Showing papers by "Henry Masur published in 1984"
TL;DR: The acquired immunodeficiency syndrome is a new disease whose cause is unknown but is almost surely due to a transmissible agent, most likely a virus.
Abstract: The acquired immunodeficiency syndrome is a new disease whose cause is unknown but is almost surely due to a transmissible agent, most likely a virus. The disease is clearly spread by sexual contact, particularly homosexual activity. Blood-borne transmission constitutes the other major recognized form of spread of the disease, although it is highly likely that the disease is not readily spread through casual, nonsexual, non-blood-borne routes. Although the disease is still highly concentrated in the United States, it is now seen in several countries throughout the world. The common denominator of the disease is a profound suppression of cell-mediated immunity, specifically a quantitative and qualitative defect in the T4 inducer or helper subset of T lymphocytes. Hyperactivity of B lymphocytes is also characteristic. The clinical manifestations are those of severe and life-threatening opportunistic infections and unusual neoplasms, particularly Kaposi's sarcoma. The mortality may well approach 100%, making this one of the most extraordinary transmissible diseases in history.
800 citations
TL;DR: Survivors with the acquired immunodeficiency syndrome at initial presentation had a significantly lower respiratory rate, and higher room air arterial oxygen tension, lymphocyte count, and serum albumin level compared to nonsurvivors.
Abstract: Clinical features of 49 episodes ofPneumocystis cariniipneumonia in patients with the acquired immunodeficiency syndrome were compared with those of 39 episodes in patients with other immu...
774 citations
TL;DR: It is suggested that impaired lymphokine production may predispose patients with AIDS to opportunistic infections, and they provide a rationale for using gamma interferon as immunotherapy.
Abstract: To examine the cellular immune defect that predisposes patients with the acquired immunodeficiency syndrome (AIDS) to opportunistic infections, we tested T lymphocytes from 16 patients for the capacity to secrete macrophage-activating products (lymphokines) including gamma interferon. Mononuclear cells from 10 of 11 patients did not generate an effective lymphokine in response to mitogen, and 11 of 16 produced subnormal levels of gamma interferon (less than 300 U per milliliter). In addition, upon stimulation with specific microbial antigen, cells from none of 14 patients generated active lymphokines, and cells from 13 to 14 completely failed to secrete gamma interferon. However, the antimicrobial function of monocytes from the patients was intact, and once stimulated with normal lymphokines or gamma interferon alone, macrophages derived from patients' monocytes responded with enhanced and effective intracellular antimicrobial activity. These results suggest that impaired lymphokine production may predispose patients with AIDS to opportunistic infections, and they provide a rationale for using gamma interferon as immunotherapy.
488 citations
TL;DR: The prevalence of EBV and CMV infections in AIDS and the chronic lymphadenopathy syndrome may be the result of an important interaction between these viruses and the cause of AIDS.
Abstract: Herpesvirus infections were studied in persons with or at risk for the acquired immune deficiency syndrome (AIDS). The infections diagnosed were as follows: patients with AIDS, cytomegalovirus (CMV) in 34 of 34, Epstein-Barr virus (EBV) in 33 of 34, herpes simplex viruses (HSV) in eight of 34, and varicella zoster virus in four of 34; patients with chronic lymphadenopathy syndrome, CMV in eight of nine and EBV in nine of nine; in healthy homosexual men, CMV in five of 13 and EBV in seven of eight. Cytomegalovirus infections were frequently related to disease and death. Herpesvirus infections are frequent causes of serious diseases in AIDS. The prevalence of EBV and CMV infections in AIDS and the chronic lymphadenopathy syndrome may be the result of an important interaction between these viruses and the cause of AIDS. ( JAMA 1984;252:72-77)
399 citations
TL;DR: Transmission of HTLV-III by lymphocyte-poor plasma confirms the potential risk of such plasma or plasma derivatives to recipients and makes the chimpanzee a valuable model for further study of AIDS.
Abstract: Two of three chimpanzees given plasma from patients with acquired immune deficiency syndrome (AIDS) or pre-AIDS showed serum antibodies to type III human T-cell leukemia virus (HTLV-III) 10 to 12 weeks after transfusion. One animal also developed lymphadenopathy, transient depression of the ratio of T4 to T8 lymphocytes, and impaired blastogenic responses. No opportunistic infections occurred. Adenopathy persisted for 32 weeks, and antibody to HTLV-III persisted for at least 48 weeks. This transmission of HTLV-III by lymphocyte-poor plasma confirms the potential risk of such plasma or plasma derivatives to recipients. The susceptibility of the chimpanzee to HTLV-III infection and the ability to simulate the human lymphadenopathy syndrome in this animal makes it a valuable model for further study of AIDS.
