Immunological responses of Gambians in relation to clinical stage of HIV-2 disease

Abstract

SUMMARYThis study describes a broad spectrum of cellular and antibody-mediated immune responses found in 28 asymptomatic and 37 symptomatic Gambian patients with HIV-2 infection. It shows that these responses vary according to the stage of infection as described by three clinical staging systems. The first system was a local one based on the signs used for the WHO Bangui clinical definition of AIDS, the second, suggested by WHO, was based on a performance scale, and the third was that used by the Centre for Disease Control. Asymptomatic patients had significantly lower mean CD4 counts, lymphoproliferative and interferon-gamma (IFN-y) responses and lower IgG and IgM antibody responses to keyhole limpet haemocyanin (KLH) than controls. These measurements and the size of the skin test reaction to purified protein derivative (PPD) or Candida antigen declined significantly according to the stage of infection. Mean values of the serological markers (82-microglobulin and neopterin and antibody titres to Epstein-Barr virus capsid antigen (EBVCA) rose significantly according to severity of disease. The Gambian or WHO clinical staging systems, which are easy and cheap to apply, may serve as an alternative to sophisticated and expensive immunological measurements when trying to stage disease and prediet prognosis.

The single recombinant M. tuberculosis protein DPPD provides enhanced performance of skin testing among HIV-infected tuberculosis patients

“…This could potentially be delineated by incorporating a demographically similar BCG "naïve" population (such as individuals in the United States), but this introduces social and geographical (environmental mycobacteria) variables that makes them less than ideal comparators. The use of TST for the diagnosis of active disease in HIV-infected individuals has been controversial with previous studies reporting reduced sensitivity in this population (Goldstein et al 1994;Graham et al 1992;Johnson et al 1992;Lifson et al 1993;Mamani et al 2013;Whittle et al 1993). It is therefore noteworthy that we also found that the DPPD appeared to be more sensitive for the detection of active TB in HIV-infected individuals than PPD.…”

“…The use of TST for the diagnosis of active disease in HIV-infected individuals has been controversial with previous studies reporting reduced sensitivity in this population (Goldstein et al 1994 ; Graham et al 1992 ; Johnson et al 1992 ; Lifson et al 1993 ; Mamani et al 2013 ; Whittle et al 1993 ). It is therefore noteworthy that we also found that the DPPD appeared to be more sensitive for the detection of active TB in HIV-infected individuals than PPD.…”

Skin tests for the detection of Mycobacterial infections: achievements, current perspectives, and implications for other diseases

“…Among groups for whom immunological-based TB testing results are traditionally poor, Mtb infection is especially problematic in immune-compromised individuals that have an increased likelihood of progression to disease such that TB is a leading cause of death in HIV/AIDS patients. The use of TST for the diagnosis of active disease in HIV-infected individuals has been controversial with previous studies reporting reduced sensitivity in this population (Goldstein et al 1994 ; Graham et al 1992 ; Johnson et al 1992 ; Lifson et al 1993 ; Mamani et al 2013 ; Whittle et al 1993 ).…”

Monitoring Immune Function

“…The DTH reaction is mediated by T-helper cells that produce IL-2 and Although some correlation between DTH reactivity and T-cell count has been observed in HIVinfected individuals, DTH anergy has been reported to be an independent predictor of HIV-1 progression (80)(81)(82). Studies in Africa of HIV-1-and HIV-2-infected individuals have also shown a correlation between DTH reactivity and clinical stage of infection (83)(84)(85)(86). However, the rate of development of cutaneous anergy is slower in HIV-2 infection than it is in HIV-1 infection (14).…”