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DILS CD8 Histology — SCE Infectious Diseases MCQ

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HardHIV MedicineDILS CD8 HistologySCE Infectious Diseases

A 40-year-old man with advanced HIV (CD4 25) develops bilateral parotid enlargement, dry mouth, and bilateral lacrimal gland swelling. He has diffuse infiltrative lymphocytosis syndrome (DILS). What is the key histological finding?

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Correct answer: D — CD8+ T-lymphocyte infiltration of affected glands (parotid, lacrimal) — DILS is a CD8-driven lymphoproliferative disorder unique to HIV, distinct from Sjögren (which is driven by CD4/B-cell autoimmunity)

DILS is characterised by massive CD8+ T-cell infiltration of exocrine glands (parotid, lacrimal, minor salivary glands) and other organs (lungs, kidneys, nerves). It is unique to HIV and is NOT Sjögren syndrome — which is autoantibody-mediated (anti-Ro/La) with CD4/B-cell infiltration. DILS typically responds to ART (reducing viral antigen load and CD8 expansion). Additional organ involvement can include: lymphocytic interstitial pneumonitis (LIP), tubulointerstitial nephritis, and peripheral neuropathy. Corticosteroids may be used for severe extra-glandular disease.

Reference: BHIVA 2022 – DILS; Lancet HIV 2020