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CLINICAL AND IMMUNOLOGIC FEATURES OF PEPIATRIC AIDS-RELATED COMPLEX (PARC)

The long-term clinical outcome for infants and children with PARC is unknown. We report our detailed clinical and immunologic analyses of 14 patients with PARC (ages 15 mos-8 yrs) who have been followed for 13-66 mos since the onset of their symptoms. Diagnostic criteria for PARC included: 1) clinical features suggestive of Human Immunodeficiency Virus (HIV) infection; 2) presence of serum antibody to HIV; 3) absence of opportunistic infections or malignancies. The most frequent clinical features at presentation were generalized lymphadenopathy (14/14) (GL), hepatosplenomegaly (10/14) (HSM), and recurrent otitis media (7/14). Except for hypergammaglobulinemia (13/14) and reversed T4/T8 ratios (9/14), immunologic analyses, including responses to mitogens and antigens, revealed no consistent abnormalities; 2 pts. had IgG2 deficiency. Over the course of follow-up, none of the pts. have developed serious or opportunistic infections and all have maintained their growth parameters. The T4/T8 ratios have remained stable (11/13) or improved (2/13). Gradual regression of GL and HSM has been noted in 6 pts. Although large scale follow-up studies over a longer period of time are needed to confirm our observations to date, PARC may represent an end-point response to HIV infection in many infected children. Detailed immunologic evaluation of these pts. may help identify a subset of children that may benefit from therapy such as IV gammaglobulin.