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Objective@#To investigate the level and timeliness of CD4+T lymphocyte cell (CD4 cell) counts at first measurement among newly reported HIV/AIDS cases in Taizhou City, Zhejiang Province from 2012 to 2021, so as to provide insights into improving the management of HIV/AIDS cases. @*Methods@#Demographic data and first measurement of CD4 cell counts of newly reported HIV/AIDS cases in Taizhou City from 2012 to 2021 were collected from the HIV/AIDS Comprehensive Control System of Chinese Disease Prevention and Control Information System. The level and time of CD4 cell counts at first measurement were descriptively analyzed, and factors affecting CD4 cell counts at first measurement were identified using a multivariable logistic regression model. @*Results@#A total of 4 834 newly reported HIV/AIDS cases were recorded in Taizhou City from 2012 to 2021, including 3 889 men (80.45%), 2 005 cases at ages of 20 to 39 years (41.48%), and 2 130 farmers (44.06%). There were 1 664 cases (34.42%) with CD4 cell counts of <200/mm3 at first detection, 2 576 (53.29%) with CD4 cell counts of 200/mm3 to 499/mm3, and 594 (12.29%) with CD4 cell counts of ≥500/mm3. The proportion of CD4 cell counts of <200/mm3 showed a tendency towards a rise from 2012 to 2021 (χ2trend =4.250, P<0.001). There were 3 465 cases (71.68%) that had an interval of ≤14 days between the first detection of CD4 cell counts and confirmatory HIV test, 740 (15.31%) that had an interval of >14 to 30 days, 315 (6.52%) that had an interval of >30 to 90 days, 135 (2.79%) that had an interval of >90 to 180 days, and 179 (3.70%) that had an interval of >180 days. The proportion of an interval of ≤14 days appeared a tendency towards a rise from 2012 to 2021 (χ2trend=6.874, P<0.001). Multivariable logistic regression analysis identified women (OR=0.630, 95%CI: 0.529-0.751), age of ≥20 years (OR: 1.958 to 3.218, 95%CI: 1.216-5.412), other or unknown routes of HIV infection (OR=1.785, 95%CI: 1.100-2.896), and identification by medical institutions (OR=1.779, 95%CI: 1.497-2.114) as factors affecting CD4 cell counts of <200/mm3 at first measurement. @*Conclusions@#The timely detection of CD4 cell counts at first measurement gradually increased with year among newly reported HIV/AIDS cases in Taizhou City from 2012 to 2021; however, there were still 34.42% of cases with CD4 cell counts of <200/mm3. Gender, age, route of HIV infection, and sample source were factors affecting CD4 cell counts of <200/mm3 at first measurement.
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@#Objective To investigate the prognostic influencing factors and recovery of CD4+ T lymphocytes in elderly HIV/AIDS patients after antiviral therapy by analyzing basic data and clinical follow-up data of elderly HIV/AIDS patients. Methods The clinical data of 3 618 elderly AIDS patients aged ≥50 yeas who received antiretroviral therapy (ART) at HIV ART sites in Liuzhou City from 2005-2015 were collected. The data, including basic information, CD4+ T cell count, WHO clinical stage, infection route and follow-up, were retrospectively analyzed. Kaplan-Meier method was used to compare the differences in patient survival, multivariate Cox regression to analyze the independent influencing factors influencing the risk of death, and to compare the recovery of CD4+ T cell counts during follow-up of patients of different genders. Results During the follow-up period, the 5-year cumulative survival rate up to the observation endpoint was 0.82 (female) and 0.66 (male). Multivariate logistic regression analysis showed that the risk factors affecting the effect of antiviral treatment were age (OR=1.909, 95%CI:1.474-2.464, P<0.001), body mass index (BMI) (OR=0.744, 95%CI: 0.574-0.965, P=0.026), opportunistic infections (OI) (OR=1.223, 95%CI:1.028-1.454, P=0.023), gender (OR=0.692, 95%CI:0.503-0.952, P=0.023) and baseline CD4+ T lymphocytes count (OR=0.563, 95%CI:0.429-0.739, P<0.001). Recovery of CD4+ T lymphocyte counts showed when baseline CD4+ T lymphocyte counts were less than 200 cells/mm3, older women with HIV/AIDS had higher CD4+ T lymphocytes than men at all times of ART treatment (P<0.05). Conclusions Older women have a higher survival rate than older men after five years of antiviral therapy. Age, BMI, gender, OI and baseline CD4+T lymphocyte count may be important indicators that affect the survival of elderly HIV/AIDS patients. Older women showed better recovery of CD4+ T lymphocytes than older men during the 4-year follow-up period after ART.
