Virginia Commonwealth University, Richmond, Virginia 23298-0049, USA.
Curr Opin HIV AIDS. 2010 Nov;5(6):498-503. doi: 10.1097/COH.0b013e32833ed6f4.
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.
HIV 感染的特征是慢性免疫系统激活和炎症细胞因子的产生。本综述将重点介绍使用血浆和细胞免疫激活和功能障碍的生物标志物来预测 HIV 感染者的死亡率和机会性疾病的最新进展。
HIV 感染导致免疫系统的早期衰老或“免疫衰老”特征，这是由慢性抗原暴露和免疫系统激活引起的。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炎症有关。抗逆转录病毒疗法可能无法完全使这种情况正常化。在调整适当的变量后，几项大型随机临床试验表明，某些炎症或凝血生物标志物（尤其是白细胞介素 6 [IL-6]、C 反应蛋白 [CRP]和 D-二聚体）的基线升高与死亡率或机会性疾病有关。目前尚不清楚升高的 IL-6 或 CRP 是否导致这种发病率和死亡率，或者它们是否只是全身炎症状态的替代标志物。
几种炎症生物标志物似乎可以提高我们预测 HIV 感染者死亡率或机会性疾病的能力。在生物标志物具有实际应用价值之前，有必要确定可以调节生物标志物水平的干预措施，然后确定这种调节是否可以减轻疾病的结局。
