Restoration of T Cell Responses to Toxoplasma gondii after Successful Combined Antiretroviral Therapy in Patients with AIDS with Previous Toxoplasmic Encephalitis
Por:
Lejeune, M, Miro, JM, De Lazzari, E, Garcia, F, Claramonte, X, Martinez, E, Ribera, E, Arrizabalaga, J, Arribas, JR, Domingo, P, Ferrer, E, Plana, M, Valls, ME, Podzamczer, D, Pumarola, T, Jacquet, A, Mallolas, J, Gatell, JM, Gallart, T
Publicada:
1 mar 2011
Resumen:
Background. It is unknown whether a Toxoplasma gondii-specific T cell response is restored after successful combined antiretroviral therapy (cART) in patients with AIDS and current or previous toxoplasmic encephalitis (TE).
Methods. We performed a multicenter cross-sectional study with 17 healthy T. gondii-positive human immunodeficiency virus (HIV)-1-uninfected individuals and 90 patients coinfected with HIV-1 and T. gondii distributed in 5 groups according to their CD4(+) T cell counts and T. gondii infection (with or without current or previous TE). We investigated the lymphocyte proliferative response (LPR) and interferon (IFN)-gamma production in response to T. gondii soluble antigen extract (SATg) and as CD4(+) and CD8(+) T cell subsets.
Results. SATg-specific LPR and IFN-gamma production were not observed in many of the most immunosuppressed patients (CD4(+) T cell count, <200 cells/mu L, with or without current or previous TE). By contrast, these responses occurred in a considerable percentage (LPR, 43%; IFN-gamma production, 80%) of patients receiving successful cART (CD4(+) T cell count, >200 cells/mu L) who presented with TE and had already stopped secondary TE prophylaxis. Similar results were found in immunocompetent asymptomatic patients who did not receive TE prophylaxis. The predictors of SATg-specific T cell responses and IFN-gamma production were a cART-mediated increase in CD4(+) T cell count and LPR to phytohemagglutinin and viral suppression and a decrease in the activated (CD38(+)) CD8(+) T cell count, respectively.
Conclusions. cART restores T. gondii-specific CD4 T cell responses in most patients with AIDS who had previous TE. Our data support the safety of withdrawing TE prophylaxis when the CD4 1 T cell count returns to levels >200 cells/mu L.
Filiaciones:
Lejeune, M:
Univ Barcelona, Serv Immunol, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Miro, JM:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
De Lazzari, E:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Garcia, F:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Claramonte, X:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Martinez, E:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Hosp Donostia, Infect Dis Unit, San Sebastian, Spain
Ribera, E:
Hosp Donostia, Infect Dis Unit, San Sebastian, Spain
Arribas, JR:
Hosp La Paz, VIH Unit, Dept Internal Med, Madrid, Spain
Domingo, P:
Hosp Santa Creu I Sant Pau, Infect Dis Unit, Barcelona, Spain
Ferrer, E:
Hosp Univ Bellvitge, Infect Dis Serv, Barcelona, Spain
Plana, M:
Univ Barcelona, Serv Immunol, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Valls, ME:
Univ Barcelona, Microbiol Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Podzamczer, D:
Hosp Univ Bellvitge, Infect Dis Serv, Barcelona, Spain
Pumarola, T:
Univ Barcelona, Microbiol Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Jacquet, A:
Univ Libre Bruxelles, Serv Genet Appl, Brussels, Belgium
Mallolas, J:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Gatell, JM:
Univ Barcelona, Infect Dis Serv, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Gallart, T:
Univ Barcelona, Serv Immunol, Hosp Clin, Inst Invest Biomed Augusti Pi & Suner, E-08036 Barcelona, Spain
Hosp Univ Vall Hebron, Dept Infect Dis, Barcelona, Spain.
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