Fine needle aspiration biopsy diagnosis of tuberculous lymphadenitis in patients with and without the acquired immune deficiency syndrome

All Bellevue Hospital cases from a recent 27-month period whose fine needle aspiration (FNA) samples of cervical or supraclavicular masses showed acute and/or granulomatous inflammation were reviewed. The 30 patients included 8 with the acquired immune deficiency syndrome (AIDS), 3 with the AIDS-related complex (ARC), 2 with AIDS risk factors and 17 without known risk factors for AIDS. Of these, mycobacterial infections had been diagnosed in 22 patients: 18 by cultures positive for Mycobacterium tuberculosis and 4 by positive staining for acid-fast bacilli. In addition to the presence of neutrophils, two criteria for the diagnosis of mycobacterial infection were identified on the routinely stained FNA smears: caseous material and granulomas. Caseous material was the most sensitive and specific criterion. Granulomas were often present in patients with mycobacterial infection, but were also occasionally present in patients with other processes. The differences in cytologic specimens between AIDS and non-AIDS patients are discussed. The findings suggest that FNA is a safe and sensitive technique for the diagnosis of mycobacterial lymphadenitis in AIDS patients and that purulent aspirates from appropriate patient populations should prompt the use of special stains and cultures to rule out mycobacterial infection.     

Alterations in the gut microbiota of patients with acquired immune deficiency syndrome

Acquired immune deficiency syndrome (AIDS), caused by infection with human immunodeficiency virus (HIV), is associated with gastrointestinal disease, systemic immune activation and changes in the gut microbiota. Here, we aim to investigate the gut microbiota patterns of HIV‐infected individuals and HIV‐uninfected individuals in populations from South China. We enrolled 33 patients with HIV (14 participants treated with highly active antiretroviral therapy [HAART] for more than 3 months; the remaining 19 individuals had not received treatment) and 35 healthy controls (HC) for a cross‐sectional comparison of gut microbiota using stool samples. Gut microbial communities were profiled by sequencing the bacterial 16S rRNA genes. Dysbiosis was more common among patients with AIDS compared with healthy individuals. Dysbiosis was characterized by decreased α‐diversity, low mean counts of Bacteroidetes, Faecalibacterium, Prevotella, Bacteroides vulgatus, Dialister and Roseburia inulnivorans, and high mean counts of Proteobacteria, Enterococcus, Streptococcus, Lactobacillus, Lachnociostridium, Ruminococcus gnavus and Streptococcus vestibularis. Increased abundance of Bacilli was observed in homosexual patients. Proteobacteria were higher among heterosexual patients with HIV infections. Tenericutes were higher among patients with history of intravenous drug abuse. Restoration of gut microbiota diversity and a significant increase in abundance of Faecalibacterium, Blautia and Bacteroides were found in patients receiving HAART compared to those who did not receive. HIV infection‐associated dysbiosis is characterized by decreased levels of α‐diversity and Bacteroidetes, increased levels of Proteobacteria and the alterations of gut microbiota correlate with the route of HIV transmission. The imbalanced faecal microbiota of HIV infection is partially restored after therapy.     

DNA image cytometry in acquired immune deficiency syndrome (AIDS)

In nine cases with the acquired immune deficiency syndrome (AIDS), including four stage I cases, three stage II cases and two stage III cases, DNA image cytometry was performed on Feulgen-stained lymph node imprint smears. Diploidy was found in three cases, tetraploidy in three cases and octoploidy in two cases. Aneuploid DNA distribution patterns were not seen. The lymphoid cells showed an enormously increased proliferation rate. Two cases in stage I revealed characteristic intranuclear DNA inclusions in lymphoid cells. These results indicate that DNA image cytometry may be useful as an adjunct to surgical pathology in certain cases to assist in the differential diagnosis between AIDS and benign conditions of the lymphoid system as well as between AIDS and malignant lymphomas, which usually have aneuploid DNA patterns.     

DNA-hydrolyzing IgG antibodies from the blood of patients with acquired immune deficiency syndrome

DNAase activity of 110 samples of IgG from the blood of AIDS patients was analyzed. It was shown that the relative activity of preparations varies very much from patient to patient, but 96% preparations show detectable level of DNAase activity. Several rigid criteria were applied and it was shown that DNAase activity is an intrinsic property of antibodies from AIDS patients. It was shown that catalytic activity could posses not only intact IgG, but also separated light chains of polyclonal antibodies. The abzymes catalyze DNA hydrolysis effectively in a wild range of pH (5.0-9.5). K(M) and V(MaKC) values of antibody-dependent hydrolysis of DNA was estimated.     

DNA-hydrolyzing IgG antibodies from the blood of patients with acquired immune deficiency syndrome

DNase activity was analyzed in 110 IgG preparations from the blood of AIDS patients. The relative activity of the preparations varied markedly among patients, being reliably detectable in 96% of the preparations. It was shown with several rigid criteria that DNAase activity is an intrinsic property of antibodies (Abs) from AIDS patients. Not only intact IgG, but also isolated light chains of polyclonal Abs were shown to possess catalytic activity. The abzymes efficiently catalyzed DNA hydrolysis in a wide range of pH (5.0–9.5). The K _M and V _max values were evaluated for Ab-dependent hydrolysis of DNA.     

