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Non-HIV AIDS: nature and strategies for its management
1Department of Immunology, Churchil Hospital, Oxford, UK.
Abstract:
Despite initial claims to the contrary, a cluster of reports of severe opportunistic infections occurring in patients without evidence of HIV infection do not appear to represent a new disease entity or present evidence of epidemiologically associated cases suggesting an infectious agent. Reported cases are reviewed and appear to represent a heterogeneous group, many of which may represent sporadic cases of late onset acquired immunodeficiency. In addition, a small group of asymptomatic subjects have been identified with constitutively low CD4 T cell populations which appear to have little or no clinical significance since these patients have no evidence of clinical immunodeficiency. Newly identified cases should be fully investigated immunologically and virologically after recovery from their presenting infection and continuous or prophylactic therapy instituted only in cases of substantiated long-term severe immunodeficiency.
Insights
Severe opportunistic infections in patients without HIV are not a new disease but likely sporadic cases of late-onset acquired immunodeficiency. Further investigation is needed for confirmed long-term immunodeficiency before treatment.
Area of Science:
- Immunology
- Infectious Diseases
- Virology
Background:
- Reports of severe opportunistic infections in individuals without HIV initially suggested a new disease entity.
- However, evidence for an infectious agent or epidemiologically linked cases was lacking.
Purpose of the Study:
- To review reported cases of severe opportunistic infections in non-HIV patients.
- To determine if these cases represent a new disease or a different form of immunodeficiency.
Main Methods:
- Review of reported cases of severe opportunistic infections in patients without HIV.
- Immunological and virological investigation of affected individuals.
Main Results:
- The reviewed cases appear heterogeneous, with many representing sporadic instances of late-onset acquired immunodeficiency.
- A subset of asymptomatic individuals with low CD4 T cell counts showed no clinical immunodeficiency, suggesting these low counts may be clinically insignificant.
Conclusions:
- The reported cases do not indicate a new disease entity or an infectious cause.
- Further immunological and virological investigation is recommended for new cases after recovery.
- Therapy should be reserved for substantiated cases of long-term severe immunodeficiency.