Prevalence and Predictors of Immunological Failure among HIV Patients on HAART in Southern Ethiopia

Immunological monitoring is part of the standard of care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunological laboratory monitoring and utilization in clinical care in Ethiopia. This study assessed the pattern of immunological monitoring, immunological response, level of immunological treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. Adequacy of timely immunological monitoring was assessed every six months the first year and every one year thereafter. Immunological response was assessed every six months at cohort level. Immunological failure was based on the criteria: fall of follow-up CD4 cell count to baseline (or below), or CD4 levels persisting below 100 cells/mm³, or 50% fall from on-treatment peak value. A total of 1,321 documents of patients reviewed revealed timely immunological monitoring were inadequate. There was adequate immunological response, with pediatric patients, females, those with less advanced illness (baseline WHO Stage I or II) and those with higher baseline CD4 cell count found to have better immunological recovery. Thirty-nine patients (3%) were not evaluated for immunological failure because they had frequent treatment interruption. Despite overall adequate immunological response at group level, the prevalence of those who ever experienced immunological failure was 17.6% (n=226), while after subsequent re-evaluation it dropped to 11.5% (n=147). Having WHO Stage III/IV of the disease or a higher CD4 cell count at baseline was identified as a risk for immunological failure. Few patients with confirmed failure were switched to second line therapy. These findings highlight the magnitude of the problem of immunological failure and the gap in management. Prioritizing care for high risk patients may help in effective utilization of meager resources.     

IgE-containing immune complexes in bronchial asthma]

Level of circulating immunological complexes and their immunoglobulin content have been determined in 36 asthmatic patients, including 15 patients with atopic asthma and 21 patients with infectious asthma. A technique of staphylococcal protein A binding has shown, that the level of the circulating immunological complexes is increased in patients with infectious bronchial asthma. An amount of IgE in these complexes has been increased in both atopic and infectious bronchial asthma. However, a level of IgE-containing immunological complexes has been higher in the atopic asthma, then that in infectious form of the disease. An increased IgA content in the immunological complexes has been noted in the infectious asthma.     

Immunological indices in differential diagnosis of active and inactive chronic endocervicitis

A total of 132 patients were examined for chronical endocervicitis by clinical, immunological and morphological methods. According to the results obtained the patients were subdivided into several groups. The first group covered 77 females with an active clinical somatic form of the disease. The second group included 55 patients with chronical inactive endocervicitis. Controls included 25 practically healthy females. No differences were found between immunological indices of peripheral blood in groups of patients with active and inactive forms of chronic endocervicitis. Immunological tests on cervical mucus in patients with chronic endocervicitis revealed differences in the total number of leukocytes, content of living cells, functional activity of neutrophils, concentration of immunoglobulins and proinflammatory cytokines. This study may contribute to the development of immunological criteria for diagnosis of inflammatory process activity as well as a diagnostic model.     

Impaired immune response associated with ABO antigen system in patients with purulent abscesses and dysentery

On the basis of a considerable number of facts--the results of the immunological survey of 197 patients with purulent infections of soft tissues and 103 shigellosis patients--the character and manifestation of immunological disturbances were found to depend on the genetic markers of blood (antigens of the AB0 system) which proved to differ in different type of pathology in patients.     

Immunological features in multiple sclerosis.

A clinical and laboratory profile of the immunological system of patients with multiple sclerosis (MS) strongly suggested that many specific immune deficiencies exist in MS. The immunological history showed that patients with MS had had more tonsillectomies, appendicectomies, and childhood infections than matched controls, which suggested that there had been problems in controlling various types of childhood infections. The cell-mediated immune response and the circulating antibody titres were specifically impaired against a variety of antigens. Patients with MS had significantly lower serum antibody titres than controls against many naturally occurring antigens-namely, diptheria and tetanus toxoids, adenovirus, and mumps viruses. Raised serum antibody titres were found against measles and varicella zoster viruses while no difference was found towards other antigens. The delayed hypersensitivity reaction and the immunological memory of patients with MS were also greatly reduced against the mumps skin test antigens. There were normal amounts of circulating T and B lymphocytes, and the phytohaemagglutinin, concanavallin A, pokeweed mitogen, and encephalitogens lymphocyte transformation was not different from that in controls. These results indicated that patients with MS have more infectious problems than normal people and that both their T and B cell systems cannot mount a fully normal immunological response to some viral and bacterial antigens, while they give an increased response to others.     

