Sansonetti Paola, Sali Michela, Fabbiani Massimiliano, Morandi Matteo, Martucci Rosa, Danesh Ali, Delogu Giovanni, Bermejo-Martin Jesus F, Sanguinetti Maurizio, Kelvin David, Cauda Roberto, Fadda Giovanni, Rubino Salvatore
Catholic University of Sacred Heart, Rome, Italy.
J Infect Dev Ctries. 2014 Jan 15;8(1):101-9. doi: 10.3855/jidc.3147.
HIV infection is considered a risk factor for severe outcomes of influenza A(H1N1)v infection. However, data on immune response against influenza A(H1N1)v virus in HIV-infected patients are lacking.
Data from seven HIV-positive and 14 HIV-negative patients infected with A(H1N1)v and from 23 HIV-positive and six HIV-negative asymptomatic controls were analyzed to evaluate the clinical picture, A(H1N1)v viral shedding, and the immune response against the virus.
Patients displayed mainly upper respiratory tract diseases (57.1%), while pneumonia was diagnosed only in HIV-negative patients (23.8% of subjects, of which 4.8% required intensive care unit admission). At day seven, 29% of HIV-infected patients were still positive for A(H1N1)v by RT-PCR on nasopharyngeal swabs. Interestingly, a persistence of CXCL10 secretion at high level and lower IL-6 levels was observed in HIV-positive subjects. The geometric mean haemagglutination inhibition titer (HI-GMT) and anti-influenza IgM levels were lower in HIV-positive individuals while anti-influenza IgG levels remained similar in the two groups.
The immune impairment due to HIV infection could affect A(H1N1)v clearance and could lead to a lower antibody response and a persistent secretion of CXCL10 at high levels. However, the lower IL-6 secretion and treatment with highly active antiretroviral therapy (HAART) could result in a milder clinical picture.
HIV感染被认为是甲型H1N1流感病毒（A(H1N1)v）感染导致严重后果的一个危险因素。然而，关于HIV感染患者对A(H1N1)v病毒免疫反应的数据却很缺乏。
分析了7例感染A(H1N1)v的HIV阳性患者、14例感染A(H1N1)v的HIV阴性患者以及23例HIV阳性无症状对照者和6例HIV阴性无症状对照者的数据，以评估临床症状、A(H1N1)v病毒脱落情况以及对该病毒的免疫反应。
患者主要表现为上呼吸道疾病（57.1%），而仅在HIV阴性患者中诊断出肺炎（占受试者的23.8%，其中4.8%需要入住重症监护病房）。在第7天，29%的HIV感染患者经鼻咽拭子RT-PCR检测A(H1N1)v仍为阳性。有趣的是，在HIV阳性受试者中观察到CXCL10持续高水平分泌且IL-6水平较低。HIV阳性个体的几何平均血凝抑制滴度（HI-GMT）和抗流感IgM水平较低，而两组的抗流感IgG水平相似。
HIV感染导致的免疫损害可能影响A(H1N1)v的清除，并可能导致较低的抗体反应以及CXCL10持续高水平分泌。然而，较低的IL-6分泌以及高效抗逆转录病毒治疗（HAART）可能导致临床症状较轻。