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Objective@#To investigate the clinical, immunological and virological characteristics of HIV-1 infected patients in the acute phase, for the sake of improving the diagnosis of acute infection with HIV-1.@*Methods@#We retrospectively analyzed the clinical manifestation and laboratory data of patients with acute HIV-1 infection who were admitted to the Center of Infectious Diseases, Guangzhou Eighth People’s Hospital from January 2012 to June 2017.@*Results@#Forty-four patients were enrolled into the study, 86.4% of them were male. 59.1% patients were homosexually transmitted. Clinical symptoms and signs mostly consisted of fever (84.1%), lymphadenopathy (56.8%) and so on, while 15.9% patients had central nervous system symptoms. Most common opportunistic infection included lung infection (50.0%) and oropharyngeal candidiasis (22.7%). Leucopenia (10 patients, 22.7%), and decreased CD4+ T cell count (267.5 cells/μl), inverted CD4+ /CD8+ ratio (86.4%) was mostly seen. Compared to patients who had HIV RNA load less than 6 lg copies/ml, the group of patients who had HIV RNA load more than 6 lg copies/ml had lower levels of CD4+ T cells (t=-3.724, P=0.001).@*Conclusions@#Patients with acute HIV infection have many different kinds of clinical symptoms and can be accompanied by opportunistic infection, and with high viremia.
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Abstract Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.
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Humans , Male , Female , Adult , HIV Infections/complications , Anti-Retroviral Agents/adverse effects , Hearing Loss/etiology , Hearing Loss/chemically induced , Audiometry, Pure-Tone , Auditory Threshold , HIV Infections/drug therapy , Prospective Studies , AIDS-Related Opportunistic Infections/complications , CD4 Lymphocyte CountABSTRACT
Objective To summarize the clinical features of encephalopathy caused by Toxoplasma gondii in AIDS patients for improving clinical diagnosis and treatment of such cases. Methods The clinical data of patients with AIDS and toxoplasmic encephalopathy were collected retrospectively. The prevalence of toxoplasmic encephalopathy in AIDS patients was analyzed. The anti-toxoplasmic efficacy of trimethoprim-sulfamethoxazole (SMZ-TMP) plus azithromycin was reviewed. Results Toxoplasmic encephalopathy was reported in about 10.0％ of the AIDS patients complicated with central nervous system disorder. Headache, fever, and limb movement disorder were the most common symptoms. Head CT/MRI scan showed that 89.5％ of the patients had multiple lesions, mostly in the parietal lobe, temporal lobe and basal ganglia. Enhancement scan revealed thatcircular enhanced foci in 76.9％ of the patients, nodular enhanced foci in 59.0％ of the patients, and surrounding edema in 79.5％ of the patients. The mean CD4+ T lymphocytes was (65.8±59.3)/μL.Anti-toxoplasmic IgG was positive in 50.0％ of the patients, higher than that of IgM (11.5％) (P＜0.05). The positive rate of IgG antibody specific for Toxoplasma gondii tested by ELISA was higher than that detected by rapid colloidal gold immunoassay (P＜0.05). Increased cerebrospinal fluid pressure was found in 42.6％ of the patients. Increased protein in CSF was identified in 66.0％ of the patients. Most (84.2％) patients were improved after treatment with SMZ-TMP plus azithromycin. Conclusions Toxoplasmic encephalopathy is one common central nervous system disease in AIDS patients. The clinical symptoms are nonspecific. There are some features in imaging examination. Low count of CD4+ T lymphocytes makes patients more susceptible to Toxoplasma infection. The anti-toxoplasmic IgG antibody may be helpful for diagnosis. The results of cerebrospinal fluid examination are not specific. SMZ-TMP in combination with azithromycin promises good treatment effect.