Sandoglobulin immunocorrection in trauma

Twenty one patients with the long-term compression syndrome (LCS) and 12 patients with burns treated with sandoglobulin in combination with antibacterial therapy were followed up. The control groups included 14 and 18 patients, respectively. All the patients had wound infections. Increased or lowered respiratory burst of peripheral blood neutrophils and lowered contents of active T-lymphocytes were detected in the majority of the patients. The patients had also an increased respiratory burst of tissue homogenate in the primary focus. Sandoglobulin decreased the periods of normalization of the immunological indices, body temperature and leukogram shifts to the right. The most pronounced effect of the drug was recorded before radical operations, i.e. in the presence of acute microbial toxemia or in patients with severe and extended burns. The procedure of immunological monitoring developed by the authors rapidly estimates the indications to the use of sandoglobulin alone or in combination with other immunomodulators.     

Physical criteria of pathological processes. II. Modulating role of functional interhemisphere asymmetry in forming and immune response in rheumatic diseases

The level of the brain permanent potential as a physiological criterion of the functional interhemisphere asymmetry, as well as immunological and biochemical characteristics of peripheral blood in patients with systemic rheumatic diseases were studied. It was found that the distribution of the characteristics of immune response in patients with different types of interhemisphere asymmetry. Significant differences were observed for average values of biochemical and immunological characteristics, their dispersions, as well as for the structure of relationships between the type of the interhemisphere asymmetry and immunobiochemical characteristics.     

The use of laser-nephelometry in evaluating fibrinogenaemia in patients with hepatocarcinoma and cirrhosis

In the present study fibrinogen was assayed by the immunonephelometric method in 19 patients afflicted with hepatocarcinoma and 24 patients afflicted with cirrhosis. The two groups were similar in age, sex and presence of HbsAg. The incidence of values above the norm was significantly greater in patients with hepatocarcinoma (p less than 0.05). Then, the concentration of fibrinogen was measured in all using two other immunological methods (Laurell and Mancini) and two coagulative methods (Clauss and Ratnoff). A dysfibrinogenemia (an excess of fibrinogen assayed by immunological methods to be greater than 100 mg/dl with respect to biological methods). is more frequent using the Nephelometer-Clauss (p less than 0.01) and Mancini-Clauss (p less than 0.01) methods in patients with hepatocarcinoma with respect to those with cirrhosis. The study of the kinetics of antifibrinogen antigen-antibody reaction failed to show differences between patients with hepatocarcinoma or cirrhosis and normal subjects.     

Immunologic reactivity to incompatible blood group substances of the ABO system in scleroderma.

The immunization with incompatible blood groups substances of the ABO system yielded distinct increases in the isohemagglutinin titers and their scores in 16 patients suffering from systemic sclerosis (scleroderma) and in 16 controls. The difference between these two groups was not statistically significant, which suggests an intact humoral immunological reactivity of these antigens. However, investigations with further antigens would be necessary to judge the immunological factors supposed to be involved in the pathogenesis of systemic sclerosis. The method may be recommended for testing the humoral immunological response in similar problems.     

