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1.
Endocr Connect ; 13(8)2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38913547

RESUMEN

Background: Papillary thyroid carcinoma has become increasingly prevalent over the years. Avoiding unnecessary treatments and the risk of complications is essential, as well as understanding the mechanisms of tumor progression and the conditions that indicate a worse prognosis. Assessment of the tumor microenvironment can allow us understand how the immune system organizes itself to contain neoplastic progression. Methods: We compared characteristics related to the lymphocytic subpopulations in the thyroid tumor microenvironment and lymph nodes in two groups, with and without lymph node metastatic involvement. Results: Of the 400 cases followed up at a thyroid cancer reference service, 32 were selected, of which, 13 cases did not present lymph node metastasis (N0 group) and 19 had lymph node involvement (N1 group). Clinical data were collected, and immunohistochemical reactions were performed for markers CD4, CD8, FoxP3, CD25, and CD20 in lymph nodes and peritumoral infiltrate. We found that the N1 group had larger tumor sizes, higher risk staging, higher frequency of extrathyroidal extension, shorter disease-free times, and higher expression of CD4+ T lymphocytes in lymph nodes; however, there was no difference in the expression of other markers or in the pattern of lymphocyte distribution in the lymph node. Conclusion: In cervical lymph nodes, the higher frequency of CD4+ T lymphocytes is related to the presence of metastasis. However, there were no differences in lymphocytic subpopulations in the thyroid tumor microenvironment. The absence of changes in unaffected lymph nodes could not predict any tumor behavior.

2.
Rev. neuro-psiquiatr. (Impr.) ; 86(3): 171-180, jul.-set. 2023. tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1560320

RESUMEN

RESUMEN Objetivo: Determinar la relación entre ansiedad, depresión y recuento de linfocitos T CD4+ en una muestra de personas portadoras del virus de inmunodeficiencia humana (VIH). Metodología: Estudio observacional y analítico. Se evaluó a 144 pacientes con VIH en un hospital general de Lima, Perú. Se utilizó la Escala de Ansiedad y Depresión Hospitalaria (HADS). Resultados: La edad media de los sujetos de estudio fue de 41 años. La mayoría estuvo constituida por varones (71,5 %), solteros (86,1 %) y con grado de instrucción secundaria (57,6 %). La duración promedio de la enfermedad fue 7,7 años; el 11,1 % presentó alguna comorbilidad; y el 95,1 % utilizó tenofovir como tratamiento. El 34 % y el 16,7 % presentaron algún nivel de ansiedad y depresión, respectivamente. Los pacientes que se encontraban en estadio de sida presentaron mayores niveles de ansiedad (p < 0,001) y depresión (p < 0,001). Los pacientes con VIH y comorbilidades médicas presentaron mayores niveles de depresión (p = 0,044). Los niveles de ansiedad (ρ = -0,516, p = 0,01) y depresión (ρ = -0,509; p = 0,01) estuvieron relacionados con el recuento de linfocitos T CD4+. Conclusión: Se encontraron mayores niveles de depresión en pacientes con comorbilidades y estadio de sida, así como mayores niveles de ansiedad en pacientes en estadio de sida. Se comprobó, además, una relación indirecta y significativa entre los niveles de ansiedad, depresión y el recuento de linfocitos T CD4+. Se recomienda capacitar a los profesionales de salud en el tamizaje de ansiedad y depresión, a fin de mejorar la salud mental de pacientes con VIH.


ABSTRACT Objective: To determine the relationship between anxiety, depression and CD4+ T lymphocyte count in a sample of people carrying the human immunodeficiency virus (HIV). Methodology: Observational and analytical study. A total of 144 HIV-positive patients were evaluated. The Hospital Anxiety and Depression Scale (HADS) was used. Results: The sample's mean age was 41 years. Most of the probands were male (71.5%), single (86.1%) and with secondary education (57.6%). The average length of the disease was 7.7 years, 11.1% presented some comorbidity, and 95.1% used tenofovir as treatment. Thirty-four and 16.7% presented some level of anxiety and depression, respectively. Patients at the AIDS stage presented higher levels of anxiety (p < 0.001) and depression (p < 0.001). Patients with HIV and medical comorbidities had higher levels of depression (p = 0.044). Anxiety (ρ = -0.516, p = 0.01) and depression (ρ = -0.509; p = 0.01) levels were related to CD4+ T lymphocyte count. Conclusion: Higher levels of depression were found in patients with comorbidities and AIDS stage, and higher levels of anxiety were found in patients at the AIDS stage. In addition, a significant indirect relationship was found between anxiety and depression levels and the CD4+ T cell count. Training healthcare professionals to screen for anxiety and depression in order to improve the mental health of HIV patients, is highly recommended.

