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Cherif I, Tsevi Y, Bawe L, Guei C, Yao H. [Efficacy of highly active antiretroviral therapy alone in the treatment of diffuse lymphocytic infiltration syndrome in an ivorian patient living with HIV: a case report]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsibulletin.2021.118. [PMID: 35686173 PMCID: PMC9128493 DOI: 10.48327/mtsibulletin.2021.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/09/2021] [Indexed: 11/05/2022]
Abstract
Objective We report in this work the efficacy of highly active antiretrovirals (ARVs) alone in the treatment of diffuse infiltrative lymphocytosis syndrome (DILS) without the use of corticosteroids, which appears risky in patients living with HIV. Observation This is a 60-year-old HIV-positive patient, discovered during the etiological workup of renal failure, which revealed a non-nephrotic glomerular profile. The renal biopsy found an interstitial infiltrate of CD8 suggestive of DILS. Management consisted in starting ARV treatment alone (lamuvidine, abacavir and raltegravir) without associated corticosteroid therapy. The clinical evolution under treatment was marked by a recovery of the renal function with a creatininemia at 99 μmol/l, a regression of the proteinuria, a CD4 rate at 293/mm3 and an HIV viral load at 533.3 copies or 1.6 log in the space of 3 months. Conclusion DILS is a diffuse systemic disease in HIV patients who are usually under poor virological control. In view of the strong immunosuppression and the absence of other infiltrative diseases, it appeared to us to be risky and unjustified to add a corticosteroid therapy.
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Affiliation(s)
- I. Cherif
- Université de Cocody, Centre hospitalier universitaire de Yopougon, Abidjan, Cote d'Ivoire
| | - Y.M. Tsevi
- Université de Lomé, Centre hospitalier universitaire Sylvanus Olympio, Lomé, Togo,*
| | - L.D. Bawe
- Université de Lomé, Centre hospitalier universitaire Sylvanus Olympio, Lomé, Togo
| | - C. Guei
- Université de Cocody, Centre hospitalier universitaire de Yopougon, Abidjan, Cote d'Ivoire
| | - H. Yao
- Université de Cocody, Centre hospitalier universitaire de Treichville, Abidjan, Cote d'Ivoire
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2
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Petrakis V, Panagopoulos P, Ntolios P, Chrysafis I, Georgaraki M, Papazoglou D. Lymphoid interstitial pneumonitis in a newly diagnosed late presenter of human immunodeficiency virus infection: a case report. J Med Case Rep 2021; 15:53. [PMID: 33526074 PMCID: PMC7852226 DOI: 10.1186/s13256-020-02572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/03/2020] [Indexed: 11/14/2022] Open
Abstract
Background An increase has been described throughout the years in the frequency of various uncommon diseases in people living with human immunodeficiency virus (HIV). Particularly late presenters are associated with a significant risk not only for acquired immune deficiency syndrome (AIDS)-defining conditions but also for non AIDS-defining diseases which aggravate the prognosis of patients. Lymphoid interstitial pneumonitis (LIP) is one of these conditions described more often after the onset of HIV epidemic. LIP is a benign polyclonal lymphoproliferative disorder of the lung with not well characterized clinical and radiographic findings. Case presentation We report the diagnostic approach and clinical progress of a newly diagnosed late presenter of HIV infection with respiratory problems in our HIV unit. The findings of computed tomography indicated the diagnosis of HIV-associated LIP, although this condition is mainly described in a normal range of CD4 cell count. Conclusion This case presentation highlights the importance of timely diagnosis and initiation of antiretroviral therapy. The increase of CD4 cell count and viral suppression may improve the symptoms of LIP.
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Affiliation(s)
- V Petrakis
- HIV Unit, University General Hospital Alexandroupolis, Democritus University of Thrace, Xanthi, Greece
| | - P Panagopoulos
- HIV Unit, University General Hospital Alexandroupolis, Democritus University of Thrace, Xanthi, Greece.
| | - P Ntolios
- Respiratory Medicine Department, University General Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - I Chrysafis
- Department of Radiology, University General Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - M Georgaraki
- HIV Unit, University General Hospital Alexandroupolis, Democritus University of Thrace, Xanthi, Greece
| | - D Papazoglou
- HIV Unit, University General Hospital Alexandroupolis, Democritus University of Thrace, Xanthi, Greece
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3
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Nakamura H, Shimizu T, Kawakami A. Role of Viral Infections in the Pathogenesis of Sjögren's Syndrome: Different Characteristics of Epstein-Barr Virus and HTLV-1. J Clin Med 2020; 9:jcm9051459. [PMID: 32414149 PMCID: PMC7290771 DOI: 10.3390/jcm9051459] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022] Open
Abstract
Viruses are possible pathogenic agents in several autoimmune diseases. Sjögren’s syndrome (SS), which involves exocrine dysfunction and the appearance of autoantibodies, shows salivary gland- and lacrimal gland-oriented clinical features. Epstein-Barr virus (EBV) is the most investigated pathogen as a candidate that directly induces the phenotype found in SS. The reactivation of the virus with various stimuli induced a dysregulated form of EBV that has the potential to infect SS-specific B cells and plasma cells that are closely associated with the function of an ectopic lymphoid structure that contains a germinal center (GC) in the salivary glands of individuals with SS. The involvement of human T-cell leukemia virus type 1 (HTLV-1) in SS has been epidemiologically established, but the disease concept of HTLV-1-associated SS remains unexplained due to limited evidence from basic research. Unlike the cell-to-cell contact between lymphocytes, biofilm-like structures are candidates as the mode of HTLV-1 infection of salivary gland epithelial cells (SGECs). HTLV-1 can infect SGECs with enhanced levels of inflammatory cytokines and chemokines that are secreted from SGECs. Regardless of the different targets that viruses have with respect to affinitive lymphocytes, viruses are involved in the formation of pathological alterations with immunological modifications in SS.
