Epidemiological analysis of factors influencing the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis

The epidemiological significance of combined forms of especially dangerous infections has not been studied enough, unlike mono-infections. Currently, there is a tendency towards an increase in the incidence of multidrug-resistant tuberculosis. The formation of severe forms of the disease is caused by other widespread infections, such as chronic viral hepatitis and HIV. Polymorbid conditions distort the clinical manifestations of tuberculosis, reduce the effectiveness of anti-tuberculosis therapy and worsen the prognosis of the disease. Risk factors among patients in this category need analysis to carefully monitor patients and ensure infection control. Objective is to analyze the factors affecting the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis. Materials and methods. Cases of the combined pathology of multiresistant tuberculosis, HIV infection and viral hepatitis with a dominant diagnosis of tuberculosis are analyzed. Results and discussion. The influence of the immunological status on the course of combined pathology was revealed. Since all the patients under study had clinical stage 4 of HIV infection, tuberculosis developed as an opportunistic infection. Severe immunosuppression (CD4 < 200 cells/ml) contributed to the progression of the generalized tuberculosis process. Long-term immunodeficiency was an unfavorable factor; in the overwhelming majority of cases, antiretroviral therapy was prescribed only after tuberculosis was detected. The dependence of the clinical form of tuberculosis on the level of CD4-lymphocytes was noted: isolated lesion of the chest organs prevailed in patients with a level of CD4-lymphocytes more than 200 cells/ml, generalization of TB process — with CD4 less than 200 cells/ml. Patients with miliary tuberculosis had a higher mortality rate compared to patients with other clinical forms, regardless of antiretroviral therapy. It was revealed that socially disoriented young people with viral hepatitis C prevailed in the structure of patients, the prevalence of which was due to the influence of aggravating factors, such as alcohol and drug abuse, and stay in prisons. Against the background of combined treatment, there was no significant effect of viral hepatitis on the course of polymorbid conditions and the effectiveness of the therapy.

The effectiveness of immunoglobulin G application in patients with drug­-resistant tuberculosis/HIV with CD4+ lymphocytes from 200 to 50 cells/µl according to biochemical data

Objective — to study the effectiveness of immunoglobulin therapy in patients with co-infection of drug-resistant tuberculosis (DR-TB)/HIV at the level of CD4+ lymphocytes from 200 to 50 cells/μl, based on a study of the dynamics of biochemical parameters. Materials and methods. The study involved 52 patients aged 20 to 55 years, with a mean age of (37.2 ± 7.8) years. All patients were HIV-positive with laboratory-confirmed DR-TB with mycobacterial resistance to first- and second-line drugs. Patients with DR-TB/HIV were distributed as follows: 1 group (control) — 26 patients with DR-TB/HIV, receiving standard treatment of second-line AMBP and ARVT; group 2 (main) — 26 patients with DR-TB/HIV, who also received standard treat­ment of second-line AMBP and ARVT, with the addition of complex therapy with intravenous immunoglobulin G (IgG). Results and discussion. Against the background of treatment, the dynamics of changes in biochemical parameters was as follows: patients in the control group, after the first 2 weeks of AMBP, there was an increase in intoxication load on the hepatobiliary and urinary systems, which led, on the one hand, to dysfunction liver with hyperbilirubinemia, increased transaminase activity, thymol turbidity, and on the other — to the development of renal failure with hypercreatininemia, hyperuricemia, azotemia and oliguria. As a result, timely appointment of ARVT (2 weeks after AMBP) in 19 (73.1 %) patients was impossible and was carried out much later than desired (after 2—3 months).Treatment of patients with comorbid pathology of DR-TB/HIV, which included complex intravenous IgG on the background of complex therapy, was accompanied by positive clinical and laboratory dynamics, which created conditions for ARVT involvement after the second week of complex therapy according to the developed treatment method. Conclusions. The use of immunologically targeted treatment with intravenous IgG made it possible to successfully prescribe ARVT to patients of the main group in 2 weeks from the start of AMBT, which is very useful to prevent adverse reactions, increase treatment efficacy and reduce mortality in patients with comorbid DR-TB/HIV in a state of deep immunosuppression.

Phototherapy effect on CD4 lymphocytes of Full Term Neonates with Jaundice

Background Neonatal jaundice is one of the most common problems that affect newborn infants, and phototherapy is usually used for treatment. Phototherapy is generally considered a very safe and well-tolerated treatment for hyperbilirubinaemia. However, clinical users should be aware of the unwanted effects of using phototherapy. Affection of neonatal immune system due to phototherapy has been reported. Objectives Evaluation of the effect of phototherapy on neonatal immune system through measuring the level of CD4+ lymphocytes. Methods A prospective cohort study was conducted on full term newborns assigned to three groups: group1 neonates with hyperbilirubinemia treated by conventional phototherapy, group2 neonates treated by LED phototherapy and healthy neonates as control group. The percentages and absolute counts ofCD4+ lymphocytes were measured by flow cytometry before phototherapy and 48 h after exposure. Results The study showed a significant decrease in CD4+ percentage in patients after 48 h of exposure to conventional phototherapy (P value &lt; 0.05). There was a significant decrease in CD4+ absolute counts after 48 h of exposure to both types of phototherapy. Conclusion Conventional and LED phototherapy which is used in the treatment of neonatal hyperbilirubinemia, caused a decrease in CD4+ absolute count 48 hours after phototherapy. Also conventional phototherapy caused a decrease in CD4+% 48 hours after exposure.

