International Journal of Scientific Pediatrics
THE CHARACTERISTIC OF THE IMMUNE STATUS AT HIV-
INFECTED CHILDREN WITH ACUTE RHINOSINUSITIS
Narzullaev N.U.
1
1 Bukhara State Medical Institute, doctor of medical sciences, associate professor
Academic Editor:
Arzikulov A.
Professor, Andijan State Medical
Institute
Received:
10 July 2022
Accepted:
22 July 2022
Published:
30 July 2022
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Annotation:
The immune status has been studied at 35 HIV-infected of children
with ARS. The control group of comparison consisted from 14 practically healthy faces.
At a HIV-infected of patients with ARS has revealed deep infringements of the immune
status, especially from the T-link of immunity and its subpopulations, and also frustration
humoral an immunity link, suppression of proinflammatory cytokine IL-10 and increase
proinflammatory IFN-γ. Under the influence of the spent treatment have not revealed
certain changes from the immune status at patients. It is possible to ascertain only positive
changes of maintenance IL-10 and parallel decrease IFN-γ in dynamics of treatment. In
the main group there were 25 HIV-infected patients with ARS, and in the control group
there were 14 practically healthy children of the same age who did not have a history of
ARS and HIV. All 35 HIV-infected children were registered with the Bukhara Regional
AIDS Center. Patients received antiretroviral therapy, antibacterial, anti-inflammatory and
local therapy in a hospital setting.
The problem of infection caused by the human immunodeficiency
virus (HIV) has been studied in otorhinolaryngology in our country since
the early 1990s. Identified and described diseases that are an indicator
of acquired immunodeficiency syndrome (AIDS), studied the symptoms
of lesions of the ear, throat and nose in HIV-infected and AIDS patients
(1,3,5).
Due to a significant increase in the number of cases of HIV infection, the
likelihood of contact of an otorhinolaryngologist with HIV-infected patients is
increasing. With HIV infection, various manifestations of the disease often
occur with damage to the upper respiratory tract. Otorhinolaryngologists,
as well as other specialists, already have to take an active part in the
diagnosis, treatment of HIV-infected persons, preventive work, which, of
course, will require knowledge of the features of the pathology of the ear,
throat and nose in HIV infection (AIDS) (2, 8.9).
The variety of clinical manifestations of HIV infection is due to the
addition of opportunistic infections, among which fungal, bacterial and viral
infections are of the greatest importance. The classic manifestation of HIV
infection that an otorhinolaryngologist may encounter is the development
of acute rhinosinusitis. Acute rhinosinusitis is one of the most common
bacterial infections in children with a normal immune system, but the
features of the course of these diseases in immunodeficiencies are poorly
understood.Meanwhile, our own experience and the few data from clinical
studies that are available today suggest that this disease, in acute, chronic
and recurrent forms, is common in HIV-infected children.And although
in most cases the etiology, symptoms and course of these diseases in
HIV-infected children and in children with a normal immune system are
the same, nevertheless, a prolonged, severe or unusual course of these
infections, with frequent relapses, or the isolation of atypical pathogens
(including pathogens of opportunistic infections) should alert the physician
to possible HIV infection. This disease has long attracted the attention of
otorhinolaryngologists and paediatricians, especially since observations
and studies have appeared indicating an association of acute rhinosinusitis
with HIV infection (6,7,10).
Key words:
the immune status, a HIV-infection, acute rhinosinusitis, cellular
immunity, humoral immunity, an immunodeficiency, cytokines.
Article
OPEN ACCESS
published: 30 July 2022
doi.org/10.56121/2181-2926-2022-3-40-45
40
IJSP
2022 / Issue 03 / Article 04
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The aim of the study was to study the parameters of the immune
system in HIV-infected children with acute rhinosinusitis.