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Kalanzi D, Mayanja-Kizza H, Nakanjako D, Mwesigwa CL, Ssenyonga R, Amaechi BT. Prevalence and factors associated with dental caries in patients attending an HIV care clinic in Uganda: a cross sectional study. BMC Oral Health 2019; 19:159. [PMID: 31324242 PMCID: PMC6642521 DOI: 10.1186/s12903-019-0847-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Chronic Human Immunodeficiency Virus (HIV) infection is associated with reduced saliva flow rate due to infiltration of HIV and proliferation of CD8 lymphocytes in salivary glands. It is unclear whether HIV infection and antiretroviral therapy (ART) increase caries risk. This study aimed to determine the prevalence and factors associated with dental caries in HIV infected adults attending the Mulago Immune Suppression Syndrome (ISS) clinic in Uganda. METHODS A cross-sectional study was conducted among HIV infected persons. Dental examinations were performed by two calibrated dentists using the WHO Radke's caries classification criteria and reported using the decayed (D), missing (M), filled (F), teeth (DMFT) index. The prevalence and factors associated with dental caries was examined through linear regression analyses. RESULTS Overall, 748 participants (females = 491, 65.6%) with a mean age of 39 ± 9.4 years were included in the final analysis; of whom 83.7% had caries (DMFT> 0), with a significantly (p < 0.05) higher prevalence among females 86.6% than males 78.2%. The mean DMFT was 5.9 ± 5.5, with statistically significant differences based on gender (males 4.9 ± 4.8 and females 6.3 ± 5.9, p < 0.05) and duration on ART (< 2 years 4.8 ± 4.4, > 2 years but < 5 years 5.7 ± 5.5, > 5 years 6.6 ± 6.0 p < 0.05). The majority (67.2%) of participants reported brushing their teeth twice or more a day, and sugar intake was not associated with dental caries. CONCLUSION Caries prevalence is high among HIV infected adults under care. Duration of ART was associated with increased risk and severity of caries. Therefore, we recommend integration of dental care in HIV treatment programs.
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Affiliation(s)
- Dunstan Kalanzi
- Department of Dentistry School of Health Sciences, Makerere University College of Health Sciences, P.O.Box 7072, Kampala, Uganda.
| | - Harriet Mayanja-Kizza
- Department of Medicine School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Lutalo Mwesigwa
- Department of Dentistry School of Health Sciences, Makerere University College of Health Sciences, P.O.Box 7072, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bennett T Amaechi
- Department of Comprehensive Dentistry, University of Texas Health San Antonio School of Dentistry, San Antonio, TX, USA
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5
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Human immunodeficiency virus and salivary gland pathology: an update. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:52-59. [PMID: 30827854 DOI: 10.1016/j.oooo.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 11/22/2022]
Abstract
Salivary gland disease is a common manifestation of human immunodeficiency virus (HIV) infection, with a significant increase in prevalence over the last two decades. This review summarizes contemporary knowledge of non-neoplastic salivary gland disease in HIV infection. The aim is to update information on and bring attention to those lesions, which are almost exclusive to the salivary glands in the HIV setting. The associated conditions include xerostomia or salivary gland hypofunction; Sjögren syndrome-like illness; salivary gland enlargements, including benign lymphoepithelial cysts (cystic lymphoid hyperplasia); diffuse infiltrative CD8+ lymphocytosis syndrome; and mucous extravasation phenomena, especially ranula. Many of these conditions show considerable overlap, and thus, the term HIV-associated salivary gland disease is used to designate HIV infection with xerostomia or salivary gland hypofunction, enlargement of one or more of the major salivary glands, or both. These manifestations may be related to HIV infection, and therefore, prompt recognition is invaluable in the diagnosis and treatment of both the salivary gland disease and HIV infection.
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Abstract
Sjögren's syndrome is a chronic inflammatory disease of the lacrimal and salivary gland with subsequent keratoconjunctivitis sicca and xerostomia. Histopathologic findings include damaged acini of the lacrimal and salivary glands with mononuclear cell infiltrates of lymphocytic and plasma cell type. The cause of the damage is cell-mediated cytotoxicity. The pathogenesis of Sjögren's syndrome is still unknown. The role of viral infections failed to show a causative effect. On the other hand, tissue destruction was shown to be mediated by activated T cells of CD4+ type that home into the lacrimal gland. This process is signal-mediated through the T-cell receptor that interacts with class II antigen on the epithelial cells of exocrine glands. This, in turn, induces the expression of Fas/APO-1 and Fas-mediated apoptosis of acinar cells. Granzyme A and perforin are cytolytic enzymes secreted by activated T lymphocytes that seem to participate in acinar cell destruction.
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Affiliation(s)
- K. Tabbara
- Ophthalmology Department, College of
Medicine, King Saud University, Riyadh
- Eye Center, The Eye Foundation for
Research in Ophthalmology, Riyadh - Saudi Arabia
| | - N. Sharara
- Eye Center, The Eye Foundation for
Research in Ophthalmology, Riyadh - Saudi Arabia
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7
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Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf 2017; 15:438-510. [PMID: 28736340 DOI: 10.1016/j.jtos.2017.05.011] [Citation(s) in RCA: 944] [Impact Index Per Article: 134.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022]
Abstract
The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjögren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.
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Affiliation(s)
- Anthony J Bron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
| | - Cintia S de Paiva
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Sunil K Chauhan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stefano Bonini
- Department of Ophthalmology, University Campus Biomedico, Rome, Italy
| | - Eric E Gabison
- Department of Ophthalmology, Fondation Ophtalmologique Rothschild & Hôpital Bichat Claude Bernard, Paris, France
| | - Sandeep Jain
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Erich Knop
- Departments of Cell and Neurobiology and Ocular Surface Center Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Victor Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Driss Zoukhri
- Tufts University School of Dental Medicine, Boston, MA, USA
| | - David A Sullivan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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8
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Saito M, Hatakeyama S, Wakabayashi Y, Yanagimoto S, Takemura T, Yotsuyanagi H. A pathologically proven case of adult-onset HIV-related lymphocytic interstitial pneumonia with acute exacerbation treated with steroid and antiretroviral therapy. J Infect Chemother 2015; 21:868-72. [PMID: 26298039 DOI: 10.1016/j.jiac.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/12/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
Abstract
Lymphocytic interstitial pneumonia (LIP) is a rare opportunistic illness in human immunodeficiency virus (HIV)-infected adults, although it is relatively common among HIV-infected children. Most adult cases have been reported in African and Afro-Caribbean patients and few cases have been reported from Asia. Acute exacerbation of HIV-related LIP has not been well described. Here we report a pathologically proven case of acute exacerbation of adult-onset HIV-related LIP. The patient was an African immigrant living in Japan who presented with chronic dyspnea and diffuse bilateral pulmonary infiltrates. His clinical, radiological, and pathological findings were consistent with those of LIP. After a diagnostic surgical lung biopsy, his hypoxemia and pulmonary infiltrates exacerbated rapidly over a few days, although his condition had not progressed during the previous year. LIP may be an important differential diagnosis among adult patients in Asian countries, especially patients of non-Asian ethnicity.