317 citations
TL;DR: Twenty patients with acquired immunodeficiency syndrome (AIDS) died and the eyes were obtained for culture and histopathologic examination, and cytomegalovirus retinitis was a significant cause of visual loss.
297 citations
TL;DR: The immune abnormality in AIDS, previously thought to involve only the T-, B-, and natural killer lymphocytes, extends to the monocyte-macrophage andective monocyte migratory function may contribute to the depressed inflammatory response to certain organisms and to the apparent unrestricted growth of certain neoplasms in patients with AIDS.
Abstract: The ineffective immune response in patients with the acquired immune deficiency syndrome (AIDS) contributes to severe and widespread infections and unrestricted growth by certain tumors. To determine whether monocyte dysfunction contributes to this immunosuppressed condition, we investigated monocyte chemotaxis in patients with AIDS. Using three different chemotactic stimuli, N-formylmethionylleucylphenylalanine, lymphocyte-derived chemotactic factor, and C5a des Arg, we studied the chemotactic responses of monocytes from seven homosexual men with AIDS, three homosexuals with lymphadenopathy and an abnormal immunological profile, seven healthy homosexual men, and 23 heterosexual control individuals. Monocytes from each of the AIDS patients with Kaposi's sarcoma and/or opportunistic infection exhibited a marked reduction in chemotaxis to all stimuli compared with the healthy control subjects. The reduced chemotactic responses were observed over a wide range of concentrations for each stimulus. Monocytes from AIDS patients who had clinically apparent opportunistic infection(s) exhibited a greater reduction in monocyte migration to all three stimuli than monocytes from the AIDS patient with only Kaposi's sarcoma. Monocytes from each of three homosexuals with lymphadenopathy and an abnormal immunological profile exhibited decreased chemotactic responses that were intermediate between those of the AIDS patients and the healthy heterosexual control subjects. In contrast to these findings, monocytes from each of seven healthy homosexuals exhibited normal chemotactic responses to the same stimuli. In addition, monocytes from AIDS patients exhibited reduced chemotaxis to soluble products of Giardia lamblia, one of several protozoan parasites prevalent in AIDS patients. Thus the immune abnormality in AIDS, previously thought to involve only the T-, B-, and natural killer lymphocytes, extends to the monocyte-macrophage. Defective monocyte migratory function may contribute to the depressed inflammatory response to certain organisms and to the apparent unrestricted growth of certain neoplasms in patients with AIDS.
266 citations
TL;DR: Subsegmental BAL may be an important and sensitive tool for early diagnosis of PCP in patients with HIV and there was no substantial morbidity attributable to the procedure.
Abstract: To assess the sensitivity of bronchoalveolar lavage in patients with the acquired immunodeficiency syndrome (AIDS) in diagnosing Pneumocystis carinii pneumonia (PCP), we prospectively performed 27 ...
113 citations
TL;DR: The PCP in patients with AIDS may require more prolonged therapy for complete resolution of this pneumonic process and there was no apparent correlation between rate of clinical response and likelihood of histologic resolution on follow-up biopsy.
Abstract: Eleven patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) were studied by repeat bronchoscopy during PCP treatment to assess histologic evidence of resolution of the pneumonia. Nine of 10 patients studied after 8 to 21 days of therapy demonstrated evidence of persistent PCP. Four of 6 patients studied after 22 to 35 days of therapy continued to demonstrate Pneumocystis carinii cysts on repeat examination, while only 1 of 4 patients studied after 35 days of therapy showed evidence of PCP pneumonia. The rate of resolution of PCP in patients with AIDS may be different from the rate of resolution of PCP in patients without AIDS. There was no apparent correlation between rate of clinical response and likelihood of histologic resolution on follow-up biopsy. The PCP in patients with AIDS may require more prolonged therapy for complete resolution of this pneumonic process.
78 citations
TL;DR: The overall mortality in patients with this syndrome remains at approximately 40 per cent, however, since no reversals of the underlying immune dysfunction have reportedly occurred either spontaneously or with therapy, the disease appears to appear to be terminal.
