Special Report Part 2: An epidemic Q & A

The July 1982 issue of PGN.

By Lawrence Mass, M.D. July 9th, 1982, page 10.

This article is reprinted courtesy of the New York Gay Men’s Health Crisis.

As though the diseases themselves weren’t confusing enough, our health emergency still seems to be shopping for a name. AID (acquired immune deficiency) seems to be the acronym most commonly applied by physicians. But there are others: GRID (gay-related immune deficiency), CAID (community-acquired immune deficiency), and ACID (acquired immune-deficiency). We even find variants of AID—the Center for Disease Control prefers AIDS (for acquired immune deficiency state or, in some instances, syndrome). All these terms point to the same condition: an immunity gone haywire for some reason other than by defect of birth or deliberately induced by a physician, such as in organ-transplant patients. Victims of famine also are often subject to suppressed immunity. AID, on the other hand, arising mainly among gay men in U.S. cities, is now recognized as a totally new syndrome with no precedent in history.

Who is at risk?

Depite the growing body of informed speculation about such potential risk factors as frequent sexual encounters with many partners, whatever it is that causes AID remains unproved and unknown. This speculation includes the possible involvement of sexually transmitted diseases such as hepatitis, herpes in several forms, gonorrhea, syphilis, and amebiasis. It also includes the use of such drugs as poppers (amyl and butyl nitrites) an marijuana. However, as the Gay Men’s Health Crisis Committee stated in a recent letter to the gay community: “Unsettling though it is, no evidence exists to incriminate any activity, drug, place of residence, or any other factor, conclusively, in the outbreak facing us.”

Am I already immune deficient?

The findings of several ongoing hospital-based studies tentatively suggest that as many as 80 to 85 percent of sexually active men in some major cities may already be immune deficient.

In recent public statements, Federal health officers (in branches of the Publich Health Service, Department of Health and Human Services) have speculated that “tens of thousands of homosexual men may have the acquired immune dysfunction” and be “at risk” for developing complications. But leading observers of the epidemic are not yet able to answer some of the most important questions now facing us. Most urgent is the question facing those individuals who appear to be in good general health but who may have laboratory evidence of immune deficiency. Which individuals are most likely eventually develop such major AID diseases as Kaposi’s sarcoma, Pneumocystis carinii pneumonia, Toxoplasma gondii infections, and other life-threatening “opportunistic” infections?

In other words, you may be immune-deficient even if you have no specific disease symptoms and seem to be in good general health.

What are the symptoms?

AID symptoms are the symptoms of the rapidly proliferating number of diseases to which AID disposes its victims. Why these particular diseases, medical authorities do not really know, because the defect as it is thus far characterized is a dysfunction of the so-called cellular branch of the immune system, anticipated diseases include those associated with or caused by viruses, fungi, protozoa and parasites—as opposed to those which are caused by bacteria that are linked with allergies that would involve the humoral branch of immunity.

The most often observed diseases in the AID outbreak have been Kaposi’s sarcoma and Pneumocystis carinii pneumonia, which have been the two primary causes of death so far. But many others, sometimes occurring in combination with KS, PCP, or both, also have been documented. These include serious, disseminated viral, fungal, and protozoan infections. The symptoms of these diseases are obviously manifold.

Generally speaking, AID symptoms may include:

  • Profound fatigue that is not transient and not explained by physical activity or by a psychiatric or substance-abuse disorder.
  • Persistent fevers or night sweats.
  • Weight loss of more than 10 pounds during a period of less than two months that is not related to diet or activity.
  • Lymphadenopathy: enlarging and hardening, painful or otherwise, of prominent lymph nodes (Diseased lymph glands are often found in the neck and armpits).
  • Recently appearing or slowly enlarging purplish or discolored nodules, plaques, lumps, or other new growths on top of or beneath the skin or on mucous membranes (inside the mouth, anus, or nasal passages or underneath the eyelids).
  • A heavy, persistent, often dry cough that is not from smoking cigarettes and that has lasted too long to be laid to influenza.
  • Persistent diarrhea.

If you have any of the above symptoms, you should consult a physician immediately. Sexually active gay men who are without symptoms are currently being advised to see a physician at least once a year for a thorough physical examination and at least twice a year for complete venereal disease testing.

What are the diagnostic tests for immune deficiency?

Routine laboratory tests cannot rule out immune deficiency, but they do help rule out the need for more extensive immunologic testing. The routine tests include white blood cell and lymphocyte counts, both of which are often low in AID victims. Skin testing with certain “recall antigens” that usually elicit reactions in immunologically health individuals continues to have uncertain diagnostic value.

When immune deficiency is strongly suggested, the diagnosis may be confirmed by several laboratory tests that are very expensive and not routinely available. These include:

  • Lymphocyte subpopulation studies, which measure the ratio of “helper” T-cells to “suppressor” T-cells. It is this critical ratio that, in AID victims, has dropped from a “standard” number, usually a figure set by measuring the ratio is healthy, often heterosexual, control subjects.
  • Lymphocyte transformation studies, that measure the ability of lymphocytes to respond to stimulation.
  • Natural killer cell studies.

Can AID be treated?

There is no certain treatment for AID. But there are treatments for the cancers and infections to which AID predisposes. These remedies include chemotherapy, antibiotics, and experimental agents and techniques. Unfortunately, many of them are costly, rare, and highly experiemental.

If you do not have a major AID condition but are thought to be immune deficient on the basis of lymphocyte subpopulation studies (T-cell ratios) you should be closely followed by a physician. Apart from experimental agents such as interferon and “immune modulators,” however, there is no treatment for the AID condition itself.

Is AID contagious?

There continues to be no incontrovertible evidence to suggest that AID is overtly contagious. Informed speculation, however, suggests that an infections agent—perhaps a virus such as cytomegalovirus or Epstein-Barr virus—is at least a critical factor in the outbreak. Federal health officers are intensely scrutinizing “clusters” of the syndrome, which seem to be appearing in coastal and Sun Belt cities more than in the Midwest, the Northeast, and Canada.

How can the risk be lowered?

Although, so far as we know, to lay direct blame on any drug, activity, place of residence, or other factor as the causes of AID would be misleading, there is tentative evidence to suggest that risk factors may include frequent sexual encounters with a variety of partners. A number of physicians, many of them gay as well, have advised their gay patients to moderate their sexual activity with fewer partners who are in good health.

It is the number of different sexual encounters that may increase risk, not sex itself.

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