Material and Methods
We investigated 35 children at the age from to 3 till 14 years of a
HIV-infected with ARS, were on hospitalization in LOR-BRANCH of the
Bukhara regional children’s versatile medical centre. Boys have made
56.6%, girls – 43.4%. Unilateral defeat of sine was observed at 57.8%,
bilateral - at 42.2%. Except inflammation signs the general anxiety, a
bad dream, refusal of a chest food, headaches was marked. Besides
traditional inspection (the general analysis of blood, urine, bacteriological
and bio-chemical researches) all patients have passed LOR-survey, under
indications - sine sounding (26.5%), X-ray additional bosoms of a nose
(9.6%). In the basic group there were 25 HIV-infected with ARS pa-tients,
and in a control - almost healthy 14 children of similar age who did not
have in anamnesis ARS and a HIV. All 25 HIV-infected children consisted
on the account in the Bukhara regional AIDS-cen-tre. Patients received
antiretroviral therapy, antibacterial, anti-inflammatory and local therapy in
the conditions of a hospital.
The HIV diagnosis was based on revealing of specific antibodies in
standard serological tests (ELISA, immune bloating in updating Western-
bloat) and comparisons epidemiological and serological data.
Immunologic studies were carried out in conjuction with the the
Institute of Immunology NA RUz (Tashkent). In researches included
patients from a HIV-infection and ARS which parents have given the
informed consent to participation in the given researches (work has been
executed according to the Helsinki declaration and it is approved by ethical
committee of Bukhara State Medical Institute).
Phenotyping lymphocyte carried out indirect by immune fluorescent
method with the help monoclonal antibodies to CDs-receptors «Sorbent
Ltd» (Russia). Defined T-lymphocytes (total set - CD3); T-helpers (subset
of Th - CD4); T-suppressors (subset of Ts - CD8); B-lymphocytes (subset
СD19).
Calculated an immunoregulatory index (IRI) – the ratio of CD4/CD8.
Concentration serum antibodies (Ig) A, M and G defined a method of radial
immune diffusion[7]. Level cytokines (IFN-γ, IL-10) in whey of peripheral
blood was studied a method of the immune enzyme analysis with use of
test sys-tems by firms «Vectors-best» (Russia). Parameters of the immune
status studied twice: before and 1 month after treatment.
The obtained data was exposed to statistical processing with use of
computer program Micro-soft of Excel 2003 on LG-Pentium IV. Significance
of differences when comparing the mean values were determined
by Student´s t test. Data are presented as of M ± m. Differences were
considered significant at P<0.05.
Results of research and their discussion
The retrospective analysis of studying of the immune status at a HIV-
infected of children with ARS has shown that in terms before carrying out
before treatment at them essential infringements have been revealed from
their immune system (tab. 1). At a HIV-infected with ARS patients observed
0.7-fold fall of absolute value of leukocytes and the relative contence
lymphocyte, double decrease in the absolute values of lymphocyte. Such
decrease was reflected in statistically significant decrease from 2 to 3 times
of absolute values of the total pool Т (CD3) - and В (CD19)- lymphocyte
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(tab. 1).
At a HIV-infected patients with ARS children showed profound
suppression T-cell immunity in their relative expression, namely, 0.6-fold
reduction in T-cells with the phenotype (CD3), even more si-gnificant
suppression T-share helpers cells - Th (CD4) – up to 13.8 ± 2.3% (in the
control group 34.2 ± 1.6%; Р<0.001), while the content of subset of T-cells
- Т (CD8)-cytotoxic exceeded the background va-lues in the control group
moderate (P>0.05).
In this connection in the given group there is an inversion an immune
regulatory index (IRI) – the ratio of CD4/CD8, - that leads to serious
changes in immune system of patients with HIV-infec-tion, combined with
the ARS. Thus, we find out a disbalance of T-cell subset with a decrease
in the proportion of helpers Th(CD4) and increase suppression parts -
Ts(CD8) (tab. 1). Reduction IRI regis-tered by us at HIV-infected with ARS
children testifies to functional insufficiency of cages with a phe-notype
of Ts(CD8), and it is a sign of the profound immunodeficiency which has
developed at patients. At a HIV-infected of patients with ARS have revealed
small activation of subset of T-killers - Tk (CD16) that, possibly, is also
pathognomonic at this pathology.
In respect of B-cell component of the immune system can be said
that moderate decrease occurred, which was statistically is possible to tell
that there was a moderate decrease that statistically confirmed (P>0.05).
