Neuropathy in diffuse infiltrative lymphocytosis syndrome: an HIV neuropathy, not a lymphoma.
OBJECTIVE
To determine whether CD8 lymphoid infiltrates in nerves of patients with HIV-associated diffuse infiltrative lymphocytosis syndrome (DILS) corresponds to a lymphomatous neoplastic process or to a proliferation of T cells reactional to HIV.


BACKGROUND
DILS is characterized by persistent CD8 hyperlymphocytosis and multivisceral CD8 T-cell infiltration, which may affect peripheral nerves.


METHODS
Presence of monoclonal T cells and HIV-1 proviral load were evaluated by polymerase chain reaction (PCR) techniques in frozen peripheral nerve samples from six patients with DILS neuropathy and 22 patients with other HIV-associated peripheral neuropathies, including mononeuritis multiplex (MM:6), inflammatory demyelinating polyneuropathies (IDP:6), distal sensory polyneuropathy (DSP:5), and toxic distal sensory polyneuropathy (TDSP:5).


RESULTS
Five of six patients with DILS showed no detectable monoclonal T-cell clones in their nerves. Nerve proviral load in DILS (6.8 +/- 0.2 log/10(5) cells) was much higher than in MM (p < 0.008), IDP (p < 0.001), DSP (p < 0.001), and TDSP (p < 0.005).


CONCLUSIONS
DILS neuropathy represents a separate entity among HIV-associated neuropathies. It is associated with massive HIV proviral load in nerve and must not be confused with a peripheral nerve T-cell lymphoma.
Gherardi
R K
RK
Groupe d'Etude et de Recherche sour le Muscle et le Nerf, Créteil, France.
Chrétien
F
F
Delfau-Larue
M H
MH
Authier
F J
FJ
Moulignier
A
A
Roulland-Dussoix
D
D
Bélec
L
L
D001706:Biopsy; D018414:CD8-Positive T-Lymphocytes / Q000737:chemistry / Q000276:immunology; D002999:Clone Cells / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D019675:Genes, T-Cell Receptor gamma / Q000235:genetics; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008218:Lymphocytosis / Q000209:etiology / Q000821:virology*; D008223:Lymphoma / Q000175:diagnosis*; D010525:Peripheral Nerves / Q000473:pathology; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis*; D016133:Polymerase Chain Reaction; D011115:Polyneuropathies / Q000175:diagnosis* / Q000821:virology; D019562:Viral Load
D004279:DNA, Viral