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Objective@#To investigate the optimal duration of pegylated-alpha interferon (Peg-INFα) combined with ribavirin (RBV) in treating chronic hepatitis C infection in human immunodeficiency virus (HIV)-infected patients.@*Methods@#A multicenter prospective study was conducted. The study subjects were divided into two groups; HIV/HCV co-infections (Group A, n = 158) and control with HCV-monoinfections (Group B, n = 60). All recruited patients received standard Peg-INFα plus RBV therapy. Group A was divided into 3 subgroups according to CD4+ cell counts: A1 subgroup, 79 cases, CD4+ counts > 350 cells /μl, who received anti-HCV before combination antiretroviral therapy(cART); A2 subgroup, 45 cases, CD4+ counts between 200 and 350 cells/μl, who did not start anti-HCV until they could tolerate cART well; A3 subgroup, 34 cases, CD4+ counts < 200 cells /μl, cART was administered first, and anti-HCV therapy was started when CD4+ counts > 200 cells/μl. The anti-HCV efficacy of two groups and 3 subgroups were compared. Statistical analysis for normal distribution and homogeneity of variance data was calculated by t-test and the counting data was analyzed by χ 2 test. The Mann-Whitney U test was used for non-normal data. A one-way analysis of variance (ANOVA) was used for the comparison of multiple groups, followed by SNK method. Multiple independent samples were used for non-parametric tests.@*Results@#There was no significant difference in age and baseline HCV RNA levels between groups and subgroups (P > 0.05). By an intent-to-treat (ITT) analysis, in Group A, the ratio of complete early virological response (cEVR) rate was 75.3% (119/158), the ratio of end of treatment virological response (eTVR) rate was 68.4% (108/158), and the ratio of sustained virological response (SVR) rate was 48.7% (77/158); in Group B, the ratio of cEVR rate was 93.3% (56/60), the ratio of eTVR rate was 90.0% (54/60), and the ratio of SVR rate was 71.7% (43/60); The therapeutic index of Group A were lower than those of Group B (P≤0.05). By per-protocol (PP) analysis, the ratio of cEVR rate in Group A [75.2% (88/112)] was still lower than that in Group B [93.3% (56/60)], but no significant differences were found in the ratio of eTVR rate and SVR rate between 2 groups (P > 0.05). Comparing the efficacy of subgroups (A1, A2 and A3) by ITT analysis, the ratios of cEVR rate were respectively 78.5% (62/79), 75.6% (34/45) and 67.6% (23/34); the ratios of eTVR rate were respectively 68.4%(54/79), 80.0%(36/45)and 52.9%(18/34); and the ratios of SVR rate were respectively 41.8%(33/79), 64.4%(29/45)and 44.1%(15/34). The ratio of eTVR in subgroup A2 was obviously higher than that in subgroup A3 and the ratio of SVR in subgroup A2 was statistically higher than that of subgroup A1(P≤0.05). However, by PP analysis, no significant differences of the therapeutic indexes were found among the respective subgroups (P > 0.05).@*Conclusion@#HIV-HCV co-infected patients would have better anti-HCV efficacy with Peg-INFα-2a plus RBV than HCV- monoinfected patients. The best time for initiating anti-HCV therapy in HIV-HCV co-infected patients is when CD4+ counts 200 cells/ μl.
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Objective:To investigate the regulation of JAK2-STAT3/STAT5 signaling pathway on CD4+T lymphocyte subsets in children with food allergy. Methods:78 children with food allergy from January 2015 to March 2017 in our hospital were enrolled as the allergy group,and 78 healthy children in our hospital were enrolled as the control group. All the patients were divided into A,B,C,D groups according to ages. A group was less than or equal to 1 year old,B group of 1-3 years old(not including 1 year old),group C 3-6 years old(not including 3 years old),group D 6-11 years old(not including 6 years old). Flow cytometry was used to detect the CD4+T lymphocyte subsets Th1,Th2,Th17 and regulatory T cells(Treg) and qPCR was used to detect the mRNA expression of peripheral blood mononuclear cells of JAK2,STAT3,STAT5. Compare the CD4+T lymphocyte subsets and JAK2,STAT3,STAT5 expression level differences among two groups children and further analysis the correlation of JAK2-STAT3/STAT5 signal transduction pathway and CD4+T lymphocyte subsets. Results:The percentage of Th1 and Treg lymphocytes and Th1/Th2 and Treg/Th17 ratio of the group A,B, C in control group were significantly higher than the allergy group,while Th2,Th17 lower than allergy group. The expression mRNA level of JAK2,STAT3 and STAT5 in the control group were significantly lower than the allergic group,the difference was statistically significant(P＜0. 05). The correlation for JAK2,STAT3,STAT5 and CD4+T level of lymphocyte subsets were compared,correlation coefficient of Th1,Treg,Th1/Th2,Treg/Th17 were all higher than 0(P＜0. 05),and the correlation coefficient of Th2 and Th17 were smaller than 0(P＜0. 05). However in group D,there was no significance. Conclusion:The JAK2-STAT3/STAT5 signaling pathway in young children with food allergy has obvious activation and CD4+T lymphocyte subsets change,and the JAK2-STAT3/STAT5 signaling pathway can effectively regulate the distribution of CD4+T lymphocyte subsets. With the age of children increasing,the correlation of these effects is weakened and disappeared.
