Immunoendocrine Interactions during HIV-TB Coinfection: Implications for the Design of New Adjuvant Therapies

Abstract

Worldwide, around 14 million individuals are coinfected with both tuberculosis (TB) and human immunodeficiency virus (HIV). In coinfected individuals, both pathogens weaken immunological system synergistically through mechanisms that are not fully understood. During both HIV and TB infections, there is a chronic state of inflammation associated to dramatic changes in immune cytokine and endocrine hormone levels. Despite this, the relevance of immunoendocrine interaction on both the orchestration of an effective immune response against both pathogens and the control of the chronic inflammation induced during HIV, TB, or both infections is still controversial. The present study reviews immunoendocrine interactions occurring during HIV and TB infections. We also expose our own findings on immunoendocrine cross talk in HIV-TB coinfection. Finally, we evaluate the use of adrenal hormones and their derivatives in immune-therapy and discuss the use of some of these compounds like the adjuvant for the prevention and treatment of TB in HIV patients.

Therapeutic potential of 7-oxo-DHEA as an adjunctive host-directed therapy for pulmonary tuberculosis

“…Both hormones impact in the functionality of immune cells and consequently impact the progression of diseases [9,11,12,37,38]. DHEA has been previously studied within the realm of TB infection, revealing a correlation between this hormone and improved management of the disease [6-8, 32,39]. Despite extensive research, no speci c receptor has been associated with DHEA.…”

Adrenalitis tuberculosa: a propósito de una actualización

“…Aunque la evidencia es limitada, se ha visto que en pacientes que presentan coinfección de VIH y TBC activa los niveles de cortisol tienden a estar levemente elevados, aunque la relación cortisol/DHEA está alterada hasta 4 veces más que en pacientes con VIH, sumado a que los niveles de cortisol se correlacionan en forma negativa con respecto al conteo de linfocitos T-CD4+. 14…”

“…3 Como se había mencionado antes, lo inespecífico de la clínica lleva a que sea necesario mantener una alta sospecha y búsqueda de IA en pacientes con factores de riesgo, destacándose aquellos con VIH en quienes los síntomas más reportados son fatiga (84-95%), pérdida de peso (66-76%), síntomas gastrointestinales (náuseas, vómito y dolor abdominal, 49-62%) y mialgias y artralgias (35-40%). 1 A nivel mundial se calcula que cerca de 14 millones de individuos presentan coinfección de VIH y TBC sobretodo en África, con un riesgo 20 veces mayor de reactivación de TBC latente 14 , por lo cual los síntomas antes enumerados en muchas ocasiones se atribuyen al estado inflamatorio crónico o agudo del proceso infeccioso o en ocasiones a efectos secundarios de la terapia antirretroviral (zidovudina puede causar hiperpigmentación y simular características de IA). 11 Hasta 50% de los pacientes con IA se diagnostican en una crisis adrenal.…”

Methods and quality of disease models incorporating more than two sexually transmitted infections: a protocol for a systematic review of the evidence

“…The modelling of STIs interacting with non-STIs, for example, HIV and tuberculosis, although being clinically important, 24 will not be examined in this review, as it will not answer our research question and is beyond the remit of the review.…”