Detection of HTLV-III/LAV-specific IgG and antigen in bronchoalveolar lavage fluid from two patients with lymphocytic interstitial pneumonitis associated with AIDS-related complex

doi:10.1016/0002-9343(87)90461-X

The American Journal of Medicine

Volume 82, Issue 3, March 1987, Pages 553-556

https://doi.org/10.1016/0002-9343(87)90461-X Get rights and content

Abstract

Lymphocytic interstitial pneumonitis, a disorder of unknown cause, has been described in association with infection by the retrovirus human T lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). This report describes the isolation of HTLV-III/LAV in bronchoalveolar lavage fluid and the quantitation of antibodies directed against HTLV-III/LAV in bronchoalveolar lavage fluid and peripheral blood of two patients with lymphocytic interstitial pneumonitis associated with acquired immune deficiency syndrome-related complex. The ratio of the concentrations of HTLV-III/LAV-specific IgG to total IgG in the bronchoalveolar lavage fluid of both patients was higher than that of the peripheral blood. These findings are consistent with the hypothesis that lymphocytic interstitial pneumonitis is sometimes associated with HTLV-III/LAV infection of pulmonary tissue that evokes a specific humoral immune response locally in the lung.

References (16)

P Solal-Geligny et al.
Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome-related complex
Am Rev Respir Dis
(1985)
M Grieco et al.
Lymphocytic interstitial pneumonia associated with the acquired immune deficiency syndrome
Am Rev Respir Dis
(1985)
JM Ziza et al.
Lymphadenopathy-associated virus isolated from bronchoalveolar lavage fluid in AIDS-related complex with lymphoid interstitial pneumonitis (letter)
N Engl J Med
(1985)
L Resnick et al.
Human T-lymphotropic viruses: syncytia formation (editorial)
JAMA
(1986)
M Essex et al.
Antigens of human T-lymphotropic virus type III/lymphadenopathy-associated virus
Ann Intern Med
(1985)
L Resnick et al.
Intra-blood-brain barrier synthesis of HTLV-III specific IgG in patients with neurologic symptoms associated with AIDS or AIDS-related complex
N Engl J Med
(1985)
RC Gallo et al.
Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS
Science
(1984)
L Resnick et al.
Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments
JAMA
(1986)

There are more references available in the full text version of this article.

Cited by (31)

