2005, Número 4
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Rev Invest Clin 2005; 57 (4)
Características inmunológicas de los niños infectados por vía vertical con el VIH: estudio de casos y controles
González I, Gil L, Molina R, González A, Toledo ME, Díaz-Jidy M, Pérez J
Idioma: Español
Referencias bibliográficas: 37
Paginas: 498-504
Archivo PDF: 94.70 Kb.
RESUMEN
La infección por el virus de la inmunodeficiencia humana (VIH) en niños condiciona una grave inmunodeficiencia con características especiales que la distinguen del adulto, ocasionando un déficit inmune global. Se realizó un estudio de casos y controles de los pacientes pediátricos cubanos infectados por transmisión vertical con el VIH comparado con niños supuestamente sanos. Ambos grupos se caracterizaron desde el punto de vista clínico y se emplearon marcadores que evaluaron el estado inmunológico y virológico. Clínicamente 75% de los pacientes infectados por VIH presentan un patrón de progresión precoz, y dos se mantienen asintomáticos. A todos los niños infectados se les suministró tratamiento antirretroviral y tres presentan valores de carga viral mayores de 100,000 cp/mL. Las alteraciones inmunes encontradas en los pacientes VIH+ fueron: una inmunodepresión celular con conteos de subpoblaciones linfoides T CD4+, CD16+/CD56+ y CD19+ disminuidas significativamente con respecto al grupo control (p ‹ 0.05). Además, se encontró un aumento de linfocitos CD3+, CD8+, CD8+/CD38+, CD3+/CD95+ y una hipergammaglobulinemia a predominio de inmunoglobulina gamma IgG en la comparación estadística (p ‹ 0.05). Por otra parte, no se encontraron diferencias significativas en los niveles séricos de C3 y C4, así como en la actividad hemolítica de las vías clásica y alterna del sistema del complemento. Este conocimiento nos permitió sentar pautas para contribuir al manejo y tratamiento de los pacientes pediátricos infectados por VIH.
REFERENCIAS (EN ESTE ARTÍCULO)
Burns DN, Mofenson LM. Paediatric HIV-1 infection. Lancet 1999; 354(Suppl. 2): 1-6.
Church JA. HIV disease in children: The many ways it differs from the disease in adults. Post Med 2000; 107(4): 163-82.
Fortuny C. Infección por VIH en el niño. En: Gatell JM, Clotet B, Podzamczer D, Miró JM (Ed.). Guía práctica del SIDA. Clínica, diagnóstico y tratamiento. 5a. ed. Barcelona: MASSON, SA; 1998, p. 494-527.
The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1: A metaanalysis of 15 prospective cohort studies. N Engl J Med 1999; 304(13): 977-87.
Lindegren ML, Byers RH Jr, Thomas P. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999; 282(6): 531-8.
Vigano A, Principi N, Villa ML, Riva C, Cupi L, Trabattoni D, et al. Inmunolologic characterization of children with human inmunodeficiency virus, with slow or rapid disease progression. J Pediatr 1995; 126: 386-94.
Patarca R, Sandler D, Maher K, Hutto C, Martin NL, Klimas Ng, et al. Immunological correlates of disease severity in pediatric slow progressors with human immunodeficiency virus type 1 infection. AIDS Res Hum Retrov 1996; 12(11): 1063-8.
Muñoz FMA, Obregón E, Navarro J, Borner C, Gurbindo MD, Sampelyo TH, et al. Relationship of virologic, immunologic, and clinical parameters in infants with vertically acquired human immunodeficiency virus type 1 infection. Pediatr-Res 1996; 40(4): 597-602.
Palumbo PE, Raskino C, Fiscus S. Predictive value of quantitative plasma HIV ARN and CD4+ lymphocyte count in VIH-infected infants and children. JAMA 1998; 279(10): 756-61.
Grubman S, Gross E, Lerner Weiss N, Hernandez M, McSherry GD, Hoyt LG, et al. Older children and adolescents living with perinatally acquired human immunodeficiency virus infection. Pediatrics 1995; 95(5): 657-63.
Bohler T, Nedel S, Debatin KM. CD95-induced apoptosis contributes to loss of primed/memory but not resting/naive T cells in children infected with human immunodeficiency virus type 1. Pediatr-Res 1997; 41(6): 878-85.
Baeir-Bitterlich G, Fuchs D, Wachter H. Chronic immune stimulation, oxidative stress, and apoptosis in HIV infection. Biochem Pharmacol 1997; 53(6): 755-63.
Tzavara V, Vlachoyiannopoulos PG, Kordossis T, Galaris D, Travlou A, Dafni U, Moutsopoulos HM. Evidence for non-adaptive immune response in HIV infection. Eur J Clin Invest 1997; 27(10): 846-9.
Kabat EA, Mayer MM. Experimental Immunochemistry. Illinois: Charles C Thomas; 1961, p. 133-239.
Platts-Mills TAE, Ishizaka K. Activation of the alternative pathway of human complement by rabbit cells. J Immunol 1974; 113: 348-58.
Garcia L, Español T. Nuevos marcadores inmunológicos y biológicos en el control y seguimiento de los niños infectados. En: Español T, Ruiz I, editores. Cuarta Jornada de Tratamiento Antirretroviral en Pediatría. 1a. Ed. Barcelona: Springer; 2000, p. 34-43.
