Perfil de citocinas pós-óbito em apresentadores tardios com infecção pelo HIV na Fundação de Medicina Tropical Heitor Vieira Dourado

Abstract

Despite the significant progress made in getting individuals living with HIV into care, many patients still present or re-enter care with advanced HIV disease and these patients are at high risk of death. The major causes of advanced disease are the initiation of antiretroviral treatment or low adherence to anti-retroviral treatment (ART). Soluble immunological markers have prognostic significance in clinical care medicine however, it is not clear whether irregular use of ART (or influences circulating cytokines levels). This study aimed to assess mortality predictors in hospitalized people living with HIV/Aids (PLHA) and to determine cytokine associations. The longitudinal observational study was carried out with 111 PLHA aged between 18 and 70 years hospitalized in Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus, Brazil. The recruitment was performed by convenience between September 2018 to November 2019. Mortality predictors were clinical-laboratory data obtained from electronic medical records and 27 types of cytokines/chemokines/growth factors measured by Luminex Multiplex Assay in plasma collected within 72 hours of admission. A second blood collection was carried out post-mortem within 6 hours. All patients had advanced diseases, respiratory syndromes were major cause of hospitalization and pulmonary tuberculosis, neurotoxoplasmosis and oropharyngeal–esophageal candidiasis were major comorbidities. The risk of death is greater among ART-naïve PLHA. Levels of the most of 27 immunological markers who died were higher than those that discharged in admission. The increases of IFN-γ, CCL2 and CCL3 were associated with death in multivariate analysis. The increase in the levels of immunological markers were associated with CD4 cell counts only in ART-naïve PLHA. In postmortem, levels of the most of 27 immunological markers were higher than their levels in admission. Multivariate model showed that among immunological markers in postmortem, the increase of IL-17 was associated with ART-naïve PLHA while the increase of IFN-γ was associated with those who experienced ART. Our data report ART-naïve PLHA hospitalized with advanced disease has greater risk of death. Individually, several immunological markers were promised to predict death in the hospital admission, and their levels increased postmortem. Our findings suggest IL-17- and IFN-γ polarized response between ART-naïve PLHA and who experienced ART, respectively, that deserve special attention to mediate different clinical outcomes in hospitalized patients with HIV/AIDS.