Challacombe S J, Sweet S P
Department of Oral Medicine and Pathology, UMDS Guy's Hospital, London, UK.
Oral Dis. 1997 May;3 Suppl 1:S79-84. doi: 10.1111/j.1601-0825.1997.tb00381.x.
The profound effects that HIV induces in systemic immunity have been well characterised, but the situation with regard to mucosal immune responses is less clear. Oral cavity fluids have been used as a marker of the mucosal immune system. Whole and parotid saliva IgA, IgA1 and IgA2 concentrations have been found to be lower in both HIV infection and AIDS subjects, whereas serum IgA and IgA subclasses are markedly raised, suggesting a dichotomy between systemic and secretory immunity. Salivary antibodies to HIV can be readily detected and secretory IgA antibody can be neutralising to some strains of HIV. HIV vaccines can also induce antibody responses in saliva, but vaccination routes other than parenteral immunisation are needed. Antibody responses to oral microbes have also been studied and it has been shown that IgA, IgA1 and IgA2 subclass antibody titres to Candida albicans and to Streptococcus mutans are increased in whole or parotid saliva from HIV patients, but reduced in AIDS patients, suggesting a compensatory response which is overcome with progressive immunodeficiency. The avidity of salivary IgA antibodies to Candida in HIV seems unimpaired, whereas relative avidities of serum antibodies in HIV patients with candidiasis are lowered. Non-specific factors which may inhibit Candida and other opportunist pathogens are also found in saliva. The candidacidal, myelomonocytic protein calprotectin is present in saliva at levels which are biologically active, although levels are lowered in HIV infection. Overall, HIV infection appears to be associated with disregulation of a number of immune factors at the mucosal surface, but the ability of patients with HIV infection to mount specific antibody secretory responses seems to be relatively intact until late in infection.
人类免疫缺陷病毒（HIV）对全身免疫系统产生的深远影响已得到充分描述，但关于黏膜免疫反应的情况尚不清楚。口腔液体已被用作黏膜免疫系统的标志物。研究发现，无论是HIV感染者还是艾滋病患者，全唾液和腮腺唾液中的IgA、IgA1和IgA2浓度均较低，而血清IgA及其亚类则显著升高，这表明全身免疫和分泌免疫之间存在差异。可以很容易地检测到唾液中针对HIV的抗体，分泌型IgA抗体对某些HIV毒株具有中和作用。HIV疫苗也能诱导唾液中的抗体反应，但需要非肠道免疫以外的接种途径。对口腔微生物的抗体反应也已得到研究，结果显示，HIV患者全唾液或腮腺唾液中针对白色念珠菌和变形链球菌的IgA、IgA1和IgA2亚类抗体滴度升高，但艾滋病患者的抗体滴度降低，这表明存在一种代偿性反应，但随着免疫缺陷的进展这种反应被克服。HIV患者唾液中针对念珠菌的IgA抗体亲和力似乎未受损害，而念珠菌病HIV患者血清抗体的相对亲和力则降低。唾液中还存在可能抑制念珠菌和其他机会性病原体的非特异性因素。具有杀念珠菌作用的骨髓单核细胞蛋白钙卫蛋白在唾液中的含量具有生物活性，不过在HIV感染时其含量会降低。总体而言，HIV感染似乎与黏膜表面多种免疫因子的调节紊乱有关，但HIV感染者产生特异性抗体分泌反应的能力在感染后期之前似乎相对完整。
