Silva-Freitas Maria Luciana, Cota Glaucia Fernandes, Machado-de-Assis Talia S, Giacoia-Gripp Carmem, Rabello Ana, Da-Cruz Alda M, Santos-Oliveira Joanna R
Laboratório Interdisciplinar de Pesquisas Médicas - Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil.
Laboratório de Pesquisas Clinicas e Políticas Públicas em Doenças Infecciosas e Parasitárias - Centro de Pesquisas René Rachou - FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil.
PLoS One. 2016 Dec 1;11(12):e0167512. doi: 10.1371/journal.pone.0167512. eCollection 2016.
The maintenance of chronic immune activation due to leishmaniasis or even due to microbial translocation is associated with immunosenescence and may contribute to frequent relapses. Our aim was to investigate whether patients with HIV-associated visceral leishmaniasis (VL/HIV) who experience a single episode of VL have different immunological behaviors in comparison to those who experience frequent relapses. VL/HIV patients were allocated to non-relapsing (NR, n = 6) and relapsing (R, n = 11) groups and were followed from the active phase of VL up to 12 months post-treatment (mpt). The patients were receiving highly active antiretroviral therapy (HAART) and secondary prophylaxis after VL therapy. During active VL, the two groups were similar in all immunological parameters, including the parasite load. At 6 and 12 mpt, the NR group showed a significant gain of CD4+ T cells, a reduction of lymphocyte activation, and lower soluble CD14 and anti-Leishmania IgG3 levels compared to the R group. The viral load remained low, without correlation with the activation. The two groups showed elevated but similar percentages of senescent T cells. These findings suggest a decreased ability of the R group to downmodulate immune activation compared to the NR group. Such functional impairment of the effector response may be a useful indicator for predicting clinical prognosis and recommending starting or stopping secondary prophylaxis.
利什曼病甚至微生物易位导致的慢性免疫激活与免疫衰老相关，并可能导致频繁复发。我们的目的是研究与频繁复发的HIV相关内脏利什曼病（VL/HIV）患者相比，经历单次VL发作的患者是否具有不同的免疫行为。VL/HIV患者被分为无复发组（NR，n = 6）和复发组（R，n = 11），从VL的急性期开始随访至治疗后12个月（mpt）。患者在VL治疗后接受高效抗逆转录病毒治疗（HAART）和二级预防。在VL活动期，两组在所有免疫参数（包括寄生虫载量）方面相似。在6个月和12个月mpt时，与R组相比，NR组的CD4 + T细胞显著增加，淋巴细胞激活减少，可溶性CD14和抗利什曼原虫IgG3水平降低。病毒载量保持较低，与激活无关。两组衰老T细胞的百分比均升高但相似。这些发现表明，与NR组相比，R组下调免疫激活的能力下降。效应反应的这种功能损害可能是预测临床预后和推荐开始或停止二级预防的有用指标。