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Objective To evaluate the effect of galactomannan(GM) test combined with CD4+ T lymphocyte detection on early diagnosis of invasive aspergillosis (IA) in patients with acquired immunodeficiency syndrome (AIDS).Methods 197 AIDS patients who were suspected with IA in a hospital from January 2014 to December 2016 were analyzed retrospectively,they were divided into confirmed IA group (n =35),clinically diagnosed IA group (n=96,suspected cases),and non-IA group(n =66),sensitivity and specificity of GM test and GM test combined CD4+ T lymphocyte counting for diagnosing IA were compared.Results In confirmed IA group,clinically diagnosed IA group,and non-IA group,the medium values of GM (minimum,maximum) were 1.29(0.65,1.84)pg /mL,0.91(0.36,1.23)pg /mL,and 0.11(0.28,0.72)pg /mL respectively,CD4+ T lymphocyte counting were 45 (29,69)cells/μL,79(35,99) cells/μL,and 89 (59,158) cells/μL respectively,GM value and CD4+ T lymphocyte counting among three groups were significantly different(all P＜0.05).The sensitivity and specificity of single GM test for diagnosing IA in AIDS patients were 64.9％ and 72.7％ respectively;sensitivity and specificity of two consecutive GM test within one week for diagnosing IA were 72.5 ％ and 95.5 ％ respectively;sensitivity and specificity of GM test combined CD4+ T lymphocyte counting were 86.3％ and 90.9％ respectively.Conclusion GM test has better diagnostic value for IA in AIDS patients,continuous GM test and GM test combined CD4+ T lymphocyte counting will further improve the clinical diagnostic value for IA.
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Objective To compare the differences of CD4 +T lymphocyte (CD4) counts between patients aged 18 and over,to explore the effect of age on treatment,36 months after having received the China National Free AIDS Antiretroviral Treatment on HIV/AIDS.Methods Through the National ART Information Ssystem,we selected those HIV/AIDS patients who initiated the ART 36 months after the ART,between January 1,2010 and December 31,2012 in Guangzhou,Liuzhou and Kunming.Patients were divided into age groups as 18-49,50-59 and 60 or over year olds,at the baseline of treatment.Under different levels of baseline CD4 counts,we chose the baseline and different time-point of CD4 counts as dependent variables,applied mixed linear model to analyze the effects of age,viral suppression,gender,baseline CD4/CDs ratio and initial treatment regimen.Results A total of 5 331 HIV/AIDS patients were recruited.No differences were found on age group ratios between different levels of baseline CD4 counts.At the level of baseline CD4＜200 cells/μl,both the 50-59 and 60 or above years old groups had lower CD4 counts than the 18-49 year-old group,within 36 months after the initiation of ART.However,at the baseline CD4 level of 200-350 cells/μl,no signiftcant differences on CD4 counts between the 50-59 year-old and 18-49 year-old groups were noticed.CD4 counts seemed lower in the 60 and above year-old group than in the 18-49 year-old group.Conclusion Age might serve as an influencing factor on CD4 counts within 36 months after the initiation of ART,suggesting that earlier initiation of ART might be of help to the recovery of immune function in the 50-59 year-old group.
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Objective To compare the differences of CD4 +T lymphocyte (CD4) counts between patients aged 18 and over,to explore the effect of age on treatment,36 months after having received the China National Free AIDS Antiretroviral Treatment on HIV/AIDS.Methods Through the National ART Information Ssystem,we selected those HIV/AIDS patients who initiated the ART 36 months after the ART,between January 1,2010 and December 31,2012 in Guangzhou,Liuzhou and Kunming.Patients were divided into age groups as 18-49,50-59 and 60 or over year olds,at the baseline of treatment.Under different levels of baseline CD4 counts,we chose the baseline and different time-point of CD4 counts as dependent variables,applied mixed linear model to analyze the effects of age,viral suppression,gender,baseline CD4/CDs ratio and initial treatment regimen.Results A total of 5 331 HIV/AIDS patients were recruited.No differences were found on age group ratios between different levels of baseline CD4 counts.At the level of baseline CD4＜200 cells/μl,both the 50-59 and 60 or above years old groups had lower CD4 counts than the 18-49 year-old group,within 36 months after the initiation of ART.However,at the baseline CD4 level of 200-350 cells/μl,no signiftcant differences on CD4 counts between the 50-59 year-old and 18-49 year-old groups were noticed.CD4 counts seemed lower in the 60 and above year-old group than in the 18-49 year-old group.Conclusion Age might serve as an influencing factor on CD4 counts within 36 months after the initiation of ART,suggesting that earlier initiation of ART might be of help to the recovery of immune function in the 50-59 year-old group.
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Chronic prostatitis is a common male disease with a high incidence rate and a serious impact on the patients' quality of life. The pathogenesis of chronic prostatitis remains unclear though it is considered to be possibly related to infection, inflammation, and abnormal pelvic nerve muscle activity. Recently, a growing number of studies have reported immune imbalance and changes of inflammatory cytokines in patients with chronic prostatitis as well as a close correlation of abnormal immune response with the occurrence of diseases, pelvic pain symptoms, mental symptoms, hyperalgesia, and so on. This review summarizes the latest advances in the studies of immunologic mechanisms of chronic prostatitis.
