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
CDC. Cutaneous nocardiosis in cancer patients receiving
immunotherapy injections--Bahamas. MMWR 1984;33:471-2,477.
Curt GA. Warning on immunoaugmentative therapy. (Letter) N
Engl
J Med 1984;311:859.
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.
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.
CDC. Changing patterns of acquired immunodeficiency syndrome
in
hemophilia patients--United States. MMWR 1985;34:241-3.
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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