艾滋病毒/丙型肝炎病毒合并感染者HAART治疗过程中IL-18水平变化的研究

Changes of IL-18 Levels in HIV/HCV Co-Infected Patients During HAART Treatment

目的研究HIV/HCV共感染者HAART治疗过程中的血浆IL-18水平变化及与免疫重建的关系。方法选取2017年1月至2019年6月,我院收治的72例HIV感染患者为研究对象,所有研究对象未接受治疗(CD4^(+)T细胞计数<200 cells/μL),其中HIV/HCV合并感染者35例(以下简称合并感染组);HIV单一感染者37例(以下简称单一感染组),采集患者HAART前4、12、24、48、72周外周静脉血,检测两组患者血浆中CD4^(+)和CD8+T细胞计数、IL-18表达量以及HIV RNA水平。结果HAART治疗前,合并感染组患者血浆IL-18表达量明显高于单一感染组,P<0.05;在HAART治疗过程中,两组患者血浆IL-18表达量呈下降趋势,合并感染组患者各监测时间点血浆IL-18表达量均高于单一感染组,P<0.05;HAART治疗前,两组患者CD4^(+)T细胞数差异不显著,P>0.05,差异无统计学意义;治疗第12、24、48、72周,单一感染组患者CD4^(+)T细胞数均显著高于合并感染组,P<0.05,差异有统计学意义;在HAART第24周时,两组患者CD4^(+)/CD8+比值呈上升趋势,单一感染组高于合并感染组,P<0.05,差异有统计学意义;HAART 24周后,两组患者外周血HIV RNA载量均<40拷贝/mL,低于监测下限,病毒抑制成功。结论HCV合并感染使艾滋病患者免疫紊乱加重,主要体现在IL-18水平提高等方面,导致患者免疫重建延缓,但国内外学者研究仍然存在争议,关于HCV上调机体IL-18水平的具体机制以及参与免疫重建的进程仍需进一步研究证实。

Objective To study the changes of plasma IL-18 levels in HIV/HCV co-infected patients during HAART treatment and its relationship with immune reconstitution.Methods The current study selected 72 HIV-infected patients admitted to our hospital from January,2017 to June,2019 as the study subjects.All subjects had not received treatments(CD4^(+)T cell count<200 cells/μL),among whom there were 35 HIV/HCV co-infection patients(hereinafter referred to as the combined infection group)and 37 patients with HIV single infection(hereinafter referred to as the single infection group).Peripheral venous blood was collected 4,12,24,48,and 72 weeks before HAART,and the plasma of the 2 groups was tested for CD4^(+)and CD8+T cell count,IL-18 expression and HIV RNA levels.Results Before HAART treatment,the plasma IL-18 expression of patients in the co-infection group was significantly higher than that in the single infection group(P<0.05).During the HAART treatment,the plasma IL-18 expression of patients in the two groups showed a downward trend.For patients in the co-infection group,plasma IL-18 expression was higher than that of the single infection group at each monitoring time point(P<0.05).Before HAART treatment,there was no significant difference in the number of CD4^(+)T cells between the two groups(P>0.05).During treatments for 12,24,48,and 72 weeks,the number of CD4^(+)T cells in the single infection group was significantly higher than that in the combined infection group(P<0.05).At the 24th week of HAART,the CD4^(+)/CD8+ratio of the two groups showed an upward trend and the infection group was higher than the combined infection group(P<0.05).After 24 weeks of HAART,the HIV RNA load in the peripheral blood of the two groups were both<40 copies/mL,which was below the lower limit of monitoring,and the virus was successfully inhibited.Conclusion HCV co-infection can aggravate the immune disorder of AIDS patients,which is mainly reflected in the increase of IL-18 level,and further leads to the delay of the patient’s immune reconstitution.However,there are still controversies in the research of domestic and foreign scholars regarding the upregulation of IL-18 by HCV.The specific mechanism of the level and the process involved in immune reconstitution still needs further research to confirm.