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Adult-onset immunodeficiency syndrome identified in Asia
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An adult-onset immunodeficiency illness identified in Thailand and Taiwan showed similar symptoms to that of advanced HIV infection but is not associated with HIV, according to researchers from the National Institute of Allergy and Infectious Diseases.
Since 2004, opportunistic infections involving neutralizing anti–interferon-gamma autoantibodies have been reported in 25 adults without HIV, mostly in East Asia. The researchers sought to identify defects that result in a predisposition to illnesses similar to advanced HIV infection. They analyzed patients and healthy controls.
All patients provided complete histories, underwent physical examination and routine clinical laboratory tests. Patients were divided into five groups — patients with disseminated, rapidly or slow-growing, nontuberculous myobacterial infection (group 1); patients with another opportunistic infection with or without nontuberculous mycobacterial infection (group 2); patients with disseminated TB (group 3); patients with pulmonary TB (group 4); and healthy controls (group 5). The study included 204 patients: 52 in group 1, 45 in group 2, nine in group 3, 49 in group 4 and 48 in group 5.
Among patients in groups 1 and 2, the washed cells had intact cytokine production and responded to cytokine stimulation. The plasma of these patients, however, inhibited the activity of interferon-gamma in normal cells. Anti–interferon-gamma autoantibodies were found in 88% of the adults in groups 1 and 2 — 81% of group 1 patients and 96% of group 2 patients. The researchers found no other anti-cytokin autoantibodies or genetic infections that correlated with infections.
“Our study showed that this adult-onset immunodeficiency syndrome is strongly associated with high-titer neutralizing antibodies to interferon-gamma, supporting the central role of interferon-gamma in the control of numerous pathogens,” the researchers wrote. “Since many patients with anti–interferon-gamma autoantibodies remain actively infected despite antimicrobial therapy, this observation suggests that therapeutic targeting of anti–interferon-gamma autoantibodies may warrant investigation.”
Disclosure: The researchers report no relevant financial disclosures.
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