Abstract 15. The relationship of psychiatric complications to viral infection in patients with AIDS

Abstract 15. The relationship of psychiatric complications to viral infection in patients with AIDS

300 v‘iruses, immunity and mental diseases There are three interesting features to this case reported herein. The first is a lengthy prodromal pe...

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300

v‘iruses,

immunity

and mental

diseases

There are three interesting features to this case reported herein. The first is a lengthy prodromal period of six to eight years. The second was the extreme clinical variability and fluctuation and on one lucid period allowed the patient to state that she felt "something is eating my brain". And the third, the variability of the EEG tracing resulting in an initial suggestion of Creutzfeldt-Jakob Disease and at a later stage a less definitive tracing. This clinical report stimulates several questions for discussion.

Abstract 14. HTLV-III and acquired immune deficiency syndrome M. Sarngadharan, L. Bruch, J, Schuepbach, A. Device, M. Popovic and R. Gallo Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes Bethesda, Maryland, U.S.A.

of Health,

The human T-cell leukemia virus, HTLV-III, isolated from T-cell cultures of patients with acquired i~unodeficiency syndrome is a T-4 lymphotropic retrovirus with a Mg2+- dependent high mol. wt. reverse transcriptase. It shares some antigenic similarities with HTLV-I and HTLV-II, but is clearly distinct from them in biological and biochemical properties. Antibodies reactive with HTLV-III are found in the sera of nearly all patients with AIDS and about 90% of patients with AIDS related complex (ARC). About 40% of homosexual men at increased risk of AIDS were also positive for anti-HTLV-III antibodies. In a collaborative study with J. Groopman of New England Deaconess Hospital, Boston, MA, and scientists at the Centers for Disease Control, Atlanta, GA, all of a group of 19 patients with no traditional risk factors for AIDS, who developed AIDS subsequent to receiving blood transfusions, and 31 of 35 high risk blood donors surveyed, had antibodies to HTLV-III. In all donor sets in which "high risk" donors were identified, at least one of them was antibody positive. Such antibodies were absent in the sera of several hundred control subjects, including These results show a close etiologia number of patients with non-AIDS related diseases. cal association between HTLV-III and AIDS. They further demonstrate that HTLV-III is transmissible via blood products, and may be a singular sufficient viral agent in the pathogenesis of AIDS, and is associated with a broad clinical spectrum, including an asymptomatic, but probably contagious, carrier state.

Abstract

15.

The relationship with AIDS

C. Britton Columbia University,

of psychiatric

New York, N.Y.,

complications

to viral infection

in patients

U.S.A.

Mental abnormalities, common in patients with AIDS and opportunistic infections other than Pneumocystis carinii pneumonia (PCP), include dementia with or without psychiatric features, psychiatric disorders with or without cognitive impairment and a confusional state. A group of patients has been identified in whom psychiatric symptoms are dominant, related to sysPsychotic temic viral infection and in some cases, are the initial symptoms of disease. behavior with paranoid features, severe anxiety state and depression are most common. Twenty-five patients with AIDS or AIDS prodrome were evaluated for mental change. Of thirteen patients with the primary diagnosis of PCP, mild situational depression and signifiExacerbation cant exacerbation of a pro-existing depression occurred in one patient each. of chronic depression occurred in one of two patients with AIDS prodrome. Of ten patients with opportunistic infections other than PCP, five had significant psychiaIn three of these, psychiatric tric symptoms not attributable to proven brain infection. All five had cytomegalovirus (CMV) infection symptoms preceded the diagnosis of AIDS. with viremia. Post-mortem brains showed microglial nodules and astrocytosis. Rare incluImmune stains of glial nodules for CMV antigen were negative. sions were seen in one case. Pathologic abnormalities did not correlate with the severity of clinical symptoms. Psychiatric symptoms in this subgroup of patients are related to viremia and may be the earliest sign of systemic infection but are not necessary caused by brain infection.