Immunopathology as a result of highly active antiretroviral therapy in HIV-1-infected patients
Immunopathology as a result of highly active antiretroviral therapy in HIV-1-infected patients
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DOI：
10.1097/00002030-199902040-00005
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发表时间：
1999-02-04
期刊：
影响因子：
3.8
通讯作者：
Reiss, P
中科院分区：
文献类型：
--
作者：
Foudraine, NA;Hovenkamp, E;Reiss, P
目的：在开始高效抗逆转录病毒治疗（HAART）后不久，越来越多地注意到与潜在的以前未被识别的机会性感染相关的异常临床炎症综合征。本研究探讨了在感染了鸟分枝杆菌胞内感染或异种分枝杆菌感染的HIV-1患者中，这种意想不到的疾病表现与微生物抗原特异性免疫反应性的体外参数之间可能存在的关系。设计：体外t细胞增殖实验是在用鸟分枝杆菌和异种分枝杆菌抗原特异性刺激患者外周血单个核细胞（PBMC）和用植物血凝素（PHA）非特异性刺激后进行的。结果与适当的对照进行比较。患者：5名患者在开始抗逆转录病毒治疗后出现CD4+细胞计数大幅上升的数周内出现与鸟支原体或非洲种支原体感染相关的异常临床综合征。结果：除1例患者外，所有患者在HAART治疗后，分枝杆菌特异性淋巴细胞增殖反应均显著升高；这暂时与CD4+细胞计数升高和临床疾病的发生有关。在没有抗真菌治疗的情况下，感染非洲分枝杆菌的患者似乎清除了感染。在4例鸟分枝杆菌感染患者中，有3例可以停止抗真菌治疗而不复发感染。结论：我们的研究结果支持HAART可能导致临床相关炎症的假设，因为在治疗开始时，针对亚临床存在的微生物病原体的特异性免疫反应性恢复。继续进行高效抗逆转录病毒疗法可能随后导致保护性免疫和清除感染。(C) 1999 Lippincott Williams & Wilkins。
Objective: Unusual clinical inflammatory syndromes associated with underlying previously unrecognized opportunistic infections are increasingly being noted shortly after starting highly active antiretroviral therapy (HAART). This study examined the possible relationship between such unexpected disease manifestations and in vitro parameters of microbial antigen-specific immune reactivity in patients infected with HIV-1 who had a Mycobacterium avium intracellulare or Mycobacterium xenopi infection.Design: In vitro T-cell proliferation experiments were performed after specific stimulation of a patient's peripheral blood mononuclear cells (PBMC) with M. avium and M. xenopi antigen and non-specific stimulation with phytohaemagglutinin (PHA). The results were compared with appropriate controls.Patients: Five patients who presented with unusual clinical syndromes associated with M. avium or M. xenopi infection within weeks of experiencing large rises in CD4+ cell counts following the initiation of antiretroviral therapy.Results: In all patients except one, mycobacteria-specific lymphoproliferative responses rose significantly following HAART; this was temporally associated with elevations in CD4+ cell counts and the occurrence of clinical disease. The patient with M. xenopi infection appeared to clear his infection subsequently without antimycobacterial therapy. In three of the four patients with M. avium infection, antimycobacterial treatment could be stopped without recurrence of infection.Conclusion: Our findings support the hypothesis that HAART may lead to clinically relevant inflammation as a result of restoration of specific immune reactivity against microbial pathogens that are subclinically present at the time treatment is initiated. Continuation of HAART may subsequently result in protective immunity and clearance of infection. (C) 1999 Lippincott Williams & Wilkins.