Risk factors in HIV-1-infected patients developing repetitive bacterial infections: toxicological, clinical, specific antibody class responses, opsonophagocytosis and Fcγ  RIIa polymorphism characteristics

Abstract

SUMMARYThe aim of the study was to determine possible factors related to the risk of developing recurrent bacterial respiratory tract infections in HIV-1-infected patients, regardless of the degree of immune cellular impairment. Thirty-three HIV-1 seropositive patients with previous repetitive bacterial respiratory tract infections (case group), 33 HIV-1 seropositive controls (matched by CD4-cell counts) without these antecedents and 27 healthy controls were studied before and after administration of pneumococcal and Haemophilus influenzae type b vaccines . Clinical or toxicological variables, cutaneous tests, complement factors, beta2-microglobulin, serum IgM, IgA, IgG and subclasses, specific antibodies (IgG, IgG 2 , IgA) against pneumococcal vaccine and polyribosylribitol phosphate (PRP), their avidity, opsonophagocytosis and IgG 2 m and Fc g RIIa allotypes were determined. A history of drug abuse ( P = 0·001), less likelihood of receiving high activity antiretroviral treatment high activity antiretroviral treatment (HAART) ( P = 0·01), higher levels of HIV-1 viral load ( P < 0·05), serum IgG ( P < 0·01) and beta2-microglobulin ( P < 0·01) were observed in the case group. Also, a lower increase in specific antibodies to pneumococcal vaccine and PRP was demonstrated in the cases in comparison with the two control groups. No differences were observed in the avidity of antibodies, opsonophagocytic capacity or IgG 2 m and Fc g RIIa allotypes between the three groups. These data indicate that vaccination strategies against encapsulated bacteria can be unsuccessful in the HIV-1-infected patients presenting repetitive bacterial respiratory tract infections if behavioural aspects or measures to improve adherence to HAART therapies are not considered.

Effectiveness of Polysaccharide Pneumococcal Vaccine in HIV-Infected Patients: a Case-Control Study

“…These results are in concordance with those observed in other cohorts [9,25,27] and case-control studies [7,8,13,16]. However, in previous studies, this protection was limited to specific groups of patients, such as patients who were white [16] or those with CD4 lymphocyte counts у200 cells/mL or у500 cells/mL [7,8,13].…”

“…The reasons for these low vaccination rates are probably related to the lack of evidence of the efficacy of the 23-valent PPV in HIV-infected patients, compared with the general population, including not only a lack of clinical efficacy but also a lower immunological response to vaccination in HIV-infected patients, compared with healthy control subjects, as has been demonstrated by other authors [21][22][23][24][25]. Another reason could be the belief that pneumococcal infection is not an important problem in HIV-infected patients in the developed world because of the widespread use of HAART and that it could be more cost-effective to concentrate efforts on strategies to improve adherence to antiretroviral therapy [18].…”

Morphine Modulation of Toll-Like Receptors in Microglial Cells Potentiates Neuropathogenesis in a HIV-1 Model of Coinfection with Pneumococcal Pneumoniae

“…A frequent occurrence in the HIV positive intravenous (IV) drug abusing population is the incidence of infection with secondary opportunistic pathogens and concurrent bacterial meningitis. Interestingly, Streptococcus pneumoniae is the most common community acquired pneumonia in these patients (Clatts et al, 2007; Caro-Murillo et al, 2007; Le Moing et al, 2006; Gebo et al, 2005; Shen et al, 2005; Nuorti et al, 2000; Payeras et al, 2002; Gordon et al, 2000; Wang et al, 2005; Klugman et al, 2007). In chronic neurodegenerative diseases such as Alzheimer’s, frequent episodes or persistent systemic infection lead to progressive decline in cognitive function and accelerate the process of neurodegeneration through activation of proinflammatory cytokines (Cunningham et al, 2005; Kreutzberg, 1996).…”

The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

“…Other risk factors related to progression of HIV infection are HIV RNA [4,30,32,33] and clinical disease stage [16,17,29].…”