Identification of inexpensive and technically simple immunological tests useful in predicting the progression to AIDS in human immunodeficiency virus (HIV)-infected patients would be especially welcome in developing countries, in which 80% of the HIV-infected patients reside and health budgets are low. In the current study, we evaluated CD4 ؉ and total lymphocyte counts and the concentrations in serum of  2-microglobulin, p24 antigen, and immunoglobulin A (IgA) as predictors of disease progression in 74 Panamanian HIV-positive patients and 50 HIV-negative healthy individuals. Total lymphocyte and CD4 ؉-cell counts for AIDS patients (1,451 ؎ 811 cells/l, P < 0.001, and 238 ؎ 392 cells/l, P < 0.0001, respectively) and asymptomatic patients (2,393 ؎ 664 cells/l, P > 0.05, and 784 ؎ 475 cells/l, P < 0.001, respectively) were lower than those observed for healthy subjects (2,596 ؎ 631 cells/l and 1,120 ؎ 296 cells/l, respectively). The levels of  2-microglobulin and IgA in serum were significantly elevated in patients with AIDS (5.7 ؎ 3.6 mg/liter, P < 0.0001, and 541 ؎ 265 mg/dl, P < 0.0001, respectively) and asymptomatic infected subjects (3.4 ؎ 2.1 mg/liter, P ؍ 0.001, and 436 ؎ 216 mg/dl, P < 0.0001, respectively) compared with the levels in healthy subjects (2.2 ؎ 0.7 mg/liter and 204 ؎ 113 mg/dl, respectively). Nonstatistically significant differences (P > 0.05) for concentrations of p24 antigen between asymptomatic infected patients (29 ؎ 13 pg/ml) and AIDS patients (40 ؎ 23 pg/ml) were observed. Total lymphocyte counts of 1,750 cells/l or less, CD4 counts of 200 cells/l or less,  2-microglobulin concentrations in serum of 4 mg/liter or higher, concentrations of IgA in serum of 450 mg/dl or higher, and the presence in serum of p24 antigen were correlated with elevated risks for developing AIDS. Monitoring both total lymphocytes and  2-microglobulin identified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4 ؉-cell evaluations and the costs associated with monitoring the immune status of HIV-positive patients.
Introducción: Los pacientes con leucemia linfoblástica aguda (LLA) tienen alto riesgo de influenza grave y la vacunación es altamente recomendada. La inmunogenicidad y efectividad de la vacuna es menor comparada a los sujetos sanos. Objetivo: Evaluar la respuesta inmune inducida por vacuna anti-influenza en niños con LLA y observar su efectividad. Métodos: Se reclutaron niños con LLA en terapia de mantención y niños sanos. Se tomaron muestras de sangre el día de la vacuna (D0) y al día 28 (D28), y se realizó test de inhibición de hemaglutinación (IHA) contra H1N1. Los pacientes fueron seguidos por un año, registrando datos clínicos y episodios de influenza. Resultados: Se incluyeron 34 niños con LLA y 9 niños sanos. Respecto al IHA en D28, 12/34 pacientes y 5/8 niños sanos presentaron títulos ≥ 1/40, resultando una tasa de seroprotección de 35 y 63%, respectivamente. Los niños seroprotegidos eran significativamente mayores. Durante el seguimiento, sólo tres pacientes, no seroprotegidos, presentaron infección por influenza, ninguno requirió oxigeno o cuidados intensivos. Discusión: Los niños con LLA alcanzaron una tasa seroprotección más baja que la observada en niños sanos. Sin embargo, ninguno de los niños seroprotegidos presentó infección por influenza, reforzando la recomendación de vacunación anual.
BackgroundVaccine immune response is impaired in cancer patients. Follicular helper T lymphocytes (cTfh) are essential for high affinity and long lasting humoral response. The objective of this study was to evaluate the role of cTfh in the immune response induced by influenza vaccine in children with acute lymphoblastic leukemia (ALL).MethodsChildren with ALL in maintenance therapy and a control group of healthy children were included. Blood samples were taken on the day of vaccination (D0), and on day 28 (D28). The humoral response was evaluated by haemagglutination inhibition test and frequency of cTfh was studied by flow cytometry.ResultsTwenty-four children with ALL and 8 healthy children were included: 67 and 38% were women, median age of 5 years old in both groups. A 33% (8/24) of patients and 63% (5/8) of controls were seroprotected at D28. Seroprotected children at D28 were significantly older than non-protected ones (10 and 3.6 years respectively, P = 0,004). During follow-up, three children with ALL had influenza infection. An increase of percentage of cTfh cells from D0 to D28 was observed in both groups, but it was significant only in ALL patients (average for ALL, D0-D28: 18–23%, P = 0.003 and average for controls, D0-D28: 22–26%). No differences were found between seroprotected and non-seroprotected children in cTfh cell at D0 or D28. The increase of percentage of cTfh cells from D0 to D28 was observed in both groups, it was significant only in non-seroprotected subjects (average for seroprotected, D0-D28: 21–24% and average for non-seroprotected, D0-D28: 18–24%, P = 0.004).ConclusionChildren with ALL achieved a lower seroprotection than healthy children. After vaccination, both groups had an increase of cTfh cells. We did not found an association between the percentage of cTfh cells and seroprotection at D28. The association between the lack of humoral response and cTfh dysfunction should be evaluated in further studies (We report public funding from Fondecyt grant Nº 11150970).Disclosures All authors: No reported disclosures.
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