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The publication, in 1981, of a report announcing the occurrence of a cluster of diagnoses of a rare form of pneumonia due to the microorganism Pneumocystis carinii in a group of male homosexuals in San Francisco constitutes the first notice of the advent of a new disease. It was quickly recognized, subsequent to that report, that the occurrence of this then rare infection was secondary to the profound depletion of the immune system caused by the new disease, which soon acquired the name of Acquired Immune Deficiency Syndrome, or more familiarly, AIDS. The causative organism was identified as a retrovirus, named Human Immunodeficiency Virus (HIV), which attacks the T4 lymphocytes of the immune system.

SUMMARY Trimethoprim-sulfamethoxazole and parenteral pentamidine isethionate are effective in 60 to 80 per cent of AIDS patients with pneumocystis pneumonia. Adverse reactions are frequent with both agents, but because the adverse reactions are less severe with trimethoprim-sulfamethoxazole, this agent is the drug of choice for patients who are not known to be intolerant of it. The recommended duration of therapy is 21 days. Aerosolized pentamidine and intravenous trimetrexate are investigational agents that show considerable promise, but their role in the therapy of pneumocystis pneumonia will have to be demonstrated in controlled trials. For patients who fail to respond to conventional agents after 5 to 10 days of therapy, therapeutic alternatives to consider would be trimetrexate, DFMO, or high-dose corticosteroids, the latter given with conventional agents. Prophylaxis against pneumocystis pneumonia is appropriate for HIV- infected patients with fewer than 300 T4 lymphocytes per cu mm, even if they are receiving zidovudine (Retrovir). It also should be considered in patients with a prior history of this infection, irrespective of the T4 count. The efficacy of trimethoprim-sulfamethoxazole, pyrimethamine-sulfadoxine, or aerosolized pentamidine has not yet been substantiated. Many patients cannot tolerate the first two combinations chronically.

Previously the authors demonstrated that most patients with AIDS have serum antilymphocyte antibodies. Therefore, in an attempt to decrease these antibodies and at least transiently increase blood lymphocytes, they treated one AIDS patient with three courses of plasmapheresis. During or after each course, his T4 lymphocytes rose significantly but subsequently fell to baseline values within two weeks after therapy. The increase in T4 lymphocytes was associated with removal of patient plasma rather than infusion of heterologous plasma. These results suggest the need for more investigation into plasmapheresis as adjunct therapy for AIDS.

SUMMARY We measured the number of Langerhans cells in clinically normal epidermis and the number of T4 lymphocytes in the plasma in 24 patients infected with HIV, and related these to the stage of the disease. A correlation is demonstrated between the numbers of Langerhans cells and T4 lymphocytes. Numbers of Langerhans cells were lower in patients with disease stages III and IV than in those with disease stage II. Thus Langerhans cell numbers could be of prognostic value in this disease.