Clinical, immunological, and virological aspects in Japanese hemophiliacs and AIDS patients

To date, 16 cases of AIDS have been officially reported in Japan: 8 of them were hemophiliacs and the others were male homosexuals. We had two hemophiliacs with AIDS, and describe these cases in this paper. One was a 48-year-old man with hemophilia B and the other was a 62-year-old man with hemophilia A. Both had ARC symptoms before developing overt and fatal opportunistic infections, candidiasis and a combination of atypical mycobacteriosis and aspergillosis. Impairment of cellular immunity such as lowered T4/T8 ratio, depressed lymphocyte response to mitogen and NK activity, and negative PPD skin reaction was evident in both patients. Anti-LAV/HTLV-III antibodies were detected in their sera, and the retrovirus was demonstrated in the lymph nodes and other organs on the postmortem electron microscopic examination. The assay for anti-LAV/HTLV-III on 70 other hemophiliacs in our clinic revealed seropositivity up to 50%. The seropositive group showed a significantly lower T4/T8 ratio on an average than the seronegative group. The prevalence of seropositivity for antibodies to other viruses including HBV, EBV, CMV, PV, and HTLV-I was markedly higher in the hemophiliacs. In LAV/HTLV-III seropositive hemophiliacs, however, no distinct correlation was found between T4/T8 ratio and the presence of antibodies to other viruses. There is a retrospective study to show that LAV/HTLV-III seropositive hemophiliacs appeared as early as 1980 in Japan. For prevention of LAV/HTLV-infection in hemophiliacs via blood products, heat-treated factor concentrates have recently become available. In a trial of the heat-treated products on 15 "virgin" hemophiliacs, no seroconversion has occurred thus far.