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Duarte NL, Bueno APS, Sanches BS, Ramos GA, Santos JMBD, Silva HFHE, Pondé JDO, Sá JGD, Rossi PM, Horn PRCB, Sztajnbok DCDN, Rubini NDPM, da Costa ES, Milito CB, de Abreu TF, Land MGP. Prognostic Factors in Children and Adolescents with Lymphomas and Vertical Transmission of HIV in Rio de Janeiro, Brazil: A Multicentric Hospital-Based Survival Analysis Study. Cancers (Basel) 2023; 15:cancers15082292. [PMID: 37190220 DOI: 10.3390/cancers15082292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72-50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02-78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81-12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84-13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76-0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil.
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Affiliation(s)
- Nathalia Lopez Duarte
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Ana Paula Silva Bueno
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Bárbara Sarni Sanches
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Gabriella Alves Ramos
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Faculty of Medical Sciences (FCM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Brazil
| | - Julia Maria Bispo Dos Santos
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Henrique Floriano Hess E Silva
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Janaina de Oliveira Pondé
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - José Gilberto de Sá
- Department of Infectious and Parasitic Diseases, Hospital Municipal Jesus (HMJ), Municipal Health Secretariat (SMS-RJ), Rio de Janeiro 20550-200, Brazil
| | - Priscila Mazucanti Rossi
- Department of Infectious and Parasitic Diseases, Hospital Municipal Jesus (HMJ), Municipal Health Secretariat (SMS-RJ), Rio de Janeiro 20550-200, Brazil
| | | | - Denise Cardoso das Neves Sztajnbok
- Pediatric Infectious Diseases Division, Department of Pediatrics, Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Brazil
| | - Norma de Paula Motta Rubini
- Department of Allergy and Immunology, School of Medicine and Surgery, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil
| | - Elaine Sobral da Costa
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Cristiane Bedran Milito
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Department of Pathology, Faculty of Medicine (FM), Clementino Fraga Filho University Hospital (HUCFF), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Thalita Fernandes de Abreu
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Infectious and Parasitic Diseases Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Marcelo Gerardin Poirot Land
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
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Incidence and Clinical Description of Lymphomas in Children and Adolescents with Vertical Transmission of HIV in Rio de Janeiro, Brazil, in Pre- and Post-Combined Antiretroviral Therapy Eras: A Multicentric Hospital-Based Survival Analysis Study. Cancers (Basel) 2022; 14:cancers14246129. [PMID: 36551614 PMCID: PMC9776495 DOI: 10.3390/cancers14246129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
The incidence of cancer in children living with HIV (CLWH) is high and lymphomas are the most common type of cancer in this population. The combined antiretroviral therapy (cART) changed the natural history of HIV infection. To determine the incidence and profile of these CLWH malignancies in Rio de Janeiro (RJ), Brazil, we conducted a retrospective and observational study of vertically infected CLWH, ranging from 0−20 incomplete years, from 1995 to 2018, at five reference centers. The study period was divided into three eras in accordance with the widespread use of cART in Brazil. 1306 patients were included. Of the 25 lymphomas found, 19 were AIDS-defining malignancies (ADM); 6 were non-AIDS-defining malignancies (NADM). The incidence rate (IR) of lymphoma developing was 1.70 per 1000 children-year (95% CI 1.09−2.50). ADM development IR decreased from 2.09−1.75−0.19 per 1000 children-year (p < 0.001) through cART eras. Cumulative Nelson−Aalen hazards of developing ADM over a 20-year period were 3.73% in the Early-cART era, 3.07% in the Mid-cART era, and 0.32% in the Late-cART era (p = 0.013). This study demonstrates the IR of lymphoma in CLWH in RJ, Brazil, as well as the benefit of cART in reducing ADM and death occurrence in the Post-cART era.
