Encephalitis with Infiltration by CD8+Lymphocytes in HIV Patients Receiving Combination Antiretroviral Treatment
Encephalitis with Infiltration by CD8+Lymphocytes in HIV Patients Receiving Combination Antiretroviral Treatment
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DOI：
10.1111/bpa.12038
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发表时间：
2013-09-01
期刊：
影响因子：
6.4
通讯作者：
Moulignier, Antoine
中科院分区：
文献类型：
--
作者：
Gray, Francoise;Lescure, Francois Xavier;Moulignier, Antoine
我们报告了10例经联合抗逆转录病毒治疗的艾滋病病毒感染患者的神经病理学结果，这些患者发生了快速进行性发作的亚急性脑病。脑活检显示脑炎病变与髓鞘丢失和轻微轴突损伤相关。HIV蛋白p24的表达不稳定且较弱;其他病原体的检测结果均为阴性。最显著的特征是弥漫性、血管周围和实质内CD 8 + T淋巴细胞浸润。6例患者治疗后好转。四个人的结局不佳，一年内死亡。1例尸检证实为HIV白质脑炎伴p24阳性多核巨细胞，伴小脑急性脱髓鞘性脑脊髓炎（ADEM）。CD 8+淋巴细胞弥漫性浸润; CD 4+细胞几乎不存在。这些情况下，可能代表一个特定的临床病理实体，其中几个可比的情况下已经描述。它们可以被包括在免疫重建疾病的广泛框架中。这种综合征已被描述为机会性感染，但很少与中枢神经系统（CNS）的HIV感染。我们的研究结果支持这一假设，即CD 8+细胞毒性淋巴细胞可能是有害的免疫重建疾病，特别是在没有CD 4+淋巴细胞。CD 8细胞毒性导致闷烧感染和/或类似于ADEM的免疫病理学反应。
We report the neuropathological findings in 10 HIV-infected patients treated by combination antiretroviral therapy who developed subacute encephalopathy of rapidly progressive onset. Brain biopsy showed encephalitic lesions variably associated with myelin loss and slight axonal damage. There was inconstant, weak expression of HIV protein p24; tests for other pathogens were negative. The most striking feature was diffuse, perivascular and intraparenchymal infiltration by CD8+ T-lymphocytes. Six patients improved after the treatment. Four had an unfavorable outcome and died within a year. Post-mortem in one case confirmed HIV leukoencephalitis with p24-positive multinucleated giant cells, associated with acute demyelinating encephalomyelitis (ADEM) in the cerebellum. There was diffuse infiltration by CD8+ lymphocytes; CD4+cells were virtually absent. These cases may represent a specific clinicopathological entity, of which a few comparable cases have been already described. They can be included in the wide framework of immune reconstitution disease. Such syndromes have been described with opportunistic infections, but only seldom with HIV infection of the central nervous system (CNS). Our findings support the hypothesis that CD8+ cytotoxic lymphocytes can be harmful in immune reconstitution disease, particularly in the absence of CD4+ lymphocytes. CD8 cytotoxicity produces an acutization of a smoldering infection and/or an immunopathological reaction similar to ADEM.