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Epidemiologic Notes and Reports Isolation of Human T- Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus from Serum Proteins Given to Cancer Patients -- Bahamas

Since 1977, a private clinic in Freeport, Grand Bahama Island, Bahamas, has given cancer patients vials of human serum proteins, prepared at the clinic, for a series of self-administered subcutaneous injections. These products, described by the clinic as immunoaugmentative therapy, are not approved for use in the United States and have been previously associated with the occurrence of cutaneous Nocardia asteroides infections (1). In addition, both hepatitis B surface antigen (HBsAg) and a variety of bacterial species have been reported in vials of serum proteins obtained from several patients who attended the clinic (1,2).

In May 1985, two laboratories in the State of Washington tested samples of the serum proteins that had been obtained from two patients who had attended the clinic. Eighteen vials were tested for human T-lymphotropic virus type III (HTLV-III) antibody by the Abbott enzyme immunoassay (EIA) method*; eight of the 18 were either repeatedly reactive or repeatedly borderline in the two laboratories' tests. All 18 specimen vials were also positive for HBsAg by the Abbott Auszyme EIA method.

In June, these specimens were sent from Washington to CDC for additional testing. Six of the 18 specimens were repeatedly reactive by the Abbott HTLV-III EIA. Testing of all 18 specimens by the Western blot method (3) yielded uninterpretable results. Aliquots of nine specimens, including the six that were reactive in the EIA, were placed in primary human lymphocyte culture in an attempt to isolate HTLV-III/lymphadenopathy-associated virus (LAV) (4). Of 18 specimens tested for HBsAg by radioimmunoassay (Ausria-II; Abbott Laboratories), 13 were positive and could be neutralized by antibody to HBsAg.

On July 2, authorities of the Bahamian Ministry of Health, accompanied by a staff member and a consultant to the Pan American Health Organization, visited the clinic. On July 17, the Ministry of Health ordered the clinic to close.

Subsequent to closure of the clinic, HTLV-III/LAV was isolated at CDC from one of the nine specimens that had been placed in lymphocyte culture. This finding was confirmed by isolation of HTLV-III/LAV from a second aliquot of this specimen. It was reactive in the HTLV-III EIA and also positive for HBsAg by radioimmunoassay. Reportedly, this specimen vial had not been used by the patient who received it at the clinic, and it had been kept frozen until it was obtained by the laboratories in Washington. The Washington laboratories do not maintain stocks of HTLV-III/LAV. Reported by S Insalaco, MD, J Shaw, Tacoma-Pierce County Blood Bank, Tacoma, S Mills, J Kobayashi, MD, State Epidemiologist, Washington State Dept of Social and Health Svcs; Ministry of Health, Nassau, Bahamas; Pan American Health Organization; Div of Field Svcs, Epidemiology Program Office, Hepatitis Br, AIDS Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: HTLV-III/LAV, the retrovirus that causes acquired immunodeficiency syndrome (AIDS), has been transmitted by transfusion of blood and blood products (4,5). The present report documents the presence of HTLV-III/LAV in a vial of serum protein prepared for injection by the clinic in the Bahamas. AIDS cases have not been reported as a consequence of receiving treatment at the clinic. In addition, the serum proteins used in this therapy may contain HBsAg. CDC has documented hepatitis B virus (HBV) infection in two clinic patients who had no other known risk for infection (6). Several other hepatitis B cases in clinic attendees are under investigation.

These findings suggest that patients who have received serum proteins for injection at this clinic may be at risk of acquiring HTLV-III/LAV and HBV infections. The magnitude of the risk is not known, but it must be assumed that all injectable materials presently in possession of attendees at the clinic are potentially contaminated. Patients who have received such therapy should consult their physicians. If it is decided to test the patient's serum for HTLV-III/LAV antibody or for evidence of HBV infection, such testing is available through state health department laboratories. If an initial test is negative, a testing of a follow-up sample, collected 6 months later, is recommended.

References

  1. CDC. Cutaneous nocardiosis in cancer patients receiving immunotherapy injections--Bahamas. MMWR 1984;33:471-2,477.

  2. Curt GA. Warning on immunoaugmentative therapy. (Letter) N Engl J Med 1984;311:859.

  3. Tsang VC, Peralta JM, Simons AR. Enzyme-linked immunoelectrotransfer blot techniques (EITB) for studying the specificities of antigens and antibodies separated by gel electrophoresis. Methods Enzymol 1983;92:377-91.

  4. Feorino PM, Jaffe HW, Palmer E, et al. Transfusion-associated acquired immunodeficiency syndrome. Evidence for persistent infection in blood donors. N Engl J Med 1985;312:1293-6.

  5. CDC. Changing patterns of acquired immunodeficiency syndrome in hemophilia patients--United States. MMWR 1985;34:241-3.

  6. CDC. Unpublished data. *Use of trade names is for identification only and does not imply endorsement by CDC or the U.S. Public Health Service.



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