Although pediatric cases of HTLV-III infection manifested as AIDS are still relatively rare, evidence that perinatal infection exists raises several questions. As in the case of hepatitis B, perinatally infected infants may constitute a worldwide reservoir of infection. AIDS in infants may only reflect an epiphenomenon of HTLV-III infection, and other clinical diseases yet to be described may be more common and ultimately of larger public health import. In the future the appearance of perinatal disease may reflect the earliest index of HTLV-III-associated disease in heterosexual populations that do not have currently known epidemiological risk factors. For example, none of the first 16 mothers studied was clinically ill at the time of delivery of an infant with AIDS. Thus detection of spread of AIDS among heterosexuals may first be evidenced by pediatric AIDS. AIDS in infants adds another example of viral-associated immunodeficiency disease syndromes. Congenital rubella, CMV, and acquired EBV are best prior studied examples of similar syndromes. In spite of its novelty, HTLV-III has already become the prototype of this form of acquired immunodeficiency because of its profound effects on T-lymphocytes. As is the case with HTLV-I infections, we regard HTLV-III infections as household diseases. Definition of an index case or even suspicion of AIDS or an AIDS-related complex in a patient implies that all household contacts should also be studied clinically, immunologically, and virologically. It is still not clear if other modes of HTLV-III spread such as respiratory droplet are involved in household spread in addition to heterosexual transfer. At present, it is only possible to define HTLV-III infections in the context of an increasingly common infection in many areas of the world. Until more is known of both the natural history of HTLV-III infections and the various modes and relative frequency of viral spread, specific recommendations for control are not possible. Control of HTLV-III infection ultimately may derive from any of several approaches depending on the yet-to-be-resolved issues of natural history. If infection is not congenital or transplacental, it may be possible to prevent infection in the newborn of a mother with positive HTLV-III serology by the use of hyperimmune serum globulin combined with vaccination as in the case of hepatitis B. In view of both the repeated occurrence of AIDS in sibships and the possible adverse effects of pregnancy on HTLV-III disese in mothers, birth control measures should be considered. Early detection of immune dysfunction and prompt treatment of infections in patients with HTLV-III infections could ameliorate their clinical course. These patients would also be ideal candidates for various chemotherapeutic trials. Vaccination or immunoprophylaxis of household contacts and/or sexual contacts may be indicated in the future.
|Original language||English (US)|
|Issue number||9 SUPPL.|
|State||Published - Dec 1 1985|
ASJC Scopus subject areas
- Cancer Research