CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN #14 - July 31, 1992
Centers for Disease Control and Prevention

1. What is this MMWR report about?

This article in the July 31, 1992, MMWR reports on clinical and laboratory findings in five persons reported with persistently low CD4 T-cell levels but without laboratory evidence of human immunodeficiency virus (HIV) infection (i.e., without a positive test result for the HIV antibody).

In some of these patients, infections were diagnosed which are sometimes seen in persons with acquired immunodeficiency syndrome (AIDS). These five patients are part of ongoing investigations being conducted by the Centers for Disease Control and Prevention (CDC).

2. Are these five persons the only cases?

An additional 21 similar cases are mentioned in the MMWR that have been described in the medical literature since 1989.

3. What is causing the low CD4 T-cell levels?

The cause or causes of the low CD4 T-cell counts in the patients described in the MMWR and other reports are unknown. They may represent a condition that was not detected until T-cell counts became widely available. Or, they may represent a different syndrome of immunodeficiency associated with CD4 T-cell depletion.

4. What about the discovery of a "new" virus?

Although there has been speculation that some of these cases are the result of infection by a "new virus," the existence of such a virus has not been proven. Two of the recent reports describe preliminary findings that suggest the presence of a retrovirus, the family of viruses that includes HIV. However, how these findings relate to the immunodeficiency found in patients in this and other reports is unknown.

5. Do these case reports represent the beginning of a new epidemic?

According to the evidence gathered so far, the number of possible cases appears to be small. There is no known connection between these cases; they are scattered worldwide. CDC is encouraging State and local health departments to report any additional cases to CDC; these will be fully investigated.

6. How long has CDC known about these cases?

A few cases were reported in the medical literature starting in 1989. Over the past several years, CDC began to receive information on some additional cases; a report on six of these cases was presented by CDC before a scientific conference in March 1992.

7. Is the blood supply still considered safe? Should I be worried if I received a blood transfusion recently?

The total number of cases of this illness reported so far is very small. Several of the reported patients had received blood transfusions. However, the role, if any, of these transfusions in this illness is not known. In an investigation of three blood donors to one reported patient, CDC found all the donors were in good health and showed no signs of HIV infection or other immunodeficiency. Further investigations are needed to determine the effect of this illness on the safety of the blood supply, but persons should not delay or decline receiving necessary blood transfusions. The FDA is aware of these cases and is working closely with blood banks.

8. How soon will a blood test be available?

Scientists expect that if the cause of these clinical findings is found to be a virus or viruses, a blood test would probably be made quickly available.

9. How can I tell if I am infected like the persons described in this report?

The cause of this illness is unknown. Hence, no test is yet available for determining who has this illness. The five patients described in the MMWR were receiving treatment by physicians for varying clinical conditions, some of which are seen in persons with AIDS. If you believe that you have any signs of the illness like the ones described in this article, you should see your physician for a clinical evaluation.

10. How is this illness spread?

We have no evidence that this illness is contagious. The number of cases reported is small and there is no report of spread to close contacts. Of the 26 patients (including the five described in this report and 21 reported elsewhere), five had received transfusions before onset of illness, five were men who had sex with men, and the remaining 16 had no known risk factors for HIV infection. In this report, follow-up investigation of the blood donors for one of the patients found that they were negative for HIV infection, in good health, and had no evidence of immune deficiency.

11. Could these cases indicate that a "casual contact" route of transmission for a retrovirus has been discovered? How can I be safe?

There is no evidence that transmission is occurring by contact with air or surfaces. If this pattern of transmission were occurring, scientists would see unexplained clusterings of cases; this has not been reported. Also, none of the household members of the patients have been reported to be ill. If the agent or agents are found to be similar to HIV, then the prevention methods used for HIV infection (i.e., abstaining from sex, using condoms, not using illicit drugs, not sharing needles) would keep you from becoming infected.

12. What is the next step in the investigation?

Additional epidemiologic and laboratory investigations are in progress. CDC and NIH are working together in this effort. Health-care providers are requested to report to CDC through the AIDS case surveillance section of their local or State health department any patients who have the following: 1) CD4 T-cell depletion (absolute CD4 T-cell level <300 cells L or <20% on more than one determination, 2) no serologic evidence of HIV infection, and 3) no defined immunodeficiency or therapy associated with T-cell depletion. HIV-negative pediatric cases with low CD4 cell counts should also be reported.

13. Whom can I contact for more information on HIV infection and AIDS?

The CDC National AIDS Hotline (1-800-342-2437) has trained information specialists to answer questions or provide referrals on HIV infection and AIDS. If you wish to receive a free copy of the July 31, 1992, MMWR, please call them or write to the CDC National Prevention Information Network, P.O. Box 6003, Rockville, Maryland 20849-6003.

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