Hypothesis: the pathogenesis of AIDS. Activation of the T- and B-cell cascades.

The hypothesis is presented that a human T-cell leukemia virus (HTLV) or a related agent produces a lytic response of T cells manifested by the acquired immune deficiency syndrome (AIDS) and a proliferative response represented by the adult leukemia/lymphoma (ATL) syndromes. The sequence or cascade of T-cell events following loss of T4 helper cells in AIDS includes reactivation of Epstein-Barr virus and a B-cell cascade of cytomegalovirus, resulting in Kaposi sarcoma in genetically susceptible persons, and of other intracellular agents (CNS viruses, M. avium intracellulari, T. gondii); opportunistic infections also occur. A comparison of AIDS and ATL syndromes is presented and the details of the B-cell cascade are outlined. The usefulness of prospective serological/immunological studies is discussed in an effort to determine the temporal sequence of infection by the candidate agents and their relation to the appearance of T4/T8 reversal and of the clinical features of AIDS.