Article
The Innate Immune Response in HIV/AIDS Septic Shock Patients: A Comparative Study
Registro en:
AMANCIO, Rodrigo T. et al. The Innate Immune Response in HIV/AIDS Septic Shock Patients: A Comparative Study. Plos One, v.8, n.7, e68730, 8p, July 2013.
1932-6203
10.1371/journal.pone.0068730
Autor
Amancio, Rodrigo T.
Japiassu, Andre M.
Gomes, Rachel N.
Mesquita, Emersom C.
Assis, Edson F.
Medeiros, Denise M.
Grinsztejn, Beatriz
Bozza, Patrícia T.
Faria Neto, Hugo C. Castro
Bozza, Fernando A.
Resumen
Introduction: In 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.
Methods: We 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.
Results: We 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.
Conclusions: IL-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.