Dickover RE, Dillon M, Gillete SG. Rapid increases in load of human inmunodeficiency virus correlate with early disease progression and loss of CD4 cells in vertically infected infants. J Infect Dis 1994; 170: 1279-84.
De Martino M, Tovo P, Galli L. Prognostic significance of inmunologic changes in 675 patiens infants perinatally exposed to human inmunodeficiency virus. J Pediatr 1991; 119: 702-9.
Mofeson LM, Korelistz J, Mayer WA. The relationship between serum inmunodeficiency virus type 1 (HIV-1) ARN level, CD4 lymphocyte percent, and long term mortality risk in HIV-1 infected children. J Infect Dis 1997; 175(5): 1029-38.
Resino S, Gurbindo D, Bellón JM, Sanchez-Ramón S, Muñoz-Fernández MA. Predictive markers of clinical outcome in vertically HIVP1 infected infants. A prospective longitudinal study. Pediatr Res 2000; 47: 509-15.
Luzuriaga K, Wu H, McManus M, Brito P, Borkowsky W, Burchett S. Dinamics of human inmunodeficiency virus type 1. Replication in vertically infected infants. J Virol 1999; 73(1): 362-7.
Pediatric European Networt for the Treatment of AIDS. HIV-1 viral load and CD4 cell count in untread children with vertically adquired asymptomatic or mild disease. AIDS 1998; 12: 1-8.
Dickover R, Dillon M, Leong KM, Krogsted P, Plaeger S, Kwok S, et al. Early prognostic indicators in primary perinatal human inmunodeficiency virus type 1 infection. J Infect Dis 1998; 178: 375-87.
Picora CA, Sullivan JL, Penicalial D, Luzuriaga K. Early. HIV-1 envelop specific cytotoxic T lymphocyte responses in vertically infected infants. J Exp Med 1997; 185: 1153-61.
Gorochov G, Neumann AU, Kereveur A, Parizot T, Li T, Katlama C, et al. Perturbation of CD4+ and CD8+ T-cell repertoires during progression to AIDS and regulation of the CD4+ repertoire during antiviral therapy. Nat Med 1998; 4: 215-21.
Philips AN, Sabin CA, Elfort J. CD8 lymphocyte counts and serum inmunoglobin levels early in HIV infection as predictors of CD4 lymphocyte depletion during eight years follow-up. AIDS 1993; 7: 975-80.
Gougeon ML, Lecoeur H, Dulioust A. Programmed cell death in peripheral lymphocytes from HIV-infected persons: increased susceptibility to apoptosis of CD4 and CD8 T cells correlates with lymphocyte activation and with disease progression. J Inmunol 1996; 156: 3509-20.
Lucia B, Jennings C, Cauda R, Ortona L, Landay AL. Evidence of a selective depletion of a CD16+ CD56+ CD8+ natural killer cell subset during HIV infection. Citometry 1995; 22: 10-15.
Martino M, Rossi ME, Azzari C, Gelli MG, Galli L, Vierucci A. Diferent meaning of CD38 molecula expression on CD4+ and CD8+ cells of children perinatally infected with human inmunodeficiency virus type 1 infection surviving longer than five years. Pediatr-Res 1998; 43(6): 752-8.
Giorgi JU, Liu Z, Huttin LE, Cumberland WG, Hennessey K, Detels R. Elevated levels of CD38+ CD8+ cell in HIV infection add to the prognostic value of low CD4+ cell levels: result of 6 years of follow-up. AIDS 1993; 6: 904-12.
Liu Z, Huttin LE, Cumberland WB. Elevated relative fluorescence intensity of CD38 antigen expression on CD38+ cells is a marker of poor prognosis in HIV infection. Cytometry 1996; 26: 1-7.
Mocroft A, Bofill M, Lipman M. CD8+ CD38+ lymphocyte percent: a useful inmunological marker for monitoring HIV-1 infected patients. J AIDS Hum Retrov 1997; 14: 158-62.
Bohler T, Baumler C, Herr I, Groll A, Kurz M, Debatin KM. Activation of the CD95 system increases with disease progression in human inmunodeficiency virus type 1 infected children and adolescents. Pediatr Infect Dis J 1997; 16(8): 754-9.
Debatin KM, Fahring Faissner A, Enenkel-Stoodt S. High expression of APO-1(CD95) on T-lymphocytes from human inmunodeficiency children. Blood 1994; 83: 3001-3.
Baumler C, Bohler T, Herr I, Benner A, Krammer DH, Debatin KM. Activation of the CD95(APO-1/FAS) system in T cells from human inmunodeficiency virus type 1 infected children. Blood 1996; 88: 1741-6.
Hu PF, Huttin LE, Huttin P. Natural killer cell inmunodeficiency in HIV disease is manifest by profoundly decreased numbers of CD16+ CD56+ cells and expansion of a population of CD16dim CD56- cells with low lytic activity. J AIDS Hum Retrov 1995; 10: 331-40.
Alexandrescu R, Ditu S, Gaucan E. Quantitative and qualitative changes in the inmunoglobulins of HIV-infected children. Rev Roum Virol 1991; 42(3-4): 123-33.