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Haq H, Elyanu P, Bulsara S, Bacha JM, Campbell LR, El-Mallawany NK, Keating EM, Kisitu GP, Mehta PS, Rees CA, Slone JS, Kekitiinwa AR, Matshaba M, Mizwa MB, Mwita L, Schutze GE, Wanless SR, Scheurer ME, Lubega J. Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa. Cancers (Basel) 2021; 13:cancers13061379. [PMID: 33803641 PMCID: PMC8003101 DOI: 10.3390/cancers13061379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Most children infected with HIV live in Sub-Sahara Africa (SSA). These children are at risk of cancers related to HIV infection, but the degree of this risk and how it is influenced by antiretroviral therapy (ART) is unknown. In this study, we determined the subtypes, incidence, and risk factors of cancers in children with HIV in SSA and receiving ART with the goal of learning how we may prevent these cancers. We found that Kaposi sarcoma and lymphoma are the most common, comprising about 77% and 19% of cancers in these children, respectively. For every 100,000 person-years, 47.6 children developed cancer. Waiting to start ART until after 2 years old and having had severe immunosuppression were the two biggest risk factors for cancer that we identified. The findings justify the recommendations to start children on ART as soon as they are diagnosed with HIV regardless of their CD4 immune status. Abstract Approximately 91% of the world’s children living with HIV (CLWH) are in sub-Saharan Africa (SSA). Living with HIV confers a risk of developing HIV-associated cancers. To determine the incidence and risk factors for cancer among CLWH, we conducted a nested case-control study of children 0–18 years from 2004–2014 at five centers in four SSA countries. Incident cases of cancer and HIV were frequency-matched to controls with HIV and no cancer. We calculated the incidence density by cancer type, logistic regression, and relative risk to evaluate risk factors of cancer. The adjusted incidence density of all cancers, Kaposi sarcoma, and lymphoma were 47.6, 36.6, and 8.94 per 100,000 person-years, respectively. Delayed ART until after 2 years of age was associated with cancer (OR = 2.71, 95% CI 1.51, 4.89) even after adjusting for World Health Organization clinical stage at the time of enrolment for HIV care (OR = 2.85, 95% CI 1.57, 5.13). The relative risk of cancer associated with severe CD4 suppression was 6.19 (p = 0.0002), 2.33 (p = 0.0042), and 1.77 (p = 0.0305) at 1, 5, and 10 years of ART, respectively. The study demonstrates the high risk of cancers in CLWH and the potential benefit of reducing this risk by the early initiation of ART.
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Affiliation(s)
- Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Peter Elyanu
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda; (P.E.); (G.P.K.); (A.R.K.)
| | - Shaun Bulsara
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
| | - Jason M. Bacha
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
- Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania;
| | - Liane R. Campbell
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
- Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania;
| | - Nader K. El-Mallawany
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
| | - Elizabeth M. Keating
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine Children’s Foundation-Lesotho, Maseru, Lesotho
| | - Grace P. Kisitu
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda; (P.E.); (G.P.K.); (A.R.K.)
| | - Parth S. Mehta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
| | - Chris A. Rees
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe, Malawi
| | - Jeremy S. Slone
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
| | - Adeodata R. Kekitiinwa
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda; (P.E.); (G.P.K.); (A.R.K.)
| | - Mogomotsi Matshaba
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gabarone, Botswana;
| | - Michael B. Mizwa
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Lumumba Mwita
- Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania;
| | - Gordon E. Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Sebastian R. Wanless
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Michael E. Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
| | - Joseph Lubega
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-8328224242
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Pedromonico Arrym M, Martins Alves PC, Virginello Castelhano M, Nitsch Mazzola T, Muller Banzato Pinto de Lemos R, Zaccariotto TR, Levy CE, Guimarães F, Nolasco da Silva MT. Preservation of cytotoxic granule production in response to mycobacterial antigens by T-lymphocytes from vertically HIV-infected Brazilian youth on effective combined antiretroviral therapy. Braz J Infect Dis 2019; 23:151-159. [PMID: 31271732 PMCID: PMC9428219 DOI: 10.1016/j.bjid.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background HIV infection harms adaptive cellular immunity mechanisms. Long-term virological control by combined antiretroviral therapy (cART) reduces the risk of mycobacterial infections. Thus, we aimed to study cellular responses to mycobacterial antigens in 20 HIV-infected adolescents with at least one year of virological control (HIV-RNA <40 copies/mL) and 20 healthy adolescents. Methods We evaluated CD8 and γδ T-cell degranulation by measurement of CD107a membrane expression after stimulation with lysates from BCG (10 μg/mL) and H37RA Mycobacterium tuberculosis (Mtb, 10 μg/mL). Immune activation and antigen-presenting ability were also assessed by determination of HLA-DR, CD80, and CD86 markers. Results TCR γδ T-cell CD107a expression was similar between groups in response to mycobacterial antigens, and lower in the HIV-infected group in response to mitogen. Higher baseline HLA-DR expression and lower mycobacterial-stimulated expression was found within the HIV-infected group. Conclusions Similar degranulation in stimulated CD8+ and TCR γδ T-cells from HIV-infected adolescents, when compared to healthy controls suggests long-term immunological preservation with immune reconstitution under successful cART. However, differences in HLA-DR expression may represent ongoing inflammation and lower specific responses in HIV-infected youth. These features may be relevant in the context of the precocity and severity of vertically acquired HIV infection.
