Thoughts on Lymphopenia in AIDS and Sarcoidosis 16 July 2003
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Trevor G Marshall,
Managing Editor

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Re: Thoughts on Lymphopenia in AIDS and Sarcoidosis

Thoughts on Lymphopenia in AIDS and Sarcoidosis

At the AIDS conference in Paris today, a study is reporting that 10% of all newly infected AIDS patients in Europe are infected with drug-resistant strains (Source: New York Times, 15 July)

As I wrote last month[1], Lymphopenia is seen in Sarcodiosis, as well as in SARS. In the case of Sarcoidosis the pathogen is presumed bacterial, as it succumbs to the tetracyclines, in the case of SARS it is presumed viral. In both diseases the more severely ill patients develop significant lymphopenia. In Sarcoidosis the lymphopenia resolves as the patient remits (under the influence of the antibiotic).

If there were a class of pathogen which is capable of mimicking the body's activated T-lymphocytes[2], then those T-cells would become unimportant to the proliferation of the inflammation. If you look at a Sarcoid Granuloma, the T-lymphocytes are relegated to the periphery of the granuloma. They are not needed by the monocytes, macrophages and giant-cells at the inflammatory core. The T-lymphocytes are pushed to the periphery, and presumably down-regulated by the high level of generated cytokines.This is the type of pathogen which I believe is responsible for Sarcoidosis.

I know of one HIV patient who was diagnosed with both HIV and Sarcodiosis (HIV diagnosed using the US guidelines) and whose Lymphocyte count has hovered just above the level of 'clinical AIDS' for a decade. Is this due to the HIV pathogen or the Sarcodiosis Pathogen?

Is it possible that this 10% with "drug-resistant strains" are actually 10% with yet-to-be-identified non-descript (new) Lymphopenic pathogens?

1. Marshall TG, Marshall FE: A Mechanism to Explain the T lymphopenia. BMJ Rapid Responses 20 June 2003:33479 [ Full Text ]

2. Lee RE: SARS E2-spike Protein Contains a Superantigen Between Residues 690 through 1050. JOIMR 2003;1(1):3[ Full Text ]

Competing interests:   None declared