Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China; Beijing Key Laboratory of Emerging Infectious Diseases, Beijing 100015, China.
Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Beijing 102206, China.
Int J Infect Dis. 2020 Feb;91:210-217. doi: 10.1016/j.ijid.2019.12.001. Epub 2019 Dec 7.
Given the improvements in antiretroviral therapy (ART) in recent years, more pediatric HIV patients receiving ART are reaching adolescence and adulthood. This study investigated the influence of poor virological response (low-level viremia (LLV) and virological failure (VF)) on the immune system of these patients.
HIV-infected, ART-experienced pediatric patients (n=206) were enrolled in this cross-sectional study. The patients were subdivided into school-age children/early adolescents, middle adolescents, and late adolescents/young adults according to their age, and further classified into virological suppression (VS), LLV, and VF groups according to plasma viral load (pVL) measurement. Thymic output, T cells subsets, and immune activation were analyzed by flow cytometry.
Compared with VS patients, VF patients displayed decreased CD4 T cell counts, while LLV and VS patients had comparable CD4 T cell counts regardless of age. Compared with VS patients, LLV and VF patients had higher percentages of CD8HLA-DR and CD8CD38 T cells, and the immune activation was positively correlated with pVL in VF and LLV patients. Thymic output levels (CD31) and regulatory T cell subpopulations in LLV and VF patients were comparable to those in VS patients. LLV patients showed comparable percentages of T cell subsets (T, T, T, and T) as VS patients in all age groups.
LLV causes excessive immune activation although it does not impair T cell recovery or naïve-to-memory T cell conversion in pediatric patients living with HIV. Therefore, T cell immune activation should be monitored at the management of LLV during ART.
近年来，抗逆转录病毒疗法（ART）取得了进展，越来越多接受 ART 的儿科 HIV 患者开始进入青春期和成年期。本研究旨在探讨不良病毒学应答（低水平病毒血症（LLV）和病毒学失败（VF））对这些患者免疫系统的影响。
本横断面研究纳入了 206 例接受过 ART 的 HIV 感染儿科患者。根据年龄将患者分为学龄儿童/青少年、中期青少年和晚期青少年/年轻成年人，并根据血浆病毒载量（pVL）测量结果进一步分为病毒学抑制（VS）、LLV 和 VF 组。采用流式细胞术分析胸腺输出、T 细胞亚群和免疫激活。
与 VS 患者相比，VF 患者的 CD4 T 细胞计数较低，而无论年龄大小，LLV 和 VS 患者的 CD4 T 细胞计数相当。与 VS 患者相比，LLV 和 VF 患者的 CD8 HLA-DR 和 CD8 CD38 T 细胞比例较高，免疫激活与 VF 和 LLV 患者的 pVL 呈正相关。LLV 和 VF 患者的胸腺输出水平（CD31）和调节性 T 细胞亚群与 VS 患者相当。LLV 和 VF 患者在所有年龄组的 T 细胞亚群（T、T、T 和 T）比例与 VS 患者相当。
尽管 LLV 不会损害 HIV 儿童患者的 T 细胞恢复或初始记忆 T 细胞转化，但它会导致过度的免疫激活。因此，在 ART 期间管理 LLV 时，应监测 T 细胞免疫激活。
