ABSTRACT
Objective To investigate the problem of adverse effects in common AIDS patients and AIDS patients with tuberculosis after highly active antiretroviral therapy (HAART). Methods The case group was composed of 106 patients with both AIDS and tuberculosis. The control group was composed of 134 common AIDS patients. The rates of adverse effects and the increase of CD4 + T cell count in those groups after first year HAART were observed and compared. Results The rates of adverse effects in the case group was 36. 8% ,which was more than that in the control group (26. 9%), but the difference was not significantly different(x2 =2.715, P =0. 099). The count of CD4+ T cell in most of the patients was increased after HAART (P ＜ 0. 01). The increase of CD4 + T cell count in the case group [(147.2 ±137.6)/μl] was higher that in the control group[(142. 1 ± 127. 0)/μl after six months HAART vs. (166. 5±133. 1)/μl in case group], and it was lower than that in control group after nine months HAART [(172.7±107.5)/μl], however the difference was not significant(P ＞0.05). Conclusions HAARTcould reconstruct the immunition of AIDS patients. The increase of CD4 + T cell count did not show significant difference between common AIDS patients and AIDS patients with tuberculosis after HAART. AIDS patients with tuberculosis might not increase the risk of development of adverse effects during HAART.
ABSTRACT
Objective To determine the incidence, clinical manifestation and part of lymphokines which represent the balance of Th1 and Th2 in the role of the immunologic mechanisms for IRIS(immune restoration inflammatory syndromes)in patients initiating HAART(Highly Active Antiretroviral Therapy).Methods A prospective study of all patients initiating HAART was performed. A period of six months tracking initiating HAART was performed. The incidence of IRIS, time of occurrence and clinical disease spectrum were recorded. The main T lymphokines including IL-2, INF-γ, IL-4, IL-10 which on behalf of the balance of Th1 and Th2 were detected. To explore the immunopathologic mechanisms for IRIS, the levels of T lymphokines at pre-HAART, initiating HAART for 1 month, 3months and 6 months were compared in IRIS group and non-IRIS group, healthy group. Results A total of 212 patients were enrolled in this study. 59 patients were diagnosed as IRIS at a median of 21 days after HAART initiation (QR 19 days).The main disease spectrum included tuberculosis, herpes virus infections, pneumocystis jirovecii pneumonia. No matter in the IRIS group or non-IRIS group, the main lymphokines baseline of IL-2, INF-γ reduced and IL-4, IL-10 increased before HAART compared to healthy group (P ＜ 0. 05), which had the tendency to restore balance relations initiating HAART. The lymphokines levels had significant difference between baseline and 6 months initiating HAART (P ＜ 0. 05). The changed levels of lymphokines between IRIS group and non-IRIS group before HAART had significant difference compared to healthy group. IL-2, INF-γ increased level[(11.68 ± 2. 89) pg/ml vs (8.52 ±2.26) pg/ml; (22. 19 ± 6. 22) pg/ml vs (18.34 ±5. 35) pg/ml] and IL-10 decreased level [(19. 21 ± 4. 03) pg/ml vs (23. 19 ± 5.92) pg/ml] had significant difference between IRIS group and non-IRIS group initiating HAART I month(P ＜0. 05). Conclusions The incidence of IRIS during 6 months initiating HAART in HIV/AIDS was 27. 8%, IRIS usually occurred in 1 month initiating HAART. The most common disease spectrum was infectious disease, including tuberculosis and herpes virus infection. Lymphokine of Th1 and Th2 existed unbalance in IRIS group and non-IRIS group before HAART. The unbalance tendency in IRIS group was more obvious. All lymphokines had the trend to recover balance. IL-2, INF-γ significantly increased and IL-10 significantly decreased, which might involve the occurrence of the IRIS.