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The Psychosocial and Neuropsychiatric Sequelae of the Acquired Immunodeficiency Syndrome and Related Disorders
548
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
associated with a variety of humoral and cellular immune defects. Major categories of reported immune deficiencies in this disease process include quantitative and functional Tlymphocyte abnormalities, natural killer cell functional anomalies, and B lymphocyte, monocyte/macrophage and serologic abnormalities. Specific deficits in each of these categories are reviewed in a detailed fashion. Based on available evidence the authors conclude that many of these defects are owing to a selective depletion or a selective dysfunction of the T4+ inducer/helper subset(s) involved in the antigen-specific immune response. In the patient with AIDS preferential infection of the vitally important T4+ helper (inducer) lymphocyte results in functional changes in immunity that lead to devastating morbidity and mortality. R. C. N. 4 figures, 1 table, 39 references
A Human T-Lymphotropic Retrovirus (HTL V -III) as the Cause of the Acquired Immunodeficiency Syndrome
R. C. GALLO AND F. WONG-STAAL, Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Ann. Intern. Med., 103: 679-689 (Nov.) 1985 Retroviruses are known to cause naturally occurring malignant and nonmalignant diseases, and can be categorized according to their modes of transmission. The first human retrovirus shown to be involved in the cause of a human cancer was isolated from a patient with adult T-cell leukemia in 1979, initially called human T-cell leukemia virus type I (HTLV-1). This virus could be isolated by the ability to culture target cells with T-cell growth factor and sensitive detection systems for the virally encoded polymerase reverse transcriptase. The same idea and technique have been used for the isolation of human T-lymphotrophic virus type 111/lymphadenopathy-associated virus (HTL V-III/LAV), which is linked causally to the acquired immunodeficiency syndrome (AIDS). The structure of HTLVIII shares some features with HTLV-I and HTL V-II, such as additional genes not found in most retroviruses. The most striking feature common to all 3 human retroviruses is their remarkable lymphotropism, particularly for the OKT4+ lymphocyte. One of the major features of HTL V-III in common with HTLV-I and HTL V-II is the phenomenon of transacting transcriptional activation owing to the presence of at least 1 extra gene in all 3 viruses. This gene encodes a protein that can activate the expression of other viral genes and some cellular genes as well. The identification of the primary cause of AIDS has led the investigators in the development of specific immunological reagents, preventive and therapeutic proposals, and comprehensive identification of the clinical diseases associated with this virus. F. T. A. 7 figures, 1 table, 56 references
The Psychosocial and Neuropsychiatric Sequelae of the Acquired Immunodeficiency Syndrome and Related Disorders Memorial Sloan-Kettering Cancer Center, New York, New York
J.C. HOLLAND ANDS. TROSS,
Ann. Intern. Med., 103: 760-764 (Nov.) 1985 A diagnosis of the potentially life-threatening acquired immunodeficiency syndrome (AIDS) and related disorders carries with it significant psychological and sociocultural implications.
The groups affected most commonly are homosexuals or bisexuals, drug abusers, recent Haitian immigrants and those who have acquired the syndrome through blood transfusion. The social stigmas attached to being a member of either of the first 2 groups are well known. Being diagnosed as having AIDS or a related disease implies that one may be a drug abuser, homosexual or bisexual. The diagnosis may create a crisis in which an otherwise private sexual preference must be revealed. Hemophiliacs and recipients of blood transfusions tend to receive a more favorable response owing to the perceived random nature of their exposure. These psychosocial problems may be accompanied by symptoms of dementia and encephalopathy, such as forgetfulness, loss of interest in work, confusion, seizures and coma. The life-threatening nature of the disease combined with its psychosocial and neuropsychiatric aspects make the process difficult to endure from the patient's standpoint. The psychological and social impact of AIDS may result in psychiatric symptoms similar to those seen in other life-threatening diseases. General management guidelines are discussed. R. C. N. 3 tables, 21 references
Psychosocial Reactions of Persons With the Acquired Immunodeficiency Syndrome S.
E. NICHOLS, Beth Israel Medical Center, New York, New York
Ann. Intern. Med., 103: 765-767 (Nov.) 1985 Patients diagnosed as having the acquired immunodeficiency syndrome (AIDS) must endure the psychosocial as well as the medical aspects of the syndrome. In general, these individuals follow the situational distress model consisting of 4 stages. In the crisis stage denial alternates with periods of intense anxiety. In the transitional stage alternating waves of anger, guilt, selfpity and anxiety are characteristic, and a profound withdrawal also may occur. The deficiency or acceptance state follows, in which patients learn to accept the limitations imposed by AIDS and realize that they still can manage their lives. This acceptance (deficiency) period may be evidenced by losses of health, energy, income and independence. As the syndrome progresses those affected may experience the last stage of preparation for death. Psychosocial problems peculiar to this syndrome may complicate or modify the process because of society's views of homosexuals and drug addicts, the groups primarily affected. It is suggested that awareness of the psychosocial reactions to AIDS offers opportunity for social progress and personal growth. R. C. N. 13 references
Social Consequences of the Acquired Immunodeficiency Syndrome
B.
