NEUROPATHY IN DIFFUSE INFILTRATIVE LYMPHOCYTOSIS SYNDROME - AN HIV NEUROPATHY, NOT A LYMPHOMA

Objective: To determine whether CD8 lymphoid infiltrates in nerves of patients with HIV-associated diffuse infiltrative lymphocytosis syndro me (DILS) cor responds to a lymphomatous neoplastic process or to a pr oliferation of T cells reactional to HIV. Background: DILS is characte rized by persistent CD8 hyperlymphocytosis and multivisceral CD8 T-cel l infiltration, which may affect peripheral nerves. Methods: Presence of monoclonal T cells and HIV-1 proviral load were evaluated by polyme rase chain reaction (PCR) techniques in frozen peripheral nerve sample s from six patients with DILS neuropathy and 22 patients with other HI V-associated peripheral neuropathies, including mononeuritis multiples (MM:6), inflammatory demyelinating polyneuropathies (IDP:6), distal s ensory polyneuropathy (DSP:5), and toxic distal sensory polyneuropathy (TDSP:5). Results: Five of six patients with DILS showed no detectabl e monoclonal T-cell clones in their nerves. Nerve proviral load in DIL S (6.8 +/- 0.2 log/10(5) cells) was much higher than in MM (p < 0.008) , IDP (p < 0.001), DSP (p < 0.001), and TDSP (p < 0.005). Conclusions: DILS neuropathy represents a separate entity among HIV-associated neu ropathies. It is associated with massive HIV proviral load in nerve an d must not be confused with a peripheral nerve T-cell lymphoma.