3.
Clin Exp Allergy ; 49(5): 644-654, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30689261

RESUMEN

BACKGROUND: The immunopathogenesis of severe asthma has been associated with an inefficient regulatory response. There are a few studies about the CD4 T cells profile among individuals with severe asthma refractory to treatment. OBJECTIVE: To evaluate the CD4 T lymphocyte profile from individuals with severe asthma according to their response to treatment, relating to their atopy status and age of asthma onset. METHODS: We evaluated nineteen individuals with severe asthma refractory to treatment (SAR), 21 with well-controlled or partly controlled severe asthma (CSA) and 23 with mild-to-moderate asthma (MMA). Lymphocytes were obtained from PBMC, and the frequency of expression of different molecules in this population was assessed using the flow cytometry. RESULTS: We observed the frequency of CD4+ IFN-γ+ T cells was higher in atopic individuals with SAR than with CSA. In addition, among the atopic and early-onset asthma (EOA), the frequency of CD4+ CTLA-4+ T cells was lower in the SAR group than the CSA group. In relation to non-atopic and late-onset asthma (LOA) phenotypes, we noted the frequency of CD4+ FoxP3+ T cells was lower in individuals with SAR than with CSA. We also observed among the LOA patients, the frequency of CD4+ TGF-ß+ T cells was decreased in SAR group than the in CSA group. CONCLUSION AND CLINICAL RELEVANCE: Our data suggest that refractoriness to treatment in asthma is associated with a lower expression of distinct regulatory molecules by CD4 T cells between those who are atopic and have EOA and those who are non-atopic and have LOA. Thus, these results may contribute to the identification of new regulatory strategies to treat asthma according to their phenotypes.


Asunto(s)
Asma/inmunología , Asma/metabolismo , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/metabolismo , Inmunomodulación , Adulto , Edad de Inicio , Asma/diagnóstico , Biomarcadores , Antígeno CTLA-4/metabolismo , Citocinas/metabolismo , Femenino , Citometría de Flujo , Humanos , Hipersensibilidad Inmediata/inmunología , Hipersensibilidad Inmediata/metabolismo , Hipersensibilidad Inmediata/patología , Inmunoglobulina E/inmunología , Inmunofenotipificación , Leucocitos Mononucleares/inmunología , Leucocitos Mononucleares/metabolismo , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/metabolismo , Vitamina D/metabolismo
4.
Int. arch. otorhinolaryngol. (Impr.) ; 22(4): 378-381, Oct.-Dec. 2018. tab
Artículo en Inglés | LILACS | ID: biblio-975599

RESUMEN

Abstract Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Infecciones por VIH/complicaciones , Antirretrovirales/efectos adversos , Pérdida Auditiva/etiología , Pérdida Auditiva/inducido químicamente , Audiometría de Tonos Puros , Umbral Auditivo , Infecciones por VIH/tratamiento farmacológico , Estudios Prospectivos , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Recuento de Linfocito CD4
5.
Int Arch Otorhinolaryngol ; 22(4): 378-381, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30357077

RESUMEN

Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.

6.
mBio ; 9(5)2018 09 11.
Artículo en Inglés | MEDLINE | ID: mdl-30206166

RESUMEN

Chronic immune activation and inflammation are hallmarks of HIV-1 infection and a major cause of serious non-AIDS events in HIV-1-infected individuals on antiretroviral treatment (ART). Herein, we show that cytosolic double-stranded DNA (dsDNA) generated in infected CD4+ T cells during the HIV-1 replication cycle promotes the mitochondrial reactive oxygen species (ROS)-dependent stabilization of the transcription factor hypoxia-inducible factor 1α (HIF-1α), which in turn, enhances viral replication. Furthermore, we show that induction of HIF-1α promotes the release of extracellular vesicles (EVs). These EVs foster inflammation by inducing the secretion of gamma interferon by bystander CD4+ T cells and secretion of interleukin 6 (IL-6) and IL-1ß by bystander macrophages through an HIF-1α-dependent pathway. Remarkably, EVs obtained from plasma samples from HIV-1-infected individuals also induced HIF-1α activity and inflammation. Overall, this study demonstrates that HIF-1α plays a crucial role in HIV-1 pathogenesis by promoting viral replication and the release of EVs that orchestrate lymphocyte- and macrophage-mediated inflammatory responses.IMPORTANCE Human immunodeficiency virus type 1 (HIV-1) is a very important global pathogen that preferentially targets CD4+ T cells and causes acquired immunodeficiency syndrome (AIDS) if left untreated. Although antiretroviral treatment efficiently suppresses viremia, markers of immune activation and inflammation remain higher in HIV-1-infected patients than in uninfected individuals. The hypoxia-inducible factor 1α (HIF-1α) is a transcription factor that plays a fundamental role in coordinating cellular metabolism and function. Here we show that HIV-1 infection induces HIF-1α activity and that this transcription factor upholds HIV-1 replication. Moreover, we demonstrate that HIF-1α plays a key role in HIV-1-associated inflammation by promoting the release of extracellular vesicles which, in turn, trigger the secretion of inflammatory mediators by noninfected bystander lymphocytes and macrophages. In summary, we identify that the coordinated actions of HIF-1α and extracellular vesicles promote viral replication and inflammation, thus contributing to HIV-1 pathogenesis.


