Natural history of primary infection with LAV in multitransfused patients. By the AIDS-Hemophilia French Study Group

Abstract

In the course of a prospective study of asymptomatic, multitransfused subjects, seroconversion to human lymphadenopathy-associated virus (LAV/HTLV-III) occurred in 34 hemophilic and in two thalassemic patients. In subjects treated with procoagulant concentrates, primary infection, as evidenced by the development of antibodies to LAV, was a clinically silent event apart from moderate lymph node enlargement in 21% of cases. Concomitant immunologic disturbances mainly affected T lymphocyte subsets. This pattern contrasted with the major lymphadenopathy syndrome observed in the thalassemic patients who received washed erythrocytes from single donors positive for LAV antibodies. Four to 10 months after seroconversion, the incidence of lymphadenopathy reached 46% and the immunologic profile associated inverted T4+/T8+ lymphocyte ratio and markedly increased serum levels of IgG. In multitransfused hemophiliac patients, primary infection with LAV appears to provoke the following simplified sequence of events: decrease of T4+ and increase of T8+ cell counts preceding or concomitant with the occurrence of IgG LAV antibodies. Polyclonal elevation of IgG and lymph node enlargement occur weeks or months later.