Persistent diffuse lymphadenopathy in homosexual men: endpoint or prodrome?

Seventy homosexual men with unexplained persistent diffuse lymphadenopathy enrolled in a prospective natural history study from November 1981 to November 1982. These men had demographic, clinical, and laboratory findings similar to those of homosexual patients with the acquired immunodeficiency syndrome. Pathologic examination of lymph node biopsies from 35 patients showed florid follicular hyperplasia. Despite benign reactive pathologic findings, most patients had constitutional symptoms and recurrent non-life-threatening infections. All had evidence of immune dysfunction with B-lymphocyte activation and inversion of the T-lymphocyte helper: suppressor ratio. To date, none of our patients has developed the more malignant manifestations of the acquired immunodeficiency syndrome. The lymphadenopathy syndrome may be an alternative phenotypic response to the "acquired immunodeficiency syndrome agent."