THE SPECTRUM OF VASCULITIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS - A CLINICOPATHOLOGICAL EVALUATION

Objective. To delineate the different types of inflammatory vascular d iseases (IVD) occurring in patients with human immunodeficiency virus (HIV) infection.Methods. Muscle, nerve, or skin biopsy specimens from 148 symptomatic HIV-infected individuals were reviewed, and subgroups of vasculitis were identified using the American College of Rheumatolo gy (ACR) 1990 clinicopathologic criteria for the classification of vas culitis. Results. IVD was documented in 34 patients (23%) and included necrotizing arteritis (3 patients), non-necrotizing arteritis (1 pati ent), neutrophilic IVD (7 patients), mononuclear IVD (17 patients), an d other small vessel inflammatory changes (6 patients). According to t he ACR criteria, 11 patients could be classified as having a distinct category of vasculitis, including polyarteritis nodosa (4 patients), H enoch-Schonlein purpura (1 patient), and drug-induced hypersensitivity vasculitis (6 patients), and 23 were classified in the group ''other vasculitis, type unspecified.'' One patient had hepatitis B virus surf ace antigenemia, 2 had cryoglobulinemia, and 2 were coinfected by huma n T lymphotropic virus type 1. Cytomegalovirus inclusions and antigens were found in endothelial cells in 1 patient. HIV antigens and genome were detected in perivascular cells of 2 of the 3 patients with necro tizing arteritis; in 1, HIV-like particles were seen by electron micro scopy. Immune deposits were found in small vessel walls in 5 skin biop sy samples showing small vessel vasculitis and in the muscle of the 3 patients with necrotizing arteritis. Conclusion. A wide range of infla mmatory vascular diseases may occur in HIV-infected individuals. Vascu lar inflammation appears multifactorial and may result from HIV-induce d immunologic abnormalities and exposure to a variety of xenoantigens, such as HIV itself, other infectious agents, and drugs.