title: Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR).
abstract: BACKGROUND
  The high incidence of cutaneous disease in HIV-1+ patients may be a marker of the chronic state of immune activation. In addition, specific cutaneous diseases may be related to the pattern and degree of immune dysregulation present in the patients at the time of the eruption. We have observed that HIV-1+ patients with pityriasis lichenoides et varioliformis acuta (PLEVA) were in the early to midstage of HIV-1 disease.
  
  
  METHODS
  To determine if there was a correlation between the phenotype of the lymphoid infiltrate and surface markers of the epidermis and the known changes in early or late-stage HIV-1 disease, we studied five HIV-1+ patients with PLEVA. Cutaneous biopsy specimens were obtained and immunohistochemical stains were used to determine the expression of ELAM-1, ICAM-1, and HLA-DR and the phenotype of the lymphoid infiltrate.
  
  
  RESULTS
  The HIV-1+ patients showed increased expression of HLA-DR on keratinocytes as well as on the mononuclear and dendritic cell populations in the epidermis and dermis. The majority of T cells were activated CD8+ cells.
  
  
  CONCLUSIONS
  Immunophenotyping of the inflammatory infiltrate in these patients is consistent with a pattern of immune dysregulation seen only in earlier stages of HIV-1 disease. Thus, PLEVA may be useful as a marker of early to midstages of HIV-1 disease.
authors.affiliation: Medical Research Institute of Chemical Defense, Aberdeen, Maryland, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Nelson
authors.forename: H
authors.initials: H
authors.lastname: Skelton
authors.forename: J
authors.initials: J
authors.lastname: Yeager
authors.forename: K F
authors.initials: KF
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D017514:Pityriasis Lichenoides / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers