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首页> 美国卫生研究院文献>PLoS Clinical Trials >Immune Activation and Bacterial Translocation: A Link between Impaired Immune Recovery and Frequent Visceral Leishmaniasis Relapses in HIV-Infected Patients
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Immune Activation and Bacterial Translocation: A Link between Impaired Immune Recovery and Frequent Visceral Leishmaniasis Relapses in HIV-Infected Patients

机译：免疫活化和细菌易位：免疫恢复受损和HIV感染患者频繁内脏利什曼病复发之间的联系

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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.
机译：由于利什曼病或什至由于微生物易位引起的慢性免疫活化的维持与免疫衰老有关，并且可能导致频繁的复发。我们的目的是调查经历了一次VL发作的HIV相关内脏利什曼病（VL / HIV）患者与经常复发的患者相比，是否具有不同的免疫学行为。 VL / HIV患者被分为非复发型（NR，n = 6）和复发型（R，n = 11）组，并从VL活跃期开始直至治疗后12个月（mpt）。患者接受高活性抗逆转录病毒治疗（HAART），并在VL治疗后进行二级预防。在主动VL期间，两组在所有免疫学参数（包括寄生虫负荷）方面均相似。与R组相比，NR组在6和12 mpt时显示出明显的CD4 + T细胞增加，淋巴细胞活化减少，可溶性CD14和抗利什曼原虫IgG3水平降低。病毒载量仍然很低，与激活无关。两组显示出升高的但相似的衰老T细胞百分比。这些发现表明与NR组相比，R组下调免疫激活的能力降低。效应子反应的这种功能损伤可能是预测临床预后并建议开始或停止二级预防的有用指标。

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