Muscle-fiber transdifferentiation in an experimental model of respiratory chain myopathy

Common variable immunodeficiency (CVID) describes a heterogeneous subset of hypogammaglobulinemias of unknown etiology. Typically, patients present with recurrent bacterial infections of the respiratory and gastrointestinal tract. A significant proportion of CVID patients develops additional autoimmune, inflammatory or lymphoproliferative complications. CVID is the most frequent symptomatic primary immunodeficiency encountered in adults. Informative monogenetic defects have been found in single patients and families but in most cases the pathogenesis is still elusive. Numerous immunological studies have demonstrated phenotypic and functional abnormalities of T cells, B cells and antigen-presenting cells. A hallmark is the impaired memory B-cell formation that has been taken advantage of for classifying CVID patients. Clinical multi-center studies have demonstrated a correlation between immunological markers and clinical presentation. Long-term outcome is significantly influenced by delay of diagnosis and treatment and the presence of chronic inflammatory complications. While immunoglobulin replacement therapy plus antibiotics can control infections in most cases, patients with non-infectious inflammatory complications such as granulomatous inflammation, interstitial lung disease, inflammatory bowel disease, lymphoproliferation and developing malignancies still represent a therapeutic challenge. In this review we provide a systematic overview of the immunological, clinical, diagnostic and therapeutic aspects of CVID and highlight recent developments in these fields.     

Partial suppression of cell mediated immunity in chromoblastomycosis

The cellular immune response of 8 patients from the Brazilian Amazon region with chromoblastomycosis was analyzed. Primary immunological responses of patients were tested by contact sensitization to 2,4-dinitro-chlorobenzene (DNCB), or rejection of first set skin allografts. 2 of 8 patients were reactive to DNCB after sensitization, and skin allograft rejection occured in an average of 14 days. Capacity of patients to mount recall immunological responses was measured by skin testing with two fungal antigens and three bacterial antigens. Delayed skin reaction to trichophytin and Candida antigens was negative in the majority of the patients. However, reactivity to mycobacterial (tuberculin), and bacterial (staphylococcal, streptococcal) antigen was high, or only slightly diminished respectively. The data suggest that patients with chromoblastomycosis have suppressed nonspecific, cell mediated immunity for some antigens (skin allografts, DNCB, fungal antigens), while reactivity to bacterial and mycobacterial antigens is not impaired.     

Immunocorrection with pentaglobin in wound infection and burn disease

Patients with wound infections and extended burns were treated with pentaglobin (Biotest-Pharma), a serum preparation containing high concentrations of immunoglobulin M. The use of the preparation at early stages after surgical operations in the patients with wound infections or at the beginning of active surgical treatment of the patients with burns decreased the terms of the body temperature normalization as well as normalization of the immunological, hematological and biochemical indices. The most pronounced efficacy of pentaglobin was observed in the patients with severe microbial toxemia. A scheme for pathogenetic immunocorrection of wound infections and burns was developed. It is based on simultaneous recording of intensity of immunological responses in peripheral blood and intensity of protective reactions in wound tissues.     

Dysregulation in microRNA Expression Is Associated with Alterations in Immune Functions in Combat Veterans with Post-Traumatic Stress Disorder

While the immunological dysfunction in combat Veterans with post-traumatic stress disorder (PTSD) has been well documented, the precise mechanisms remain unclear. The current study evaluated the role of microRNA (miR) in immunological dysfunction associated with PTSD. The presence of peripheral blood mononuclear cells (PBMC) and various lymphocyte subsets in blood collected from PTSD patients were analyzed. Our studies demonstrated that the numbers of both PBMC and various lymphocyte subsets increased significantly in PTSD patients. When T cells were further analyzed, the percentage of Th1 cells and Th17 cells increased, regulatory T cells(Tregs) decreased, while Th2 cells remained unaltered in PTSD patients. These data correlated with increased plasma levels of IFN-γ and IL-17 while IL-4 showed no significant change. The increase in PBMC counts, Th1 and Th17 cells seen in PTSD patients correlated with the clinical scores. High-throughput analysis of PBMCs for 1163 miRs showed that the expression of a significant number of miRs was altered in PTSD patients. Pathway analysis of dysregulated miRs seen in PTSD patients revealed relationship between selected miRNAs and genes that showed direct/indirect role in immunological signaling pathways consistent with the immunological changes seen in these patients. Of interest was the down-regulation of miR-125a in PTSD, which specifically targeted IFN-γ production. Together, the current study demonstrates for the first time that PTSD was associated with significant alterations in miRNAs, which may promote pro-inflammatory cytokine profile. Such epigenetic events may provide useful tools to identify potential biomarkers for diagnosis, and facilitate therapy of PTSD.     