Abstract: THE acquired immunodeficiency syndrome (AIDS) is a disease of the immune system that results in the development of life-threatening opportunistic infections or unusual neoplasms or both. Although effective therapies exist for many of the infectious and neoplastic complications of this syndrome, no successful treatment has been developed for the underlying immune defect. Thus, patients are susceptible to recurrent and life-threatening infections and progressive neoplastic processes. The overall mortality in patients with this syndrome remains at approximately 40 per cent. However, since no reversals of the underlying immune dysfunction have reportedly occurred either spontaneously or with therapy, the disease appears to . . .
64 citations
TL;DR: Case histories of five AIDS patients evaluated for abdominal pain are presented to demonstrate the unusual spectrum of intra-abdominal pathology that may be encountered in the AIDS patient.
Abstract: Acquired immune deficiency syndrome (AIDS) is a recently recognized entity characterized by a deficiency in cell mediated immune response. The syndrome is manifested by the development of otherwise rare malignant neoplasms and severe life-threatening opportunistic infections. Case histories of five AIDS patients evaluated for abdominal pain are presented to demonstrate the unusual spectrum of intra-abdominal pathology that may be encountered in the AIDS patient. As the number of patients with AIDS continues to escalate, surgical evaluation and intervention will be required more frequently. An understanding of this syndrome and its complications is mandatory for the surgeon to adequately evaluate AIDS patients with abdominal pain.
Journal Article•
TL;DR: Patients with acquired immunodeficiency syndrome were treated with a natural product, highly purified human interleukin-2, and immunologic changes during the study included a decrease in the number of circulating T8 lymphocytes, increased skin test reactivity, and a decline in serum immunoglobulin levels.
Abstract: Twelve patients with acquired immunodeficiency syndrome were treated with a natural product, highly purified human interleukin-2. Doses ranged from 250 to 250,000 units. No clinical responses were seen. Minimal toxicity was noted and consisted of mild prolongation of partial thromboplastin time and proteinuria. Immunologic changes during the study included a decrease in the number of circulating T8 lymphocytes, increased skin test reactivity, and a decline in serum immunoglobulin levels.
TL;DR: Blood samples from a series of patients with Kaposi's sarcoma or infectious complications of the acquired immunodeficiency syndrome and from 18 homosexual contacts of AIDS patients were screened for interferon-related tubuloreticular inclusions (TRI) in circulating leukocytes, demonstrating localization of TRI in T suppressor/cytotoxic cells was demonstrated with monoclonal anti-Leu 2a antibodies.
Abstract: Blood samples from a series of 12 patients with Kaposi's sarcoma or infectious complications of the acquired immunodeficiency syndrome (AIDS) and from 18 homosexual contacts of AIDS patients were screened for interferon-related tubuloreticular inclusions (TRI) in circulating leukocytes. In the AIDS patients, TRI were detected by transmission electron microscopy in 1.5 to 10% of mononuclear cell sections. They were most frequent in patients with a decreased fraction of T helper cells and T4/T8 ratios less than 0.2. Only rare TRI-positive sections were found in 3/12 homosexual contacts with lymphadenopathy and 1/6 asymptomatic contacts. Serum interferon was found to be elevated in each AIDS case tested, but was not a sufficient condition for detection of TRI in homosexual contacts. Active DNA virus infections, including cytomegalovirus, were common to the AIDS cases and possibly contributed to the TRI pathogenesis. Localization of TRI in T suppressor/cytotoxic cells was demonstrated with monoclonal anti-Leu 2a antibodies. The pathophysiologic significance of interferon stimulation with formation of TRI in immunocompetent cells requires further investigation.
TL;DR: There is no evidence that the antitumor responses obtained in AIDS-related malignancies translate into survival advantages to the AIDS victim.