Granulomatous-lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID)
2010, Clinical Immunology
Citation Excerpt :
Viruses, such as Epstein–Barr virus (EBV), human immunodeficiency virus (HIV), and human herpesvirus type 8 (HHV-8) have also been suggested to play a role in the underlying pathogenesis of LIP including that occurring in CVID. A relatively high frequency of EBV has been found in the lungs of patients with LIP [23,24], and the similar association has been demonstrated between HIV and LIP [25,26]. Human herpesvirus type 8 (HHV-8) has been demonstrated to be a potentially important factor in the pathogenesis of GLILD in CVID patients, as extensively discussed in the next section.
Infectious complications of the lung occur quite frequently in patients with common variable immunodeficiency (CVID), a clinical syndrome that represents a primary immunodeficiency. However, there appears to be noninfectious pulmonary complications in association with CVID as well, and recently the term granulomatous-lymphocytic interstitial lung disease (GLILD) has been created to describe these noninfectious, diffuse lung disease complications that develop in CVID patients. They exhibit both granulomatous and lymphoproliferative histologic patterns, consisting of lymphocytic interstitial pneumonia (LIP), follicular bronchiolitis, and lymphoid hyperplasia. There are many unanswered questions surrounding this relatively unstudied entity. In an attempt to answer some of these questions, this review discusses in detail pathologic and clinical features of GLILD and its proposed pathogenesis with a particular attention to potential role of human herpesvirus 8 (HHV-8). Lastly, therapeutic approach is discussed to generate novel treatment strategy to better care for a subgroup of CVID patients afflicted with this entity.
Histopathological aspects of HIV infection
2007, Revue Francophone des Laboratoires
Les lésions histologiques induites par un effet cytopathogène du virus de l'immunodéficience humaine (VIH) sont de diagnostic difficile car elles sont souvent peu spécifiques, se traduisant comme pour la plupart des infections virales par un infiltrat inflammatoire lymphocytaire. II existe toutefois des images parfois plus caractéristiques (au niveau du système nerveux central), ou très évocatrices par l'association de lésions élémentaires (au niveau du tissu lymphoïde), qui permettent de pouvoir fortement impliquer l'action du VIH au niveau de ces tissus. La mise en évidence des protéines du VIH ou de l'ARN virai au sein de ces lésions permet alors d'associer les modifications morphologiques observées à une action directe de ce virus. II est difficile dans certaines localisations, cardiovasculaire, neuromusculaire, digestive, pulmonaire, ou au niveau tissu hématopoïetique, d'éliminer une étiologie associée pouvant être responsable ou co-responsable des lésions observées. Nous décrivons ici les aspects histologiques des principales lésions pour lesquelles le VIH est directement impliqué ou fortement incriminé.
Histological features caused by a cytopathogenic effect of the human immunodeficiency virus (HIV) can be difficult to be diagnosed since there are often non specific, and characterized, as in other viral infections, by a diffuse lymphocytic inflammation. However, some features are characteristics (in the central nervous system), or very evocative because of the presence of different lesions (in lymphoid tissues), allowing to strongly suspect a direct action of the HIV in these tissues. Moreover, the detection of viral proteins or RNA in these lesions allows to linked the observed morphological alterations to the HIV effect It is frequently difficult, particularly in some cardiovascular, neuromuscular, digestive, pulmonary, and hematopoietic locations, to eliminate other associated etiological factors responsible or co-responsible of the observed lesions. Here, we describe the main features of the histological lesions for which the HIV is directly involved.
Lymphoid interstitial pneumonia resolved through antiretroviral therapy in an adult infected by human immunodeficiency virus
2004, Archivos de Bronconeumologia
La neumonía intersticial linfoidea es una entidad poco frecuente, caracterizada por la infiltración del intersticio y los espacios alveolares por linfocitos, células plasmáticas y otros elementos linforreticulares. Su etiología es desconocida y se asocian factores autoinmunitarios e infecciosos. La incidencia ha aumentado en los últimos años, fundamentalmente en niños y en relación con el síndrome de la inmunodeficiencia adquirida, siendo más rara en la población adulta. No hay acuerdo en cuanto a las pruebas diagnósticas necesarias para su confirmación, aunque la sospecha suele basarse en datos clínicos y radiológicos, y debe confirmarse con muestras histológicas. El tratamiento más empleado son los esteroides, bien solos o en combinación con otros agentes inmunodepresores, aunque no hay ensayos controlados y se han descrito casos de pacientes con sida resueltos con tratamiento antirretroviral exclusivamente. Presentamos el caso de un adulto con infección por el virus de la inmunodeficiencia adquirida al que se diagnosticó de neumonía intersticial linfoidea en nuestro servicio mediante biopsia pulmonar abierta y que se resolvió con antirretrovirales sin precisar de tratamiento esteroideo asociado.
Lymphoid interstitial pneumonia (LIP) is a rare entity characterized by the infiltration of interstitial tissues and alveolar spaces by lymphocytes, plasma cells, and other lymphoreticular structures. The etiology of LIP is unknown, although associations with autoimmune and infectious factors have been described. The incidence of LIP has risen in recent years, mainly in children with acquired immunodeficiency syndrome (AIDS), while remaining less common in the adult population. No agreement has been reached regarding the diagnostic tests necessary for a firm diagnosis although suspicion is usually based on clinical and radiographic findings, with confirmation provided by examination of histological samples. The most common treatment is corticosteroids, either alone or in combination with other immunosuppressant agents although no evidence from controlled trials is available and cases have been reported in which LIP resolved in AIDS patients with antiretroviral therapy alone. We report the case of a human immunodeficiency virus-infected adult who was diagnosed with LIP by open lung biopsy and who responded to antiretroviral drugs with no need for associated corticosteroid therapy.
Malignant and benign lymphoid lesions of the lung
2004, Annals of Diagnostic Pathology
Lymphoid lesions of the lung produce a complex of problems for the practicing pathologist. Although these lesions are eventually referred to hematopathologists, it is still the general surgical pathologist who first encounters them and confronts the problem of formulating an initial diagnosis. Over the last 20 years there has been a revolution in our knowledge of the classification and natural history of the pulmonary lesions, a plethora of information which warrants a thorough review. The purpose of this discussion is to report the clinical features and courses, pathologic features and, when known, etiologies or pathogenesis of the major “primary” pulmonary lymphoid lesions and present a brief approach to differential diagnosis. I will divide the lesions into malignant and benign, discussing each in turn.
Lymphoid interstitial pneumonia: A narrative review
2002, Chest
Citation Excerpt :
Even in instances where EBV antigen or antibody is found in the lung, there are likely other adjunctive mechanisms, including a dysregulated host immune system, driving or allowing cellular proliferation. HIV antigen and antibody have been found in BAL and lung tissue specimens of some HIV-positive patients with LIP.33,34 Chayt et al35 reported a significantly increased number of cells expressing human T-lymphotropic virus (HTLV) type III RNA in HIV-positive patients with LIP compared to HIV-positive patients with lung pathology other than LIP.
Lymphoid interstitial pneumonia (LIP) is regarded as both a disease and a nonneoplastic, inflammatory pulmonary reaction to various external stimuli or systemic diseases. It is an uncommon condition with incidence and prevalence rates that are largely unknown. Liebow and Carrington originally classified LIP as an idiopathic interstitial pneumonia in 1969. Although LIP had since been removed from that category, the most recent consensus classification sponsored by the American Thoracic Society and the European Respiratory Society recognizes that some cases remain idiopathic in origin, and its clinical, radiographic, and pathologic features warrant the return of LIP to its original classification among the idiopathic interstitial pneumonias. LIP also belongs within a spectrum of pulmonary lymphoproliferative disorders that range in severity from benign, small, airway-centered cellular aggregates to malignant lymphomas. It is characterized by diffuse hyperplasia of bronchus-associated lymphoid tissue. The dominant microscopic feature of LIP is a diffuse, polyclonal lymphoid cell infiltrate surrounding airways and expanding the lung interstitium. Classically, LIP occurs in association with autoimmune diseases, most often Sjögren syndrome. This has led to consideration of an autoimmune etiology for LIP, but its pathogenesis remains poorly understood. Persons who are seropositive for HIV, and children in particular, are at increased risk of acquiring LIP. Some studies suggest causal roles for both HIV and Epstein-Barr virus. The incidence of LIP is approximately twofold greater in women than men. The average age at diagnosis is between 52 years and 56 years. Symptoms of progressive cough and dyspnea predominate. There is great variability in the clinical course of LIP, from resolution without treatment to progressive respiratory failure and death. Although LIP is often regarded as a steroid-responsive condition, and oral corticosteroids continue to be the mainstay of therapy, response is unpredictable. Approximately 33 to 50% of patients die within 5 years of diagnosis, and approximately 5% of cases of LIP transform to lymphoma.
Viruses and other miscellaneous organisms
1996, Clinics in Chest Medicine

