Avaliação da Translocação Microbiana em Gestantes Infectadas pelo HIV
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2016-02-26
Autores
Manfio, Vanessa Martinez [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: aproximadamente 39.000.000 de pessoas vivem com HIV/aids no mundo, sendo 757.042 no Brasil, notificados desde 1980 até junho de 2014, e estima-se 12.000 casos de mulheres gestantes infectadas por ano. Na infecção pelo HIV, além da depleção intensa de linfócitos T CD4+ no intestino, ocorre comprometimento de vários mecanismos protetores epiteliais, fatores que causam danos na barreira intestinal e resultam na translocação microbiana, induzindo aumento da ativação imune sistêmica e inflamação crônica. No entanto, a translocação microbiana na infecção pelo HIV tem sido pouco investigada durante a gestação, período em que a mulher é suscetível a infecções bacterianas. Objetivo: estudar marcadores de translocação microbiana e inflamação em gravidas infectadas pelo HIV. Casuística e métodos: foram estudadas 30 voluntárias, sendo 12 gestantes infectadas pelo HIV (G1), 10 gestantes não infectadas (G2) e, oito mulheres infectadas pelo HIV não grávidas (G3), mas dentro da faixa etária reprodutiva. Foram coletados dados referentes à idade, idade gestacional (IG), carga viral plasmática do HIV (CV), contagem de linfócitos T CD4+ e nadir de T CD4+. A translocação microbiana foi avaliada por dosagem plasmática de CD14 solúvel (sCD14) pelo método imunoenzimático (ELISA) e, o estado inflamatório, pela análise de IL- 17, IL-10, IL-8, IL-1β, IL-6, IL-12p70 e TNF-α por citometria de fluxo (CBA). Para a análise estatística paramétrica foi utilizado o teste ANOVA, seguido de Tukey-Kramer e, para as não paramétricas, Distribuição Gamma, considerando diferenças significativas quando p<0,05. Resultados: a média de T CD4+, CV e nadir foram, respectivamente, para G1, 601 células/mm³, 25670 cópias/mL e 442 células/mm³ e, para G3, 583 células/mm³, 2299 cópias/mL e 196 células/mm³. Em relação à idade, os grupos diferiram entre si, sendo menor em G1 e maior em G3. Não houve diferenças nas dosagens de citocinas. Foram observados níveis elevados de sCD14 em todos os grupos, havendo diferença entre G1 (6727±2030) e G3 (11515±10746), [p=0,02] e entre G2 (5456±769) e G3 [p<0,001]. Conclusão: Embora não tenha ocorrido diferença no estado inflamatório entre os grupos, todas as gestantes mostraram níveis elevados de sCD14, independente da presença ou não da infecção pelo HIV, porém, os maiores valores foram das mulheres infectadas e não gestantes, sugerindo que a gravidez poderia influenciar em mecanismos de translocação, alterando, especialmente os níveis do marcados estudado.
Introduction: Approximately 39.000.000 million people are living with HIV/AIDS worldwide and 757.042 in Brazil, reported from 1980 to June 2014, and it is estimated 12.000 cases of HIV-infected pregnant women annually. In HIV infection, besides the intense basal CD4+ T lymphocytes depletion, occurs impairment of various epithelial protective mechanisms, factors that contribute to intestinal barrier damages and result in microbial translocation, leading to increased systemic immune activation and chronic inflammation. However, microbial translocation in HIV infection has been poorly investigated during pregnancy, period which women are susceptible to bacterial infections. Objective: to study microbial translocation markers and the inflammatory status in HIV-infected pregnant women. Patients and Methods: We studied 30 volunteers, 12 HIV-infected pregnant women (G1), 10 HIV-uninfected pregnant women (G2) and 8 HIV-infected nonpregnant women (G3) in the same reproductive age than the other groups. Data were collected regarding age, gestational age (GA), plasma HIV viral load (VL), lymphocyte CD4+ T count and nadir. The microbial translocation was evaluated by measurement of plasmatic soluble CD14 (sCD14), performing the immunoenzymatic method (ELISA) and of inflammatory cytokines (IL-17, IL-10, IL-8, IL-1β, IL-6, IL -12p70 and TNF-α) by flow cytometry (CBA). The parametric statistical analysis was performed using ANOVA followed by Tukey-Kramer post-hoc test, and for non-parametric, Gamma Distribution, considered significant when p <0.05. Results: The mean of CD4+ T count, nadir and VL were, respectively for G1 601 cells/mm³, 442 cells/mm³ and 25670 copies/mL, and for G3, 583 cells/mm³, 196 cells/mm³ and 2299 copies/mL. The age was different between G1 and G3. Plasmatic levels of cytokines did not differ among groups. High levels of sCD14 were observed in all groups, with statistical difference between G1 (6727±2030) and G3 (11515±10746) [p = 0.02] and G2 (5256±769) and G3 [p <0.001]. Conclusion: Although there was no difference in the inflammatory state between the groups, all pregnant women showed high levels of sCD14, those HIV-infected and uninfected, however, the HIV-infected non-pregnant women showed the highest values of this marker, suggesting that the pregnancy might influence on translocation mechanisms, changing the plasmatic sCD14 values.
Introduction: Approximately 39.000.000 million people are living with HIV/AIDS worldwide and 757.042 in Brazil, reported from 1980 to June 2014, and it is estimated 12.000 cases of HIV-infected pregnant women annually. In HIV infection, besides the intense basal CD4+ T lymphocytes depletion, occurs impairment of various epithelial protective mechanisms, factors that contribute to intestinal barrier damages and result in microbial translocation, leading to increased systemic immune activation and chronic inflammation. However, microbial translocation in HIV infection has been poorly investigated during pregnancy, period which women are susceptible to bacterial infections. Objective: to study microbial translocation markers and the inflammatory status in HIV-infected pregnant women. Patients and Methods: We studied 30 volunteers, 12 HIV-infected pregnant women (G1), 10 HIV-uninfected pregnant women (G2) and 8 HIV-infected nonpregnant women (G3) in the same reproductive age than the other groups. Data were collected regarding age, gestational age (GA), plasma HIV viral load (VL), lymphocyte CD4+ T count and nadir. The microbial translocation was evaluated by measurement of plasmatic soluble CD14 (sCD14), performing the immunoenzymatic method (ELISA) and of inflammatory cytokines (IL-17, IL-10, IL-8, IL-1β, IL-6, IL -12p70 and TNF-α) by flow cytometry (CBA). The parametric statistical analysis was performed using ANOVA followed by Tukey-Kramer post-hoc test, and for non-parametric, Gamma Distribution, considered significant when p <0.05. Results: The mean of CD4+ T count, nadir and VL were, respectively for G1 601 cells/mm³, 442 cells/mm³ and 25670 copies/mL, and for G3, 583 cells/mm³, 196 cells/mm³ and 2299 copies/mL. The age was different between G1 and G3. Plasmatic levels of cytokines did not differ among groups. High levels of sCD14 were observed in all groups, with statistical difference between G1 (6727±2030) and G3 (11515±10746) [p = 0.02] and G2 (5256±769) and G3 [p <0.001]. Conclusion: Although there was no difference in the inflammatory state between the groups, all pregnant women showed high levels of sCD14, those HIV-infected and uninfected, however, the HIV-infected non-pregnant women showed the highest values of this marker, suggesting that the pregnancy might influence on translocation mechanisms, changing the plasmatic sCD14 values.
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Palavras-chave
Translocação microbiana, Gestantes, HIV, sCD14, Citocinas, Microbial translocation, Pregnant women, Cytokines