PITYRIASIS LICHENOIDES ET VARIOLIFORMIS-ACUTA IN HIV-1- A MARKER OF EARLY-STAGE DISEASE( PATIENTS )

Background The high incidence of cutaneous disease in HIV-1+ patients may be a marker of the chronic state of immune activation. In addition , specific cutaneous diseases may be related to the pattern and degree of immune dysregulation present in the patients at the time of the er uption. We have observed that HIV-1+ patients with pityriasis lichenoi des et varioliformis acuta (PLEVA) were in the early to midstage of HI V-1 disease. Materials and methods To determine if there was a correla tion between the phenotype of the lymphoid infiltrate and surface mark ers of the epidermis and the known changes in early or late-stage HIV- 1 disease, we studied five HIV-1+ patients with PLEVA. Cutaneous biops y specimens were obtained and immunohistochemical stains were used to determine the expression of ELAM-1, ICAM-1, and HLA-DR and the phenoty pe of the lymphoid infiltrate. Results The HIV-1+ patients showed incr eased expression of HLA-DR on keratinocytes as well as on the mononucl ear and dendritic cell populations in the epidermis and dermis. The ma jority of T cells were activated CD8+ cells. Conclusions Immunophenoty ping of the inflammatory infiltrate in these patients is consistent wi th a pattern of immune dysregulation seen only in earlier stages of HI V-I disease. Thus, PLEVA may be useful as a marker of early to midstag es of HIV-I disease.