title: HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting.
abstract: BACKGROUND
  There is a paucity of clinical and histopathological data about HIV-associated lymphocytic interstitial pneumonitis (LIP) in adults from HIV endemic settings. The role of Ebstein-Barr virus (EBV) in the pathogenesis remains unclear.
  
  
  METHODS
  We reviewed the clinical, radiographic and histopathological features of suspected adult LIP cases at the Groote Schuur Hospital, Cape Town South Africa, over a 6 year period. Archived tissue sections were stained for CD3, CD4, CD8, CD20 and LMP-1 antigen (an EBV marker).
  
  
  RESULTS
  42 cases of suspected LIP(100% HIV-infected) were identified. 75% of patients were empirically treated for TB prior to being referred to the chest service for further investigation. Tissue samples were obtained using trans-bronchial biopsy. 13/42 were classified as definite LIP (lymphocytic infiltrate with no alternative diagnosis), 19/42 probable LIP (lymphocytic infiltrate but evidence of anthracosis or fibrosis) and 10 as non-LIP (alternative histological diagnosis). Those with definite LIP were predominantly young females (85%) with a median CD4 count of 194 (IQR 119-359). Clinical or radiological features had poor predictive value for LIP. Histologically, the lymphocytic infiltrate comprised mainly B cells and CD8 T cells. The frequency of positive EBV LMP-1 antigen staining was similar in definite and non- LIP patients [(2/13 (15%) vs. 3/10 (30%); p = 0.52].
  
  
  CONCLUSIONS
  In a HIV endemic setting adult HIV-associated LIP occurs predominantly in young women. The diagnosis can often be made on transbronchial biopsy and is characterized by a predominant CD8 T cell infiltrate. No association with EBV antigen was found.
authors.affiliation: Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa. richard.vanzyl-smit@uct.ac.za.
authors.forename: Richard N
authors.initials: RN
authors.lastname: van Zyl-Smit
authors.affiliation: Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa. jashiranaidoo@yahoo.co.uk.
authors.forename: Jashira
authors.initials: J
authors.lastname: Naidoo
authors.affiliation: Department of Anatomical Pathology, UCT Faculty of Health Sciences & NHLS Laboratories, Groote Schuur Hospital, Cape Town, South Africa. Helen.Wainwright@uct.ac.za.
authors.forename: Helen
authors.initials: H
authors.lastname: Wainwright
authors.affiliation: Department of Radiology, Groote Schuur Hospital, Cape Town, South Africa. qshartley@gmail.com.
authors.forename: Quanita
authors.initials: Q
authors.lastname: Said-Hartley
authors.affiliation: Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa. malika.davids@uct.ac.za.
authors.forename: Malika
authors.initials: M
authors.lastname: Davids
authors.affiliation: Department of Radiology, Groote Schuur Hospital, Cape Town, South Africa. goodman@gem.co.za.
authors.forename: Hillel
authors.initials: H
authors.lastname: Goodman
authors.affiliation: Constantiaberg Hospital, Cape Town, South Africa. seanob@mweb.co.za.
authors.forename: Sean
authors.initials: S
authors.lastname: Rogers
authors.affiliation: Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa. keertan.dheda@uct.ac.za.|Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa. keertan.dheda@uct.ac.za.
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
mesh_terms: D000328:Adult; D018951:Antigens, CD20 / Q000276:immunology; D017252:CD3 Complex / Q000276:immunology; D015704:CD4 Antigens / Q000276:immunology; D016827:CD8 Antigens / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D019353:Endemic Diseases; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006295:Health Resources; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology; D014763:Viral Matrix Proteins / Q000378:metabolism; D055815:Young Adult
chemical_list: D018951:Antigens, CD20; D017252:CD3 Complex; D015704:CD4 Antigens; D016827:CD8 Antigens; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D014763:Viral Matrix Proteins