Characteristics of salivary diffuse infiltrative lymphocytosis syndrome inWest Africa - Human immunodeficiency virus-associated salivary ductal epithelial atypia?

Objective.-To determine the prevalence of diffuser infiltrative lymphocytos is syndrome (DILS) in the minor salivary glands of 30 African Cameroonian a dults with the acquired immunodeficiency syndrome (AIDS). Design.-Salivary gland tissue was analyzed using a modified classification system that was developed to aid the diagnosis of Sjogren syndrome. The adv antages and disadvantages of this approach are discussed. Materials and Methods.-Formalin-fixed, paraffin-embedded, hematoxylin-eosin -stained biopsy sections were prepared for 30 patients with AIDS, 26 health y individuals who declined human immunodeficiency virus (HIV) testing, and 4 seronegative healthy controls. Tissues were immunostained for CD4/CD8(+) lymphocytes and cytomegalovirus (CMV), and transmission electron microscopy was performed to locate viral particles. Patients were tested for HIV-1 an d HIV-2 by the HIV/Chek System 3 or CAMSTIX-HIV-1 and HIV-2 assay. Results.-Severe salivary ductal atypia (96%) was the feature most strongly associated with AIDS, and the lymphocytic focus score was the second histol ogic feature most strongly correlated with AIDS. Forty-eight percent of pat ients with HIV-1 infection had more than 1 lymphocytic focus in a minor sal ivary gland. These lymphocytes were primarily CD8(+). We report, to the bes t of our knowledge, the first case of multinucleated salivary duct epitheli al cells in minor salivary glands also containing enveloped virus particles . All cases were negative for CMV. Conclusions.-The prevalence of DILS in West Africans with AIDS appears high er than the prevalence reported in whites from the United States and Europe and in blacks from the United States, a group that has been reported to ha ve a greater incidence of DILS than whites. This discrepancy may be related to differences in patient selection criteria. The determination of lymphoc ytic focus score, as used in the diagnosis of Sjogren syndrome, with the ad junct of ductal atypia is useful for assessing DILS. The impact of patient selection, drug therapy, and parasites on salivary gland pathology is discu ssed.