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Affiliation(s)
- Makoto Saito
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shuji Hatakeyama
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan; Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan.
| | - Yoshitaka Wakabayashi
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shintaro Yanagimoto
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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9
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van Zyl-Smit RN, Naidoo J, Wainwright H, Said-Hartley Q, Davids M, Goodman H, Rogers S, Dheda K. HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting. BMC Pulm Med 2015; 15:38. [PMID: 25896166 PMCID: PMC4426542 DOI: 10.1186/s12890-015-0030-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/31/2015] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Richard N van Zyl-Smit
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa.
| | - Jashira Naidoo
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa.
| | - Helen Wainwright
- Department of Anatomical Pathology, UCT Faculty of Health Sciences & NHLS Laboratories, Groote Schuur Hospital, Cape Town, South Africa.
| | | | - Malika Davids
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa.
| | - Hillel Goodman
- Department of Radiology, Groote Schuur Hospital, Cape Town, South Africa.
| | - Sean Rogers
- Constantiaberg Hospital, Cape Town, South Africa.
| | - Keertan Dheda
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, Lung Infection and Immunity Unit, University of Cape Town, Cape Town, South Africa. .,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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10
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Ghrenassia E, Martis N, Boyer J, Burel-Vandenbos F, Mekinian A, Coppo P. The diffuse infiltrative lymphocytosis syndrome (DILS). A comprehensive review. J Autoimmun 2015; 59:19-25. [PMID: 25660200 DOI: 10.1016/j.jaut.2015.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 12/18/2022]
Abstract
The Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a rare multisystemic syndrome described in HIV-infected patients. It is characterised by CD8(+) T-cell lymphocytosis associated with a CD8(+) T-cell infiltration of multiple organs. DILS is usually seen in uncontrolled or untreated HIV infection but can also manifest itself independently of CD4(+) T-cell counts. The syndrome may present as a Sjögren-like disease that generally associates sicca signs with bilateral parotiditis, lymphadenopathy, and extraglandular organ involvement. The latter may affect the lungs, nervous system, liver, kidneys, and digestive tract. Anomalies of the respiratory system are often identified as lymphocytic interstitial pneumonia. Facial nerve palsy, aseptic meningitis or polyneuropathy are among the more frequent neurological features. Hepatic lymphocytic infiltration, lymphocytic interstitial nephropathy and digestive tract lymphocytic infiltration account for more rarely noted complications. Sicca syndrome, organomegaly and/or organ dysfunction associated with polyclonal CD8(+) T-cell organ-infiltration are greatly suggestive of DILS in people living with HIV. Labial salivary gland biopsy is therefore helpful when the focus score is equal or greater than 1 (or Chisholm Score ≥ 3). Primary Sjögren syndrome, chronic HCV or HTLV1 infection, graft versus host disease, IgG4-related disease, and immune reconstitution inflammatory syndrome are among the differential diagnoses that need to be considered. Treatment consists in highly active anti-retroviral therapy (HAART), which is usually effective in resolving clinical signs and symptoms. Steroids, however, may also be occasionally required when organ infiltration does not respond to HAART. This review should provide an insight into this rare entity complicating the course of HIV infection.
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Affiliation(s)
- Etienne Ghrenassia
- DHU i2B, Service de Médecine Interne, Hôpital Saint-Antoine, AP-HP, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Nihal Martis
- Service de Médecine Interne, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, 151 Route Saint-Antoine de Ginestière, 06200 Nice, France.
| | - Julien Boyer
- Service d'Anatomo-Pathologie, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, 151 Route Saint-Antoine de Ginestière, 06200 Nice, France.
| | - Fanny Burel-Vandenbos
- Service d'Anatomo-Pathologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, 30 Avenue de la Voie Romaine, 06000 Nice, France.
| | - Arsène Mekinian
- DHU i2B, Service de Médecine Interne, Hôpital Saint-Antoine, AP-HP, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Paul Coppo
- Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France.
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11
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Abstract
Human immunodeficiency virus type 1 (HIV-1) is the retrovirus responsible for the development of AIDS. Its profound impact on the immune system leaves the host vulnerable to a wide range of opportunistic infections not seen in individuals with a competent immune system. Pulmonary infections dominated the presentations in the early years of the epidemic, and infectious and noninfectious lung diseases remain the leading causes of morbidity and mortality in persons living with HIV despite the development of effective antiretroviral therapy. In addition to the long known immunosuppression and infection risks, it is becoming increasingly recognized that HIV promotes the risk of noninfectious pulmonary diseases through a number of different mechanisms, including direct tissue toxicity by HIV-related viral proteins and the secondary effects of coinfections. Diseases of the airways, lung parenchyma and the pulmonary vasculature, as well as pulmonary malignancies, are either more frequent in persons living with HIV or have atypical presentations. As the pulmonary infectious complications of HIV are generally well known and have been reviewed extensively, this review will focus on the breadth of noninfectious pulmonary diseases that occur in HIV-infected individuals as these may be more difficult to recognize by general medical physicians and subspecialists caring for this large and uniquely vulnerable population.
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13
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Abstract
Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy.
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Affiliation(s)
- Louis Mandel
- Department of Oral and Maxillofacial Surgery, Salivary Gland Center, Columbia University College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA.
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14
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Ghrenassia E, Roulin L, Aline-Fardin A, Marzac C, Féger F, Gay J, Pacanowski J, Hertig A, Coppo P. The spectrum of chronic CD8+ T-cell expansions: clinical features in 14 patients. PLoS One 2014; 9:e91505. [PMID: 24618699 PMCID: PMC3950180 DOI: 10.1371/journal.pone.0091505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/12/2014] [Indexed: 01/18/2023] Open
Abstract
Chronic CD8+ T-cell expansions can result in parotid gland swelling and other organ infiltration in HIV-infected patients, or in persistent cytopenias. We report 14 patients with a CD8+ T-cell expansion to better characterize the clinical spectrum of this ill-defined entity. Patients (9 women/5 men) were 65 year-old (range, 25–74). Six patients had ≥1 symptomatic organ infiltration, and 9 had ≥1 cytopenia with a CD8+ (>50% of total lymphocyte count) and/or a CD8+/CD57+ (>30% of total lymphocyte count) T-cell expansion for at least 3 months. One patient had both manifestations. A STAT3 mutation, consistent with the diagnosis of large granular lymphocyte leukemia, was found in 2 patients with cytopenia. Organ infiltration involved lymph nodes, the liver, the colon, the kidneys, the skin and the central nervous system. Three patients had a HIV infection for 8 years (range, 0.5–20 years). Two non-HIV patients with hypogammaglobulinemia had been treated with a B-cell depleting monoclonal antibody (rituximab) for a lymphoma. One patient had a myelodysplastic syndrome with colon infiltration and agranulocytosis. The outcome was favorable with efficient antiretroviral therapy and steroids in HIV-infected patients and intravenous immunoglobulins in 2/3 non-HIV patients. Six patients had an agranulocytosis of favorable outcome with granulocyte-colony stimulating factor only (3 cases), cyclophosphamide, methotrexate and cyclosporine A, or no treatment (1 case each). Three patients had a pure red cell aplasia, of favorable outcome in 2 cases with methotrexate and cyclosporine A; one patient was unresponsive. Chronic CD8+ T-cell expansions with organ infiltration in immunocompromised patients may involve other organs than parotid glands; they are non clonal and of favorable outcome after correction of the immune deficiency and/or steroids. In patients with bone marrow infiltration and unexplained cytopenia, CD8+ T-cell expansions can be clonal or not; their identification suggests that cytopenias are immune-mediated. Our results extend the clinical spectrum of chronic CD8+ T-cell expansions.
