Biomarkers of immune dysfunction in HIV.
Biomarkers of immune dysfunction in HIV.
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DOI：
10.1097/coh.0b013e32833ed6f4
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发表时间：
2010-11
影响因子：
4.1
通讯作者：
Landay AL
中科院分区：
文献类型：
--
作者：
Nixon DE;Landay AL
HIV感染的特征是慢性免疫系统激活和炎性细胞因子产生。这篇综述将重点介绍使用免疫系统激活和功能障碍的血浆和细胞生物标记物来预测HIV感染者的死亡率和机会性疾病的最新进展。艾滋病毒感染导致免疫系统早期老化或“免疫衰老”的特征，这是由慢性抗原暴露和免疫系统激活驱动的。肠道细菌成分的微生物易位与慢性免疫激活和可能的全身性炎症有关。抗逆转录病毒治疗可能不会完全使这种情况正常化。在几个大型随机临床试验中，某些炎症或凝血障碍的生物标志物，特别是白介素6(IL-6)、C反应蛋白(CRP)和d-二聚体的基线升高，在调整适当的变量后，与死亡率或机会性疾病有关。目前尚不清楚是IL-6或CRP升高导致了这种发病率和死亡率，还是它们只是全球炎症状态的替代标记物。几个炎性生物标志物似乎增加了我们预测艾滋病毒感染者死亡或机会性疾病的能力。在生物标记物发挥作用之前，有必要确定适度生物标记物水平的干预措施，然后确定这种缓和是否会减轻疾病结果。
HIV infection is characterized by chronic immune system activation and inflammatory cytokine production. This review will highlight recent developments using plasma and cellular biomarkers of immune system activation and dysfunction to predict mortality and opportunistic disease in HIV-infected individuals. HIV infection results in features characteristic of early aging of the immune system or ‘immune senescence’, driven by chronic antigen exposure and immune system activation. Microbial translocation of gut bacterial components is associated with chronic immune activation and possibly systemic inflammation. Antiretroviral therapy may not fully normalize this condition. Baseline elevations of certain biomarkers of inflammation or coagulopathy, notably interleukin-6 (IL-6), C-reactive protein (CRP), and d-dimer, have been associated with mortality or opportunistic disease, after adjustment for appropriate variables, in several large randomized clinical trials. It is not known if elevated IL-6 or CRP causes this morbidity and mortality or if they are simply surrogate markers of a global inflammatory state. Several inflammatory biomarkers appear to add to our ability to predict mortality or opportunistic disease in HIV-infected individuals. Before biomarkers will be useful, it will be necessary to identify interventions that moderate biomarker levels, and then determine if this moderation attenuates disease outcomes.