Predictors of development of HIV-associated neurological diseases
Journal Title: Туберкульоз, легеневі хвороби, ВІЛ-інфекція - Year 2018, Vol 0, Issue 2
Abstract
Objective — to study the impact of demographic, epidemiological and genetic factors on the course of HIV infection and manifestation of neurological diseases. Materials and methods. The study involved 70 patients with the fourth clinical stage of HIV infection who were hospitalized to the Municipal Clinical Hospital N 21 of Dnieper city and were followed at the Regional Center for AIDS Prevention and Prophylaxis, aged 24 to 61 year, on average (38.91 ± 0.87) years. All patients were divided into 2 groups. The first group included 31 patients with the presence of neurological diseases, including cerebral toxoplasmosis, tuberculous meningitis, bacterial staphylococcal meningitis, fungal meningitis and HIV-encephalopathy. The second group consisted of 39 patients with other illnesses, indicative for the 4th clinical stage of HIV, but without the involvement of nervous system. The genetic study involved the typing of DRB1 alleles by the PCR method, variant of sequencespecific primers (PCRSSP). The study was carried out by sets of «HLA-DNA-TECH» for the typing of the genes DRB1 produced by «DNA-Technology» (Russia). The study was conducted with the consent of all patients. Indicators of the number of T-lymphocytes CD4+ and HIV RNA of blood plasma were taken into consideration during the period of the manifestation of opportunistic diseases (data used from medical cards). Results and discussion. The analysis of the results of 31 patients with neurological diseases among 70 patients with the 4th clinical stage of HIV infection has shown that most cases of CNS pathology occurred in HIV infected patients at the background of profound immunosuppression and high viral load of HIV RNA, as evidenced by the reverse correlation of manifestation of neurological signs and the number of CD4 Tlymphocytes: rs = –0.31 (p < 0.01), as well as direct correlation with the HIV RNA viral load in the blood — rs = +0.32 (p < 0, 01). The higher chances for the development of neurological diseases in women infected with HIV than in men were determined: OR 3.52 (95 % CI 1.28—9.73); p = 0.015 FET). At sexual transmission of HIV, a higher incidence of diseases of the nervous system was observed (61.3 % vs. 28.2 %; p = 0.008 FET), which was probably related to the gender index: women are more likely to have sexual transmission of HIV infection. The tendency to the increased number of carriers of alleles DRB1*01 — 38.7 % vs 15.4 % (p = 0.032 FET) and DRB1*16 — 32.3 % vs 17.9 % (p = 0.262 FET) among patients with HIV-associated diseases of the central nervous system was determined, as compared with other opportunistic diseases. At the same time, in the presence of the alleles DRB1*04, DRB1*11, DRB1*13, the central nervous system involvement was observed less frequently than the other HIV-associated pathology, which also had a tendency pattern (p > 0.05) and required further clarification. The indicated trends in increasing the risk of developing neurological diseases in DRB1*01 allele carriers were probable in HIV-infected male patients (53.8 %; p < 0.05), and DRB1 allele*16 — in female patients (38.9 %; p < 0.05). Significantly associated with opportunistic diseases of another etiology were found in women with DRB1*11 (72.7 %; p < 0.05) and DRB1*04 (36.4 %; p = 0.054 FET) allele carriers, and in males — with the DRB1*13 phenotype (25.0 %; p = 0.077 FET). Conclusions. Thus, a high risk of developing HIV-associated neurological diseases is observed in women with sexual transmission of HIV and may be associated with DRB1*01 and DRB1*16 alleles. There is a tendency towards a certain protective effect, with respect to the development of neurological pathology, in the presence of DRB1*04, DRB1*11, DRB1*13 alleles, which require further investigation.
Authors and Affiliations
K. Yu. Lytvyn, L. R. Shostakovych-Koretska, O. О. Volikova
Keywords
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