Fatores associados à não resposta imunológica após terapia antirretroviral adequada
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Data
2019-08-15
Autores
Arruda, Mayara Gomes
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Universidade Estadual Paulista (Unesp)
Resumo
Algumas pessoas que vivem com HIV/Aids (PVHA) apresentam-se como não respondedores imunológicos, o que consiste em linfócitos T CD4+ abaixo de 350/mm3, após pelo menos um ano de tratamento e com cargas virais do HIV em níveis indetectáveis. Tratou-se de estudo retrospectivo, cujo objetivo foi avaliar marcadores clínicos e laboratoriais como características de não resposta imunológica em PVHA. Foram analisados 52 pacientes: 26 não respondedores imunológicos (G1) e 26 com resposta adequada (G2), que apresentavam contagens de linfócitos T CD4+ abaixo de 350 células/mm3, no pré-tratamento. Avaliações metabólicas e inflamatórias foram realizadas em cinco momentos: pré-tratamento, seis, 12, 24 e 36 meses após início da terapia. As variáveis foram perfil lipídico, proteína C reativa (PCR), clearance de creatinina, hemoglobina, leucócitos e linfócitos totais, contagens de CD4+ e relação T CD4+/CD8+. Dos 52 pacientes, 80,7% eram homens, com médias de idades de 35 a 55 anos. As médias de cargas virais no pré-tratamento para G1 foram de 5,41 e para G2 5,40 em log10 (cópias de RNA/mL), não havendo diferença (p=0,16) entre os grupos. Houve diferenças na PCR entre os momentos iniciais, seis, 12 e 36 meses (p<0,001), com níveis mais elevados em G1. Na comparação dos linfócitos CD4+ e a relação CD4+/CD8+ foram menores em todos os períodos, em G1. Houve diferença entre os grupos para triglicérides, mais altos em G2 no momento inicial (p 0,004) e com seis meses (p 0,001), bem como para colesterol aos 12 meses (0,004). A hemoglobina foi mais baixa em G1 (P 0,003) no momento inicial. Tanto os leucócitos quanto os linfócitos totais encontravam-se mais baixos no G1 em todos os momentos, não apresentando diferenças apenas aos 36 meses para leucócitos e 24 meses para linfócitos. As conclusões do presente estudo foram que a PCR elevada, a baixa relação CD4+/CD8+, anemia e leucopenia foram as principais características pré-tratamento e fatores de risco de indivíduos não respondedores imunológicos à terapia antirretroviral adequada.
Some people living with HIV / AIDS (PLHA) present themselves as non-immune responders, which consists of CD4 + T lymphocytes below 350 / mm3, after at least one year of treatment and with viral loads of HIV at undetectable levels. It was a retrospective study; whose objective was to evaluate clinical and laboratory markers as characteristics of non-immune response in PLHA. Fifty- two patients were analyzed: 26 non-responders (G1) and 26 with adequate response (G2), who had CD4 + T lymphocyte counts below 350 cells / mm3, before pretreatment. Metabolic and inflammatory evaluations were performed in five moments: pre-treatment, six, 12, 24 and 36 months after initiation of therapy. The variables were lipid profile, C-reactive protein (CRP), creatinine clearance, hemoglobin, total leukocytes and lymphocytes, CD4 + counts and CD4 + / CD8 + T ratio. Of the 52 patients, 80.7% were men, with averages ranging from 35 to 55 years. The means of viral loads in the pretreatment for G1 were 5.41 and for G2 5.40 in log10 (copies of RNA / mL), there was no difference (p = 0.16) between the groups. There were differences in CRP between the initial moments, six, 12 and 36 months (p <0.001), with higher levels in G1. In the comparison of CD4 + lymphocytes and the CD4 + / CD8 + ratio was lower in all periods, in G1. There was a difference between the groups for triglycerides, higher in G2 at the initial time (p 0.004) and at six months (p 0.001), as well as at 12 months (0.004). Hemoglobin was lower in G1 (P 0.003) at baseline. Both leukocytes and total lymphocytes were found to be lower in G1 at all times, with differences not only at 36 months for leukocytes and 24 months for lymphocytes. In conclusion, elevated CRP and the low CD4 + / CD8 + ratio were the main characteristics of non-immunological PHVA responders.
Some people living with HIV / AIDS (PLHA) present themselves as non-immune responders, which consists of CD4 + T lymphocytes below 350 / mm3, after at least one year of treatment and with viral loads of HIV at undetectable levels. It was a retrospective study; whose objective was to evaluate clinical and laboratory markers as characteristics of non-immune response in PLHA. Fifty- two patients were analyzed: 26 non-responders (G1) and 26 with adequate response (G2), who had CD4 + T lymphocyte counts below 350 cells / mm3, before pretreatment. Metabolic and inflammatory evaluations were performed in five moments: pre-treatment, six, 12, 24 and 36 months after initiation of therapy. The variables were lipid profile, C-reactive protein (CRP), creatinine clearance, hemoglobin, total leukocytes and lymphocytes, CD4 + counts and CD4 + / CD8 + T ratio. Of the 52 patients, 80.7% were men, with averages ranging from 35 to 55 years. The means of viral loads in the pretreatment for G1 were 5.41 and for G2 5.40 in log10 (copies of RNA / mL), there was no difference (p = 0.16) between the groups. There were differences in CRP between the initial moments, six, 12 and 36 months (p <0.001), with higher levels in G1. In the comparison of CD4 + lymphocytes and the CD4 + / CD8 + ratio was lower in all periods, in G1. There was a difference between the groups for triglycerides, higher in G2 at the initial time (p 0.004) and at six months (p 0.001), as well as at 12 months (0.004). Hemoglobin was lower in G1 (P 0.003) at baseline. Both leukocytes and total lymphocytes were found to be lower in G1 at all times, with differences not only at 36 months for leukocytes and 24 months for lymphocytes. In conclusion, elevated CRP and the low CD4 + / CD8 + ratio were the main characteristics of non-immunological PHVA responders.
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Palavras-chave
Não resposta imunológica, TARV, resposta imunológica discordante, Hiv/aids, CD4+, CD8+