Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
AIDS. 2010 Aug 24;24(13):2029-39. doi: 10.1097/QAD.0b013e32833c3268.
The factors associated with fibrosis in lymphoid tissue in long-term treated HIV-infected patients and their correlation with immune reconstitution were assessed.
Tonsillar biopsies were performed in seven antiretroviral-naive patients and 29 successfully treated patients (median time on treatment, 61 months). Twenty patients received protease inhibitors-sparing regimens and nine protease inhibitor-containing regimens. Five tonsillar resections of HIV-negative individuals were used as controls. Lymphoid tissue architecture, collagen deposition (fibrosis) and the mean interfollicular CD4(+) cell count per mum were assessed.
Naive and long-term treated HIV-infected patients had a higher proportion of fibrosis than did HIV-uninfected persons (P < 0.001). Patients with greater collagen deposition showed lower levels of CD4 cells in lymphoid tissue (P = 0.03) and smaller increase in peripheral CD4(+) T cells (r = -0.40, P = 0.05). The factors independently associated with fibrosis in lymphoid tissue were age (P < 0.0001), treated patients with detectable lymphoid tissue viral load when compared with patients with undetectable lymphoid tissue viral load (median 5 vs. 12%, respectively, P = 0.017) and patients receiving a protease inhibitor-sparing vs. a protease inhibitor-containing regimen (median 8 vs. 2.5%, respectively, P = 0.04).
Fibrosis in lymphoid tissue was associated with a poor reconstitution of CD4(+) T cells and long-term antiretroviral therapy did not reverse this abnormality. HIV infection, older age, a detectable level of lymphoid tissue viral load in treated patients and protease inhibitor-sparing regimens seem to favour fibrosis in lymphoid tissue.
评估与长期接受抗逆转录病毒治疗的 HIV 感染患者的淋巴组织纤维化相关的因素及其与免疫重建的相关性。
对 7 例未接受过抗逆转录病毒治疗的患者和 29 例成功接受治疗的患者（中位治疗时间 61 个月）进行了扁桃体活检。其中 20 例患者接受了不含蛋白酶抑制剂的方案治疗，9 例患者接受了含蛋白酶抑制剂的方案治疗。5 例 HIV 阴性个体的扁桃体切除术作为对照。评估了淋巴组织的结构、胶原沉积（纤维化）和每个滤泡间 CD4+细胞的平均计数。
未接受过治疗和长期接受抗逆转录病毒治疗的 HIV 感染患者的纤维化比例高于未感染 HIV 的个体（P < 0.001）。胶原沉积较多的患者淋巴组织中 CD4 细胞水平较低（P = 0.03），外周血 CD4+T 细胞的增加幅度较小（r = -0.40，P = 0.05）。与淋巴组织病毒载量不可检测的患者相比，淋巴组织病毒载量可检测的治疗患者（中位数分别为 5%和 12%，P = 0.017）和接受不含蛋白酶抑制剂方案治疗的患者（中位数分别为 8%和 2.5%，P = 0.04）与淋巴组织纤维化相关的独立因素是年龄（P < 0.0001）。
淋巴组织纤维化与 CD4+T 细胞的重建不良有关，长期抗逆转录病毒治疗并不能逆转这种异常。HIV 感染、年龄较大、治疗患者的淋巴组织病毒载量可检测以及不含蛋白酶抑制剂的方案似乎有利于淋巴组织纤维化的发生。
