DEPLETION OF STROMAL AND INTRAEPITHELIAL ANTIGEN-PRESENTING CELLS IN CERVICAL NEOPLASIA IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Human immunodeficiency virus-positive (HIV+) women have an increased r isk of lower genital tract dysplasia and neoplasia, and studies of the central lymphoid system suggest that impaired immunosurveillance play s a role in the development of their cervical tumors. Intraepithelial and stromal immunocompetent cell counts were compared in cervical spec imens from 50 HIV+ and 50 appropriately matched HIV-women (controls) w ith low and high grade squamous intraepithelial lesions (SIL), or carc inoma. Each histological class of HIV+ women displayed fewer intraepit helial Langerhans' (S100+) cells (LC) (as already known), and also few er stromal LC and both intraepithelial and stromal (CD68+) macrophages . LC and macrophages were reduced in all HIV+ patients, whereas reduct ion of cervical T lymphocytes was found in only immunocompromised subj ects (peripheral blood CD4+ T-cell count <500/mu L). A mucosal quantit ative deficiency of antigen-presenting cells (APC) thus precedes that of T cells. HIV infection appears to lead to early impairment of mucos al immunoreactivity mainly because of defective antigen presentation. This impairment may be one mechanism underlying die increased frequenc y of cervical dysplasia/neoplasia, and the enhanced aggressiveness of invasive cancers in HIV+ women. Copyright (C) 1996 by W.B. Saunders Co mpany.