Asunto(s)
Linfocitos T CD4-Positivos/virología , Vesículas Extracelulares/metabolismo , VIH-1/fisiología , Interacciones Huésped-Patógeno , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Mediadores de Inflamación/metabolismo , Replicación Viral , Linfocitos T CD4-Positivos/metabolismo , Línea Celular , ADN/metabolismo , ADN Viral/metabolismo , VIH-1/crecimiento & desarrollo , Humanos , Interferón gamma/metabolismo , Macrófagos/metabolismo , Especies Reactivas de Oxígeno/metabolismo
7.
Rev. cuba. invest. bioméd ; 34(3): 254-263, ilus, tab
Artículo en Español | LILACS, CUMED | ID: lil-773355

RESUMEN

INTRODUCCIÓN: el debut del sida es una forma de presentación de la enfermedad caracterizada por alteración del estado general, síndrome de desgaste, graves infecciones oportunistas, neoplasias y alteraciones neurológicas. El tratamiento con antirretrovirales ha aumentado la esperanza de vida de estos pacientes. OBJETIVOS: identificar las enfermedades oportunistas, asociadas a la condición clínica de los pacientes bajo estudio, y su relación con el conteo de linfocitos T CD4+ y la carga viral así como, evaluar la mortalidad en el grupo de pacientes estudiados y su relación con las enfermedades oportunistas. MÉTODOS: se realizó un estudio observacional prospectivo de corte transversal. El tamaño de la muestra estuvo condicionado al universo total de pacientes VIH/sida del servicio de Medicina del Instituto de Medicina Tropical "Pedro Kourí". La muestra (55 pacientes) se seleccionó, se tuvo en cuenta los sujetos que fueron diagnosticados con debut de sida y presentaron enfermedades oportunistas durante un año. RESULTADOS: las enfermedades oportunistas infecciosas como neurotoxoplasmosis 21,8 % y neumonía por Pneumocystis jirovecii 12,7 % fueron los eventos definitorios de sida predominantes. No hubo asociación estadística significativa, con el conteo bajo de linfocitos T CD4+ bajos y carga viral elevada. En los pacientes mayores de 50 años con más de una enfermedad oportunista el riesgo de morir fue 4,72 veces mayor que para el resto. CONCLUSIONES: las enfermedades oportunistas infecciosas como neurotoxoplasmosis y Pneumocystis jirovecii,fueron los eventos definitorios de sida predominantes. La mortalidad asociada a sida en los pacientes mayores de 50 años aumentó en los individuos que presentaron más de una enfermedad oportunista. Estos resultados son útiles para el diseño de estrategias de tratamiento que disminuyan la aparición de las enfermedades oportunistas y mejoren aun más, la supervivencia de los pacientes VIH/sida.


INTRODUCTION: onset of aids is a form of presentation of the disease that is characterized by altered general condition, wornout syndrome, serious opportunistic infections, neoplasias and neurological alterations. The antiretroviral treatment has increased the life expectancy of these patients. OBJECTIVES: to identify the opportunistic diseases associated to the clinical condition under study and their linking to the CD4+ T lymphocyte count and the viral load as well as to evaluate the mortality in the studied group and its relationship with opportunistic diseases. METHODS: prospective, observational and cross-sectional study of a sample of 55 patients. The size of the sample depended on the total universe of HIV/aids patients in the medicine service of "Pedro Kouri" Tropical Medicine Institute. The study took into account those subjects who were diagnosed with onset of aids and presented with opportunistic diseases during one year. RESULTS: infectious opportunistic diseases such as neurotoxoplasmosis (21.8 %) and pneumonia caused by Pneumocystis jirovecii (12.7 %) were the predominant defining events of aids. There was no statistically significant association with low CD4+ T lymphocyte count and high viral load. In patients over 50 years of age with more than one opportunistic disease, the risk of dying was 4.72 times higher than in the rest of the group. CONCLUSIONS: infectious opportunistic diseases as neurotoxoplasmosis and Pneumocystis jirovecii were the prevailing defining events of aids. Aids-associated mortality in patients aged over 50 years increased in individuals who presented more than one opportunistic disease. These results are useful for the design of treatment strategies that reduce the occurrence of opportunistic diseases and improve even more the survival of HIV/aids patients.


