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PUTTING THE "NEW" AIDS-LIKE ILLNESS IN PERSPECTIVE.
The 1992 International Conference on AIDS raised the specter of a new epidemic of AIDS-like illness with its reports of patients who had persistent low CD4+ cell counts (at least two counts below 300 per cubic millimeter) yet lacked evidence of HIV infection. Some investigators presented evidence for a possible retroviral cause. A series of new reports puts this syndrome -- known as idiopathic CD4+ T-lymphocytopenia (ICL) -- in perspective.
In the first, the CDC reviewed 230,179 cases in its AIDS Reporting System and found 47 patients (0.02 percent) with ICL. About 40 percent of these had HIV risk factors. Forty percent had AIDS-defining illnesses (mainly opportunistic infections), 53 percent had other conditions, and the rest were asymptomatic. The CDC also studied 23 contacts of these patients (e.g., spouses or blood donors); all were clinically and immunologically normal.
Three other papers describe 21 patients with ICL, including 13 cited in the CDC report. Most of the papers note depressed numbers of other lymphocytes as well, particularly CD8+ T cells. One team found low numbers of B cells and natural killer cells, while another reported normal levels. In contrast to HIV infection, CD4+ cell counts did not seem to decline progressively, and low counts sometimes rebounded. There was no hypergammaglobulinemia, as is seen in AIDS. Intensive testing for known human and monkey retroviruses yielded negative findings.
Collectively, these reports indicate that ICL is quite rare. Judging from cases identified over the past 10 years, it does not seem to be increasing in prevalence. The authors and editorialist Anthony Fauci conclude that the syndrome is probably heterogeneous in etiology and prognosis and probably not transmissible. Whether it is congenital or acquired remains uncertain.
— ALK
Published in Journal Watch General Medicine February 16, 1993
Citation(s):
Fauci AS. CD4+ T-lymphocytopenia without HIV infection -- no lights, no camera, just facts. N Engl J Med 1993 Feb 11 328 429-431.
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Duncan RA et al. Idiopathic CD4+ T-lymphocytopenia -- four patients with opportunistic infections and no evidence of HIV infection. N Engl J Med 1993 Feb 11 328 393-398.
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Spira TJ et al. Idiopathic CD4+ T-lymphocytopenia -- an analysis of five patients with unexplained opportunistic infections. N Engl J Med 1993 Feb 11 328 386-392.
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Ho DD et al. Idiopathic CD4+ T-lymphocytopenia -- immunodeficiency without evidence of HIV infection. N Engl J Med 1993 Feb 11 328 380-385.
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Smith DK et al. Unexplained opportunistic infections and CD4+ T- lymphocytopenia without HIV infection: an investigation of cases in the United States. N Engl J Med 1993 Feb 11 328 373-379.
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