Clinical Manifestation, Risk Factors and Lymphokines in the Role of the Immune Mechanism for IRIS Initiating HAART
|School||Central South University|
|Keywords||Human immunodeficiency virus type 1 AIDS Anti -retroviral therapy Immunity Reconstitution inflammatory syndrome Lymphokines|
Background and purpose: highly active anti-retroviral therapy (HAART) in HIV / AIDS patients, making HIVRNA was inhibited, accompanied by the increase in CD4 cell count, and ultimately reduce the incidence of opportunistic infections, and to improve the clinical condition and prolong the patient's life. However, shortly after HAART initiation (multi-March), the the immune imbalance due to the reconstruction of the antigen-specific immune response, making clinical atypical infection or are under control of infection anomalous increase and other inflammatory or tumor known as immune reconstitution inflammatory response syndrome (IRIS), immune reconstitution syndrome or immune reconstitution disease (IRD). IRIS is the most common infection. Mortality after its occurrence, its diagnosis is also a certain degree of difficulty, thereby affecting the choice of treatment and prognosis of judgment. Different countries, different regions due to the different basis of disease spectrum, virus epidemic strains and ethnic differences, different timing and program of antiviral therapy and other factors, caused the reported the IRIS clinical features, disease there is a certain difference. Foreign countries reported more than retrospective studies, while China is rarely reported in the area; exploration risk prediction factors for IRIS, but there are different views; For IRIS occurred immunopathogenesis and not very clear, and research. HIV / AIDS receiving HAART study to collect general information to track the progression of the disease, and the detection of the relevant series of indicators, to try to understand the region IRIS common spectrum of disease, clinical manifestations, increase awareness of the IRIS judgment; find risk factors for the occurrence of IRIS; immunopathogenesis explore possible from the the lymphokines representatives Th1/Th2 balance between varying levels. Methods: A prospective study method, for three years, all inpatient and outpatient highly active anti-retroviral therapy (HAART) for HIV / AIDS tracking follow-up observation period of six months, according to the more recognized standard diagnosis of IRIS and non- IRIS, the IRIS incidence, time of occurrence, the clinical spectrum of disease; General before the start of HAART on the the IRIS set of non-IRIS group, including gender, age, clinical stage, route of infection the number and categories of basic infection, infection control situations (fever the presence and extent of instead) after the start of HAART programs, CD4, HIVRNA level and HAART 3,6 CD4 level of growth, HIVRNA drop of into multivariate logistic regression analysis to compare (part of the random sampling test and t test) to detect the IRIS risk factors; separate frozen specimens pre-serum specimens from different periods, selected at random from the the IRIS group of non-IRIS group in some specimens, on behalf of the Th1/Th2 balance between T lymphokines: IL -2, IFN-γ, IL-4, IL-10 detection, and healthy group control before and HAART, HAART after January, March and June, when the level of changes in comparison to explore part of the IRIS occurred immunopathogenesis. The results: a total of a total of 212 cases observed cases of HAART initial startup. Male 131 cases, female 81 cases; AIDS patients with 183 cases, 28 cases of HIV chronic asymptomatic infected persons; opportunistic infections were 165 cases before HAART, 57 cases of opportunistic infections; 64 before HAART CD4 median level / the μl, HIVRNA median level 5.08log10 of copies / ml. HAART start in June, a total of diagnose IRIS59 cases, the rate was 27.8%, the mortality rate was 3.39%. IRIS occurred in a median time of 21 days after HAART initiation. The spectrum of disease that occurs depends on the frequency of high to low: tuberculosis (including tuberculosis, lymphatic system, tuberculous peritonitis), herpes virus infections (including genital herpes, herpes simplex, herpes zoster), lung spores bacterial pneumonia, cryptococcal brain inflammation, Penicillium marneffei mycosis, cytomegalovirus infection, cirrhosis, and atypical mycobacterial infections, histoplasmosis, autoimmune hepatitis. IRIS risk factors: the basis of the number of infections (OR = 1.655), the degree of infection control (OR = 2.344), HAART before CD4 foundation level (OR = 1.556). In the IRIS group in the non-IRIS group, on behalf of the Th1/Th2 balance between major lymphokines IL-2, IFN-γ and IL-4, IL-10 levels before HAART foundation values ??than those of the normal population detected were reduced with the increase (P lt; 0.05), after HAART initiation were showed a gradually increased trend to restore balance and fall, the two HAART start June value than HAART baseline, there were significant differences in sexual (P lt; 0.05). Base value with the normal control, the degree of change of the lymphokines IRIS group before HAART initiation than non IRIS group is more obvious, and 1 month after the start of the HAART, IL-2, INF-gamma reduction level of increased levels of IL-10 in the IRIS exist between the group and the non-IRIS group significant sex difference (P lt; 0.05), the decline in the level of IL-4 during the same period was no significant difference (P gt; 0.05). Conclusion: This study found that the following phenomenon: HIV / AIDS in start HAART6 month within the IRIS incidence of 27.8%, the mortality rate was 3.39%, IRIS occurred a median time after HAART initiation in January, the most common disease spectrum tuberculosis, herpes virus infections. 2.IRIS occurrence of infection on the basis of the number and degree of heat control, that the basis of pre-HAART CD4 levels associated antigen load; HAART baseline infection, the infection has not been effectively controlled and low-foundation CD4, are prone to the IRIS. IRIS occurrence of gender, age, route of infection, HAART program, the basis of the level and the rate of decline in HIV RNA, CD4 growth rate and found no correlation. HAART before, 3.IRIS group and non-IRIS group Th1/Th2 imbalance, the imbalance of the former tend to be more pronounced after HAART initiation has a trend to restore the balance of Th1 representatives factor IL-2 and INF-γ value The significantly increased and Th2 Representative factors work the values ??of the L-10 significantly decreased may be involved in the occurrence of the IRIS.