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Longitudinal study of 18 children with perinatal LAV/HTLV III infection: attempt at prognostic evaluation
Insights
This study in children with LAV/HTLV III infection found that impaired antigen-specific immune responses and abnormal antibody profiles predict a poor prognosis. These immune markers offer early prognostic value for disease progression.
Area of Science:
- Pediatric Immunology
- Viral Immunology
- Infectious Diseases
Background:
- Human T-lymphotropic virus type III (HTLV-III), also known as Lymphadenopathy-associated virus (LAV), is a significant cause of pediatric illness.
- Understanding the immunologic profile of infected children is crucial for predicting disease course and outcomes.
Purpose of the Study:
- To investigate the prognostic value of immunologic markers in children with LAV/HTLV-III infection.
- To correlate in vitro immune responses with clinical outcomes and survival.
Main Methods:
- Longitudinal study of 18 children with symptomatic LAV/HTLV-III infection.
- Comprehensive immunologic assessments including lymphocyte markers, in vitro antigen/mitogen responses, skin tests, and antibody profiling (isoagglutinins, post-vaccination, Candida, and LAV/HTLV-III specific antigens).
- Radioimmunoprecipitation assay used for serologic profiling against key LAV/HTLV-III antigens (GP110, P18, P25).
Main Results:
- Antigen-induced proliferative responses were normal in 10 patients with stable disease but profoundly impaired in eight patients who experienced mortality or opportunistic infections.
- Impaired in vitro responses correlated well with negative antigen skin tests.
- Abnormal antibody responses, low isoagglutinins, and specific LAV/HTLV-III antibody profiles were frequent in patients with poor outcomes.
Conclusions:
- Impaired antigen-specific cellular immunity and specific antibody profiles are significant indicators of poor prognosis in pediatric LAV/HTLV-III infection.
- These immunologic measurements provide early prognostic value, detectable soon after clinical symptom onset.
Abstract:
We performed a longitudinal study (mean follow-up 19.5 months, range 3 to 42 months) in 18 consecutive children with clinical symptoms of LAV/HTLV III infection. Twelve patients were born to mothers infected with LAV/HTLV III, and six were infected by blood products administered during the first weeks of life. Immunologic studies included lymphocyte markers, in vitro responses to mitogens and antigens with corresponding skin tests, and antibody response with isoagglutinins, post-vaccination antibodies, and Candida. A serologic profile of antibody to GP110, P18, and P25 LAV/HTLV III antigens by radioimmunoprecipitation assay was also performed. The antigen-induced proliferative responses were normal in 10 patients who had a stable course, but were profoundly impaired in eight others who died or had poor condition with opportunistic infections. These in vitro measurements were well correlated with antigen skin tests. An abnormal antibody response to antigens, a low level of isoagglutinins, and a peculiar profile of LAV/HTLV III antibodies were also frequently observed in these eight patients. These measurements appear to be of prognostic value because they were noticed soon after onset of clinical symptoms.