Albuquerque Adriana S, Foxall Russell B, Cortesão Catarina S, Soares Rui S, Doroana Manuela, Ribeiro Alice, Lucas Margarida, Antunes Francisco, Victorino Rui M M, Sousa Ana E
Unidade de Imunologia Clínica, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Av Prof Egas Moniz, 1649-028, Lisboa, Portugal.
Clin Immunol. 2007 Oct;125(1):67-75. doi: 10.1016/j.clim.2007.07.001. Epub 2007 Aug 9.
A significant proportion of HIV-1+ patients with suppression of viremia under antiretroviral therapy fail to recover CD4(+) T-cell counts (ART-Discordants). Similarly, untreated HIV-2+ patients can also exhibit major CD4 depletion in spite of undetectable viremia. We characterize here the immunological disturbances associated with major CD4-lymphopenia in these two scenarios as compared to untreated viremic HIV-1+ patients with similar CD4-lymphopenia and HIV-1+ patients with successful immunological and virological responses under ART. Low CD4 counts were associated with major naive CD4 and CD8 depletion, irrespective of type of infection or ART-exposure. However, ART-Discordants exhibited lower levels of T-cell activation as compared to both untreated HIV-2 and HIV-1 cohorts, and a less marked increase in circulating IL-7 despite similar CD4 depletion. Nevertheless, ART-Discordants showed a preserved Bcl-2 expression, suggesting increased IL-7 consumption, which in conjunction with the relatively lower T-cell activation may contribute to their CD4 count stability and low rate of opportunistic infections.
相当一部分接受抗逆转录病毒治疗后病毒血症得到抑制的HIV-1阳性患者未能恢复CD4(+) T细胞计数（抗逆转录病毒治疗反应不一致者）。同样，未经治疗的HIV-2阳性患者尽管病毒血症检测不到，但也可能出现严重的CD4细胞耗竭。与未经治疗、病毒血症阳性且CD4淋巴细胞减少情况相似的HIV-1阳性患者以及接受抗逆转录病毒治疗后免疫和病毒学反应成功的HIV-1阳性患者相比，我们在此描述了这两种情况下与严重CD4淋巴细胞减少相关的免疫紊乱。无论感染类型或是否接受抗逆转录病毒治疗，低CD4计数都与主要的初始CD4和CD8细胞耗竭有关。然而，与未经治疗的HIV-2和HIV-1队列相比，抗逆转录病毒治疗反应不一致者的T细胞活化水平较低，尽管CD4细胞耗竭情况相似，但循环IL-7的增加不太明显。尽管如此，抗逆转录病毒治疗反应不一致者的Bcl-2表达保持不变，提示IL-7消耗增加，这与相对较低的T细胞活化可能共同导致其CD4计数稳定以及机会性感染发生率较低。
