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


METHODS
Clinical case study.


METHODS
University-affiliated hospitals and outpatient clinics.


METHODS
Consecutive sample of 17 patients.


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.
Itescu
S
S
New York University Medical Center, New York.
Brancato
L J
LJ
Buxbaum
J
J
Gregersen
P K
PK
Rizk
C C
CC
Croxson
T S
TS
Solomon
G E
GE
Winchester
R
R
D000328:Adult; D044383:Black People; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D015805:HLA-DR5 Antigen / Q000032:analysis* / Q000235:genetics; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000276:immunology; D008218:Lymphocytosis / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000473:pathology; D010641:Phenotype; D011658:Pulmonary Fibrosis / Q000276:immunology / Q000473:pathology; D013577:Syndrome; D050378:T-Lymphocytes, Regulatory; D014985:Xerophthalmia / Q000276:immunology; D014987:Xerostomia / Q000276:immunology
D015805:HLA-DR5 Antigen