How hepatitis C virus modifies the immunological profile of Sj?gren syndrome: analysis of 783 patients

IntroductionWe conducted a study to analyze how infection by hepatitis C virus (HCV) may influence the immunological serum pattern of patients with Sjögren syndrome (SS).MethodsSince 1994, we have tested serum HCV-IgG antibodies in 783 patients with SS diagnosed according to the 1993 European classification criteria. The immunological profile at diagnosis was compared according to the presence or absence of HCV.ResultsOf the 783 patients with SS, 105 (13.4 %) tested positive for HCV-IgG antibodies (88 females, 17 males, mean age at SS diagnosis: 62.9 years). Multivariate analysis showed that patients with SS-HCV had a higher mean age and a higher frequency of low C3/C4 levels, cryoglobulins, and hematological neoplasia compared with patients without HCV. The frequency of anti-La antibodies compared with anti-Ro antibodies was higher in patients with SS-HCV (17 % vs. 15 %) and lower in patients without HCV infection (30 % vs. 43 %). The frequency of concomitant detection of the three main cryoglobulin-related markers (cryoglobulins, rheumatoid factor activity, and C4 consumption) was threefold higher in patients with SS-HCV compared with patients without HCV. SS-HCV patients with genotype 1b showed the highest frequencies of immunological abnormalities related to cryoglobulins and the lowest frequencies of anti-Ro/La antibodies.ConclusionsWe found HCV infection in 13 % of a large series of Spanish patients with SS. The HCV-driven autoimmune response was characterized by a lower frequency of anti-Ro/La antibodies, an abnormal predominance of anti-La among anti-Ro antibodies, and a higher frequency of cryoglobulinemic-related immunological markers in comparison with patients without HCV infection. This immunological pattern may contribute to the poor outcomes found in patients with SS-HCV.     

Evaluation of Clinical and Immunological Markers for Predicting Virological Failure in a HIV/AIDS Treatment Cohort in Busia,Kenya

Background

In resource-limited settings where viral load (VL) monitoring is scarce or unavailable, clinicians must use immunological and clinical criteria to define HIV virological treatment failure. This study examined the performance of World Health Organization (WHO) clinical and immunological failure criteria in predicting virological failure in HIV patients receiving antiretroviral therapy (ART).

Methods

In a HIV/AIDS program in Busia District Hospital, Kenya, a retrospective, cross-sectional cohort analysis was performed in April 2008 for all adult patients (>18 years old) on ART for ≥12 months, treatment-naive at ART start, attending the clinic at least once in last 6 months, and who had given informed consent. Treatment failure was assessed per WHO clinical (disease stage 3 or 4) and immunological (CD4 cell count) criteria, and compared with virological failure (VL >5,000 copies/mL).

Results

Of 926 patients, 123 (13.3%) had clinically defined treatment failure, 53 (5.7%) immunologically defined failure, and 55 (6.0%) virological failure. Sensitivity, specificity, positive predictive value, and negative predictive value of both clinical and immunological criteria (combined) in predicting virological failure were 36.4%, 83.5%, 12.3%, and 95.4%, respectively.

Conclusions

In this analysis, clinical and immunological criteria were found to perform relatively poorly in predicting virological failure of ART. VL monitoring and new algorithms for assessing clinical or immunological treatment failure, as well as improved adherence strategies, are required in ART programs in resource-limited settings.     

Efficiency of immunocorrection using cytokines in the therapy of papillomavirus infection

The data of the immunological examination and the results of treatment of 86 patients with papillomavirus infection (PVI) are presented. The multifactor suppression of cell-mediated and humoral immunity was established. The degree of immune disturbances correlated with the spread and severity of lesions. The use of systemic injections of cytokines (leukinferon and concentrated interferon) in low doses as adjuvant therapy with laser-radiosurgery led to the normalization of most immunological characteristics and the course of PVI without relapses.     

