The Influence of Gender and of AIDS on the Immunity of Autopsied Patients' Esophagus

Abstract

Previous studies have shown that males who have AIDS are more frequently affected by infectious diseases than females. The esophagus is the organ in the digestive tube that is more commonly affected by opportunistic infections during the syndrome. The aim of this study was to assess the influence of AIDS and of gender on local immunity of the esophageal epithelium. Fragments of the esophagus from 29 autopsied women and 37 autopsied men were collected at a university hospital from 1980 to 2009 and were divided in groups with and without AIDS. The IgA-, IgG-, and IgM-positive cells and Langerhans cells (LCs) were immunostained, respectively, with anti-IgA, anti-IgG, anti-IgM, and anti-S100. The software Image J was used to measure the esophageal epithelium and to count the epithelium cellular layers. Patients with AIDS, apart from gender, showed an increase in IgA-, IgG-, and IgM-positive cells and a reduction of Langerhans cells, in thickness and in number of cellular layers in the esophageal epithelium. However, among individuals with AIDS, men presented lower secretory expression of IgA-, IgG-, and IgM-positive cells than women and more intense reduction of LCs. Women have naturally presented better local esophageal immunity than men. Although AIDS possibly causes immunological and morphological alterations in the esophageal epithelium in both genders, women have better esophageal immunity, which may explain a greater frequency of hospital admissions due to infection of men with AIDS when compared with women.

The Influence of Age, Smoking, Antiretroviral Therapy, and Esophagitis on the Local Immunity of the Esophagus in Patients with AIDS

“…In the course of an infection by HIV, there is a decrease in the local immunity of the esophageal mucosa due to the reduction in the number of cells connected with immune response, such as LCs. 14,16,17 Data collected during this study reinforce that ART contributes to the immune recovery of the esophagus, increasing the LC population in the epithelium.…”

“…The epithelial cells are part of the innate immune system, as they are physical barriers important to the defense against pathogens, 13 and studies demonstrate a reduction in the esophageal epithelium in patients with AIDS. 16,17 Probably, these patients had already had thinner esophageal epithelium due to personal characteristics or to a more aggressive HIV virulence, which allowed the passage of microorganisms through the epithelial barrier.…”

“…Previous studies demonstrated the influence of gender on the local immunity of the esophageal epithelium. 17 In order to avoid hormonal variations caused by the menstrual cycle, only men were included in this study. Postmortem samples removed from the upper third of the esophagus of 22 male individuals with AIDS, aged 21 to 51 years, autopsied in the General Pathology Division of General Hospital of Triângulo Mineiro Federal University, in the state of Minas Gerais, Brazil, were collected from 1982 to 2009.…”

“…15 Studies investigating the esophagus of patients with AIDS have suggested a decrease in the local immunity of this organ. 16,17 The aim of this study was to evaluate the influence of clinical and behavioral characteristics, such as age, smoking, antiretroviral therapy (ART), and esophagitis on the morphology and immunity of the esophageal epithelium and on the viral load and CD4 T lymphocyte count in male patients with AIDS.…”

Esophageal mucosa in HIV infection: A“deeper” look at this little spoken organ

“…The T‐cell response and inflammatory markers in the esophageal mucosa in HIV+ patients are not well known. Few studies (most of them in post‐mortem patients with AIDS) have shown morphological changes, such as a reduction in the thickness of the esophageal epithelium and in the number of Langerhans cells, as well as alterations in the immunoglobulin (Ig)‐A, Ig‐G, and Ig‐M expressions . These findings could be the basis for an increased susceptibility to opportunistic infections in this organ.…”