Perfil imunológico dos indivíduos com a coinfecção HIV/Leishmania infantum

Abstract

The risk to develop visceral leishmaniasis (VL) in subjects with HIV+ (Human immunodeficiency virus) is greater than for immunocompetent people with asymptomatic Leishmania infantum. The hypothesis of this study was that persistent T cell activation in HIV co-infected persons and asymptomatic Leishmania infection increases the risk of progression to VL and to relapse. To test this hypothesis, a crosssectional study of subjects HIV+ was carried out between May 2014 and August 2016 in an endemic area for LV, in the state of Rio Grande do Norte, northeast Brazil, with the goal to determine the rate of asymptomatic L. infantum infection in HIV-infected persons (HIV +) and the immunological status of this co-infection. A total of 1,134 HIV+ subjects was recruited. A subgroup of HIV/L. infantum was followed to determine the level of T cell activation, senescence, anergy, exhaustion and regulation and clinical follow up and compared to a HIV+, AIDS/VL, VL alone and healthy individuals. The rate of L. infantum asymptomatic infection was 23.6%. Of the 268 HIV/L. Infantum, 2 developed VL and died. Subjects with HIV/L. infantum, AIDS/VL and VL group presented higher expression of CD38HLA-DR and PD1 in CD8 cells than subjects with only HIV. For all groups, there was an increased expression of CD57 in T CD8 lymphocytes. HIV/L. infantum group presented the higher CD25FoxP3 expression in T CD8 lymphocytes. People infected with L. infantum had a greater activation of CD8 T lymphocytes. This persistent activation may lead to possible immunologic deficits that in individuals with immunosuppressive diseases would increase the risk to develop VL. Therefore, prophylaxis with leishmanicidal drugs should be considered.