STUDY OF ACQUIRED IMMUNODEFICIENCY AND KAPOSI'S SARCOMA

The major objective of this grant application is to develop methods to
detect AIDS in blood samples for transfusion, the potential to transmit
AIDS, so that such blood specimens can be eliminated from the blood donor
pool. The study population will consist of 350 male homosexuals of whom
20% are symptom free, 60% have the AIDS-Related Symptom Complex (ARC), and
20% have AIDS with Kaposi's sarcoma, Opportunistic Infection, or both. In
addition, 500 (or more if necessary) blood bank donor specimens, 100
primary breast cancer patients, and 100 acute leukemia patients will be
studied. The latter patient group will be evaluated at diagnosis and one
year later when they usually have received multiple blood transfusions and
immunosuppressive chemotherapy. Also, 100 female hospital employees with
no AIDS contacts will be additional controls. The premise of the study
will be that one single test may either over-\or underestimate the
potential to transmit AIDS. Therefore, a battery of nine tests will be
applied to 15 ml of blood from each donor and we will select two or three
parametera which identify 100% of ARC patients with lymphadenopathy, 100%
of patients who move from symptom free to ARC or from ARC to AIDS, and 100%
of AIDS patients (with the precaution that some of the potentially positive
parameters may become negative in patients with advanced disease). The
parameters to be studied will include CMV antibody titer (indirect
immunofluorescence), antithymic antibody titer (indirect
immunofluorescence), immune complexes (Clq biding assay, modified for
ELISA), serum alpha-interferon titers (including acid lability by
cytopathic effect modification), serum beta-2 microglobulin level
(radioimmunoassay), blood levels of cella marking for the T3, T4, and T8
antigens, with calculation of the 4:8 ratio and lymphocytes (flow
cytometry), 5'-nucleotidase levels in terms of enzyme activity /10 6 /hr
(for conversion of C 14 -AMP substrate). Data will be analyzed by
chi-squared and ANOVA tests, and multivariant logistic regression
analysis. Evaluation of 500 normal blood bank specimens will allow an
estimate of cost effectiveness procedures. Evaluation of transfused
leukemia patients will give estimate of clinical risk. (SR)