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Humans , Male , Chronic Disease , Cytokines , Blood , Hyperalgesia , Allergy and Immunology , Pelvic Pain , Allergy and Immunology , Prostatitis , Blood , Allergy and Immunology , Quality of LifeABSTRACT
Objective:To determine the effects of Foxp3-overexpressing lung cancer cells on activated CD4+T lymphocyte.Methods: Stable Foxp3-overexpressing lung cancer cells NCIH-1299,NCIH-hFoxp3,was generated by transfection of NCIH-1299 cells with plasmid pcDNA3-hFoxp3 mediated by Lipofectamine 2000 and by selection with G418,and validated by quantitative PCR and Western blot.The expression levels of IL-8 and IL-10 secreted by NCIH-hFoxp3 and NCIH-control were measured by ELISA.IL-2 secrection by activated human CD4+T lymphocyte which was tested after stimulation with 20% conditioned medium of NCIH-hFoxp3 and NCIH-control cells.The proliferation of activated human CD4+ T lymphocytes was assessed by MTT after coculture with NCIH-hFoxp3 cells.The adhesive ability of activated human CD4+ T lymphocytes was probed with NCIH-hFoxp3 cells by immunocytochemistry.Results: Compared with NCIH-control cells,NCIH-hFoxp3 secreted high level of IL-10 and low level of IL-8.NCIH-hFoxp3 with Foxp3 overexpression significantly suppressed the proliferation,adhesive potential and IL-2 expression by activated CD4+ T cells.Conclusion: Suppression of immune activities of activated CD4+ T cells by Foxp3 overexpression in lung cancer cells may correlate with cytokine IL-8 and IL-10,which can contribute lung cancer progression.
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Objective To investigate the band pattern characteristics of Western bolt (WB) by analyzingthe change of anti-virus antibodies from patients with different clinical stages of human immunodeficiency virus 1 (HIV-1) infection.Methods Antibodies were detected by WB test,CD4+ T cells by flow cytometer.Results Among 208 cases,193 male cases accounted for 92.79％,and 163 cases of men who have sex with men (MSM) accounted for 78.37％.The antibodies against viral protein gp160,gp120,gp41,p66,p51,p31,p24 showed high positive rates,and no significant different was detected across different clinical stages.The positive rate of p55 antibody,encoding by gag gene,was significantly higher in those HIV positive individuals infected via homosexual compared with HIV-1 positive individuals through heterosexual contact (P＜0.05).The 5 common WB bands patterns were as following:all bands①,missing p55②,missing p39③,missing p55 + p39④ and missing p39 + p55 + p17⑤.Primary stage infection group showed the highest appearance rate of all bands (44.2％).Conclusions The WB bands patterns and CD4+ T lymphocyte counts can help to judge immune status,determine disease stages and monitor disease progression.We should take effective measures for the MSM and floating population.
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Objective To investigate the band pattern characteristics of Western bolt (WB) by analyzingthe change of anti-virus antibodies from patients with different clinical stages of human immunodeficiency virus 1 (HIV-1) infection.Methods Antibodies were detected by WB test,CD4+ T cells by flow cytometer.Results Among 208 cases,193 male cases accounted for 92.79％,and 163 cases of men who have sex with men (MSM) accounted for 78.37％.The antibodies against viral protein gp160,gp120,gp41,p66,p51,p31,p24 showed high positive rates,and no significant different was detected across different clinical stages.The positive rate of p55 antibody,encoding by gag gene,was significantly higher in those HIV positive individuals infected via homosexual compared with HIV-1 positive individuals through heterosexual contact (P＜0.05).The 5 common WB bands patterns were as following:all bands①,missing p55②,missing p39③,missing p55 + p39④ and missing p39 + p55 + p17⑤.Primary stage infection group showed the highest appearance rate of all bands (44.2％).Conclusions The WB bands patterns and CD4+ T lymphocyte counts can help to judge immune status,determine disease stages and monitor disease progression.We should take effective measures for the MSM and floating population.
