title: Remission of severe CD8(+) cytotoxic T cell skin infiltrative disease in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy.
abstract: BACKGROUND
  A CD8 cutaneous lymphoinfiltrative disease has been described in human immunodeficiency virus (HIV)-infected patients presenting with a severe erythroderma. The true nature of this severe skin infiltrative disorder is still elusive. Although some clinical features of this syndrome have raised the hypothesis of its malignant nature in initial observations, several studies have provided stronger support to the hypothesis that it is a reactive pseudotumoral process.
  
  
  METHODS
  From 1995 through 2008, 8 HIV type 1 (HIV-1)-infected patients presenting with a chronic skin eruption, diagnosed as CD8 T cell infiltration of the skin, were studied.
  
  
  RESULTS
  All patients showed diffuse infiltrated skin with superficial lymphadenopathy. A profound CD4(+) lymphocytopenia and eosinophilia were other major features. Histological and immunostaining analysis revealed a predominant dermal and epidermal infiltration by CD8(+) T cells belonging to the cytotoxic lineage, without evidence for a monoclonal status by polymerase chain reaction-based molecular analysis of lesional skin. A remission of skin symptoms occurred in all cases following highly active antiretroviral therapy, which paralleled the decrease of HIV-1 RNA load and the increase of CD4(+) peripheral blood absolute count.
  
  
  CONCLUSIONS
  Altogether, these results emphasize the reactive, nonmalignant nature of this syndrome and strongly support the coupling between HIV-induced immune deficiency and uncontrolled CD8 activation.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM) U976 and Department of Dermatology, AP-HP Hôpital Saint-Louis, Université Paris Diderot (Paris 7), France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Sbidian
authors.forename: Maxime
authors.initials: M
authors.lastname: Battistella
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Rivet
authors.forename: Béatrice
authors.initials: B
authors.lastname: Flageul
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
authors.forename: Guy
authors.initials: G
authors.lastname: Gorochov
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Cayuela
authors.forename: Claire
authors.initials: C
authors.lastname: Rabian
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dupin
authors.forename: Céleste
authors.initials: C
authors.lastname: Lebbé
authors.forename: Anne
authors.initials: A
authors.lastname: Janin
authors.forename: Michel
authors.initials: M
authors.lastname: Janier
authors.forename: Eric
authors.initials: E
authors.lastname: Oksenhendler
authors.forename: Hervé
authors.initials: H
authors.lastname: Bachelez
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D003873:Dermatitis, Exfoliative / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006651:Histocytochemistry; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D012074:Remission Induction; D012867:Skin / Q000473:pathology; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*
chemical_list: D019380:Anti-HIV Agents