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Affiliation(s)
- Etienne Ghrenassia
- Service d’Hématologie, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
| | - Louise Roulin
- Service d’Hématologie, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
| | - Aude Aline-Fardin
- Service d’Anatomie Pathologique, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
- Université Pierre et Marie Curie (UPMC), Univ Paris 06, Paris, France
| | - Christophe Marzac
- Laboratoire d’Immuno-Hématologie, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
| | - Frédéric Féger
- Laboratoire d’Immuno-Hématologie, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
| | - Julie Gay
- Service d’Hématologie, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
- Université Pierre et Marie Curie (UPMC), Univ Paris 06, Paris, France
| | - Jérome Pacanowski
- Service de Maladies Infectieuses et Tropicales, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
| | - Alexandre Hertig
- Urgences Néphrologiques et Transplantation Rénale, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
- Université Pierre et Marie Curie (UPMC), Univ Paris 06, Paris, France
| | - Paul Coppo
- Service d’Hématologie, Hôpitaux Universitaire de L’Est Parisien, AP-HP, Paris, France
- Université Pierre et Marie Curie (UPMC), Univ Paris 06, Paris, France
- Inserm U1009, Institut Gustave Roussy, Villejuif, France
- Centre de Référence des Microangiopathies thrombotiques, Paris, France
- * E-mail:
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Bruscolini A, Abbouda A, Locuratolo N, Restivo L, Trimboli P, Romanelli F. Dry Eye Syndrome in Non-Exophthalmic Graves' Disease. Semin Ophthalmol 2014; 30:372-6. [PMID: 24460515 DOI: 10.3109/08820538.2013.874491] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present study aims to assess qualitative and quantitative characteristics of tear film and corneal related impairment and to evaluate the quality of life in a cohort of non-exophthalmic Graves' disease (GD) patients. METHODS The series comprised 50 eyes from 25 newly diagnosed GD patients with no proptosis. As control group, 56 eyes of 28 thyroid disease-free subjects were enrolled. RESULTS The results of Schirmer I and II, break-up time, and Oxford scheme showed a significant difference between GD and controls. By ocular surface disease index (OSDI) questionnaire, eleven (44%) GD patients had normal ocular surface, while two (8%) had mild, four (16%) had moderate, and eight (32%) had severe dry eye. The mean score of the OSDI in the GD group was significantly (p < 0.001) higher with respect to the control group. CONCLUSIONS This study shows that the tear film and cornea are damaged in newly non-exophthalmic GD subjects.
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Affiliation(s)
- A Bruscolini
- a Department of Ophthalmological Sciences , Sapienza University , Rome , Italy
| | - A Abbouda
- a Department of Ophthalmological Sciences , Sapienza University , Rome , Italy
| | - N Locuratolo
- b Section of Endocrinology and Diabetology, Ospedale Israelitico , Rome , Italy , and
| | - L Restivo
- a Department of Ophthalmological Sciences , Sapienza University , Rome , Italy
| | - P Trimboli
- b Section of Endocrinology and Diabetology, Ospedale Israelitico , Rome , Italy , and
| | - F Romanelli
- c Department of Experimental Medicine , Sapienza University , Rome , Italy
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Abstract
Peripheral nerve disorders are associated with all stages of HIV infection. Distal sensory polyneuropathy is characterised by often-disabling pain that is difficult to treat. It is prevalent in both high-income and low-income settings. In low-income settings, use of potentially neurotoxic antiretrovirals, which are inexpensive and widely available, contributes substantially to incidence. Research has focused on identification of factors that predict risk of distal sensory polyneuropathy and elucidation of the multifactorial mechanisms behind pathogenesis. Sensorimotor polyneuropathies and polyradiculopathies are less frequent than distal sensory polyneuropathy, but still occur in low-income settings and have potentially devastating consequences. However, many of these diseases can be treated successfully with a combination of antiretroviral and immune-modulating therapies. To distinguish between peripheral nerve disorders that have diverse, overlapping, and frequently atypical presentations can be challenging; a framework based on a clinicoanatomical approach might assist in the diagnosis and management of such disorders.
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Abstract
A spectrum of noninfectious, nonmalignant lymphocytic infiltrative disorders, including nonspecific interstitial pneumonitis and lymphocytic interstitial pneumonitis, was frequently described in HIV-infected adults in the precombination antiretroviral therapy (ART) era. With the advent of ART, these conditions are less commonly encountered when caring for HIV-infected adults, possibly as a consequence of the effects of HIV treatment on pulmonary immunology. By contrast, reports of sarcoidosis among HIV-infected persons were uncommon in the pre-ART era, but sarcoidosis is increasingly recognized since the introduction of ART and may represent an immune reconstitution phenomenon. Other causes of interstitial pneumonitis are infrequently encountered among HIV-infected persons.
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Affiliation(s)
- Sarah R Doffman
- Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.
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Stolagiewicz N, Tinwel B, Cormack IS, Lucas SB, Devaraj A, Kay-Loke T, Chua F. Spontaneous pneumothorax in a 50-year-old man with diffuse pulmonary nodules. Chest 2013; 143:1174-1179. [PMID: 23546494 DOI: 10.1378/chest.12-0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Brendan Tinwel
- Pathology Department, Croydon University Hospital, Croydon
| | - Ian S Cormack
- Department of Genito-Urinary Medicine, Croydon University Hospital, Croydon
| | - Sebastian B Lucas
- Histopathology Department, School of Medicine, King's College London, London, England
| | - Anand Devaraj
- Radiology Department, St. George's Hospital NHS Trust, London
| | - Tuck Kay-Loke
- Department of Respiratory Medicine, Croydon University Hospital, Croydon
| | - Felix Chua
- Respiratory Medicine Department, Croydon University Hospital, Croydon
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Ingen-Housz-Oro S, Sbidian E, Ortonne N, Penso-Assathiany D, Chambrin V, Bagot M, Bachelez H, Wolkenstein P, Chosidow O. HIV-related CD8+ cutaneous pseudolymphoma: efficacy of methotrexate. Dermatology 2013; 226:15-8. [PMID: 23343593 DOI: 10.1159/000346242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/19/2012] [Indexed: 11/19/2022] Open
Abstract
Human immunodeficiency virus (HIV)-related CD8+ cutaneous pseudolymphoma (CD8+ cytotoxic T cell skin infiltrative disease) is an inflammatory process resulting from a massive infiltration of the skin by activated, oligoclonal, HIV-specific, cytotoxic T lymphocytes. Usually, CD8+ cutaneous pseudolymphoma affects patients with a deep immunosuppression, and is rare in patients with mild immunosuppression. In deeply immunocompromised patients, highly active antiretroviral therapy (HAART) is considered as the first-line treatment. In contrast, the choice of therapy in moderately immunocompromised patients and/or patients already receiving HAART remains nonconsensual. We report a case of HIV-related CD8+ cutaneous pseudolymphoma in a moderately immunocompromised patient who was successfully and safely treated with methotrexate. We review the literature on HIV-related CD8+ pseudolymphoma and the use of methotrexate in HIV-positive patients.