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Objective To understand the correlations between HIV-1 subtypes and changes in CD4+T cell count over time in patients with different subtypes of HIV-1 infection.Methods A total of 94 patients who were diagnosed with HIV-1 infection in Nanjing and received at least twice CD4+T cell counting test before antiretroviral therapy (ART) were recruited in this study.Descriptive analysis was used to present the rates of CD4+T cell decline for different HIV-1 subtypes.Logistic regression analysis and nonparametric test were conducted to investigate the factors responsible for CD4+T cell decline and to analyze the correlations between the rates of CD4+T cell decline and HIV-1 subtypes.Results The median monthly rate of CD4+T cell decline was-2.20 [interquartile range (IQR):-11.36-2.13] cell/μl.Of all patients,25.5% (24/94) had a significant decline (≥30%) in CD4+T cell count.Compared with the patients infected with CRF01_AE,those infected with CRF07_BC (OR=0.28,95%CI: 1.7-6.5) or other subtypes (OR=0.16,95%CI: 1.0-2.9) had a lower risk of significant decline in CD4+T cell count.In addition,results of the nonparametric test showed that the patients infected with CRF01_AE (M=-21.54,IQR:-30.97——11.92 cell/μl) had a faster CD4+T cell loss than those infected with CRF07_BC (M=-11.26,IQR:-14.06——5.63 cell/μl) (P=0.033).Conclusion HIV-1 subtype is associated with the rate of CD4+T cell decline.It is important to monitor the changes in CD4+T cell count in patients infected with CRF01_AE and to carry out timely ART.
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INTRODUCCIÓN: el debut del sida es una forma de presentación de la enfermedad caracterizada por alteración del estado general, síndrome de desgaste, graves infecciones oportunistas, neoplasias y alteraciones neurológicas. El tratamiento con antirretrovirales ha aumentado la esperanza de vida de estos pacientes. OBJETIVOS: identificar las enfermedades oportunistas, asociadas a la condición clínica de los pacientes bajo estudio, y su relación con el conteo de linfocitos T CD4+ y la carga viral así como, evaluar la mortalidad en el grupo de pacientes estudiados y su relación con las enfermedades oportunistas. MÉTODOS: se realizó un estudio observacional prospectivo de corte transversal. El tamaño de la muestra estuvo condicionado al universo total de pacientes VIH/sida del servicio de Medicina del Instituto de Medicina Tropical "Pedro Kourí". La muestra (55 pacientes) se seleccionó, se tuvo en cuenta los sujetos que fueron diagnosticados con debut de sida y presentaron enfermedades oportunistas durante un año. RESULTADOS: las enfermedades oportunistas infecciosas como neurotoxoplasmosis 21,8 % y neumonía por Pneumocystis jirovecii 12,7 % fueron los eventos definitorios de sida predominantes. No hubo asociación estadística significativa, con el conteo bajo de linfocitos T CD4+ bajos y carga viral elevada. En los pacientes mayores de 50 años con más de una enfermedad oportunista el riesgo de morir fue 4,72 veces mayor que para el resto. CONCLUSIONES: las enfermedades oportunistas infecciosas como neurotoxoplasmosis y Pneumocystis jirovecii,fueron los eventos definitorios de sida predominantes. La mortalidad asociada a sida en los pacientes mayores de 50 años aumentó en los individuos que presentaron más de una enfermedad oportunista. Estos resultados son útiles para el diseño de estrategias de tratamiento que disminuyan la aparición de las enfermedades oportunistas y mejoren aun más, la supervivencia de los pacientes VIH/sida.
INTRODUCTION: onset of aids is a form of presentation of the disease that is characterized by altered general condition, wornout syndrome, serious opportunistic infections, neoplasias and neurological alterations. The antiretroviral treatment has increased the life expectancy of these patients. OBJECTIVES: to identify the opportunistic diseases associated to the clinical condition under study and their linking to the CD4+ T lymphocyte count and the viral load as well as to evaluate the mortality in the studied group and its relationship with opportunistic diseases. METHODS: prospective, observational and cross-sectional study of a sample of 55 patients. The size of the sample depended on the total universe of HIV/aids patients in the medicine service of "Pedro Kouri" Tropical Medicine Institute. The study took into account those subjects who were diagnosed with onset of aids and presented with opportunistic diseases during one year. RESULTS: infectious opportunistic diseases such as neurotoxoplasmosis (21.8 %) and pneumonia caused by Pneumocystis jirovecii (12.7 %) were the predominant defining events of aids. There was no statistically significant association with low CD4+ T lymphocyte count and high viral load. In patients over 50 years of age with more than one opportunistic disease, the risk of dying was 4.72 times higher than in the rest of the group. CONCLUSIONS: infectious opportunistic diseases as neurotoxoplasmosis and Pneumocystis jirovecii were the prevailing defining events of aids. Aids-associated mortality in patients aged over 50 years increased in individuals who presented more than one opportunistic disease. These results are useful for the design of treatment strategies that reduce the occurrence of opportunistic diseases and improve even more the survival of HIV/aids patients.
