Immunologic and Serologic Studies in a Child with Associated HIV Infection

A 15-month-old black male infant of drug-abusing parents presented with failure to thrive, lymphadenopathy, hepatosplenomegaly, and interstitial pneumonia. At 4 years, oral candidiasis, purulent otitis, and recurrent cryptococcal meningitis developed. Abnormal cerebrospinal fluid (CSF) values, along with lymphocytosis, anemia, and elevations in immunoglobulins, β₂-microglobulin, and viral antibody levels against human immunodeficiency virus (HIV), Epstein—Barr virus, and cytomegalovirus were also observed. The viral culture for HIV was also positive. Cryptococcus neoformans (Cn) was repeatedly isolated from the CSF. An initial positive culture and elevated antigen titer to Cn corresponded to markedly suppressed T-lymphocyte responses. Improved T-cell function and a negative Cn culture occurred with therapy, although in vitro B-cell responsiveness and the CD₄/CD₈ ratio remained low. The reappearance of a positive Cn culture, despite declining serum antigen titers was associated with markedly suppressed T-cell function. In this case, a decline in T-cell responsiveness appears to have been predictive of recurrent cryptococcal disease.