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Affiliation(s)
- Mauro Pedromonico Arrym
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Paulo César Martins Alves
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Mariana Virginello Castelhano
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Taís Nitsch Mazzola
- State University of Campinas, Center for Molecular Biology and Genetical Engineering, Campinas, SP, Brazil
| | | | - Tânia Regina Zaccariotto
- State University of Campinas Clinics Hospital, Clinical Pathology Laboratory, Campinas, SP, Brazil
| | - Carlos Emilio Levy
- State University of Campinas Clinics Hospital, Clinical Pathology Laboratory, Campinas, SP, Brazil
| | - Fernando Guimarães
- State University of Campinas, Center for Integral Attention to Women's Health, SP, Brazil
| | - Marcos Tadeu Nolasco da Silva
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil.
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Pathogenesis of infections in HIV-infected individuals: insights from primary immunodeficiencies. Curr Opin Immunol 2017; 48:122-133. [PMID: 28992464 PMCID: PMC5682227 DOI: 10.1016/j.coi.2017.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/14/2017] [Accepted: 09/17/2017] [Indexed: 12/12/2022]
Abstract
Following infection with almost any given microorganism other than an emerging pathogen, only a minority of individuals develop life-threatening clinical disease, implying that these individuals have some form of immunodeficiency. A growing number of inherited and acquired immunodeficiencies have been deciphered over the last 50 years. HIV infection is probably the best-known acquired immunodeficiency. It emerged about 40 years ago and precipitates various severe infections, the occurrence of which is associated with a fall in circulating CD4+ T cells. However, despite the strength of this correlation, infection rates differ between patients with similar levels and durations of CD4+ T lymphopenia in the presence or absence of antiretroviral treatment. Moreover, a few infections seem to be less dependent on total CD4+ T-cell levels. The fine detail of the mechanisms underlying these infections is unknown. We discuss here how studies of the human genetics and immunology of some of these infections in patients with primary immunodeficiencies (PIDs) have provided unique insights into their molecular and cellular basis. Defects of specific CD4+ Th-cell subsets account for some of these infections, as best exemplified by Th1* for mycobacteriosis and Th17 for candidiasis. PIDs are individually rare, but collectively much more common than initially thought, with new disorders being discovered at an ever-increasing pace and a global prevalence worldwide approaching that of HIV infection. Studies of known and new PIDs should make it possible to dissect the pathogenesis of most human infections at an unprecedented level of molecular and cellular precision. The predictive, preventive, and therapeutic implications of studies of immunity to infection in PIDs may extend to HIV-infected patients and patients with infectious diseases in other settings.
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Foster C, Bamford A, Turkova A, Welch S, Klein N. Paediatric European Network for Treatment of AIDS Treatment Guideline 2016 update: antiretroviral therapy recommended for all children living with HIV. HIV Med 2016; 18:133-134. [PMID: 27385585 PMCID: PMC5248631 DOI: 10.1111/hiv.12399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- C Foster
- The Family Clinic, Imperial College NHS Trust, London, UK
| | - A Bamford
- Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
| | - A Turkova
- MRC Clinical Trials Unit, London, UK
| | - S Welch
- Paediatrics, Birmingham Heartlands Hospital, Birmingham, UK
| | - N Klein
- Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK.,Institute of Child Health, London, UK
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