State of Immunity in Pregnant With Recurrent Forms of Urogenital Herpes Infection

Abstract

Objectives. To study the nature of changes in some indices of systemic immunity and cytokine profile in pregnant with recurrent form of HSV-1,2 in the 2nd and 3rd trimesters of pregnancy. Materials and methods. The study involved examination of 50 pregnant with urogenital recurrent herpes virus infection with ultrasonographic signs of intrauterine infection of the fetus at gestational term of 28-41 weeks. Group 1 included 28 pregnant with active stage of infection; Group 2 comprised 22 pregnant with latent course of the disease. Control group consisted of 50 healthy pregnant at the same gestational term without bacterial or viral infection. The study involved the assessment of population and subpopulation content of the circulating pool of lymphocytes in serum by flow cytometry, determination of systemic profile of IL-1β, IL-6, IL-10, TNF-α in serum and local level of TNF-α in vaginal secretion by ELISA. The comparison with the control group was carried out using the nonparametric Mann-Whitney test. Results. In the 2nd and 3rd trimesters of gestation the pregnant with recurrent genital herpes, regardless of its form, were found to have a deficiency of circulating pool of lymphocytes with phenotype CD4 +, CD8 +, an increase in NK cells and markers of early (CD25 +) and late (HLA-DR) activation. The study showed an increase in the level of proinflammatory cytokines IL-1β, TNF-α, IL-6 and a decrease in the anti-inflammatory mediator IL-10 at a statistically significant level compared with the indices for physiological pregnancy. The increase in the circulating pool of pro-inflammatory cytokines was accompanied by an increase in the local production of TNF-α in vaginal secretion. Conclusions. 1. In the 2nd and 3rd trimesters of gestation the patients with recurrent genital herpes, regardless of the stage of the infection, secondary to a decrease in the circulating pool of CD3+, CD4+, CD8+ lymphocytes, were shown to have an increase in the killer activity of lymphoid cells with a simultaneous increase in the number of lymphocytes bearing markers of cellular cytotoxicity activation (CD25+, HLA-DR), which indicated a priority in the expression of cytotoxic reactions. 2. Recurrence of genital herpes virus infection in the 2nd and 3rd trimesters of gestation was associated with a shift in Th-1/Th-2 ratio towards Th-1predominance, which was expressed by an increase in the systemic level of IL-1β, TNF-α with a decrease in IL-10 peripheral circulation. 3. Recurrent genital herpes in the 2nd and 3rd trimesters of gestation was accompanied by an almost 3-fold increase in the local level of TNF-α, compared with physiological pregnancy, more severe in the active form compared with the latent one.