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Previous Volume 328:393-398 February 11, 1993 Number 6 Next

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ABSTRACT

Background and Methods We describe four patients without major risk factors for human immunodeficiency virus (HIV) infection, each of whom presented with severe opportunistic infections and was found to have idiopathic CD4+ T-lymphocytopenia. We performed assays to detect the presence of retroviruses and undertook immunophenotyping of subgroups of peripheral-blood lymphocytes.

Results The opportunistic infections at presentation included Pneumocystis carinii pneumonia, cryptococcal meningitis (two patients, one with concurrent pulmonary tuberculosis), and histoplasma-induced brain abscess. During 10 to 68 months of observation, none of the four patients had evidence of infection with HIV type 1 or 2 or human T-cell lymphotropic virus type I or II on the basis of epidemiologic, serologic, or polymerase-chain-reaction studies or culture, nor was there any detectable reverse transcriptase activity. Although all the patients had severe, persistent CD4+ T-lymphocytopenia (range, 12 to 293 cells per cubic millimeter), the CD4+ cell count progressively declined in only one and was accompanied by multiple opportunistic infections. All four patients had significantly reduced numbers of circulating CD8+ T cells, natural killer cells, or B cells (or all three).

Conclusions These four patients had idiopathic CD4+ T-lymphocytopenia with opportunistic infections but no evidence of HIV infection. Instead of the progressive, selective depletion of CD4+ T cells characteristic of HIV infection, some patients with idiopathic immunodeficiency have stable CD4+ cell counts accompanied by reductions in the levels of several other lymphocyte subgroups.

Source Information

From the Evans Memorial Department of Clinical Research and the Department of Medicine, Thorndike Memorial Laboratory and the Maxwell Finland Laboratory for Infectious Diseases, Boston City Hospital and University Hospital, Boston University School of Medicine, Boston (R.A.D., G.M.A., A.M.S., S.M.L.); the Infectious Disease Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, N.H. (C.F.v.R.); and Cleveland Veterans Affairs Medical Center and Case Western Reserve University, Cleveland (Z.T.). Presented at the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Anaheim, Calif., October 11-14, 1992.

Address reprint requests to Dr. Duncan at Thorndike Bldg. 311, Boston City Hospital, 818 Harrison Ave., Boston, MA 02118.

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