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Humans , Pneumonia, Pneumocystis , Acquired Immunodeficiency Syndrome , Toxoplasmosis, Cerebral , AIDS-Related Opportunistic Infections , Cross-Sectional Studies/methods , Prospective Studies , Observational StudyABSTRACT
BACKGROUND/AIMS: Advanced human immunodeficiency virus (HIV) infection, despite sustained viral suppression by highly active antiretroviral therapy (HAART), is a risk factor for poor immunologic recovery. However, some patients with advanced infection do show immunologic recovery. In this study, predictive factors of immunologic recovery were analyzed in advanced HIV patients showing sustained viral suppression. METHODS: A case-control study was conducted in HIV-infected adult patients with HIV-1 RNA or = 500/mm3 at 4 years with HAART). To analyze the CD4 T cell kinetics, the CD4 slope (monthly changes in the CD4 T cell count) was estimated for each patient using a linear regression between the CD4 T cell count and the time since HAART initiation. RESULTS: Of 102 eligible patients, 73 had advanced HIV, and 33 (45.2%) showed immunologic recovery. The median CD4 slopes (cells/mm3 per month) during 0 to 6 and 0 to 12 months of HAART in the 73 advanced patients were significantly higher in responders than in non-responders (0 to 6 months, 38.6 vs. 22.8; 0 to 12 months, 24.5 vs. 13.5). Multivariate analyses showed opportunistic infections at the start of HAART (adjusted odds ratio [OR], 0.28) and a CD4 slope > or = 20 during 0 to 12 months of HAART (adjusted OR, 10.10) were independently associated with immunologic recovery. CONCLUSIONS: The CD4 slope can be an early predictor of long-term immunologic recovery in advanced HIV patients.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Biomarkers/blood , CD4 Lymphocyte Count , Case-Control Studies , Chi-Square Distribution , HIV Infections/diagnosis , HIV-1/drug effects , Linear Models , Logistic Models , Monitoring, Immunologic/methods , Multivariate Analysis , Odds Ratio , Predictive Value of Tests , RNA, Viral/blood , Time Factors , Treatment Outcome , Viral LoadABSTRACT
Objective:To study the clinicopathologic features of IgG4-related pulmonary inflammatory pseudotumor (IRPIP), and its correlations with CD4+T lymphocytes and interleukin-10 (IL-10) expression,and to investigate the immunopathological factors in the disease of IgG4-related pulmonary inflammatory pseudotumor .Methods: Expressions of IL-10, CD3, CD20, CD4, CD8 were examined by immunohistochemistry in 17 cases of IgG4-related pulmonary inflammatory pseudotumor tissues and 15 cases of IgG4-nonrelated pulmonary inflammatory pseudotumor tissues ( INPIP) .To analyze the differences of these indexes expression between IRPIP and INPIP.Results: In group of IRPIP, the CD4+T lymphocytes number and the ratio of CD 4+T lymphocytes number/CD8+T lymphocytes number were all apparently higher than those in the group of INPIP (P=0.006,0.023,respectively).The cells numbers of CD3,CD8,IL-10 positive expression in IRPIP were higer than those in INPIP ,and the cells number of CD20 positive expression in IRPIP was lower than that in INPIP,but these differences all had no statistical significance (P>0.05).In IRPIP,the number of IgG4+plasmacytes was positively related to the number of IL-10+cell (r=0.517),the correlation had statistical significance (P=0.033). Conclusion:The number of CD4+T lymphocytes increased in addition to the increased number of IgG 4+plasmacytes in the lesion back-ground of IRPIP,and the number of IgG4+plasmacytes was positively related to the number of IL-10+cells.It is suggested that the increased number of Th 2 lymphocyte and the increased secretion of cytokine IL-10were are immunopathological factors participated in the disease of IRPIP .