Features of the lymphocytic microenvironment in metastatic uveal melanoma

Introduction. Uveal melanoma is a malignant neoplasm of the vascular tract of the eye. Prevention of metastasis of this tumor is one of the main tasks in order to increase the rates of relapse-free survival of patients. Despite the pronounced immunosuppressive activity of uveal melanoma cells, its lymphocytic microenvironment exerts its antitumor effect.Aim of the study. Compare the lymphocytic microenvironment of primary uveal melanomas and distant metastases (to the liver).Мaterials and methods. The tissue material of choroid melanoma after enucleation and the material of tumor metastases for the period 2013-2018 were studied. An immunohistochemical study was performed using CD8, CD4, and CD56 markers for the qualitative and quantitative assessment of lymphocytes in the tumor stroma.Results. Differences were found in the lymphocytic infiltration of the uveal melanoma stroma and its distant metastases. A statistically significantly greater representation of CD4, CD8-lymphocytes and CD56 cells in tumor metastases than in primary melanoma tissue samples, with CD4-lymphocytes predominant. A direct high-strength correlation was registered between the number of CD4-lymphocytes and CD8-lymphocytes.Discussion. Malignant cells actively modify their cellular and stromal-vascular environment, ensuring their active growth and reproduction. The question of the immune reactivity of the surrounding cells in relation to uveal melanoma remains debatable. According to our data, which is consistent with a number of other studies, uveal melanoma cells do not completely evade the body's immune response. Thus, the determination of possible points of antitumor exposure can be based on a detailed study of the microenvironment of uveal melanoma. Conclusions. The pronounced lymphocytic infiltrate found in uveal melanoma metastases in comparison with the primary tumor indicates an active immune response of the body to the tumor. These results of our study confirm the importance of further studying the immune-mediated antitumor effect on uveal melanoma and the need to investigate possible approaches to immunotherapy.

Clinical observation of an HIV-infected patient heterozygous for the mutant allele of the CCR5 del 32 chemokine receptor

The article describes the clinical observation of an HIVinfected patient heterozygous for the mutant allele of the CCR5 del 32 chemokine receptor, who is not receiving antiretroviral therapy. The follow-up showed the course of the disease over 20 years of follow-up, without receiving antiretroviral therapy, with a gradual decrease in the number of CD4-lymphocytes and an increase in viral load.

Independent predictors of forecasting the course of congenital HIV infection in children

The purpose is to characterize the clinical and laboratory parameters in children with different rates of congenital HIV infection progression and, based on the data obtained, to develop independent predictors of forecasting the course of the disease.Research methods. The comparison of clinical, immunological and virological parameters in 91 children with HIV infection with rapid (26%) and slow progression of the disease (74%) was carried out. The criterion for the rapid progression of HIV infection was considered the development of the AIDS clinic in the first two years of life.Results. Testing of clinical, immunological and virological parameters in a multivariate logistic regression model revealed independent predictors of rapid progression in children aged 6 months — HIV blood viral load more than 1 00 000 cop./ml (odds ratio OR 23.9; 95% confidence interval 95% CI 4.6—71.8; P < 0.001) and a decrease of blood CD4-lymphocytes less than 25% (OR 6.3; 95% CI 1.2—33.4; P = 0.029). The predictor «HIV blood viral load more than 100 000 cop./ml» was characterized by a higher sensitivity (91.3%), specificity (97.1 %) compared to the indicator «CD4 lymphocyte count less than 25%» (88.2% and 86.9%).Conclusion. In 26% of children with HIV infection, there is a rapid progression of the disease with the development of AIDS clinic during the first two years of life. The independent predictors of forecasting an unfavorable course of the disease are HIV blood viral load of more than 1 00 000 cop./ml and a decrease in CD4 lymphocytes in the blood of less than 25% at the age of 6 months. The level of viremia seems to be more preferable for predicting the course of HIV infection in children due to its high sensitivity and specificity.

Immunohistochemical Evaluation of Gingival CD4+ lymphocytes in Response to Allograft Bone Powder (Ceno Bone) - Animal Study

CD4 T lymphocytes play a central role in allergic reactions. Thus the present study aimed to, immunohistochemically, evaluate the presence of these lymphocytes in rabbit gingival tissues after the replacement of Cenobone. This experimental one way blinded study was performed on 20 gingival tissues gathered from disease-free rabbits with or without bone powder, respectively groups A and B. Immunohistochemical envision method was performed for mapping CD4 lymphocytes. The number and intensity of staining were compared between groups in 5 consequent HPF without overlap with the light microscope in connective tissue. Data were analyzed by Fisher exact test, Wilcoxon, and chi-square statistically in SPSS20 software. The number of CD4 T cells was higher in group A compared to group B.(P=0.02) Pattern of distribution in connective tissue did not show a difference between the two groups. (P=0.41). Results of the present study might confirm the role of CD4 T in an allergic reaction to bone powder material and suggest this cell as a useful factor for the prediction of allergic reactions in the first weeks of surgery. Further studies in this field are required.

Incidence of community-acquired pneumonia in HIV-infected people, depending on the level of immunodeficiency and viral load

The aim of the study was to study the timing and frequency of community — acquired pneumonia in HIV-infected people, depending on the level of immunodeficiency and viral load.Materials and methods. Based on the materials of the Perm regional center for the fight and prevention of AIDS and infectious diseases, medical documentation was studied for 396 patients with HIV-associated pneumonia who died in 2014–2018 the frequency of community-acquired pneumonia (EAP) was estimated depending on the level of immunodeficiency and viral load.Results and discussion. It turned out that in most cases, EAP in relation to HIV infection is a secondary disease. The average duration of EAP after HIV infection was 4,6±3,7 years. With increasing immunodeficiency and viral load, the incidence of VP increases. Most often, VP is registered with CD4+ lymphocytes less than 200 cells/μl and viral load of 10 000–100 000 copies/ml.