Plasma fatty acid levels in patients with acquired immune deficiency syndrome and in controls

Polyunsaturated fatty acids (PUFAs) are known to modulate the immune system in vivo and to inactivate envelope viruses in vitro. Patients with AIDS had low total plasma lipid levels and low levels of a number of individual fatty acids. However, the C20 and C22 essential fatty acids of the n-3 series were selectively and highly significantly reduced. Normalization of these fatty acid levels in AIDS patients may be a worthwhile therapeutic aim.     

Length of survival of patients with acquired immune deficiency syndrome in the United Kingdom.

An analysis of the lengths of survival of patients with the acquired immune deficiency syndrome presenting with different opportunistic diseases was performed using epidemiological data routinely collected at the PHLS Communicable Disease Surveillance Centre. The overall crude case fatality rate was 55.4% (93/168). The median survival times were: 21.2 months for Kaposi''s sarcoma, 12.5 months for Pneumocystis carinii pneumonia, and 13.3 months for other opportunistic infections. The shortest median survival time (6.6 months) was found for those with both Kaposi''s sarcoma and P carinii pneumonia. There were significant differences between durations of survival of patients with Kaposi''s sarcoma and those with all other diseases, which indicated impaired cellular immunity apart from opportunistic infections. This analysis shows that those with Kaposi''s sarcoma alone have the most favourable prognosis.     

Murine models for acquired immune deficiency syndrome

The mouse has been suggested as a host for comparative studies of several aspects of Human Acquired Immune Deficiency Syndrome (AIDS). Models include studies where part or all of the genome of Human Immunodeficiency Virus (HIV) has been incorporated into murine DNA in living mice. However, the most promising opportunities for study of immunological changes, vaccine development, cofactor involvement in disease, and anti-retroviral and immunostimulatory drug testing involve infection with murine retroviruses which cause many functional changes similar to AIDS. The viruses' effects on immune systems are reviewed with special emphasis. LP-BM5 murine leukemia virus which infects T and B cells, and macrophages. LP-BM5 infection suppresses cell functions while causing polyclonal lymphocyte activation. Murine immunological characterization, availability of inbred mouse strains, economy of using mice versus primates or humans models, and similarity of immune change caused by murine retroviruses compared to those seen in AIDS caused by HIV encourage rapid development of the LP-BM5 murine leukemia model.     

The distribution of selenium and mortality owing to acquired immune deficiency syndrome in the continental United States

A hypothesis has been proposed that Selenium (Se) concentration in the environment as measured by its uptake by alfalfa, which sorbs Se from the soil in proportion to what is present, exerted an apparent effect on incidence of (acquired immune deficiency syndrome) AIDS such that AIDS’ mortality within the conterminous United States was lower where the Se quantity in the soil was high than where the amount was low. The object of this study was to test this hypothesis for statistical significance and to discover whether the apparent pattern of AIDS mortality in relation to Se distribution holds true with respect to all ages, both races (Black and White), and both genders. The statistical analysis employed was analysis of variance. Age-specific data as well as age-adjusted data were subject to statistical analysis. Ages where AIDS mortality rates per 100,000 were greatest were in the range from 25–54 yr for low-, medium-, and high-Se areas of the US. Black mortality owing to AIDS showed highly statistically significant results for the three Se regions, both genders, and six age groups, whereas white mortality was not as significantly affected by Se. A hypothesis is proposed that the Black population during the last decade or so has been less migratory than the White population. Thus, their food supply and hence its Se content have been more stable than that of the White population, which is more prone to consume imported foods of unknown Se content and be more migratory. A second hypothesis is advanced that suggests that medical care is not equally available to the poor and especially poor Blacks. Black men and women die at a greater death rate than do Whites. This implies that a lack of medical care is the true cause. This article suggests that a pattern exists between the geographical distribution of Se using alfalfa as a dietary guide and AIDS’ mortality such that an inverse relationship persists between Se quantity in an area and AIDS’ mortality in the same area.     

Experimental oral polio vaccines and acquired immune deficiency syndrome

The simian immunodeficiency virus (SIV) of the common chimpanzee is widely acknowledged as the direct ancestor of HIV-1. There is increasing historical evidence that during the late 1950s, kidneys were routinely excised from central African chimpanzees by scientists who were collaborating with the polio vaccine research of Dr Hilary Koprowski, and sent - inter alia - to vaccine-making laboratories in the USA and Africa, and to unspecified destinations in Belgium. While there is no direct evidence that cells from these kidneys were used as a substrate for growing Dr Koprowski's oral polio vaccines, there is a startling coincidence between places in Africa where his CHAT vaccine was fed, and the first appearances in the world of HIV-1 group M and group-M-related AIDS. Because of the enormous implications of the hypothesis that AIDS may be an unintended iatrogenic (physician-caused) disease, it is almost inevitable that this theory will engender heated opposition from many of those in the scientific establishment, and those with vested interests.     

Pulmonary Mycobacterium tuberculosis in acquired immune deficiency syndrome.

A case of pulmonary infection with Mycobacterium tuberculosis in a patient with the acquired immune deficiency syndrome (AIDS) was studied. Diagnosis of AIDS was confirmed by the finding of pulmonary M tuberculosis with oral and oesophageal candidiasis accompanied by characteristic immunological changes with evidence of infection with human T cell lymphotropic virus III. Treatment of this patient was complicated by an unusual drug interaction between rifampicin and ketoconazole, leading to subtherapeutic serum concentrations and poor clinical response to treatment. Intravenous treatment was more effective than oral treatment. This drug interaction should be studied in greater detail as ketoconazole and rifampicin may be used together to treat patients with candidiasis and infection with M tuberculosis.