Asunto(s)
Humanos , Neumonía por Pneumocystis , Síndrome de Inmunodeficiencia Adquirida , Toxoplasmosis Cerebral , Infecciones Oportunistas Relacionadas con el SIDA , Estudios Transversales/métodos , Estudios Prospectivos , Estudio Observacional
8.
Ther Clin Risk Manag ; 10: 631-9, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25120369

RESUMEN

BACKGROUND: Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. METHODS: In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. RESULTS: After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. CONCLUSION: This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

9.
Rev. Inst. Med. Trop. Säo Paulo ; Rev. Inst. Med. Trop. Säo Paulo;55(4): 267-273, Jul-Aug/2013. tab, graf
Artículo en Inglés | LILACS | ID: lil-679539

RESUMEN

SUMMARY Combination Antiretroviral Therapy (cART) aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL) and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1): 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI) and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2): 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution. .


RESUMO A terapia antirretroviral na aids visa inibir a replicação viral, retardar a progressão da imunodeficiência e melhorar a sobrevida do paciente. O objetivo do estudo foi comparar dois esquemas de tratamentos antirretrovirais, quanto à carga viral plasmática (CV) e contagem de linfócitos T CD4+, durante 48 semanas de tratamento, pela revisão de 472 prontuários no período de 1998 a 2005, em um Serviço de Ambulatórios Especializados. Foram incluídos para o estudo 58 pacientes que receberam esquema tríplice como terapêutica inicial, os quais formaram dois grupos: Grupo 1 (G1): 47 indivíduos em tratamento com dois inibidores de transcriptase reversa análogos de nucleosídeos (ITRN) e um inibidor de transcriptase reversa não análogo de nucleosídeo; Grupo 2 (G2): 11 pacientes em tratamento com dois ITRN e um inibidor de protease. Entre os pacientes de G1 e G2, 53.2% e 81.8%, respectivamente, foram classificados como portadores de aids com doença definidora. A contagem de linfócitos T CD4+ aumentou progressivamente até a 24ª semana de tratamento, em todos os doentes e, a CV tornou-se indetectável em 68,1% dos casos de G1 e em 63,6%, do G2. O estudo concluiu que, em ambos os grupos de tratamento, houve evolução laboratorial semelhante e essa observação foi compatível com evolução clínica favorável dos pacientes estudados. .

10.
Univ. odontol ; 31(66): 51-58, ene.-jun. 2012. tab
Artículo en Español | LILACS | ID: lil-673810

RESUMEN

Objetivo: determinar la frecuencia de las lesiones orales que se presentaron en los pacientescon VIH/sida que asistieron a la Unidad de Infectología del Hospital UniversitarioSan Ignacio en Bogotá, Colombia, en el periodo 2005-2010. Métodos: se realizó un estudioobservacional descriptivo con una muestra de 180 de un total de 1600 historias clínicas.Los criterios de inclusión fueron historias clínicas de pacientes con VIH/sida mayores de18 años de edad. Se excluyeron las historias clínicas de pacientes que no presentaban losresultados del conteo de linfocitos T CD4+. Los hallazgos se analizaron descriptivamentepor medio de distribuciones de frecuencia y promedios. Resultados: la frecuencia generalde lesiones orales fue del 47,8 %. La lesión oral más frecuente fue la candidiasis seudomembranosa(12,8 %), seguida por leucoplasia vellosa (5 %) y herpes simple (4,4 %). En elanálisis la presencia de lesiones orales se asoció un conteo promedio de linfocitos T CD4+de 135 células/mm3. Conclusiones: las lesiones orales más frecuentes fueron candidiasisoral seudomembranosa, leucoplasia vellosa y herpes simple. La disminución de células TCD4+ se asocia con la aparición de lesiones orales...