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Affiliation(s)
- S Ingen-Housz-Oro
- Department of Dermatology, AP-HP, Henri Mondor Hospital, FR-94000 Créteil, France.
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20
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López-Verdín S, Andrade-Villanueva J, Zamora-Perez AL, Bologna-Molina R, Cervantes-Cabrera JJ, Molina-Frechero N. Differences in Salivary Flow Level, Xerostomia, and Flavor Alteration in Mexican HIV Patients Who Did or Did Not Receive Antiretroviral Therapy. AIDS Res Treat 2013; 2013:613278. [PMID: 24455222 PMCID: PMC3880737 DOI: 10.1155/2013/613278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 11/17/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction. Objective and subjective alterations related to salivary flow have been reported in patients infected with human immunodeficiency virus (HIV), and these alterations are associated with the introduction of antiretroviral therapy. The aim of the current study was to discern whether these alterations are disease induced or secondary to drug therapy. Objective. The objective was to determine the relationships between low salivary flow, xerostomia, and flavor alterations in HIV patients who did or did not receive antiretroviral therapy. Materials and Methods. In this cross-sectional study, HIV patients were divided into two groups based on whether they had received antiretroviral therapy. Those patients with a previous diagnosis of any salivary gland disease were excluded. A survey was used to assess subjective variables, and colorimetry and salivary flow rates were measured using the Schirmer global test. Results. A total of 293 patients were included. The therapy group showed a significantly lower average salivary flow than did the group without therapy, and we observed that the flow rate tended to decrease after one year of therapy. The results were not conclusive, despite significant differences in xerostomia and flavor alteration between the groups. Conclusion. The study results suggest that antiretroviral therapy can cause cumulative damage that affects the amount of salivary flow.
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Affiliation(s)
- Sandra López-Verdín
- 1Instituto de Investigación en Odontología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico
| | - Jaime Andrade-Villanueva
- 2Unidad de VIH del Hospital Civil de Guadalajara “Fray Antonio Alcalde”, 44340 Guadalajara, JAL, Mexico
| | - Ana Lourdes Zamora-Perez
- 1Instituto de Investigación en Odontología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico
| | - Ronell Bologna-Molina
- 3Departamento de Investigación, Facultad de Odontología, Universidad Juárez del Estado de Durango, 34100 Durango, DGO, Mexico
- 4Facultad de Odontología, Universidad de la República (UDELAR), 11600 Montevideo, MVD, Uruguay
| | - José Justino Cervantes-Cabrera
- 1Instituto de Investigación en Odontología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico
| | - Nelly Molina-Frechero
- 5Departamento de Atención a la Salud, Universidad Autónoma Metropolitana, Xochimilco, Calz del Hueso 1100 Villa Quietud, Coyoacán, 04960 Ciudad de México, DF, Mexico
- *Nelly Molina-Frechero:
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Golbus JR, Gallagher G, Blackburn G, Cinti S. Polyneuropathy associated with the diffuse infiltrative lymphocytosis syndrome. ACTA ACUST UNITED AC 2012; 11:223-6. [PMID: 22544447 DOI: 10.1177/1545109712442798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diffuse infiltrative lymphocytosis syndrome (DILS) arises in HIV-positive patients secondary to infiltration of lymphocytes into the peripheral tissues and produces the disease's characteristic symptoms-parotid gland enlargement and a sicca syndrome. Many patients, however, first seek medical attention for treatment of the extraglandular manifestations of DILS, most commonly interstitial pneumonitis. In this case report, we describe an atypical presentation of DILS characterized by polyradiculoneuropathy in the absence of parotid gland enlargement or interstitial pneumonitis. Minor salivary gland biopsy of the patient's lip confirmed a chronic inflammatory state with lymphoid aggregates within the minor salivary glands. He was started on prednisone with immediate improvement in his symptoms. This report illustrates for clinicians the diverse extraglandular manifestations of DILS and underscores the importance of considering it in the differential diagnosis of HIV-positive patients with a preserved CD4 count who present with peripheral neuropathy.
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Oldham SAA, Barron B, Munden RF, Lamki N, Lamki L. The Radiology of the Thoracic Manifestations of AIDS. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10408379891244190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jeffers L, Webster-Cyriaque JY. Viruses and salivary gland disease (SGD): lessons from HIV SGD. Adv Dent Res 2011; 23:79-83. [PMID: 21441486 DOI: 10.1177/0022034510396882] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Viral infections are often associated with salivary gland pathology. Here we review the pathogenesis of HIV-associated salivary gland disease (HIV-SGD), a hallmark of diffuse infiltrative lymphocytosis syndrome. We investigate the presence and contributions of viral diseases to the pathogenesis of salivary gland diseases, particularly HIV-SGD. We have detected BK viral shedding in the saliva of HIV-SGD patients consistent with viral infection and replication, suggesting a role for oral transmission. For further investigation of BKV pathogenesis in salivary glands, an in vitro model of BKV infection is described. Submandibular (HSG) and parotid (HSY) gland salivary cell lines were capable of permissive BKV infection, as determined by BKV gene expression and replication. Analysis of these data collectively suggests the potential for a BKV oral route of transmission and salivary gland pathogenesis within HIV-SGD.
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Affiliation(s)
- L Jeffers
- School of Dentistry, Department of Dental Ecology, University of North Carolina at Chapel Hill, NC, USA.
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Yoo J, Baumstein D, Kuppachi S, Singh A, Chander PN. Diffuse Infiltrative Lymphocytosis Syndrome Presenting as Reversible Acute Kidney Injury Associated With Gram-Negative Bacterial Infection in Patients With Newly Diagnosed HIV Infection. Am J Kidney Dis 2011; 57:752-5. [DOI: 10.1053/j.ajkd.2010.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 12/01/2010] [Indexed: 11/11/2022]
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Sipsas NV, Gamaletsou MN, Moutsopoulos HM. Is Sjögren's syndrome a retroviral disease? Arthritis Res Ther 2011; 13:212. [PMID: 21489323 PMCID: PMC3132012 DOI: 10.1186/ar3262] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Circumstantial evidence suggests that retroviruses play a role in the pathogenesis of Sjögren's syndrome. Such evidence, derived from studies of patients with Sjögren's syndrome, includes the following: the presence of serum antibodies cross-reactive with retroviral Gag proteins; the occurrence of reverse transcriptase activity in salivary glands; the detection of retroviral antigens, retrovirus-like particles, or novel retroviral sequences in salivary glands; the occurrence of Sjögren's syndrome-like illnesses in patients having confirmed systematic infections with retroviruses such as human immunodeficiency virus-1 (HIV-1) and human T lymphotropic virus type 1; and the beneficial effect of anti-retroviral treatment on the occurrence of HIV-1-associated sicca syndrome. Additional evidence is provided by animal models.
