HIV infection predisposes skin to toxic epidermal necrolysis via depletion of skin-directed CD4+ T cells - 14/05/14
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).
Limitations |
This study is limited by small sample sizes.
Conclusion |
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.
Le texte complet de cet article est disponible en PDF.Key words : adverse cutaneous drug eruptions, cytotoxic T lymphocytes, HIV, immunohistochemistry, regulatory T cells, toxic epidermal necrolysis
Abbreviations used : ACDE, SJS, TEN, Treg
Plan
| Supported by a Medical Dermatology Career Development Award to Dr Saavedra from the Dermatology Foundation. Additional funding was also received from the Office for Diversity and Community Partnership, Harvard Medical School. |
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| Conflicts of interest: None declared. |
Vol 70 - N° 6
P. 1096-1102 - juin 2014 Retour au numéro
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