DETECTION OF THE CARRIER STATE OF AIDS

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Evidence that AIDS may be transmitted by transfusion of blood from asymptomatic members of AIDS high risk groups has prompted a search for a screening test that can be used to identify a carrier state for the disorder. We propose to assess selected alternative assays for their ability to predict the development of AIDS or persistent lymphadenopathy syndrome in a group of homosexual men at increased risk for developing these disorders. We will also study two groups of volunteer blood donors with laboratory findings seen uncommonly in our general donor pool, but known to be significantly more prevalent in patients with AIDS and AIDS related disorder. The populations to be studied serially over 3 years will include 150 apparently healthy homosexual men with multiple anonymous sexual partners, 100 volunteer blood donors with persistent inversions of the ratio of helper/inducer to suppressor/cytotoxic T lymphocytes (Th:Ts), 100 volunteer blood donors with antibodies to the human T cell leukemia/lymphoma viruses (HTLV), and 50 volunteer blood donors with Th:Ts within the normal range. Groups of 5 patients with fully expressed AIDS and 50 with persistent generalized lymphadenopathy will be tested at the beginning of the study only. In addition to clinical follow-up, the following assays will be performed at the initiation of the study and at six month intervals thereafter: analysis of T lymphocyte subsets using a panel of monoclonal antibodies, including several novel reagents; measurement in serum of soluble forms of lympohcyte surface molecules; tests to detect antibodies to the three identified types of human T cell leukemia lymphoma viruses (HTLV); tests of circulating immune complexes; serum levels of beta-2-microglobulin and thymosin alpha-1; and tests for the presence of antibody to hepatitis B core antigen (HBcAb). These assays have been chosen for study on the basis of encouraging preliminary studies and potential ease of methodology. Correlation of the clinical and laboratory findings in the AIDS hight risk and blood donor groups may help to identify the procedure or combination of procedures best able to predict subsequent development of AIDS or related disorders, with potential applications to screening donated blood to detect an AIDS carrier state.