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Affiliation(s)
- Nikolaos V Sipsas
- Pathophysiology Department, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens-11527, Greece.
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The spectrum of rheumatic manifestations of HIV Infection in an era of antiretroviral therapy. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60048-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fox RI, Fox CM. Sjögren's syndrome: Infections that may play a role in pathogenesis, mimic the disease, or complicate the patient's course. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60046-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Yacyshyn E, Chiowchanwisawakit P, Emery DJ, Jhamandas J, Resch L, Taylor G. Syphilitic myositis: a case-based review. Clin Rheumatol 2011; 30:729-33. [DOI: 10.1007/s10067-010-1668-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
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30
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Nassiri N, Djalilian AR, Hamrah P, Pflugfelder SC. Dry Eye. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kabenge C, Ng S, Muyinda Z, Ameda F. Diagnostic ultrasound patterns of parotid glands in human immunodeficiency virus-positive patients in Mulago, Uganda. Dentomaxillofac Radiol 2010; 39:389-99. [PMID: 20841456 DOI: 10.1259/dmfr/23992216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine sonographically, in parotid glands of human immunodeficiency virus-positive patients, the condition of glands with or without enlargement, and propose a classification system for the patterns observed using diagnostic ultrasound imaging. METHODS In this prospective clinical study, ultrasound scans were performed on 200 patients aged 4-62 years at Mulago Hospital, Uganda. RESULTS There were four main distinct ultrasound pathological patterns in the parotids, i.e. lymphocytic aggregations (LAs), lymphoepithelial cysts (LECs), fatty infiltration (FI) and lymphadenopathy only. There were additional subdivisions depending on the presence of echogenic foci and intraparotid lymphadenopathy. Of those patients (n = 64) without parotid enlargement, only 8% showed normal ultrasound features, whereas 34% showed LECs and 31% showed LAs. Of those (n = 136) with parotid enlargement, 46% showed LECs, 23% showed FI and 15% showed LAs. The overall prevalence of LECs in the study sample was 42%. LECs were multiple, mainly between 7 mm and 12 mm in diameter and 26% showed internal echogenic foci either mobile or stationary. In contrast, LAs tended to be ill-defined, less than 5 mm and were not associated with posterior acoustic enhancement. Features differentiating LAs from LECs have not been previously described. Parotid FI (lipodystrophy) was noted in patients on highly active antiretroviral therapy, who showed lesser prevalence of LECs after 12 months of treatment. CONCLUSIONS Our study of 200 patients is probably the largest such study in the English language literature. The wide spectrum of diagnostic ultrasound patterns was categorized into four main groups (ten subgroups).
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Affiliation(s)
- C Kabenge
- Department of Oral Surgery, Mulago Hospital, Uganda
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Abstract
Salivary gland abnormalities and salivary dysfunction are important orofacial disorders. Patients with such problems are usually seen in the dental office for evaluation and therapy, and the dental practitioner is required to make a diagnosis and institute care. Therefore, it is necessary for the dentist to be knowledgeable regarding the more common pathologic entities that involve the salivary apparatus, and also be familiar with the diagnostic and therapeutic tools that are available. Successful diagnosis is dependent on the organized integration of the information derived from past history, clinical examination, salivary volume study, imaging, serology, and histopathologic examination. This article discusses the most common disorders seen in the Salivary Gland Center and indicates the current approaches to diagnosis. Improvement in diagnostic skills will avoid serious complications and lead to specific and effective therapy.
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Affiliation(s)
- Louis Mandel
- College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA.
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Arturo Kantor P. Actualización clínica en OJO seco para el médico no oftalmólogo. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70613-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nittayananta W, Talungchit S, Jaruratanasirikul S, Silpapojakul K, Chayakul P, Nilmanat A, Pruphetkaew N. Effects of long-term use of HAART on oral health status of HIV-infected subjects. J Oral Pathol Med 2010; 39:397-406. [PMID: 20202089 DOI: 10.1111/j.1600-0714.2009.00875.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to determine the effects of long-term use of highly active antiretroviral therapy (HAART) on oral health status of HIV-infected subjects. METHODS Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in HIV-infected subjects with and without HAART, and in non-HIV individuals. The following data were recorded; duration and risk of HIV infection, type and duration of HAART, CD4 cell count, viral load, presence of orofacial pain, oral dryness, oral burning sensation, oral lesions, cervical caries, and periodontal pocket. Multiple logistic regression analysis was performed to determine the effects of long-term use of HAART on oral health status of HIV-infected subjects. RESULTS One hundred and fifty-seven HIV-infected subjects - 99 on HAART (age range 23-57 years, mean 39 years) and 58 not on HAART (age range 20-59 years, mean 34 years) - and 50 non-HIV controls (age range 19-59 years, mean 36 years) were enrolled. The most common HAART regimen was 2 NRTI + 2 NNRTI. HIV-infected subjects without HAART showed greater risks of having orofacial pain, oral dryness, oral lesions, and periodontal pockets than those with short-term HAART (P < 0.01). The subjects with long-term HAART were found to have a greater risk of having oral lesions than those with short-term HAART (P < 0.05). The unstimulated and stimulated salivary flow rates of the subjects with HAART were significantly lower than in those without HAART (P < 0.05). CONCLUSION We conclude that long-term HAART has adverse effects on oral health status of HIV-infected subjects.
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Affiliation(s)
- Wipawee Nittayananta
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
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Chahin N, Temesgen Z, Kurtin PJ, Spinner RJ, Dyck PJB. HIV lumbosacral radiculoplexus neuropathy mimicking lymphoma: diffuse infiltrative lymphocytosis syndrome (DILS) restricted to nerve? Muscle Nerve 2010; 41:276-82. [PMID: 19882634 DOI: 10.1002/mus.21507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diffuse infiltrative lymphocytosis syndrome (DILS) is a hyperimmune reaction against HIV. It leads to MHC-restricted clonal expansion of CD8 T cells characterized by circulating CD8 hyperlymphocytosis and CD8 T-cell infiltration in organs. Our patient presented with painful lumbosacral radiculoplexus neuropathy and tested positive for HIV. Nerve biopsy showed large collections of CD8 lymphocytes suspicious for lymphoma. Symptoms, signs, and repeat biopsy improved with antiretroviral treatment. The presentation and treatment response suggest that this case is localized DILS.
