Smith K J, Nelson A, Skelton H, Yeager J, Wagner K F
Medical Research Institute of Chemical Defense, Aberdeen, Maryland, USA.
Int J Dermatol. 1997 Feb;36(2):104-9. doi: 10.1046/j.1365-4362.1997.00006.x.
The high incidence of cutaneous disease in HIV-1+ patients may be a marker of the chronic state of immune activation. In addition, specific cutaneous diseases may be related to the pattern and degree of immune dysregulation present in the patients at the time of the eruption. We have observed that HIV-1+ patients with pityriasis lichenoides et varioliformis acuta (PLEVA) were in the early to midstage of HIV-1 disease.
To determine if there was a correlation between the phenotype of the lymphoid infiltrate and surface markers of the epidermis and the known changes in early or late-stage HIV-1 disease, we studied five HIV-1+ patients with PLEVA. Cutaneous biopsy specimens were obtained and immunohistochemical stains were used to determine the expression of ELAM-1, ICAM-1, and HLA-DR and the phenotype of the lymphoid infiltrate.
The HIV-1+ patients showed increased expression of HLA-DR on keratinocytes as well as on the mononuclear and dendritic cell populations in the epidermis and dermis. The majority of T cells were activated CD8+ cells.
Immunophenotyping of the inflammatory infiltrate in these patients is consistent with a pattern of immune dysregulation seen only in earlier stages of HIV-1 disease. Thus, PLEVA may be useful as a marker of early to midstages of HIV-1 disease.
HIV-1阳性患者皮肤疾病的高发病率可能是免疫激活慢性状态的一个标志。此外，特定的皮肤疾病可能与皮疹发作时患者存在的免疫失调模式和程度有关。我们观察到，急性痘疮样苔藓状糠疹（PLEVA）的HIV-1阳性患者处于HIV-1疾病的早期至中期。
为了确定淋巴细胞浸润的表型与表皮表面标志物以及HIV-1疾病早期或晚期已知变化之间是否存在相关性，我们研究了5例患有PLEVA的HIV-1阳性患者。获取皮肤活检标本，并使用免疫组织化学染色来确定ELAM-1、ICAM-1和HLA-DR的表达以及淋巴细胞浸润的表型。
HIV-1阳性患者的角质形成细胞以及表皮和真皮中的单核细胞和树突状细胞群体上HLA-DR的表达增加。大多数T细胞是活化的CD8+细胞。
这些患者炎症浸润的免疫表型分析与仅在HIV-1疾病早期阶段出现的免疫失调模式一致。因此，PLEVA可能作为HIV-1疾病早期至中期的一个标志。
