title: HIV infection predisposes skin to toxic epidermal necrolysis via depletion of skin-directed CD4⁺ T cells.
abstract: BACKGROUND
  A greater incidence of adverse cutaneous drug eruptions, including toxic epidermal necrolysis (TEN), occurs among HIV-infected patients.
  
  
  OBJECTIVE
  We sought to determine if immunophenotypical differences exist in the inflammatory infiltrates of TEN lesions from HIV-infected individuals versus noninfected individuals.
  
  
  METHODS
  The inflammatory infiltrates in 12 cases of TEN from HIV-positive patients were characterized and compared with the infiltrates present in 12 cases of TEN from HIV-negative patients.
  
  
  RESULTS
  TEN infiltrates consisted of CD3, CD4, and CD8 immunoreactive T lymphocytes in both the dermis and epidermis. HIV infection was associated with an 8-fold increase in the ratio of CD8(+) to CD4(+) T cells infiltrating the dermis (P = .006) and a decrease in the number of dermal CD4(+) cells (P = .044). There was also a significant decrease in the ratio of CD25(+) to CD4(+) cells in the epidermis of HIV-infected skin (P = .011).
  
  
  CONCLUSIONS
  This study is limited by small sample sizes.
  
  
  CONCLUSIONS
  A decrease in the number of skin-directed CD4(+) cells and an increase in the ratio of CD8(+) to CD4(+) cells exists in TEN lesions among HIV-infected individuals and likely contribute to an increased risk of developing drug reactions because of the loss of skin-protective CD4(+)CD25(+) regulatory T cells.
authors.affiliation: Department of Dermatology at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Chao
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Dermatology, Nelson R. Mandela School of Medicine, Durban, South Africa.
authors.forename: Anisa
authors.initials: A
authors.lastname: Mosam
authors.affiliation: Department of Dermatology, Nelson R. Mandela School of Medicine, Durban, South Africa.
authors.forename: Avumile
authors.initials: A
authors.lastname: Mankahla
authors.affiliation: Department of Dermatology, Nelson R. Mandela School of Medicine, Durban, South Africa.
authors.forename: Ncoza
authors.initials: N
authors.lastname: Dlova
authors.affiliation: Department of Dermatology at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: asoavedra@partners.org.
authors.forename: Arturo
authors.initials: A
authors.lastname: Saavedra
mesh_terms: D000328:Adult; D017677:Age Distribution; D001707:Biopsy, Needle; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D016022:Case-Control Studies; D015984:Causality; D003875:Drug Eruptions / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D017678:Sex Distribution; D013262:Stevens-Johnson Syndrome / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*; D055815:Young Adult
keywords: HIV; adverse cutaneous drug eruptions; cytotoxic T lymphocytes; immunohistochemistry; regulatory T cells; toxic epidermal necrolysis