Decrease B(CD19) lymphocytes was reflected in the spectrum of serum
immuno-globulin (SI) content of two classes - IgA and IgG, and quantity
IgM, on the contrary, increased (tab. 1).
The data obtained by us testifies to profound infringements in the
functioning of the immune sy-stem in children of patients with a HIV-
infection and ARS, which were reflected a spectrum cellular and humoral
immunity factors. These disorders appear to be quite possible as a fact
that plays an im-portant in the pathogenesis of this mixed-pathology in
children. The decrease of the relative quanti-tative propeties of Th(CD4) -
this aggravating factor, and an unfavorable forecast criterion.
The spent treatment did not lead to appreciable changes of parameters
of immune system at a HIV-infected of children with ARS. We observed a
tendency in moderate increase of separate links of cellular immunity and
humoral immunity, however restoration of key parameters of the immune
status (tab. 1). Besides, at patients with chronic processes saved pressure
of the humoral component of sys-tem of immunity remained at P>0.05. In
a HIV-infected of patients with ARS have found out weak increase Т(CD3)
and B(CD19) in their relative and absolute values, and also moderate
increase of production of Tk(CD16), Ts(CD8), the concentration of IgA
(tab. 1).
Spectrum studying cytokines at a HIV-infected of children with ARS
has shown that at them presence of significant differences between values
of the basic group with control group was marked. So, for example, if at
healthy children level IFN-γ made 23.70 ± 5.38 pg/ml, at a HIV-infected
of children with ARS the similar parameter was in 3/5 times above and
there was at level 82.84 ± 21.17 g/ml (tab. 2). So, high level IFN-γ at a
HIV-infected of children with ARS testified to expressiveness of degree of
inflammatory reaction.
It is known that as a source IFN-γ serve activated T-lymphocytes
and natural killers. Among T-lymphocytes producers IFN-γ are both the
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cytotoxic Ts (СD8), and Th (СD4) cells, however at a differ-rentiation of
the last on Тh1 and Тh2 ability to develop IFN-γ keep only Тh1-cells. The
major function IFN-γ is its participation in medium interrelations between
lymphocytes and macrophages, and also in regulation of a parity cellular
and humoral components of the immune response. Being the basic
product Тh1-клеток, IFN-γ reduces secretor activity Тh2-cells. Thus, IFN-γ
enhances the development of cellular immunity and suppresses displays
Indicator
Healthy (n=14)
Patients (n=25)
Leukocytes, num./mklt
6123 ± 162
4251 ± 321***
4437± 234***
Lymphocytes, %
29.6 ± 1.7
21.4 ± 2.15**
22.7 ± 2.4*
Lymphocytes, abs.
1812.4 ± 35.7
931.5 ± 97.2***
1003.6 ± 47.5***
Т(CD3), %
58.3 ± 2.5
38.4 ± 3.2***
41.2 ± 2.7***
Т(СD3), abs.
1058.2 ± 72.2
362.5 ± 43.6***
425 ± 51,4***
Th(CD4), %
34.4 ± 1.6
13.8 ± 2.3***
12.4 ± 2.7***
Тs(CD8), %
22.7 ± 1.2
24.2 ± 2.8
26.5 ± 3.1
IRI (CD4/CD 8)
1.5 ± 0.14
0.58 ± 0.31**
0.49 ± 0,36**
Тk(CD16), %
15.4 ± 0.9
16,2 ± 2,5
18,4 ± 3,2
В(CD19), %
24.3 ± 1.22
19,62 ± 4,4
22.5 ± 2.6
CD19, abs.
351.6 ± 29.4
182.1 ± 20.5***
228.7 ± 34.9**
IgА, mg%
129.2 ± 10.8
84.4 ± 7.8**
101.9 ± 13.6
IgМ, mg%
86.7 ± 8.9
140.4 ± 13.1***
136.3 ± 16.5**
IgG, mg%
1047.3 ± 33.4
888.7 ± 42.7**
761.4 ± 54.6***
The note:
in numerator the data before treatment, in a denominator - after treatment;
* - Р <0.05; ** - Р <0.01; *** - Р <0.001 - in comparison with control group.
