Медицина/12. Инфекционные болезни

К.мед.н. Меленко С.Р.

Буковинський державний медичний університет, Україна

Modern diagnostics methods of HIV/AIDS progression

Laboratory criteria of severity and prognosis of HIV infection at the present stage include determining the level of CD4 lymphocytes and the number of nucleic acids in the blood (viral load) [1]. Rate of CD4 lymphocytes is traditionally regarded as the most reliable indicator of prognosis of HIV infection. The number of CD4+ T-lymphocytes reflects the degree of damage already developed immune system. Changes in CD4 levels can assess the severity of immunodeficiency, which emerged in the patient, to determine the likelihood of opportunistic infections, the plan of treatment and evaluate its effectiveness, to determine prognosis. There is a correlation of complications with the level of CD4+ T-lymphocytes. Determination of CD4+ T-lymphocytes, conducted in dynamics, makes it possible to accurately assess the risk of opportunistic infections and other conditions caused by HIV infection, to assess the effectiveness of HAART.

The level of viral load speeds the destruction, or the rate at which the disease progresses. In turn, the rate of progression reflecting the replication rate of HIV in the body. The effectiveness of many drugs HAART depends on the initial viral load. The probability of HIV transmission in any form of contact is directly correlated with viral load. Concurrent research content CD4+ T-lymphocytes and the level of viral load, as well as in dynamics, enables most accurately to predict the course of HIV infection and evaluate the effectiveness of HAART [2].

However, economic inaccessibility of these methods do not allow to use them widely. Today it is the actual search for reliable prognostic markers of progression of HIV infection and their relationship to clinical manifestations of disease, presence of opportunistic infections, antiretroviral treatment efficacy and more. Thus the main goal of scientists is not a replacement for determination of the number of CD4 lymphocytes or content of nucleic acids of the virus and the possibility of obtaining additional information to create predictive models of the progression of HIV infection. It is known that on the basis of indirect markers one can judge the state of the immune system in patients with HIV/AIDS. They include the contents of β2-microglobulin (β2M) in serum and neopterin in serum or urine. β2-low-protein, which form the light chain of antigen and major histocompatibility complex, appearance on the surface of the most somatic cells, including T-, B-lymphocytes and macrophages. Increased content β2M occurs during non-specific stimulation of lymphoid tissue that occurs in various pathological conditions, with infectious diseases of viral origin. Neopterin guanosine triphosphate produced by macrophages in response to stimulation of γ-interferon and in large quantities, in it’s turn, produced by activated T-lymphocytes. A number of studies was to clarify the correlation of the above figures the number of CD4-lymphocyte count and disease progression. Most researchers agree that there is a connection between them and these parameters can be taken into account in predictive models of the progression of HIV infection [3]. Quantitative determination of p24 antigen is of value in early detection of HIV infection and monitoring the effectiveness of antiretroviral therapy [4].

Among the pathogenetic mechanisms that lead to changes of hemostasis in HIV infection has important direct vascular endothelial damage by infection with HIV and opportunistic infections, characterized cytotoxic effect against cells of the vascular wall, such as cytomegalovirus, hepatitis B virus and C and others. Another important mechanism of endothelial damage in HIV infection are changes in the immune system. Activation and/or endothelial damage are fundamental in the development of a wide range of pathological processes. Lately crucial diagnostic methods of the functional state of endothelium in liver disease, chronic obstructive pulmonary diseases, coronary heart disease, diabetes, hypertension and others assume ever greater topicality. The data obtained are useful for assessing the degree of severity of disease and to monitor therapeutic measures. The search for fundamentally new approaches to integrated diagnosis of endothelial dysfunction in patients with HIV/AIDS and investigation of their relationship with severity, presence of opportunistic infections is continued.

It is quite different from the traditional approach to studying the functional state of endothelial vascular wall – definition of blood substances that are synthesized in endothelial cells and secreted them in the lumen, and consequently in circulating blood. It is shown that among these substances, are: von Willebrand factor, E-selectin and thrombomodulin [5]. Among the numerous studies of various aspects of HIV infection the study of free radical oxidation, including lipid peroxidation play an important role. In patients with HIV infection it has been a significant intensification of lipid peroxidation against a background of inhibition of antioxidant protection. It shows the accumulation of highly toxic peroxidation products and decreased activity of catalase, ceruloplasmin concentration in the blood. Therefore, determining the level of malondialdehyde, catalase and ceruloplasmin can be used to diagnose the severity and prognosis of HIV infection.

References:

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2. Hambelton J. The Medical Management of AIDS / J. Hambelton ; [eds M.A. Sande, P. L. Volbering]. – [5th ed.]. – Philadelphia, 2007. – P. 239-246.

3. Plasma from patients with idiopathic and human immunodeficiency virus-associated thrombotic thrombocytopenic purpura induces apoptosis in microvascular endothelial cells / J. Laurence, D. Mitra, M. Steiner [et al.] // J. Pathol. – 2009. – V. 188, N 1. – P. 76-81.

4. Nadal D. Prospective evaluation of amplification-boosted ELISA for heat-denatured p24 antigen for diagnosis and monitoring of pediatric human immunodeficiency virus type 1 infection / D. Nadal // J. Infect. Dis. – 2009. – V. 5, N 5. – Р. 1089-1095.

5. Melenko S.R. Von Willebrand factor as a marker of endothelium disfunction on patints with HIV/AIDS / S.R. Melenko, V.D. Sorokhan // Материали за IV международна научна практична конференция «Образование и наука», 17-25-ти октомври, 2010. – Т. 16. София «Бял ГРАД-БГ» ООД. – С.56-59.