234 Autoimmune role in AIDS dementia complex

234

235

AUTOIMHUNE ROLE IN AIDS DEMENTIA COMPLEX. Steven E. Schutzer, M.D., New York, NY The human immunodeficiency virus (HIV) commonly produces a progressive dementia referred to as AIDS dementia complex (ADC). Undefined, indirect viral effects, rather than direct cell death, appear responsible for ADC. We hypothesized an autoimmune etiology as Autoantibodies such a mechanism. (autoAbs) to brain tissue in ADC were detected by two techniques. Indirect immunofluorescence of HIV+ sera on mouse brain showed f antibrain IgG autoAbs as follows: 10/11 AIDS p,zlleyts (pts); 5/5 ADC pts; O/6 neurologic and immunologic disease pts. Controls were negative. Western blots against non HIV brain tissue demonstrated specific IgG antibrain autoAbs in CSF and serum from 2 ADC pts. Pt 1 serum showed reactivity against two bands also stained by Pt 2 serum; Pt 1 CSF, and Pt 2 serum and CSF, stained a higher molecular weight band. These bands were distinct from those of HIV lysates detected by these pts' sera. As a control, multiple sclerosis serum and CSF did not stain any of these . bands. In conclusion, this suggests specific autoAbs reactive to brain tissue are 1) present in the CSF and sera of ADC pts, 2) distinct from anti-HIV Abs, 3) rare in controls, and 4) may have pathogenetic significance.

236

ENHANCED IgE-MEDIATED

237

NITH

A. Tedeschi, M. Froldi,

M.O.. L. Chianura, R.D. and C. Zanussi,

AIOS patients manifest

with

in patients

subjects.

stimulated

with

re A23187.

Histamine

technique

of

atopic of

f-met

and f-met

often

were

symptoms. evaluated

were

ionophofluorone-

by PRIST.

found

IgE levels, and calcium

11 and

were

and calcium

by an automated

IgE levels

peptide

diseases

leukocytes

peptide

was measured

and total

H.D.,

Italy

allergic

releasability

Dextran-sedimented anti-IgE,

M.D.,

AIDS (5), ARC (6), LAS (7). 5 HIV negative drug addicts

No significant differences controls, concerning total content

Milan,

Jacobson MD, and ME Martin MD. San Antonio, TX. Newer antihistamines provide an alternatrve to the adverse CNS symptoms associated with older but less expensive antihistamines. To determine if grving a single bedtime dose of the latter will circumvent these adverse we conducted a J-week double-blind effects, placebo-controlled crossover study in 8 normal volunteers. Each received either 10 doses of terfenadine (T) 60 mg brd or 5 doses of hydroxyzine (H) 50 mg qhs with qAM placebo (PI, followed the second week by P bid, followed the third week by the other active drug. Cognitive performance was measured by a computer-based eye-hand reaction time testing apparatus to determlne simple reaction time (SRT) and choice reaction time (CRT). Symptom scores and ID skin reactivity to .l and .Ol mg/ml histamine were recorded for each regimen. SRT and CRT for T, H, and P were 231.5, 239.7, 230.0 msec (p=NS) and 275.9, 250.0, 282.2 msec (p=NS) respectively. However, drowsiness and dry mouth were sfgnificantly greater for H compared to T and P fp<.O5). Histamine wheal areas were signiffcantly and comparably suppressed by T and H compared to P (p(.O5). In conclusion. qhs dosing of H produced no slowing of CNS performance as measured by SRT and CRT but did produce significant subjective side effects. T provided histamine skin test suppression comparable to qhs H without significant side effects. Use of single bedtime dose of H prevents some but not all of its side effects.

IN PATIENTS

A. Lazzarin,

recurrences

and basophil

20 normal

tric

or

affected with drug addicts,

HIV positive

M.D., M.D.,

a history

exacerbations

IgE levels

Total

BASOPHIL RELEASABILITY

INFECTION.A. Miadonna, M.D., E. Leggieri,

HIV

between patients and basophil histamine ionophore-induced

histamine

release. Conversely, anti-IgE-mediated histamine release was significantly increased in HIV infected subjects (mean histamine release + S.E.M. 41 + 9% with 0.1 mg/ml anti-IgE; ~~0.04) and, in particular. in AIDS (56 + 7% with 0.1

rig/ml

anti-IgE;

mg/ml anti-IgE; mal subjects

(21

pCO.001) pCO.001) ? 3% with

These findings suggest IgE-mediated basophil

and ARC (50 ?r 8% uith

patients, 0.1

when compared

0.1 with

nor-

mg/ml anti-IgE).

that HIV infection can enhance releasability. An impairment of

the

immune system or a direct infection account for our data. However, the

of basophil cells could latter is quite unlikely,

since

detected

no CD4 antigen

has ever

been

A PLACEBO-CONTROLLED CROSSOVER STUDYOF SIMPLE ANDCHOICEREACTIONTIMESCOMPARING TERFENADINE VS NIGHTIMRHYDROXYZINE - DWGoetz MD. JM

on basophil

membrane.

COMPARISON OF EFFICACY AND TACHYPHYLAXIS OF CONTINUOUS TREATMENTWITH ASTEMIZOLB AND TERFENADINE IN RAGWEEDPOLLEN-INDUCED RHINOCONJIJNCTIVITIS. E.F.Juniper, J.White, J.Dolovich. Departments of P?edicine, McMaster University and St. Joseph's Hospital; Hamilton, 0ntario;Canada. Astemisole and terfenadine were compared in a double blind randomized trial during the ragweed pollen season. 60 adults were matched according to their sensitivity to ragweed pollen. 30 took astemizole 1Omg daily, and 30 terfenadine 60mg twice daily. Medications were started one week before and continued daily throughout the ragweed pollen season (7 weeks). If the trial medications were insufficient, Beconase steroid nasal spray and Vasocon-A eye drops were used in the minimum dose that would ensure symptoms were not troublesome. Subjects completed a daily diary of symptoms and the amount of concomitant medications used. Astemizole showed greater efficacy than terfenadine in controlling rhinorrhea and less nasal spray was used by the astemizole Other nasal symptoms, eye symptoms and group. use of eye drops were similar in the two groups. Skin test sensitivity to serial dilutions of histamine were measured 1 and 7 weeks after starting trial medication. More tachyphylaxis was shown by the subjects on terfenadine as demonstrated by a larger increase in skin sensitivity over the study period. The results suggest that when the two medications are started before and continued daily throughout the pollen season, astemizole is more effective than terfenadine in controlling nasal symptoms but there is little difference for eye

symptoms

phylaxis

227

and

may occur

that

with

over

7 weeks

terfenadine.

more

tachy-