J. CASSENS, American Association of Physicians for Human Rights, Philadelphia, Pennsylvania
Ann. Intern. Med., 103: 768-771 (Nov.) 1985 Writing from the prospective of a homosexual physician the author discusses some of the pertinent psychosocial issues associated with the acquired immunodeficiency syndrome (AIDS). It is emphasized that in addition to the medical implications the homosexual community must deal with the fear of loss of confidentiality and exposure of sexual orientation if the
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
associated with a variety of humoral and cellular immune defects. Major categories of reported immune deficiencies in this disease process include quantitative and functional Tlymphocyte abnormalities, natural killer cell functional anomalies, and B lymphocyte, monocyte/macrophage and serologic abnormalities. Specific deficits in each of these categories are reviewed in a detailed fashion. Based on available evidence the authors conclude that many of these defects are owing to a selective depletion or a selective dysfunction of the T4+ inducer/helper subset(s) involved in the antigen-specific immune response. In the patient with AIDS preferential infection of the vitally important T4+ helper (inducer) lymphocyte results in functional changes in immunity that lead to devastating morbidity and mortality. R. C. N. 4 figures, 1 table, 39 references
A Human T-Lymphotropic Retrovirus (HTL V -III) as the Cause of the Acquired Immunodeficiency Syndrome
R. C. GALLO AND F. WONG-STAAL, Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Ann. Intern. Med., 103: 679-689 (Nov.) 1985 Retroviruses are known to cause naturally occurring malignant and nonmalignant diseases, and can be categorized according to their modes of transmission. The first human retrovirus shown to be involved in the cause of a human cancer was isolated from a patient with adult T-cell leukemia in 1979, initially called human T-cell leukemia virus type I (HTLV-1). This virus could be isolated by the ability to culture target cells with T-cell growth factor and sensitive detection systems for the virally encoded polymerase reverse transcriptase. The same idea and technique have been used for the isolation of human T-lymphotrophic virus type 111/lymphadenopathy-associated virus (HTL V-III/LAV), which is linked causally to the acquired immunodeficiency syndrome (AIDS). The structure of HTLVIII shares some features with HTLV-I and HTL V-II, such as additional genes not found in most retroviruses. The most striking feature common to all 3 human retroviruses is their remarkable lymphotropism, particularly for the OKT4+ lymphocyte. One of the major features of HTL V-III in common with HTLV-I and HTL V-II is the phenomenon of transacting transcriptional activation owing to the presence of at least 1 extra gene in all 3 viruses. This gene encodes a protein that can activate the expression of other viral genes and some cellular genes as well. The identification of the primary cause of AIDS has led the investigators in the development of specific immunological reagents, preventive and therapeutic proposals, and comprehensive identification of the clinical diseases associated with this virus. F. T. A. 7 figures, 1 table, 56 references
The Psychosocial and Neuropsychiatric Sequelae of the Acquired Immunodeficiency Syndrome and Related Disorders Memorial Sloan-Kettering Cancer Center, New York, New York
J.C. HOLLAND ANDS. TROSS,
Ann. Intern. Med., 103: 760-764 (Nov.) 1985 A diagnosis of the potentially life-threatening acquired immunodeficiency syndrome (AIDS) and related disorders carries with it significant psychological and sociocultural implications.
The groups affected most commonly are homosexuals or bisexuals, drug abusers, recent Haitian immigrants and those who have acquired the syndrome through blood transfusion. The social stigmas attached to being a member of either of the first 2 groups are well known. Being diagnosed as having AIDS or a related disease implies that one may be a drug abuser, homosexual or bisexual. The diagnosis may create a crisis in which an otherwise private sexual preference must be revealed. Hemophiliacs and recipients of blood transfusions tend to receive a more favorable response owing to the perceived random nature of their exposure. These psychosocial problems may be accompanied by symptoms of dementia and encephalopathy, such as forgetfulness, loss of interest in work, confusion, seizures and coma. The life-threatening nature of the disease combined with its psychosocial and neuropsychiatric aspects make the process difficult to endure from the patient's standpoint. The psychological and social impact of AIDS may result in psychiatric symptoms similar to those seen in other life-threatening diseases. General management guidelines are discussed. R. C. N. 3 tables, 21 references
Psychosocial Reactions of Persons With the Acquired Immunodeficiency Syndrome S.
E. NICHOLS, Beth Israel Medical Center, New York, New York
Ann. Intern. Med., 103: 765-767 (Nov.) 1985 Patients diagnosed as having the acquired immunodeficiency syndrome (AIDS) must endure the psychosocial as well as the medical aspects of the syndrome. In general, these individuals follow the situational distress model consisting of 4 stages. In the crisis stage denial alternates with periods of intense anxiety. In the transitional stage alternating waves of anger, guilt, selfpity and anxiety are characteristic, and a profound withdrawal also may occur. The deficiency or acceptance state follows, in which patients learn to accept the limitations imposed by AIDS and realize that they still can manage their lives. This acceptance (deficiency) period may be evidenced by losses of health, energy, income and independence. As the syndrome progresses those affected may experience the last stage of preparation for death. Psychosocial problems peculiar to this syndrome may complicate or modify the process because of society's views of homosexuals and drug addicts, the groups primarily affected. It is suggested that awareness of the psychosocial reactions to AIDS offers opportunity for social progress and personal growth. R. C. N. 13 references
Social Consequences of the Acquired Immunodeficiency Syndrome
B.
J. CASSENS, American Association of Physicians for Human Rights, Philadelphia, Pennsylvania
Ann. Intern. Med., 103: 768-771 (Nov.) 1985 Writing from the prospective of a homosexual physician the author discusses some of the pertinent psychosocial issues associated with the acquired immunodeficiency syndrome (AIDS). It is emphasized that in addition to the medical implications the homosexual community must deal with the fear of loss of confidentiality and exposure of sexual orientation if the