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Background Mooren 's ulcer is an immune-related corneal inflammatory disease,and its pathogenesis remains below understood.Previous studies showed that the imbalance of T helper cell type 1 (Th1) and Th2 cell play important roles in the development of some autoimmune diseases.Thereby the influence of Th1/Th2 cells on the pathogenesis of Mooren's ulcer is being concerned.Objective This study was to investigate the change of Th1 and Th2 subsets in periphery blood of patients with active Mooren's ulcer.Methods Eleven consecutive patients with active Mooren's ulcer and 8 age-and gener-matched healthy controls were included in Zhongshan Ophthalmic Center,Sun Yat-sen University from January 2012 to July 2013 under the approval of Ethic Committee of this hospital and informed consent of each subject.The peripheral blood samples of all the subjects were obtained separately and periphery blood mononuclear cells (PBMCs)were isolated.The percentages of Th1 and Th2 in the PBMCs were assayed by flow cytometer.The relative expressions of T-bet mRNA,GATA-3 mRNA and signal transducer and activator of transcription 5 (Stat5) mRNA in the PBMCs were examined and compared by real-time fluorescence quantitative PCR (RT-qPCR) Results The percentage of Th1 cells in CD4+ T cells and Th1/Th2 value was 0.21％ (0.11％,0.31％) and 8.01 (4.49,12.01) respectively in the Mooren's ulcer group,which were significantly lower than 0.35％ (0.22％,0.71％)and 23.90 (22.49,33.49)in the normal control group,respectively (Z =-2.01,P =0.04 ; Z =-3.06,P =0.00).However,no significant difference was found in the percentage of Th2 between the two groups (Z=-1.98,P＞0.05).The relative expressions of T-bet mRNA and GATA-3 mRNA in PBMCs were significantly lower in the Mooren's ulcer group than those in the normal control group (Z =-3.47,-3.06,both at P=0.00) ;While the relative expression of Stat5 mRNA in PBMCs was insignificant changed between the two groups (Z =-1.05,P =0.33).Conclusions Th1 and Th2 cells are unbalanced in the active Mooren's ulcer patients.In addition,the down-expression of relevant transcription factors in peripheral blood also is seen in these patients.It is inferred that Th1 and Th2 cells may participate in the progress of Mooren's ulcer.
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Objective To establish a experimental autoimmune thyroiditis(EAT) rat model and to observe pathological change levels of CD4 + T lymphocyte infiltration in thyroid tissues under different iodine nutrient conditions.Methods One hundred and thirty-five four weeks old female Lewis rats(body weight about 80 g) were divided into control(NC),model(TG),high iodine-Ⅰ (HⅠ),high iodine and model-Ⅰ (HⅠ + TG),high iodine-Ⅱ (H Ⅱ),high iodine and model-Ⅱ (H Ⅱ + TG) groups according to body weight by random number table.There were 20 rats in NC,HⅠ and H Ⅱ groups,and 25 rats in TG,H Ⅰ + TG and H Ⅱ + TG groups.The rats of HⅠ and HⅠ + TG groups drank deionized water containing iodine 25.7 mg/L; rats of HⅡl and H Ⅱ + TG groups drank deionized water containing iodine 423.3 mg/L; rats of NC and TG groups drank distilled water.Rats of TG,HⅠ + TG and H Ⅱ + TG groups were immunized with 0.1 ml thyroglobulin(Tg,8.0 g/L) in incomplete Freunds adjuvant (IFA),once two weeks for three times.Urine samples were collected after immunization for 8 weeks; after immunization for 15 weeks,rats were killed,blood samples and thyroid tissues were taken.Urinary iodine was determined by arsenic-cerium catalytic spectrophotometry; pathological changes in thyroid tissue were observed by Hematoxylin-Eosin (HE) method ; immunohistochemical method was used to identify the infiltration of inflammatory cells in thyroid tissue.Results The difference of rat thyroid relative quality between groups was statistically significant (F =44.428,P ＜ 0.05).Compared with NC group (0.085 25 mg/g),thyroid relative qualities were increased in experimental groups (TG,HⅠ,HⅠ + TG,H Ⅱ,H Ⅱ + TG groups:0.095 22,0.092 85,0.097 48,0.096 55,0.095 33 mg/g,all P ＜ 0.05).The difference of urinary iodine between groups was statistically significant(x2 =106.4,P＜ 0.05).Compared with NC group(456.45 μg/L),urinary iodine levels in TG,HⅠ,HⅠ +TG,HⅡ,HⅡ + TG groups(800.08,18 633.20,13 869.00,87 889.97,61 661.51 μg/L) were increased(all P ＜ 0.05).The pathological changes of rats in each group were increased with increasing of iodine intake.Rats in NC group had normal thyroid structure; in TG,HⅠ groups,a small amount of lyrnphocytes were found between thyroid follicular; the lymphocytes infiltrated into the follicular in HⅠ + TG group; rats in H Ⅱ,H Ⅱ + TG groups had follicular fusion,and diffused inflammatory cell infiltration.There was a tendency of increased CD4+ T lymphocyte infiltration in rat thyroid with increasing of iodine intake.There was no CD4+ T lymphocyte positive staining in NC group; TG group had a small amount of positive cells; HⅠ group had scattered yellowish-brown positive cells.HⅠ + TG group had a focal lymphocyte infiltration; HⅡ group had follicular expansion obviously; follicular structure damage in HⅡ + TG group was serious,and showed a diffused yellow dye.Conclusion Excessive iodine intake and Tg immunization can induce and aggravate the incidence of autoimmune thyroiditis in rats,and pathological change situation has exacerbated with increasing of iodine intake; excessive iodine intake may also lead to an increased tendency of CD4+ T lymphocytes infiltration in thyroid tissue of EAT rat.