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A Diffuse Infiltrative CD8 Lymphocytosis Syndrome in Human Immunodeficiency Virus (HIV) Infection: A Host Immune Response Associated with HLA-DR5

1990; American College of Physicians; Volume: 112; Issue: 1 Linguagem: Inglês

10.7326/0003-4819-112-1-3

1539-3704

Silviu Itescu,

Immunodeficiency and Autoimmune Disorders

Study Objective: To describe the clinical, immunologic, and immunogenetic features of a diffuse infiltrative lymphocytic disorder resembling Sjögren syndrome in persons infected with human immunodeficiency virus (HIV). Design: Clinical case study. Setting: University-affiliated hospitals and outpatient clinics. Patients: Consecutive sample of 17 patients. Measurements and Main Results: All of the 17 patients had bilateral parotid gland enlargement; 14 had xerostomia and 6 had xerophthalmia. Of the 17 patients, 14 had generalized lymphadenopathy, 10 had histologically proved lymphocytic interstitial pneumonitis, 4 had neurologic involvement, and 3 had lymphocytic infiltration of the gastrointestinal tract. Gallium scanning in all of 11 tested patients showed abnormal salivary gland uptake. Minor salivary gland biopsies showed more than 2 lymphocytic foci per 4 mm2 tissue in all of 11 tested patients, the infiltrate consisting predominantly of CD8 cells. Fifteen patients had circulating CD 8 lymphocytosis; the principal phenotype of these cells was CD8 + CD29 +. Rheumatoid factor and antinuclear antibodies were infrequent, and none of the patients had anti-Ro/SS-A or anti-La/SS-B antibodies. HLA-DR5 was significantly more frequent in the black patients (10 of 12) compared with controls (13 of 45). Only one patient developed an opportunistic infection during 544 patient-months of study, and none has died of AIDS. Conclusions: A distinct syndrome primarily characterized by parotid gland enlargement, sicca symptoms, and pulmonary involvement occurs in HIV infection. This disorder is associated with CD 8 lymphocytosis and the presence of HLA-DR5, and appears to be a genetically determined host immune response to HIV.