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To assess the incidence and the clinical features of the sulfone syndrome associated with dapsone prophylaxis in HIV infected patients. Patients with HIV infection and fewer than 200/uL CD4 cells with severe hypersensitivity reactions occurring within the first month of chemoprophylaxis with dapsone were retrospectively evaluated. Clinical features and laboratory findings of three patients who presented hypersensitivity reaction to dapsone were consistent with the established criteria for the diagnosis of sulfone syndrome. This syndrome has been reported in 1% of HIV patients receiving dapsone 100 mg daily and in 3-6% of patients on multidrug therapy for leprosy. Amongst our patients with HIV infection receiving twice weekly dapsone prophylaxis, the cumulative incidence of sulfone syndrome was 2.5%. The vigilance for the sulfone syndrome should be mantained even during low-dose chemoprophylaxis especially in the first two months of administration.

Increased susceptibility to bacterial recurrent infection is characteristically associated with impaired B cells function but also with a defective PMN function. We studied PMN CT in 15 HIV positive drug addicts patients with persistent generalized lymphoadenopathy (PGL), in 15 symptom free HIV negative drug addicts (SFDA) and in 15 healthy blood donors to evaluate influence of HIV infection on PMN functions. CT of patients with PGL was reduced to 78% (p0.0001) and 75% (p0.00001) of CT in SFDA patients and healthy blood donors, respectively. We conclude that HIV infection causes defective PMNL CT and then it can increase susceptibility to bacterial recurrent infections in these patients.

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The authors analyze the clinical aspects of HIV infection in light of the most recent studies. The natural history of the disease appears more definite than in the recent years, but many aspects are still unclear. Current therapy and future therapeutic trends are also discussed. A prospective study of 108 HIV-positive subjects, observed for periods ranging from 6 months to 2 years showed a cumulative probability of evolution to full-blown AIDS of 34.4%/year for subjects with immunodeficiency (WR3-WR5 groups, according to the Walter Reed classification). Finally, the authors report their clinical experience with 35 patients with full-blown AIDS from 1984 to 1987.

The aim of this retrospective study is to evaluate the correlation between T-cell immunity and pulmonary disorders in a group of Italian subjects with HIV infection. HIV-infected patients seen at the Institute of Infectious Diseases, University of Verona, were included in this study if they had a specific acute pneumonia, a CD4+ cell count and a CD4+/CD8+ ratio during the 60 days immediately before the onset of pulmonary disease. Cases receiving any antimicrobial prophylaxis were excluded. Pneumonia was recognized by usual clinical and radiologic abnormalities. The diagnostic procedure included sputum examination, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. The specimens were processed for bacterial, mycobacterial and fungal stains and cultures. Ziehl-Neelsen, periodic acid-Schiff and silver methenamine stains were performed on the transbronchial biopsy specimens in addition to usual pathologic examinations mononuclear. Determination of percentage of peripheral blood mononuclear cells bearing CD4+ and CD8+ markers was done by conventional fluorescent antibody cell-sorter analysis of the mononuclear cell population. Absolute number of CD4+ lymphocytes was determined by multiplying the total lymphocyte count by the percent of mononuclear cells bearing CD4+ marker. From October 1987 to August 1991, 61 patients, 50 males and 11 females, had 65 episodes of specific pneumonia. The average age of patients was 31.4 years (range 29-59 years). The risk factors for HIV infection included intravenous drug abuse (47 patients), homosexuality (6 patients), bisexuality (3 patients) and heterosexual contact (5 patients). Before the onset of pulmonary disorders, patients were classified in the following clinical HIV-related stages: asymptomatic state (22 episodes), ARC (22 episodes) and AIDS (21 episodes). In decreasing order of frequency diagnosis of pneumonias were PCP (29 episodes), community-acquired bacterial pneumonia (16 episodes), pulmonary tuberculosis (8 episodes), nonspecific interstitial pneumonia (4 episodes), PCP and pulmonary tuberculosis (3 episodes), cytomegalovirus pneumonia (2 episodes), and one of each episode of PCP and pulmonary cryptococcosis, pulmonary candidiasis, pulmonary Kaposi's sarcoma. The mean and the standard deviation of immunologic values regarding the four primary diagnostic groups were: PCP CD4+/CD8+ 0.50 +/- 0.42, CD4+/mm3 196 +/- 190; bacterial pneumonia CD4+/CD8+ 0.53 +/- 0.44, CD4+/mm3 247 +/- 139; pulmonary tuberculosis CD4+/CD8+ 0.62 +/- 0.38, CD4+/mm3 260 +/- 170; nonspecific interstitial pneumonia CD4+/CD8 + 0.57 +/- 0.48, CD4+/mm3 240 +/- 189. No significant statistical differences with respect to CD4+/CD8 ratios and CD4+ cell counts among these diagnostic groups were found by standard analysis of variance.(ABSTRACT TRUNCATED AT 400 WORDS)