PMID- 15085359
OWN - NLM
STAT- MEDLINE
DCOM- 20041015
LR  - 20220316
IS  - 0001-6322 (Print)
IS  - 0001-6322 (Linking)
VI  - 108
IP  - 1
DP  - 2004 Jul
TI  - Cerebral CD8+ lymphocytosis in HIV-1 infected patients with immune restoration 
      induced by HAART.
PG  - 17-23
AB  - In HIV infected persons, highly active antiretroviral therapy (HAART) has reduced 
      both the morbidity and incidence of several disorders. Its effects on direct 
      HIV-induced damage to the CNS remain controversial. In addition, HAART may 
      provoke an "immune reconstitution inflammatory syndrome" (IRIS). Herein we report 
      two patients who, despite HAART, developed a diffuse encephalopathy. Their 
      clinical, radiological and neuropathological features are described. 
      Immunohistochemical and PCR analyses were used to detect HIV and to exclude other 
      viruses in brain tissue. The unusual inflammatory reaction in the brain tissue 
      was defined by immunohistochemistry. Both patients had advanced HIV disease with 
      low CD4 counts and high HIV "viral loads" before starting HAART. In both, HAART 
      induced an increase in CD4 count and a marked reduction in HIV viral load, which 
      was accompanied, in patient one, by worsening of pre-existing, and, in patient 
      two, by development of, acute encephalopathy. At post-mortem examination, the 
      brain of patient one showed HIV encephalitis. In addition, the brains of both 
      patients revealed HIV-DNA by PCR, diffuse microglial hyperplasia and massive and 
      diffuse perivascular and intraparenchymal infiltration by CD8+/CD4- lymphocytes. 
      We suggest that the rapid immune reconstitution induced by HAART in these two 
      patients led to a redistribution of lymphocytes into peripheral blood. This was 
      followed by recruitment of CD8+ lymphocytes into the brain, which resulted in the 
      diffuse infiltration described. The appearances in patient two further suggest 
      that HIV brain infection, even without encephalitis, is sufficient to trigger 
      this response.
FAU - Miller, Robert F
AU  - Miller RF
AD  - Department of Primary Care and Population Sciences, Centre for Sexually 
      Transmitted Diseases, UCL, London, UK.
FAU - Isaacson, Peter G
AU  - Isaacson PG
FAU - Hall-Craggs, Margaret
AU  - Hall-Craggs M
FAU - Lucas, Sebastian
AU  - Lucas S
FAU - Gray, Francoise
AU  - Gray F
FAU - Scaravilli, Francesco
AU  - Scaravilli F
FAU - An, Shu F
AU  - An SF
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20040414
PL  - Germany
TA  - Acta Neuropathol
JT  - Acta neuropathologica
JID - 0412041
RN  - 0 (Antigens, CD)
RN  - 0 (Antigens, Differentiation, Myelomonocytic)
RN  - 0 (CD3 Complex)
RN  - 0 (CD68 antigen, human)
RN  - 0 (LN 3 oligosaccharide)
RN  - 0 (Oligosaccharides)
SB  - IM
MH  - Adult
MH  - Antigens, CD/metabolism
MH  - Antigens, Differentiation, Myelomonocytic/metabolism
MH  - Antiretroviral Therapy, Highly Active/*adverse effects/methods
MH  - CD3 Complex/metabolism
MH  - CD8-Positive T-Lymphocytes/*metabolism
MH  - Cerebellum/immunology/*pathology/virology
MH  - HIV Infections/drug therapy/*immunology/virology
MH  - HIV-1
MH  - Humans
MH  - Immunohistochemistry/methods
MH  - Magnetic Resonance Imaging, Cine/methods
MH  - Male
MH  - Middle Aged
MH  - Oligosaccharides/metabolism
EDAT- 2004/04/16 05:00
MHDA- 2004/10/16 09:00
CRDT- 2004/04/16 05:00
PHST- 2003/12/03 00:00 [received]
PHST- 2004/01/15 00:00 [revised]
PHST- 2004/02/20 00:00 [accepted]
PHST- 2004/04/16 05:00 [pubmed]
PHST- 2004/10/16 09:00 [medline]
PHST- 2004/04/16 05:00 [entrez]
AID - 10.1007/s00401-004-0852-0 [doi]
PST - ppublish
SO  - Acta Neuropathol. 2004 Jul;108(1):17-23. doi: 10.1007/s00401-004-0852-0. Epub 
      2004 Apr 14.