Remission of severe CD8(+) cytotoxic T cell skin infiltrative disease in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy.
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.
Sbidian
Emilie
E
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.
Battistella
Maxime
M
Rivet
Jacqueline
J
Flageul
Béatrice
B
Molina
Jean-Michel
JM
Joly
Pascal
P
Caumes
Eric
E
Gorochov
Guy
G
Cayuela
Jean-Michel
JM
Rabian
Claire
C
Dupin
Nicolas
N
Lebbé
Céleste
C
Janin
Anne
A
Janier
Michel
M
Oksenhendler
Eric
E
Bachelez
Hervé
H
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*
D019380:Anti-HIV Agents