Document 1143
 DOCN  M94A1143
 TI    Immunohistological assessment of cutaneous drug hypersensitivity
       reactions in HIV-infected patients.
 DT    9412
 AU    Cooper DA; Carr A; Vasak E; Munro V; Penny R; Centre for Immunology, St.
       Vincent's Hospital, Sydney, Australia.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(2):199 (abstract no. PB0811). Unique
       Identifier : AIDSLINE ICA10/94371432
 AB    OBJECTIVES: The pathogenesis of drug hypersensitivity in HIV disease is
       unknown. To further study the nature of hypersensitivity, the
       histopathological features of morbilliform drug hypersensitivity
       reactions were examined in a group of HIV-infected patients. METHODS:
       Skin sections from 23 HIV-infected subjects with morbilliform drug
       reactions were examined by light microscopy (LM), direct
       immunofluorescence (IF) and immunohistochemistry (IH) to determine the
       nature of the inflammatory infiltrate and the role of immunoglobulin
       (Ig), complement and cytokines. RESULTS: The main LM findings were
       spongiosis, hydropic generation of the basal layer, civatte bodies, an
       epidermal lymphocytic infiltrate (50%), and a perivascular dermal
       infiltrate of lymphocytes (87%) and macrophages (50%). IH demonstrated
       that the lymphocytic infiltrate consisted of CD8+, HLA-DR+ T-lymphocytes
       (some of which also stained for CD38), a marked depletion of epidermal
       Langerhans cells (90%), and strong cytoplasmic staining of keratinocytes
       for IL-6 (60%), IL-1 beta (50%), TNF-alpha (45%) and to a lesser degree,
       IFN-gamma (35%). IF did not demonstrate any significant deposition of Ig
       or complement. The findings were independent of the responsible drug,
       the duration of either therapy or the rash, and of peripheral blood CD4+
       and CD8+ cell counts. DISCUSSION: These data suggest that activated CD8+
       lymphocytes and perhaps epidermal production of cytokines are involved
       in the pathogenesis of cutaneous drug hypersensitivity in HIV+ patients.
       The common histological features, regardless of the causative drug,
       suggests a common pathogenesis.
 DE    CD4-CD8 Ratio  Drug
       Eruptions/*COMPLICATIONS/IMMUNOLOGY/METABOLISM/PATHOLOGY  Fluorescent
       Antibody Technique  Human  HIV Infections/*COMPLICATIONS
       Immunohistochemistry  Interleukin-1/ANALYSIS  Interleukin-6/ANALYSIS
       Keratinocytes/PATHOLOGY  Langerhans Cells/PATHOLOGY  Lymphocyte Subsets
       Skin/CHEMISTRY/IMMUNOLOGY/PATHOLOGY  Tumor Necrosis Factor/ANALYSIS
       MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).