During the past five years, we have been dealing with a major dilemma, a new diseasethe acquired immunodeficiency syndrome (AIDS)as male homosexuals and bisexuals, male and female intravenous drug abusers, and recipients of blood products are apparently being exposed to an agent that has a proclivity f o r attacking and damaging the human immune system. The agent appears to have a tropism for the human T helper lymphocyte. Once the host has become infected, three pathways may follow: 1) benign development of antibodies with no clinical disease (serologic positivity only), 2 ) development of generalized persistent lymphadenopathy with or without constitutional symptoms including fevers, night sweats, malaise, diarrhea and weight loss of unknown etiology (pre-AIDS syndrome), 3 ) or the appearance of devastating T helper cell lymphocytopenia associated immunoincompetence, a condition that predisposes the host to the development of multiple severe, recurrent, life-threatening opportunistic infections and unusual malignancies (AIDS syndrome). yet no definitive diagnostic test or immunologic profile. The Centers for Disease Control clinical criteria for the diagnosis of AIDS are indicated in Table 1.
AIDS is currently defined by clinical rather than laboratory criteria. There is as EPIDEMIOLOGY Until the late 1970's, Pneumocystis carinii pneumonia (PCP) and an aggressive form of Kaposi's sarcoma (KS) had almost never been observed in healthy individuals without obvious immunosuppressive disorders. were recognized to occur in an increasing number of relatively young men who resided in New York and California and who were homosexuals or drug abusers. [ 1-81 tions of these patients revealed a profound immunoincompetence that , by history , appeared to have been acquired during adulthood. [9-111 By December 1984, more than 7000 cases of AIDS had been reported to the Centers for Disease Control (CDC) and up to a dozen new cases were being reported daily. abusers, recipients of blood products, and residents of some developing countries. The majority of blood product recipients are hemophiliacs who received concentrated factor VIII infusions. [ 12-16] Residents of developing countries , particularly in Central Africa and Haiti, have also developed AIDS. [17,18] Most of the women with AIDS have been intravenous drug abusers; others were recipients of whole blood and/or cellular components (i.e. open heart surgery, septic abortion) or were the sexual partners of bisexual and/or intravenous drug abusing men.[l9] AIDS has been documented in several young children whose mothers have been intravenous drug abusers or Haitian, and in a few children who received blood products. [ 20-22 ] Suddenly in 1981, these and other unusual disease processes Immunologic investiga-AIDS victims, primarily male, include homosexual and bisexual men, intravenous drug 0 1985 Alan R. Liss, Inc.