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Affiliation(s)
- Nizar Chahin
- Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Parke AL, Buchanan WW. Sjögren's syndrome: History, clinical and pathological features. Inflammopharmacology 2010; 6:271-87. [PMID: 17657625 DOI: 10.1007/s10787-998-0012-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/1998] [Accepted: 09/11/1998] [Indexed: 11/28/2022]
Abstract
The history, ocular and oral clinical features, and histopathology of Sjögren's syndrome are described. Primary Sjögren's syndrome is defined when only the ocular and oral components are present, while the secondary form refers to the association with a connective tissue disorder, especially rheumatoid arthritis, or other illness such as AIDS, hepatitis C infection, or biliary cirrhosis. Sjögren's syndrome is a common, but often overlooked disorder. Patients with severe disease run a forty-times risk of developing lymphoma usually of the B cell type.
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Affiliation(s)
- A L Parke
- Department of Medicine, The University of Connecticut Health Center, Farmington, Connecticut, USA
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Mo SI, Lee HG, Cho AR, Chung HK, Lee HS, Choi JS, Seo KH, Nah SS, Kim YH, Na JO. Lymphoid Interstitial Pneumonia Associated with Primary Sjogren's Syndrome - A Case Report. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.5.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sang Il Mo
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyeok Gyu Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - A Ra Cho
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hye Kyoung Chung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ho Sung Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae Sung Choi
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ki Hyun Seo
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seong-Su Nah
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Yong Hoon Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ju Ock Na
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
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Cole J, Pantanowitz L, Aboulafia D. Human immunodeficiency virus and chronic lymphocytic leukemia. Leuk Lymphoma 2009; 50:1885-8. [PMID: 19883317 DOI: 10.3109/10428190903216820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rheumatic manifestations associated with HIV in the highly active antiretroviral therapy era. Curr Opin Rheumatol 2009; 21:404-10. [PMID: 19444116 DOI: 10.1097/bor.0b013e32832c9d04] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To evaluate the rheumatic manifestations associated with HIV infection in the highly active antiretroviral therapy (HAART) era. RECENT FINDINGS The overall prevalence of rheumatic manifestations in HIV population is approximately 9% with various clinical features. Anti-TNF agents do not appear to adversely affect the CD4 cell counts or viral load if the HIV infection is well controlled prior to initiation of therapy. SUMMARY In the HAART era, HIV-infected individuals can be affected by various rheumatic syndromes including arthritis, spondyloarthritis, DILS, vasculitides, connective tissue disease, myopathies, and musculoskeletal diseases. With the use of HAART, the prevalence of spondyloarthritis and Diffuse Infiltrative Lymphocytosis Syndrome has decreased, whereas the musculoskeletal complications of HIV and HAART, such as osteopenia, osteonecrosis, and infection continue to be a concern. With immune restoration, various inflammatory and autoimmune diseases, such as SLE, rheumatoid arthritis, and polymyositis may occur de novo or exacerbate. Most antirheumatic therapies used in HIV-negative individuals appear to be safe and effective in the setting of HIV infection as long as prudent guidelines are followed.
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HIV infection and rheumatic diseases: the changing spectrum of clinical enigma. Rheum Dis Clin North Am 2009; 35:139-61. [PMID: 19481002 DOI: 10.1016/j.rdc.2009.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, the authors discuss the occurrence and prevalence of rheumatic syndromes before and after highly active antiretroviral therapy became the usual mode of treatment. The immunologic, environmental, and genetic factors behind the combination of HIV infection and rheumatic manifestation contribute to the complexity of these diseases. Miscellaneous case reports are discussed in relation to HIV infection. The authors conclude that geriatric care of HIV patients is on the horizon as more people have access to newer, more effective therapy and mortality is on the decline. Younger HIV patients will be committed to a lifetime of therapy to address bone disease and other chronic problems. In the future, newer agents may steer the clinical scenario in unforeseen directions.
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Mircheff AK, Warren DW, Wood RL. Hormonal Support of Lacrimal Function, Primary Lacrimal Deficiency, Autoimmunity, and Peripheral Tolerance in the Lacrimal Gland. Ocul Immunol Inflamm 2009; 4:145-72. [DOI: 10.3109/09273949609079648] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gupta N, Gupta R, Rajwanshi A, Bakshi J. Multinucleated giant cells in HIV-associated benign lymphoepithelial cyst-like lesions of the parotid gland on FNAC. Diagn Cytopathol 2009; 37:203-4. [PMID: 19170173 DOI: 10.1002/dc.20991] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Benign lymphoepithelial cyst-like lesion (BLEL), a previously rare lesion of the parotid gland consisting of marked lymphoid hyperplasia with accompanying squamous-lined cysts, has been described in patients with the acquired immune deficiency syndrome (AIDS) or AIDS risk factors. Histologically, these cysts are lined by a squamous or cuboidal epithelium. The lumen contains a pale homogenous material with foamy macrophages and lymphocytes with the cyst wall having germinal centers and a dense infiltrate of lymphoid cells. On FNAC, the aspirates are mostly cystic with the presence of reactive lymphoid tissue, numerous histiocytes, and metaplastic cell clusters. Multinucleated giant cells (MGCs) are also rarely seen in such lesions. We report a case of HIV-associated BLEL with numerous large sized multinucleated giant cells.
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Affiliation(s)
- Nalini Gupta
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
Sjögren's syndrome (SS) is a systemic disease with a predilection for the exocrine glands. It also is considered to be an autoimmune epitheliitis, and, as the respiratory system is lined throughout with epithelial cells, it should not be surprising that patients who have SS may develop pulmonary disease. This article describes these manifestations.
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Affiliation(s)
- Ann L Parke
- Division of Rheumatology, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105-1208, USA
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Invernizzi P, Selmi C, Poli F, Frison S, Floreani A, Alvaro D, Almasio P, Rosina F, Marzioni M, Fabris L, Muratori L, Qi L, Seldin MF, Gershwin ME, Podda M. Human leukocyte antigen polymorphisms in Italian primary biliary cirrhosis: a multicenter study of 664 patients and 1992 healthy controls. Hepatology 2008; 48:1906-12. [PMID: 19003916 PMCID: PMC2592501 DOI: 10.1002/hep.22567] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic factors are critical in determining susceptibility to primary biliary cirrhosis (PBC), but there has not been a clear association with human leukocyte antigen (HLA) genes. We performed a multicenter case-control study and analyzed HLA class II DRB1 associations using a large cohort of 664 well-defined cases of PBC and 1992 controls of Italian ancestry. Importantly, healthy controls were rigorously matched not only by age and sex, but also for the geographical origin of the proband four grandparents (Northern, Central, and Southern Italy). After correction for multiple testing, DRB1*08 [odds ratio (OR), 3.3; 95% confidence interval (CI), 2.4-4.5] and DRB1*02 (OR 0.9; 95% CI 0.8-1.2) were significantly associated with PBC, whereas alleles DRB1*11 (OR 0.4; 95% CI 0.3-0.4) and DRB1*13 (OR 0.7; 95% CI 0.6-0.9) were protective. When subjects were stratified according to their grandparental geographical origin, only the associations with DRB1*08 and DRB1*11 were common to all three areas. Associated DRB1 alleles were found only in a minority of patients, whereas an additive genetic model is supported by the gene dosage effect for DRB1*11 allele and the interaction of DRB1*11,*13, and *08. Lastly, no significant associations were detected between specific DRB1 alleles and relevant clinical features represented by the presence of cirrhosis or serum autoantibodies. In conclusion, we confirm the role for HLA to determine PBC susceptibility and suggest that the effect of HLA is limited to patient subgroups. We suggest that a large whole-genome approach is required to identify further genetic elements contributing to the loss of tolerance in this disease.
