A diffuse infiltrative CD8 lymphocytosis syndrome in human immunodeficiency virus (HIV) infection: a host immune response associated with HLA-DR5

Ann Intern Med. 1990 Jan 1;112(1):3-10. doi: 10.7326/0003-4819-112-1-3.

Abstract

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 CD8 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 CD8 lymphocytosis and the presence of HLA-DR5, and appears to be a genetically determined host immune response to HIV.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Blacks
  • Female
  • HIV Infections / immunology*
  • HLA-DR5 Antigen / analysis*
  • HLA-DR5 Antigen / genetics
  • Humans
  • Keratoconjunctivitis Sicca / immunology
  • Lymphocytosis / immunology*
  • Lymphocytosis / pathology
  • Male
  • Middle Aged
  • Parotid Gland / pathology
  • Phenotype
  • Pulmonary Fibrosis / immunology
  • Pulmonary Fibrosis / pathology
  • Syndrome
  • T-Lymphocytes, Regulatory*
  • Xerophthalmia / immunology
  • Xerostomia / immunology

Substances

  • HLA-DR5 Antigen