Objective: To determine the frequency of mouth diseases in HIV/aids patients attending theInfectious Disease Unit of the San Ignacio University Hospital in Bogota, Colombia, during2005-2010. Methods: A descriptive study with a sample of 180 out of 1600 clinical recordswas carried out. Criterion for inclusion in the study was patients 18 years of age. Recordswithout T-lymphocyte (CD4) count were excluded. Data were analyzed descriptively throughfrequency distribution and averages measures. Results: Mouth diseases were reportedin 47.8 % of the records. The most common lesion was pseudomembranous candidiasis(12.8 %), followed by hairy leukoplakia (5 %) and herpes simplex (4.4 %). Mouth diseases wereassociated with an average CD4 count of 135/mm3. Conclusion: Oral pseudomembranouscandidiasis, hairy leukoplakia and herpes simplex were the most frequent diseases. A decreasein CD4 cell count is associated with mouth diseases...


Asunto(s)
VIH , Candidiasis Bucal , Enfermedades de la Boca , Herpes Simple , Infecciones por VIH , Leucoplasia Bucal , Patología Bucal
11.
Rev. Soc. Boliv. Pediatr ; 44(3): 189-201, ago. 2005. ilus
Artículo en Portugués | LILACS | ID: lil-738356

RESUMEN

Objetivo: verificar se a vacinação contra influenza em crianças infectadas pelo HIV aumentaria a carga viral e reduziria os linfócitos T CD4+, conseqüentes à ativação da imunidade com antígenos dependentes do linfócito T. Métodos: estudo prospectivo descritivo, com 51 crianças infectadas pelo HIV, vacinadas contra influenza em 1999, em Florianópolis, Brasil. Coletaram-se amostras de sangue no dia da vacinação, 14 a 20 e 60 a 90 dias após, para determinação dos níveis da carga viral do HIV e de linfócitos T CD4+. A análise estatística constou dos testes ANOVA de Friedman, t de Student para amostras dependentes, Correção de Bonferroni e Wilcoxon. Resultados: a média de idade foi de 6,08 anos (1 a 12,9 anos). A mediana da contagem de linfócitos T CD4+ no dia da vacinação e nos dois momentos subseqüentes foi de 789, 645 e 768 células/mm3. Observou-se redução significativa na contagem de linfócitos T CD4+ entre a primeira e a segunda determinação (p=0,0001, teste de Wilcoxon), o mesmo não ocorrendo entre a primeira e a terceira. Não houve diferença significativa nas porcentagens de linfócitos T CD4+ entre a primeira aferição e a segunda. A mediana da carga viral em log10 cópias/ml foi de 4,38, 4,30 e 4,25, nos três momentos, respectivamente. Oito de 44 pacientes (18,2%) evidenciaram elevação >0,5 log10 cópias/ml na carga viral entre a primeira e segunda aferição, quatro dos quais retornaram aos níveis basais na terceira. Conclusões: não se observou alteração significativa na porcentagem de linfócitos T CD4+, apesar de ocorrer elevação da carga viral do HIV, de forma transitória, após vacinação contra influenza. Recomenda-se uma certa prudência na aplicação da vacina contra influenza para as crianças com condição clínica e imunológica não estável, principalmente se essas não estiverem sob terapêutica antiretroviral eficaz.


Objective: to identify whether influenza immunization in HIV infected children could increase HIV viral load and decrease CD4+ lymphocytes count as a consequence of the response induced by a T cell-dependent antigen. Methods: prospective, descriptive study, with 51 HIV infected children, vaccinated against influenza in 1999, in Florianópolis, Brazil. Blood samples were collected at three different moments: on the immunization day; between 14 and 20 days later; between 60 and 90 days later. Plasma levels of HIV viral load and CD4+ lymphocytes count were determined. Friedman ANOVA test, Student t-test for dependent samples, Bonferroni correction, and Wilcoxon matched test were performed for statistic analysis. Results: children’s mean age was 6.08 years (1 to 12.9 years). The medians of CD4+ lymphocyte count on vaccination day and at the other two moments were 789, 645 and 768 cells/ mm3, respectively. A significant reduction was observed in the CD4+ lymphocyte count between the first and the second analyses, but the same did not happen between the first and the third analyses. There was no significant difference of CD4+ lymphocyte percentage between the first and the second analyses. The median of HIV viral load values in log10 copies/ml was 4.38, 4.30 and 4.25, at the three moments respectively. Eight out of 44 patients (18.2%) showed increase > 0.5 log10 copies/ml in HIV viral load between the first and the second analyses and among these, four returned to levels close to their base levels in the third analysis. Conclusion: there was no significant change in the CD4+ lymphocyte percentage, in spite of a transitory increase in HIV viral load after influenza vaccination. Caution should be used when administering vaccine against flu to children with no stable clinical and immunological conditions, mainly if they are not under effective anti-retroviral therapeutics.

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