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Being Alive
ICL: Mystery Virus, Non-HIV/AIDS, or ???
Walt Senterfitt
November 5, 1992
Being Alive 1992 Nov 5: 7

The international media-driven hullabaloo over newly reported, unexplained cases of AIDS-like profound immune suppression without evidence of HIV infection was initially met with an amazingly inept response from the CDC, exacerbating the suspicions of many that there is more here than meets the eye. Within a few weeks, a more credible strategy developed in the NIH and the CDC. They convened a diverse group of top clinicians to share stories and brainstorm, started a search of existing data bases of closely-followed patients who might be at risk, and asked all US physicians to report any cases that might fit the surveillance definition of ICL (standing for the catchily-phrased "idiopathic CD4+ T-lymphocytopenia").

The CDC's data to date were presented at ICAAC and discussed by a panel of AIDS experts. The first 48 confirmed cases had a male:female ratio of 1.6:1 and an average CD4+ count of 130. Three cases were asymptomatic, 19 had AIDS-defining opportunistic infections (cryptococcal infection being the most common), and 25 were symptomatic with other, generally less severe infections. A number of different clinical profiles were observed. In contrast to AIDS cases, 62% had no discernible risk factors for HIV infection. There is no noticeable geographic clustering of the cases, unlike early reports of AIDS and other new outbreaks of infectious disease. Overall, the expert panel felt that the syndrome is in fact exceedingly rare (as opposed to simply not having been noticed earlier) and that there is no evidence to date for an infectious agent as the cause. It seems more likely that the causes are multiple and varied. Everyone agreed that continued close surveillance and analysis of the cases is important to ensure that this initial assessment is correct and that we can learn what in fact is going on.