Cutaneous reactions at the site of post-infection gp160 vaccination therapy in HIV-1+ patients. Military Medical Consortium for the Advancement of Military Medicine.
BACKGROUND
Post-infection vaccination with human immunodeficiency virus type 1 (HIV-1) specific antigens has been hypothesized as a mechanism for generating a more effective immune response to the HIV-1 virus. Cutaneous reactions at the site of immunization may provide information on the pattern of immune activation induced by the vaccine.


OBJECTIVE
To evaluate exaggerated local cutaneous reactions in eight HIV-1+ patients enrolled in a phase I and II gp160 vaccine study.


METHODS
Cutaneous biopsy specimens were obtained and evaluated using routine histologic, immunofluorescence, and immunohistochemical techniques.


RESULTS
A mononuclear cell infiltrate with tissue eosinophilia, in some cases forming flame figures, was present on histologic sections. There was no evidence of immune complex deposition. Activated T-helper cells formed a major portion of the mononuclear cell infiltrate.


CONCLUSIONS
A delayed-type hypersensitivity reaction, mediated by T cells with a T-helper 2 cytokine pattern, was favored by clinical and histologic features. The most likely antigen stimulating this reaction is residual lepidopteran used in the preparation of the vaccine; however, baculovirus antigens may also play a role. In addition, the adjuvant, aluminum phosphate, as well as the underlying patterns of immune dysregulation present in HIV-1+ patients, may potentiate these reactions.
Smith
K J
KJ
Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland, USA.
Skelton
H G
HG
Ruiz
N
N
Samlaska
K
K
Wagner
K F
KF
D016915:AIDS Vaccines / Q000276:immunology*; D000328:Adult; D005260:Female; D019302:HIV Envelope Protein gp160 / Q000276:immunology*; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology; D008297:Male; D012867:Skin / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology; D014611:Vaccination
D016915:AIDS Vaccines; D019302:HIV Envelope Protein gp160