1. ¹Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
2. ²Departments of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
3. ³Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
4. ⁴Department of Infectious and Parasitic Disease Pathology, Armed Forces Institute of Pathology, Washington DC
5. ⁵Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
6. ⁶Division of Pathology, Hospital for Sick Children, University of Toronto, Toronto, Canada
7. ⁷Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

Correspondence: Lertlakana Bhoopat, M.D., Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; e-mail: lbhoopat@mail.med.cmu.ac.th; fax: 053-217144.

Accepted 28 August 2001.

Abstract

In Thailand, the predominant HIV subtype is E, rather than Subtype B as in North America and Europe, and the predominant mode of transmission is heterosexual contact. Subtype E has the ability to replicate in vitro in Langerhans cells. We hypothesized that this cell type might constitute a reservoir for the HIV virus in vaginal mucosa of asymptomatic carriers. To examine this hypothesis, we compared vaginal tissue histology in HIV-1–seropositive cases with seronegative cases and determined the immunophenotype of HIV-1–infected cells, their numbers, and their distribution in vaginal mucosa. Vaginal biopsies were performed at four different sites from six asymptomatic HIV-1 Subtype E–infected persons and from six seronegative cases at necropsy and examined histologically. Immunophenotyping was performed using immunoperoxidase for Gag p24 HIV, CD3, CD20, CD68, CD1a, S-100 and p55 antigens and by double labeling, combining immunoperoxidase with alkaline phosphatase using pairs of the above antigens. Twenty of twenty-four vaginal biopsies (83.3%) from HIV-seropositive cases showed definite inflammation compared to five of twenty-four vaginal necropsies (20.8%) from HIV-seronegative cases. One third of HIV-seropositive biopsies (8/24) demonstrated p24-positive cells in the epithelium, whereas three-fourths (18/24) of the biopsies revealed p24-positive cells in the lamina propria. All seropositive patients showed positive cells in at least one biopsy, but not all biopsies contained positive cells. Infected cells were more frequently observed at sites of greater inflammation. The dendritic cell count in HIV-seropositive vaginal epithelium was significantly higher than that observed in the seronegative cases (P =.004). The majority of p24-positive cells in the vaginal epithelium were Langerhans cells (CD1a+/S-100+), whereas in the lamina propria, about half of p24-positive cells were Langerhans-related dendritic cells (p55+ and S-100+) and half were T lymphocytes. In conclusion, the increased propensity for heterosexual transmission of Subtype E may be related to vaginal inflammation, leading to the accumulation of Langerhans cells and related dendritic cells which, once infected with HIV, can act as a reservoir for further virus transmission.