OUTPATIENT BIOPSIES OF THE PALATINE TONSIL - ACCESS TO LYMPHOID-TISSUE FOR ASSESSMENT OF HUMAN-IMMUNODEFICIENCY-VIRUS RNA TITERS

OBJECTIVES: Our objective was to assess the feasibility of using tonsi llar lymphoid biopsy specimens obtained on an outpatient basis to quan titate a patient's lymphoid human immunodeficiency virus (HIV) RNA tit ers. DESIGN: A pilot cohort study was performed. PATIENTS: We evaluate d ten HIV-seropositive patients who ranged in age from 26 to 48 years and had CD4+ cell counts ranging from 110 to 833 at enrollment. MAIN O UTCOME MEASURES: The main outcome measures were tolerance and safety o f outpatient tonsil biopsies and quantitation of HIV RNA titers in ton sillar lymphoid biopsy specimens, plasma, and peripheral blood mononuc lear cells determined by a new method of HIV RNA signal amplification with branched DNA probes. RESULTS: Outpatient tonsil biopsies were wel l tolerated and were performed without complications, Nine of In tonsi l biopsies from the HIV-seropositive patients examined were positive f or significant concentrations of HIV RNA, ranging from 10(6) to 10(9) HIV RNA equivalents per gram of tissue. All of the HIV RNA-positive to nsillar lymphoid specimens had HIV RNA titers that were 10(2) to 10(4) times greater than those recovered from plasma (per milliliter) of th e same patient obtained at the time of biopsy. CONCLUSIONS: Sufficient tonsillar tissue can be obtained in an outpatient clinic setting to q uantitate lymphoid HIV titers by the new branched-DNA signal amplifica tion method with relative ease and without complication. The biopsy me thod described here affords ready access to the lymphoreticular system , which may help to advance our understanding of the pathogenesis of m yriad immune diseases without the need for excisional node biopsies.