Table 1
Parameters of immune system at a HIV-infected of children with ARS in dynamics of
treatment
humoral immunity. Hence, IFN-γ plays an important role in immune
regulation, being key by the cytokine cellular immune response and
inhibitor of the humoral immune response [8].
Level IL-10 in group at a HIV-infected of children with ARS
approximately in 8 times higher than those values of the control group. It is
known that IL-10 it is described as the factor stimulating B-lymphocytes as
it causes proliferation B-cells. The main producers IL-10 are Тh2 cells. IL-
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Indicator
Healthy (n=14)
Patients (n=25)
IFN-γ, pg/ml
23.70 ± 5,38
82.84 ± 21.17**
21.93 ± 7.42
IL-10, pg/ml
10.95 ± 3.63
86.08 ± 19.43***
52.04 ± 12.06**
The note:
in numerator the data before treatment, in a denominator - after treatment;
* - Р <0.05; ** - Р <0.01; *** - Р <0.001 - in comparison with control group.
Table 2.
The maintenance pro- and anti-inflammatory cytokines at HIV-infected of children in a
combination with ARS in dynamics of treatment
10 inhibits functions of macrophages and secretion by them IL-1, FNO and
IL-6, having thus anti-inflammatory an effect. IL-10 causes proliferation
and a differentiation B - and T-lymphocytes, influences development
hematopoietic cells, on macrophages, natural killers, basophiles, being
the functional antagonist cyto-kines, produced Th1 cells. IL-10 promotes
development of allergic reactions, possesses the expressed anti-
inflammatory action [8].
Level IL-10 in group at a HIV-infected of children with ARS
approximately in 8 times higher than those values of the control group. It is
known that IL-10 it is described as the factor stimulating B-lymphocytes as
it causes proliferation B-cells. The main producers IL-10 are Тh2 cells. IL-
10 inhibits functions of macrophages and secretion by them IL-1, FNO and
IL-6, having thus anti-inflammatory an effect. IL-10 causes proliferation
and a differentiation B - and T-lymphocytes, influences development
hematopoietic cells, on macrophages, natural killers, basophiles, being
the functional antagonist cyto-kines, produced Th1 cells. IL-10 promotes
development of allergic reactions, possesses the expressed anti-
inflammatory action [8].
The comparative analysis has shown that the parity IFN-γ/IL-10
(proinflammatory/anti-inflammatory cytokines or Th1/Th2) at healthy
children equaled 2.2. In the presence of the expressed inflammatory
process, that is at children of the basic group, this indicator made 0.96.
The expressed disbalance in functioning of the core regulator cytokines
which was expressed by acute lifting of level anti-inflammatory cytokines
and suppression proinflammatory cytokines, acute inflammatory condi-
tions being the basic regulators is revealed.
Thus, the HIV-infected of children with ARS have an expressed
stimulation of production both proinflammatory, and anti-inflammatory
cytokines. Such processes can as a necessary condition for protection
against the infectious agent and system damaging action of high
concentration proinflam-matory cytokines [8].
After treatment carrying out in group of a HIV-infected of children
with ARS level IFN-γ has come nearer to control values, and level IL-10
in dynamics of treatment if decreased, but nevertheless remained at high
level, in 5.5 exceeding those parameters at children of control group.
The parity IFN-γ/IL-10 in the basic group tended to even bigger to
decrease, making 0.42.
Thus, at a HIV-infected of children with ARS deep deficiency of most
of the parameters of the immune status is observed. One of the major
disorders of the immune status is a significant suppres-sion of Th (CD4)-
lymphocytes and inversion of the IRI with an increase in functional activity
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2022 / Issue 03 / Article 04
of Ts (CD8)-lymphocytes, which is unfavorable clinical criteria. The given
patients did not have positive dy-namics of changes of the immune status
after treatment carrying out. Under the influence of treatment there was
a suppression proinflammatory of cytokine IFN-γ. However, it should
highlight that the dete-cted change in the level of IL-10 and a violation
of the proportion of pro- and anti-inflammatory cyto-kines indicates the
presence of preexisting immune deficiency, which, apparently, and was
manifes- ted in the form of complications associated with HIVinfection.
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