LYMPHADENOPATHY: ENDPOINT OR PRODROME? UPDATE OF A 24‐MONTH PROSPECTIVE STUDY

Abstract

This article presents preliminary 24-month findings from a prospective study initiated in San Francisco in 1981 with the following objectives: to refine the clinical definition of the lymphadenopathy syndrome; to compare these patients to patients with Category A acquired immunodeficiency syndrome (AIDS) with regard to epidemiologic, virologic, and immunologic variables; to follow a cohort of these patients to establish the natural history of the syndrome; and to evaluate screening variables for early transformation to more malignant manifestations of AIDS. It was hypothesized that the lymph node syndrome is prodromal AIDS, and that such patients are at risk of developing Kaposi's sarcoma, lymphoma, Pneumocystis carinii pneumonia, and other opportunistic infections. 200 homosexual lymphadenopathy patients, with a mean age of 33 years, have been enrolled in the study. These men have had an average of 800 sexual partners, and have a history of past sexually transmitted diseases. The graph of the year of onset of adenopathy parallels the exponentially increasing number of new AIDS cases over the past 4 years. Systemic symptoms seen in these patients resemble those in patients with Kaposi's sarcoma and P. carinii pneumonia. 1/3 of lymphadenopathy patients give a history of antecedent flu-like illness, often with fever, diarrhea, and upper respiratory symptoms lasting for 1 week, that occurred 1-2 months before the appearance of their nodes. Involvement of inguinal and axillary nodes has been observed in 100% of patients, while 80% have enlarged posterior cervical nodes. The average patient has 10 nodal groups involved. Immunologic testing reveals a reversal of the T-lymphocyte helper:suppressor ratio (mean of 0.7), and 2/3 of patients have both decreased absolute number and percentage of helper cells with increased suppressors. 198 of these patients have remained with persistent generalized lymphadenopathy without transformation to AIDS, yielding a 1% conversion rate. It is concluded that the lymphadenopathy syndrome is a distinct new syndrome most certainly AIDS-related. Further study will reveal whether it is truly prodromal or an alternate phenotypic response to a common inciting insult.