Corticosteroid Therapy, Vitamin D Status, and Inflammatory Cytokine Profile in the HIV-Tuberculosis Immune Reconstitution Inflammatory Syndrome

被引：60

作者：

Conesa-Botella, Anali ^{[1
,2
]}

Meintjes, Graeme ^{[1
,3
,4
,5
]}

Coussens, Anna K. ^{[6
]}

van der Plas, Helen ^{[5
]}

Goliath, Rene ^{[1
]}

Schutz, Charlotte ^{[1
,4
]}

Moreno-Reyes, Rodrigo ^{[7
]}

Mehta, Meera

Martineau, Adrian R. ^{[3
,8
]}

Wilkinson, Robert J. ^{[1
,3
,4
,5
,6
]}

Colebunders, Robert ^{[2
]}

Wilkinson, Katalin A. ^{[1
,5
,6
]}

机构：

[1] Univ Cape Town, Inst Infect Dis & Mol Med, Clin Infect Dis Res Initiat, Observatory, South Africa

[2] Univ Antwerp, Inst Trop Med, Dept Clin Sci, Antwerp, Belgium

[3] Univ London Imperial Coll Sci Technol & Med, Div Med, London SW7 2AZ, England

[4] GF Jooste Hosp, Infect Dis Unit, Manenberg, South Africa

[5] Univ Cape Town, Dept Med, Observatory, South Africa

[6] MRC Natl Inst Med Res, Div Mycobacterial Res, London, England

[7] Univ Libre Brussels, Erasme Hosp, Dept Nucl Med, B-1050 Brussels, Belgium

[8] Queen Mary Univ London, Ctr Primary Care & Publ Hlth, London, England

来源：

CLINICAL INFECTIOUS DISEASES | 2012年 / 55卷 / 07期

基金：

英国惠康基金;

关键词：

REGULATORY T-CELLS; D-BINDING PROTEIN; ANTIRETROVIRAL THERAPY; D DEFICIENCY; MYCOBACTERIUM-TUBERCULOSIS; INFECTION; D-3;

D O I：

10.1093/cid/cis577

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) in patients coinfected with human immunodeficiency virus (HIV) and tuberculosis starting antiretroviral therapy (ART) is associated with hypercytokinemia. As adjunctive corticosteroid therapy and vitamin D have immunomodulatory properties, we investigated the relationship between cytokine/chemokine profiles, corticosteroid use, and vitamin D deficiency in TB-IRIS patients. Methods. Plasma from 39 TB-IRIS and 42 non-IRIS patients was collected during a prospective study of HIV-associated tuberculosis patients starting ART. In total, 26% of patients received corticosteroid (CTC) therapy pre-ART for severe tuberculosis. Concentrations of total 25-hydroxyvitamin D (25(OH) D) and 14 cytokines/chemokines were determined at ART initiation and 2 weeks later. Results. Patients prescribed concurrent CTC had lower interferon gamma (IFN-gamma), IP-10, tumor necrosis factor (TNF), interleukin (IL)-6, IL-8, IL-10, IL-12p40, and IL-18 pre-ART (P <= .02). TB-IRIS presented at 12 days (median) of ART, irrespective of CTC use. In patients who developed TB-IRIS (not on CTC) IL-6, IL-8, IL-12p40, IL-18, IP-10, and TNF increased during 2 weeks (P <= .04) of ART. Vitamin D deficiency (total 25(OH) D <75 nmol/L) was highly prevalent (89%) at baseline. Although vitamin D deficiency at either baseline or 2 weeks was not associated with TB-IRIS, in those not on CTC the median 25(OH) D decreased during 2 weeks (P = .004) of ART. Severe vitamin D deficiency (total 25(OH) D <25 nmol/L) was associated with higher baseline TNF, IL-6, and IL-8 irrespective of IRIS status. Conclusions. CTC modifies the inflammatory profile of those who develop TB-IRIS. The association between severe vitamin D deficiency and elevated proinflammatory cytokines support a study of vitamin D supplementation in HIV-TB co-infected patients starting ART.

引用

页码：1004 / 1011

页数：8

共 31 条

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