HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting

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dc.contributor.authorvan Zyl-Smit, Richard N
dc.contributor.authorNaidoo, Jashira
dc.contributor.authorWainwright, Helen
dc.contributor.authorSaid-Hartley, Quanita
dc.contributor.authorDavids, Malika
dc.contributor.authorGoodman, Hillel
dc.contributor.authorRogers, Sean
dc.contributor.authorDheda, Keertan
dc.date.accessioned2015-06-13T07:30:16Z
dc.date.available2015-06-13T07:30:16Z
dc.date.issued2015-04-22
dc.date.updated2015-05-11T18:01:14Z
dc.description.abstractBackground: There is a paucity of clinical and histopathological data about HIV-associated lymphocytic interstitial pneumonitis (LIP) in adults from HIV endemic settings. The role of Ebstein-Barr virus (EBV) in the pathogenesis remains unclear. Methods: We reviewed the clinical, radiographic and histopathological features of suspected adult LIP cases at the Groote Schuur Hospital, Cape Town South Africa, over a 6 year period. Archived tissue sections were stained for CD3, CD4, CD8, CD20 and LMP-1 antigen (an EBV marker). Results: 42 cases of suspected LIP(100% HIV-infected) were identified. 75% of patients were empirically treated for TB prior to being referred to the chest service for further investigation. Tissue samples were obtained using trans-bronchial biopsy. 13/42 were classified as definite LIP (lymphocytic infiltrate with no alternative diagnosis), 19/42 probable LIP (lymphocytic infiltrate but evidence of anthracosis or fibrosis) and 10 as non-LIP (alternative histological diagnosis). Those with definite LIP were predominantly young females (85%) with a median CD4 count of 194 (IQR 119ā€“359). Clinical or radiological features had poor predictive value for LIP. Histologically, the lymphocytic infiltrate comprised mainly B cells and CD8 T cells. The frequency of positive EBV LMP-1 antigen staining was similar in definite and non- LIP patients [(2/13 (15%) vs. 3/10 (30%); pā€‰=ā€‰0.52]. Conclusions: In a HIV endemic setting adult HIV-associated LIP occurs predominantly in young women. The diagnosis can often be made on transbronchial biopsy and is characterized by a predominant CD8 T cell infiltrate. No association with EBV antigen was found.en_ZA
dc.identifier.apacitationvan Zyl-Smit, R. N., Naidoo, J., Wainwright, H., Said-Hartley, Q., Davids, M., Goodman, H., ... Dheda, K. (2015). HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting. <i>BMC Pulmonary Medicine</i>, http://hdl.handle.net/11427/13058en_ZA
dc.identifier.chicagocitationvan Zyl-Smit, Richard N, Jashira Naidoo, Helen Wainwright, Quanita Said-Hartley, Malika Davids, Hillel Goodman, Sean Rogers, and Keertan Dheda "HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting." <i>BMC Pulmonary Medicine</i> (2015) http://hdl.handle.net/11427/13058en_ZA
dc.identifier.citationvan Zyl-Smit, R. N., Naidoo, J., Wainwright, H., Said-Hartley, Q., Davids, M., Goodman, H., ... & Dheda, K. (2015). HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting. BMC pulmonary medicine, 15(1), 38.en_ZA
dc.identifier.issn1471-2466en_ZA
dc.identifier.ris TY - Journal Article AU - van Zyl-Smit, Richard N AU - Naidoo, Jashira AU - Wainwright, Helen AU - Said-Hartley, Quanita AU - Davids, Malika AU - Goodman, Hillel AU - Rogers, Sean AU - Dheda, Keertan AB - Background: There is a paucity of clinical and histopathological data about HIV-associated lymphocytic interstitial pneumonitis (LIP) in adults from HIV endemic settings. The role of Ebstein-Barr virus (EBV) in the pathogenesis remains unclear. Methods: We reviewed the clinical, radiographic and histopathological features of suspected adult LIP cases at the Groote Schuur Hospital, Cape Town South Africa, over a 6 year period. Archived tissue sections were stained for CD3, CD4, CD8, CD20 and LMP-1 antigen (an EBV marker). Results: 42 cases of suspected LIP(100% HIV-infected) were identified. 75% of patients were empirically treated for TB prior to being referred to the chest service for further investigation. Tissue samples were obtained using trans-bronchial biopsy. 13/42 were classified as definite LIP (lymphocytic infiltrate with no alternative diagnosis), 19/42 probable LIP (lymphocytic infiltrate but evidence of anthracosis or fibrosis) and 10 as non-LIP (alternative histological diagnosis). Those with definite LIP were predominantly young females (85%) with a median CD4 count of 194 (IQR 119ā€“359). Clinical or radiological features had poor predictive value for LIP. Histologically, the lymphocytic infiltrate comprised mainly B cells and CD8 T cells. The frequency of positive EBV LMP-1 antigen staining was similar in definite and non- LIP patients [(2/13 (15%) vs. 3/10 (30%); pā€‰=ā€‰0.52]. Conclusions: In a HIV endemic setting adult HIV-associated LIP occurs predominantly in young women. The diagnosis can often be made on transbronchial biopsy and is characterized by a predominant CD8 T cell infiltrate. No association with EBV antigen was found. DA - 2015-04-22 DB - OpenUCT DO - 10.1186/s12890-015-0030-2 DP - University of Cape Town J1 - BMC Pulmonary Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 SM - 1471-2466 T1 - HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting TI - HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting UR - http://hdl.handle.net/11427/13058 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/13058
dc.identifier.urihttp://dx.doi.org/10.1186/s12890-015-0030-2
dc.identifier.vancouvercitationvan Zyl-Smit RN, Naidoo J, Wainwright H, Said-Hartley Q, Davids M, Goodman H, et al. HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting. BMC Pulmonary Medicine. 2015; http://hdl.handle.net/11427/13058.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holdervan Zyl Smit et al.; licensee BioMed Central.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Pulmonary Medicineen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpulmmed/
dc.subject.otherLymphocytic interstitial pneumoniaen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherHistologyen_ZA
dc.titleHIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor settingen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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