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The spleen is the graveyard of CD4+ cells in patients with immunological failure of visceral leishmaniasis and AIDS.
Reinaldo, Luis Gustavo Cavalcante; Araújo Júnior, Raimundo José Cunha; Diniz, Thiago Melo; Moura, Rafael de Deus; Meneses Filho, Antônio José; Furtado, Caio Victor Verçosa de Macedo; Dos Santos, Washington Luis Conrado; Costa, Dorcas Lamounier; Eulálio, Kelsen Dantas; Ferreira, Gabriel R; Costa, Carlos Henrique Nery.
Afiliação
  • Reinaldo LGC; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Araújo Júnior RJC; Hospital Getúlio Vargas, Teresina, Brazil.
  • Diniz TM; Hospital Getúlio Vargas, Teresina, Brazil.
  • Moura RD; Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
  • Meneses Filho AJ; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Furtado CVVM; University Hospital of the Federal University of Piauí, Teresina, Brazil.
  • Dos Santos WLC; Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
  • Costa DL; Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
  • Eulálio KD; Department of Community Medicine, Federal University of Piauí, Teresina, Brazil.
  • Ferreira GR; Oswaldo Cruz Foundation, Gonçalo Moniz Institute, Salvador, Brazil.
  • Costa CHN; Maternal and Child Department, Federal University of Piauí, Teresina, Brazil.
Parasit Vectors ; 17(1): 132, 2024 Mar 15.
Article em En | MEDLINE | ID: mdl-38491526
ABSTRACT

BACKGROUND:

Visceral leishmaniasis (VL), or kala-azar, is a common comorbidity in patients with AIDS in endemic areas. Many patients continue to experiences relapses of VL despite virological control, but with immunological failure. These patients remain chronically symptomatic with hypersplenism, for example with anemia, leukopenia, and thrombocytopenia, and are at risk of severe co-infection due to low CD4+ count. Therefore, in this study, splenectomized patients with VL and HIV infection were investigated to understand why the CD4+ count fails to recover in these patients, evaluating the importance of spleen mass for hypersplenism and immunological failure.

METHODS:

From a retrospective open cohort of 13 patients who had previously undergone splenectomy as salvage therapy for relapsing VL, 11 patients with HIV infection were investigated. This study compared the patients' complete blood cell count (CBC) and CD4+ and CD8+ cell counts before and after splenectomy with respect to spleen weight.

RESULTS:

CBC was substantially improved after splenectomy, indicating hypersplenism. However, to the best of our knowledge, this is the first study to show that spleen mass is strongly and negatively correlated with CD4+ cell count (ρ = -0.71, P = 0.015).

CONCLUSIONS:

This finding was unexpected, as the spleen is the most extensive lymphoid tissue and T-lymphocyte source. After reviewing the literature and reasoning, we hypothesized that the immunological failure was secondary to CD4+ loss initially by apoptosis in the spleen induced by productive HIV infection and, subsequently, by pyroptosis sustained by parasitic infection in spleen macrophages.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Síndrome da Imunodeficiência Adquirida / Hiperesplenismo / Leishmaniose Visceral Limite: Humans Idioma: En Revista: Parasit Vectors Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Síndrome da Imunodeficiência Adquirida / Hiperesplenismo / Leishmaniose Visceral Limite: Humans Idioma: En Revista: Parasit Vectors Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido