What is the relationship between Human Immunodeficiency Virus (HIV) and dendritic cell neoplasms?

From the Guidelines

HIV infection is not directly linked to dendritic cell neoplasms, but antiretroviral therapy may have a potential role in treating related conditions like adult T-cell leukemia-lymphoma (ATL). The relationship between HIV and dendritic cell neoplasms is not well-established, but research on related conditions provides insight into potential therapeutic approaches.

• The use of antiretrovirals like zidovudine, tenofovir, and raltegravir has shown efficacy against HTLV-1 in tissue culture, as reported in a 2019 study 1.
• However, the effectiveness of these agents in vivo, particularly in targeting dendritic cell neoplasms, remains uncertain.
• A recent phase I study using vaccination with Tax peptide-pulsed dendritic cells in patients with aggressive ATL demonstrated promising results, with an induction of immune response against Tax and long-term remission 1.
• The combination of AZT/IFN has also shown activity in treating ATL, although the mechanism of action is unclear, and it is uncertain whether these drugs function via antiviral activity or other mechanisms 1.
• The primary approach to managing dendritic cell neoplasms in the context of HIV or related conditions like ATL involves optimizing antiretroviral therapy and considering specific cancer treatments, with a focus on restoring immune function and reducing the risk of tumor progression. Key considerations in managing these conditions include:
• Regular monitoring of immune function and tumor response
• The potential role of immunotherapy, such as vaccination with Tax peptide-pulsed dendritic cells, in treating related conditions like ATL
• The importance of optimizing antiretroviral therapy to reduce the risk of tumor progression and improve overall outcomes.

From the Research

Relationship between HIV and Dendritic Cell Neoplasms

• The relationship between Human Immunodeficiency Virus (HIV) and dendritic cell neoplasms is complex, with evidence suggesting that HIV infection may play a role in the formation of certain dendritic cell tumors 2.
• A case report of a 47-year-old man with HIV infection and a history of hypertension described the development of a follicular dendritic cell (FDC) sarcoma, a rare type of tumor that can occur in lymph nodes and extranodal sites 2.
• Research studies have demonstrated the presence of HIV-related FDC hyperplasia, suggesting a possible link between HIV infection and the development of FDC sarcomas 2.

Dendritic Cells and HIV Infection

• Dendritic cells (DCs) are key phagocytic cells that play a crucial role in the innate and adaptive immune responses against HIV-1 infection 3.
• DCs can process and present HIV-1 antigens to T cells, initiating a directed response against infected cells 3.
• The use of DC-based immunotherapy has been explored as a potential treatment for HIV-1 infection, with studies demonstrating the safety and efficacy of autologous DC vaccines in inducing HIV-1-specific T-cell responses 3, 4.

Dendritic Cells and HIV Persistence

• Follicular dendritic cells (FDCs) can retain infectious HIV within a non-degradative cycling compartment, allowing the virus to persist in the body even in the presence of antiretroviral therapy (ART) 5.
• The retention of infectious HIV by FDCs can contribute to the persistence of the virus and the difficulty in achieving a cure for HIV infection 5.
• Activated dendritic cells and monocytes have been observed in HIV-infected individuals with suboptimal CD4 recovery, and the expression of interferon-inducible protein-10 (IP-10) in monocytes has been associated with low future CD4 recovery 6.