View all citing articles on Scopus

^☆: This work-was supported in part by the Key Pharmaceuticals Medical Research and Educational Foundation of Miami, Florida, and the Sophie and Nathan Gumenick Research Fund.

View full text

Case reportDetection of HTLV-III/LAV-specific IgG and antigen in bronchoalveolar lavage fluid from two patients with lymphocytic interstitial pneumonitis associated with AIDS-related complex☆

Abstract

Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome-related complex

Am Rev Respir Dis

Lymphocytic interstitial pneumonia associated with the acquired immune deficiency syndrome

Am Rev Respir Dis

Lymphadenopathy-associated virus isolated from bronchoalveolar lavage fluid in AIDS-related complex with lymphoid interstitial pneumonitis (letter)

N Engl J Med

Human T-lymphotropic viruses: syncytia formation (editorial)

JAMA

Antigens of human T-lymphotropic virus type III/lymphadenopathy-associated virus

Ann Intern Med

Intra-blood-brain barrier synthesis of HTLV-III specific IgG in patients with neurologic symptoms associated with AIDS or AIDS-related complex

N Engl J Med

Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS

Science

Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments

JAMA

Case report
Detection of HTLV-III/LAV-specific IgG and antigen in bronchoalveolar lavage fluid from two patients with lymphocytic interstitial pneumonitis associated with AIDS-related complex☆