Uremia causes premature ageing of the T cell compartment in end-stage renal disease patients

ABSTRACT: BACKGROUND: End-stage renal disease (ESRD) patients treated with renal replacement therapy (RRT) have premature immunologically aged T cells which may underlie uremia-associated immune dysfunction. The aim of this study was to investigate whether uremia was able to induce premature ageing of the T cell compartment. For this purpose, we examined the degree of premature immunological T cell ageing by examining the T cell differentiation status, thymic output via T cell receptor excision circle (TREC) content and proliferative history via relative telomere length in ESRD patients not on RRT. RESULTS: Compared to healthy controls, these patients already had a lower TREC content and an increased T cell differentiation accompanied by shorter telomeres. RRT was able to enhance CD8+ T cell differentiation and to reduce CD8+ T cell telomere length in young dialysis patients. An increased differentiation status of memory CD4+ T cells was also noted in young dialysis patients. CONCLUSION: Based on these results we can conclude that uremia already causes premature immunological ageing of the T cell system and RRT further increases immunological ageing of the CD8+ T cell compartment in particular in young ESRD patients.     

Assessment of the human immunological status by taking into account the correlations among individual indices

The problem of correlation of the parameters of the immune system in the normal subjects and in patients with immunological diseases has been considered. The most informative relations have been determined and an attempt has been made to reveal common and specific signs of various immunological diseases.     

Association between clinical symptoms and lymphocyte abnormalities in a population with chronic domestic exposure to industrial solvent-contaminated domestic water supply and a high incidence of leukaemia

Summary An unusually high incidence of leukaemia and recurrent infections was noted in children exposed in utero to domestic water supply contaminated with industrial solvents including trichloroethylene, perchloroethylene and 1,2-transdichloroethylene. Medical and laboratory investigations were carried out on 28 family members of the patients with leukaemia with particular emphasis on the immunological system to determine if they displayed symptoms associated with acute or chronic exposure to these chlorinated hydrocarbons. The principal organ systems affected were neurological, immunological and cardiological. Damage to these systems was found in all subjects by history, physical and laboratory parameters. Damage to the immunological system was manifest by altered ratios of T lymphocyte subpopulations, increased incidence of auto-antibodies, increased infections and recurrent rashes.     

Interleukin-15 modulates interferon-gamma and beta-chemokine production in patients with HIV infection: implications for immune-based therapy

Interleukin (IL)-15 is a cytokine that has lymphocyte stimulatory activity similar to that of IL-2, and plays important immunoregulatory functions during HIV disease. To evaluate the role of IL-15 in HIV infection the following patients were studied: 18 antiretroviral-naive patients with advanced disease; 19 patients with continuous viral suppression and immunological response after 48-120 weeks of highly active antiretroviral therapy (HAART); and 12 patients with evidence of virological and immunological HAART treatment failure. Nineteen healthy blood donors were included as controls. The production of IL-15 by human peripheral blood monocytes stimulated with lipopolysaccharide and Mycobacterium avium complex, the priming effect of IL-15 on IFN-gamma production from purified CD4(+) and CD8(+) T cells, and the ability of IL-15 to stimulate the beta-chemokine release from purified CD4(+) and CD8(+) T cells were analyzed. In the present work IL-15 production by human peripheral blood monocytes was significantly increased in HIV-infected patients with long-term virological and immunological response to HAART. IL-15 enhanced the in vitro priming of CD4(+) and CD8(+) T cells for IFN-gamma production, also in patients receiving HAART. Finally, IL-15 had positive effects on RANTES, MIP-1alpha, and MIP-1beta release by CD4(+) and CD8(+) T cells. In conclusion IL-15 could affect the immune response of HIV-infected patients by augmenting and/or modulating IFN-gamma production and beta-chemokine release. These data about functional properties of IL-15 could provide new implications for immune-based therapies in HIV infection.