Factors associated with collagen deposition in lymphoid tissue in long-term treated HIV-infected patients.
OBJECTIVE
The factors associated with fibrosis in lymphoid tissue in long-term treated HIV-infected patients and their correlation with immune reconstitution were assessed.


METHODS
Tonsillar biopsies were performed in seven antiretroviral-naive patients and 29 successfully treated patients (median time on treatment, 61 months). Twenty patients received protease inhibitors-sparing regimens and nine protease inhibitor-containing regimens. Five tonsillar resections of HIV-negative individuals were used as controls. Lymphoid tissue architecture, collagen deposition (fibrosis) and the mean interfollicular CD4(+) cell count per mum were assessed.


RESULTS
Naive and long-term treated HIV-infected patients had a higher proportion of fibrosis than did HIV-uninfected persons (P < 0.001). Patients with greater collagen deposition showed lower levels of CD4 cells in lymphoid tissue (P = 0.03) and smaller increase in peripheral CD4(+) T cells (r = -0.40, P = 0.05). The factors independently associated with fibrosis in lymphoid tissue were age (P < 0.0001), treated patients with detectable lymphoid tissue viral load when compared with patients with undetectable lymphoid tissue viral load (median 5 vs. 12%, respectively, P = 0.017) and patients receiving a protease inhibitor-sparing vs. a protease inhibitor-containing regimen (median 8 vs. 2.5%, respectively, P = 0.04).


CONCLUSIONS
Fibrosis in lymphoid tissue was associated with a poor reconstitution of CD4(+) T cells and long-term antiretroviral therapy did not reverse this abnormality. HIV infection, older age, a detectable level of lymphoid tissue viral load in treated patients and protease inhibitor-sparing regimens seem to favour fibrosis in lymphoid tissue.
Diaz
Alba
A
Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Alós
Llúcia
L
León
Agathe
A
Mozos
Anna
A
Caballero
Miguel
M
Martinez
Antonio
A
Plana
Montserrat
M
Gallart
Teresa
T
Gil
Cristina
C
Leal
Manuel
M
Gatell
Jose M
JM
García
Felipe
F
D000328:Adult; D000375:Aging / Q000276:immunology / Q000378:metabolism*; D018791:CD4 Lymphocyte Count; D003094:Collagen / Q000276:immunology / Q000378:metabolism*; D005260:Female; D005355:Fibrosis; D015658:HIV Infections / Q000276:immunology / Q000473:pathology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000473:pathology* / Q000821:virology; D012307:Risk Factors; D019562:Viral Load
D003094:Collagen