us to follow the response of our hemophilic patients who were immunized as part of the general population vaccination program.…”

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confidence: 99%

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Response of hemophilic patients to poliovirus vaccination: Correlation with HIV serology and with immunological parameters

Varon

Handsher

Dardik

et al. 1993

Journal of Medical Virology

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Hemophilic patients may present immunological dysfunctions resulting from either human immunodeficiency virus (HIV) infection, or other factors like impure factor VIII concentrate and other viral infections. We evaluated prospectively the serologic response to polio vaccination of Israeli hemophilic patients who were vaccinated during an outbreak of poliomyelitis. Eighty-two hemophilic patients, 43 seronegative and 39 seropositive for human immunodeficiency virus (HIV), were vaccinated with enhanced inactivated poliovirus (eIPV). Titers of antibodies for poliovirus types 1-3 were determined before and 4 weeks after immunization. T helper and suppressor lymphocytes (T4 and T8), B and T lymphocyte mitogenic response, and natural killer cells were tested and correlated with the response to vaccination. Both groups responded to vaccination with increased titers of antibodies to the three viral types, 4 weeks after immunization. HIV-seronegative patients, however, exhibited higher titers than the HIV-seropositive group. The same pattern was found when 21 patients were tested 1 year after the exposure to eIPV. HIV seropositive patients were grouped according to their T4 count (between 16/microliter and 500/microliter). There was no statistically significant difference in the response of these different groups to vaccination. No correlation was found between the response to vaccination and other immune parameters. These results suggest that asymptomatic HIV-seropositive hemophilic patients respond well to eIPV, irrespective of their T4 count.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Response of hemophilic patients to poliovirus vaccination: Correlation with HIV serology and with immunological parameters

Varon

Handsher

Dardik

et al. 1993

Journal of Medical Virology

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“…However, the rate of decline was significantly more rapid in those aged 25 and above (9 subjects; mean rate± SD, 17.5 ± 9.2% per year vs. 9.5 ± 4.7% per year in those under 25; p <0.05) (Fig.1). The CD4 count in those with lymphadenopathy (12), splenomegaly (11), or both (6), did not differ significantly from those without these findings ( 6). The rate of decline in CD4 cells in those with factor IX deficiency was no different from those with classical hemophilia.…”

Section: Discussionmentioning

confidence: 94%

“…Subjects were first evaluated for signs of HIV-related illness from August 1981 to May 1983 (6) and have undergone repeated examinations and immunologic studies for up to 9 years.…”

Section: Patientsmentioning

confidence: 99%

CD4 Cells in HIV-1 Infected Hemophiliacs: Effect of Factor VIII Concentrates

et al. 1991

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SummaryThe goal of this study was to determine the long-term clinical outcome of Human Immunodeficiency Virus (HIV) infection in a group of HIV-seropositive hemophiliacs for whom the dates of seroconversion were known and to investigate whether the use of monoclonal antibody purified factor (high purity) concentrate and treatment with zidovudine may alter the effect of HIV infection in seropositive hemophiliacs.Twenty-eight hemophiliacs were followed for up to 9 years after seroconversion. In addition, 13 seropositive patients who elected to receive (high purity) factor VIII concentrate for up to 1.5 years were compared to a contemporaneous concurrent control group of 8 seropositive patients treated with intermediate purity factor VIII concentrate, and then both groups were followed for an additional 1.5 years while receiving zidovudine.The acquired immunodeficiency syndrome (AIDS) developed in 9 of 28 patients (33%) from 1 to 9 years following seroconversion. CD4 cell count declined at a rate of 13.5% per year for the cohort but for persons 25 years and above the rate was significantly higher (17.5 ± 9.2% per year vs. 9.5 ± 4.7%, mean ± SD, p <0.05) than in those under 25. All three patients who had undergone splenectomy developed AIDS.Subjects treated with high purity concentrates, with the exception of one patient who developed the nephrotic syndrome secondary to amyloidosis, had stable CD4 cell counts. On the other hand, all patients receiving intermediate purity concentrates had a decline in CD4 cells, and the difference from initial levels was highly significant (p = 0.01). The CD4 cell concentrations in these patients were stable after treatment with zidovudine.We conclude that the incidence of AIDS in seropositive hemophiliacs more than 9 years after seroconversion is similar to that seen in other seropositive groups. CD4 cell counts declined more rapidly in those patients who were older at the time of seroconversion. Splenectomy may adversely affect the outcome of HIV infection.Individuals receiving high purity concentrate may have less immunosuppression than those receiving intermediate purity concentrates. Randomized controlled trials are needed to confirm these observations.

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Altered immunity in hemophilia correlates with the presence of antibody to human T-cell lymphotropic virus type III (HTLV-III)

et al. 1986

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Twenty-nine heterosexual patients with hemophilia were investigated with histories, physical examinations, laboratory evaluations of immune function, delayed hypersensitivity skin tests, and assays for antibody to human T-cell lymphotropic virus type III (HTLV-III). Sixteen patients were HTLV-III antibody positive and 13 were HTLV-III antibody negative. No patient had the acquired immune deficiency syndrome (AIDS). Patients who had antibody to HTLV-III had received significantly more units and lots of factor concentrates in the preceding 5 years than those who did not have antibody. HTLV-III antibody-positive patients had significantly fewer total T cells (Leu-1 positive) and significantly fewer helper T cells (Leu-3 positive) than HTLV-III negative patients. Antibody-positive patients also had increased amounts of IgG and decreased thymidine incorporation in response to concanavalin A in vitro. There were no differences in in vitro lymphocyte responses to phytohemagglutinin (PHA), pokeweed mitogen, Candida, tetanus, or purified protein derivative (PPD), no significant impairments of gamma interferon or interleukin-2 (IL-2) production, and no anergy. Ten patients with antibody to HTLV-III had immunologic studies repeated 1 year after the original evaluation. A significant increase was seen in suppressor (Leu-2-positive) T cells but not in total T-cell or helper T-cell numbers, helper/suppressor ratios, or T-cell functional assays. We conclude that the immune abnormalities in hemophiliacs are the result of contact with HTLV-III but that these abnormalities may remain stable over prolonged periods.

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Sequential Clinical and Immunologic Abnormalities in Hemophiliacs

Cited by 11 publications

References 28 publications

Response of hemophilic patients to poliovirus vaccination: Correlation with HIV serology and with immunological parameters

Response of hemophilic patients to poliovirus vaccination: Correlation with HIV serology and with immunological parameters

CD4 Cells in HIV-1 Infected Hemophiliacs: Effect of Factor VIII Concentrates

Altered immunity in hemophilia correlates with the presence of antibody to human T-cell lymphotropic virus type III (HTLV-III)

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