Abstract: Almost 40% of the 3000 US patients with acquired immunodeficiency syndrome (AIDS) have a malignancy at the time of reporting and the incidence of AIDS patients who develop a malignancy during the course of the disease may be 65-70%. 2 types of malignancies have been noted with increased frequency in AIDS victims: Kaposis sarcoma and malignant lymphomas. About 35% of all AIDS patients and 50% of homosexual or bisexual victims have developed Kaposis sarcoma and those with coincident opportunistic infection have 2.5 times the mortality of those without such infection. There are 2 essential features to the histopathology of Kaposis sarcoma: 1) vascular proliferation and 2) spindle-shaped neoplastic cells in a network of reticulin fibers that appear to be of endothelial origin. The treatment of the epidemic form of Kaposis sarcoma has not been successful and the projected 2-year survival is only 30%. The causes of death in the majority of such patients are overwhelming opportunistic infections especially cytomegalovirus and Pneumocystis carinii and irreversible cachexia and wasting. Interferon therapy has had a beneficial effect in patients with disease limited to skin with T4/T8 ratios over 0.5 and without a prior history of opportunistic infection; however there is no evidence that interferon exerts any beneficial effects on the underlying immune defects. An aggressive 6-drug combination chemotherapy regimen has been tried on patients whose tumors appeared to be life-threatening and was effective in controlling the Kaposis sarcoma but again did not appreciably alter immune parameters. Several other approaches to the treatment of epidemic Kaposis sarcoma are under evaluation including gamma interferon interleukin-2 and plasmapheresis. Patients who develop malignant lymphomas require combined treatment with central nervous system radiation and systemic combination chemotherapy. There is no evidence that the antitumor responses obtained in AIDS-related malignancies translate into survival advantages to the AIDS victim.
TL;DR: Thirteen AIDS patients at the National Institutes of Health with KS of the head and neck region are presented; the mortality rate in this subgroup of AIDS patients is extraordinarily high (62%), with an average longevity of 11 months following initial diagnosis.
Abstract: Since 1981 a new syndrome of acquired immune deficiency (AIDS) has been recognized. Male homosexuals, male and female intravenous drug abusers, and recipients of blood products (i.e., hemophiliacs) appear to be the populations at risk. The syndrome has been manifested by community-acquired opportunistic infections and/or Kaposi's sarcoma (KS). Otolaryngologic manifestations of AIDS are not infrequent. Thirteen AIDS patients at the National Institutes of Health with KS of the head and neck region are presented. All 13 patients were homosexual or bisexual males. Nine initially presented with KS, five with KS of the head or neck. As a group the patients demonstrated lesions involving the oropharyngeal, tracheobronchial, and gastrointestinal regions. Their clinical course and complications are presented in detail. The mortality rate in this subgroup of AIDS patients is extraordinarily high (62%), with an average longevity of 11 months following initial diagnosis.
TL;DR: There are many features of the epidemiology and clinical manifestations of AIDS that are consistent with the possibility that CMV or EBV infections may be relevant to the etiology of AIDS, and results of studies pertaining to each of these aspects are summarized.
Abstract: Herpesvirus infections are of interest in the acquired immunodeficiency syndrome (AIDS) for many reasons. They are frequent causes of serious diseases in individuals susceptible to opportunistic infections,'. * and infections caused by cytomegalovirus (CMV) and herpes simplex viruses (HSV) are known to be prevalent in the sociological group that comprises the majority of AIDS cases, homosexual men?' Epstein-Barr virus (EBV) is known to be associated with Burkitt's lymphoma and central nervous system lymphoma in patients with AIDS,). and the possibility that a viral infection may be associated with Kaposi's sarcoma merits consideration. The immunology of herpesvirus infections has been studied extensively, and definition of abnormalities in these responses may provide insights into the basic nature of the immune defects in AIDS. Finally, there are many features of the epidemiology and clinical manifestations of AIDS that are consistent with the possibility that CMV or EBV infections may be relevant to the etiology of AIDS.' In this report we summarize results of studies pertaining to each of these aspects of herpesvirus infections.
TL;DR: Data reveal that Pneumocystis carinii pneumonia and Candida esophagitis can be managed successfully in patients with acquired immune deficiency syndrome if appropriately diagnosed.
TL;DR: A homosexual man with AIDS developed multifocal KS with involvement of the palate, larynx, trachea, and esophagus and short-course local radiation therapy effectively resolved the mucosal KS lesions in the treated areas.
Abstract: A homosexual man with AIDS developed multifocal KS with involvement of the palate, larynx, trachea, and esophagus. Symptoms included dysphagia and gagging with resultant inanition. Short-course local radiation therapy effectively resolved the mucosal KS lesions in the treated areas. Other otolaryngologic manifestations included herpes stomatitis and oral candidiasis.