The Innate Immune Response in HIV/AIDS Septic Shock Patients: A Comparative Study

Abstract

IntroductionIn recent years, the incidence of sepsis has increased in critically ill HIV/AIDS patients, and the presence of severe sepsis emerged as a major determinant of outcomes in this population. The inflammatory response and deregulated cytokine production play key roles in the pathophysiology of sepsis; however, these mechanisms have not been fully characterized in HIV/AIDS septic patients.MethodsWe conducted a prospective cohort study that included HIV/AIDS and non-HIV patients with septic shock. We measured clinical parameters and biomarkers (C-reactive protein and cytokine levels) on the first day of septic shock and compared these parameters between HIV/AIDS and non-HIV patients.ResultsWe included 30 HIV/AIDS septic shock patients and 30 non-HIV septic shock patients. The HIV/AIDS patients presented low CD4 cell counts (72 [7-268] cells/mm3), and 17 (57%) patients were on HAART before hospital admission. Both groups were similar according to the acute severity scores and hospital mortality. The IL-6, IL-10 and G-CSF levels were associated with hospital mortality in the HIV/AIDS septic group; however, the CRP levels and the surrogates of innate immune activation (cytokines) were similar among HIV/AIDS and non-HIV septic patients. Age (odds ratio 1.05, CI 95% 1.02-1.09, p=0.002) and the IL-6 levels (odds ratio 1.00, CI 95% 1.00-1.01, p=0.05) were independent risk factors for hospital mortality.ConclusionsIL-6, IL-10 and G-CSF are biomarkers that can be used to predict prognosis and outcomes in HIV/AIDS septic patients. Although HIV/AIDS patients are immunocompromised, an innate immune response can be activated in these patients, which is similar to that in the non-HIV septic population. In addition, age and the IL-6 levels are independent risk factors for hospital mortality irrespective of HIV/AIDS disease.

Prognostic Factors for Survival in Patients with Acute Invasive Fungal Rhinosinusitis

“…17 Human CRP is composed of multiple subunits of polypeptide, and it is an acute-phase protein produced by the liver in response to inflammatory cytokines. Cur- 18 AIFR is an opportunistic infection, but previous reports have shown that immunosuppression and other long-term comorbidities have no significant effect on acute-phase reactions, including elevation of CRP during severe infection. [17][18][19] However, some authors suggested the limitation of CRP as a prognostic marker.…”

“…Cur- 18 AIFR is an opportunistic infection, but previous reports have shown that immunosuppression and other long-term comorbidities have no significant effect on acute-phase reactions, including elevation of CRP during severe infection. [17][18][19] However, some authors suggested the limitation of CRP as a prognostic marker. 20,21 Especially, single CRP measurement may not be reliable due to its variability.…”

Genetic, molecular and physiological basis of variation in Drosophila gut immunocompetence

“…This is particularly the case in the developing world where almost 20% of child deaths can be linked to a pathogenic invasion of the intestine 49 . In many cases, this invasion is by opportunistic pathogens on immunocompromised individuals, who might have a functioning innate immune system like AIDS patients 50 . In addition, enteric infections by opportunistic Pseudomonas species have been reported in hospitalized patients 51 52 .…”

The Impact of HIV Co-Infection on the Genomic Response to Sepsis

“…However, knowledge on the impact of chronic HIV infection on the host response to sepsis is limited. Two previous studies examined the cytokine response in sepsis patients with or without HIV co-infection and found few differences in cytokine levels [ 7 , 8 ]. On the other hand, in Malawian children with bacterial sepsis, those with HIV co-infection had more profound increases in angiopoietin 2, an angiogenic peptide that increases endothelial activation and is associated with disseminated intravascular coagulation and mortality in sepsis [ 9 ].…”