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Affiliation(s)
- Pietro Invernizzi
- Department of Internal Medicine, Istituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy,Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA
| | - Carlo Selmi
- Department of Internal Medicine, Istituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy,Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA
| | - Francesca Poli
- Organ and Tissue Transplantation Immunology, IRCCS, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milan, Italy
| | - Sara Frison
- Organ and Tissue Transplantation Immunology, IRCCS, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milan, Italy
| | - Annarosa Floreani
- Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Domenico Alvaro
- Department. of Clinical Medicine, Division of Gastroenterology, University of Rome “La Sapienza”, Rome, Italy, Department. of Polo Pontino, University of Rome “La Sapienza”, Rome, Italy
| | - Piero Almasio
- Division of Gastroenterology, University of Palermo, Palermo, Italy
| | - Floriano Rosina
- Division of Gastroenterology and Hepatology, Gradenigo Hospital, Turin, Italy
| | - Marco Marzioni
- Department of Gastroenterology, Polytechnic University of Marche, Ancona, Italy
| | - Luca Fabris
- Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy, CeLiveR, Gastroenterology and Liver Transplant Unit, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Luigi Muratori
- Department of Internal Medicine, Cardioangiology, Hepatology, Alma Mater Studiorum University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Lihong Qi
- Rowe Program in Genetics, Departments of Biochemistry, Medicine and Public Health Sciences, University of California, Davis, CA
| | - Michael F. Seldin
- Rowe Program in Genetics, Departments of Biochemistry, Medicine and Public Health Sciences, University of California, Davis, CA
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA
| | - Mauro Podda
- Department of Internal Medicine, Istituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy
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Navazesh M, Mulligan R, Karim R, Mack WJ, Ram S, Seirawan H, Greenspan J, Greenspan D, Phelan J, Alves M. Effect of HAART on salivary gland function in the Women's Interagency HIV Study (WIHS). Oral Dis 2008; 15:52-60. [PMID: 19017280 DOI: 10.1111/j.1601-0825.2008.01456.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the impact of highly active antiretroviral therapy (HAART) on salivary gland function in human immunodeficiency virus (HIV) positive women from the Women's Interagency HIV Study (WIHS). DESIGN Longitudinal cohort study. SUBJECTS AND METHODS A total of 668 HIV positive women from the WIHS cohort with an initial and at least one follow-up oral sub-study visit contributed 5358 visits. Salivary gland function was assessed based on a dry mouth questionnaire, whole unstimulated and stimulated salivary flow rates, salivary gland enlargement or tenderness and lack of saliva on palpation of the major salivary glands. MAIN OUTCOME MEASURES Changes in unstimulated and stimulated flow rates at any given visit from that of the immediate prior visit (continuous variables). The development of self-reported dry mouth (present/absent), enlargement or tenderness of salivary glands (present/absent), and absence of secretion on palpation of the salivary glands were binary outcomes (yes/no). RESULTS Protease Inhibitor (PI) based HAART was a significant risk factor for developing decreased unstimulated (P = 0.01) and stimulated (P = 0.0004) salivary flow rates as well as salivary gland enlargement (P = 0.006) as compared with non-PI based HAART. CONCLUSIONS PI-based HAART therapy is a significant risk factor for developing reduced salivary flow rates and salivary gland enlargement in HIV positive patients.
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Affiliation(s)
- M Navazesh
- USC School of Dentistry, Los Angeles, CA 90089-0641, USA.
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Tzioufas AG, Voulgarelis M. Update on Sjögren's syndrome autoimmune epithelitis: from classification to increased neoplasias. Best Pract Res Clin Rheumatol 2008; 21:989-1010. [PMID: 18068857 DOI: 10.1016/j.berh.2007.09.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Sjögren's syndrome is a chronic inflammatory process that primarily involves the exocrine glands. Its clinical manifestations range from autoimmune exocrinopathy to extraglandular (systemic) involvement affecting the lungs, kidneys, blood vessels, and muscles; it can occur alone (primary Sjögren's syndrome) or in association with other autoimmune diseases (secondary Sjögren's syndrome). In recent years, clinical and laboratory observations have highlighted the central role of the epithelial cell and it has been suggested that the etiological name of the disease should be 'autoimmune epithelitis'. The extraglandular manifestations of the disease are divided in two groups: (1) lung, kidney (interstitial nephritis), and liver involvement as a result of lymphocytic invasion in epithelial tissues; and (2) skin vasculitis, peripheral neuropathy, and glomerulonephritis, with low C4 levels, which is the result of immune complex disease, are associated with increased morbidity and high risk for lymphoma. The diagnosis of the disease is based on the classification criteria, raised by the American-European Study Group and which have been built on the European preliminary classification criteria, developed in 1992. The association of Sjögren's syndrome with lymphoma is well documented as in approximately 5% of patients the benign autoimmune process is transformed into a lymphoid malignancy. The salivary extranodal marginal zone B-cell lymphomas of the mucosa-associated lymphoid tissue type are the most common lymphoma in Sjögren's syndrome. These tumors are antigen-stimulated B-cell lymphomas and are characterized by localized stage, indolent clinical course, and recurrence in other extranodal sites. Among the clinical and serological parameters that have been associated with lymphoma development in patients with Sjögren's syndrome, the presence of palpable purpura, low C4 and mixed monoclonal cryoglobulinemia constitute the main predictive markers; patients displaying these risk factors should be monitored closely. The purpose of this review is to discuss the clinical picture, the diagnostic procedure, and the malignant lymphoproliferation in the disease.
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Levay PF, Botes ME. Diffuse Infiltrative Lymphocytosis Syndrome (DILS). S Afr Fam Pract (2004) 2008. [DOI: 10.1080/20786204.2008.10873692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Zafrani L, Coppo P, Dettwiler S, Molinier-Frenkel V, Agbalika F, Guiard-Schmid JB, Pialoux G, Xu-Dubois YC, Rondeau E, Hertig A. Nephropathy associated with the diffuse infiltrative lymphocytosis syndrome. Kidney Int 2007; 72:219-24. [PMID: 17361111 DOI: 10.1038/sj.ki.5002207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L Zafrani
- APHP, Hopital Tenon, Urgences Néphrologiques & Transplantation Rénale, et Université Pierre et Marie Curie (UPMC), Paris, France
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