Relationship Between Hiv/aids Patients' Immune Status With Opportunistic Infections And Mineral Contents In Plasma

ObjectivesSince 1981,acquired immunodeficiency syndrome(AIDS) was first found in America and then it had spread rapidly all over the world.It has become a worldwide health problem and many countries have paid great attention on it.AIDS can be transmitted by three routes:sexcial transmission,the blood transmission and vertical transmission.The blood transmission is the main reason of high AIDS prevalence in the central rural areas in China.The pathogen of AIDS is HIV,which mainly attacks CD₄⁺T lymphocytes.The consequences of affected CD₄⁺T lymphocytes are opportunistic infections and cancer.Up to date,there were no effective methods to cure or prevent AIDS.Many studies have shown that in HIV infection,the gradual decline of CD₄⁺T lymphocytes is associated with host immune dysfunction.The deficiency of CD₄⁺T lymphocytes is the key in AIDS pathogenesis.Globally,AIDS is an epidemic,severe and fatal disease.It has been shown that nutritional status plays critical role in the disease progress of AIDS and HIV infection. Nutrient deficiency may influence immunity which in turn,affects the disease course of HIV/AIDS.Some minerals can influence immunity by acting as the components of metalloenzymes which are involved in major immunologic functions.The objectives of the study are to investigate the immunologic function of HIV/AIDS patients,the clinical manifestations of the HIV/AIDS patients and the relationship among CD₄⁺T cell level and opportunistic infections(OIS),to evaluate the prognostic function of the CD₄⁺T cell counts in predicting opportunistic infections, to study the significance of CD₄⁺T cell count in the development of blood-transmitted AIDS and provide the theoretical basis for the further prevention and the treatment of HIV/AIDS in Henan province.The study also explored the relationship between HIV and cellular immunity dysfunction,and the potential correlation between the changes of plasm mineral matter and cellular immunity dysfunction by testing HIV/AIDS patients' peripheral blood T lymphocyte subgroups and plasm zinc,iron,calcium and magnesium levels.Subjects and Methods1 The subjectsThe subjects were from Henan province and were first time diagnosed as HIV or AIDS patients.The diagnostic criteria was based on the HIV/AIDS diagnostic criteria promulgated by Centers for Disease Control of USA.The confirmation of Anti-HIV positive was carried out by using Western blot(W-B) in Henan province or Zhoukou city CDC or other qualified CDCs.The HIV-seronegative controls were randomly selected from healthy relatives living together with HIV/AIDS subjects.2 The sample collectionAfter overnight fasting,5 ml of blood was taken from the ulnar vein and transferred to a test tube with EDTA-K₃.Within one hour,the blood samples were centrifuged at 1500rpm for 10 minutes at room temperature.The supernatant was collected and stored at -80℃for future use.3 T lymphocytes countsThe 20μl TriTEST reagents CD4FITC/CDSPE/CD3PerCP were added to the CD4 counting vials and 50μl whole blood was added in the vial.After 15-min incubation in the dark at room temperature,the erythrocytes were lysed by using FACS lysing solution.After further 15-min incubation,the vials were taken to perform FACS analysis by using Multiset software.The numbers of CD3+T/CD4+T/CD8+T cells were counted and the percentages of them were calculated automatically.The ratio of CD₄⁺T/CD₈⁺T was also calculated.4 Plasma Zn,Fe,Ca,Mg determinationPlasma levels of iron,zinc,calcium,and magnesium were measured by LK98B micronutrients analyzer.5 Statistical analysisThe data were analyzed by SPSS12.0.The results were expressed as mean±standard deviation((?)±S).T-test was applied to compare two independent samples. One way ANOVA was applied to compare the means of samples.χ²test were used in the data analysis of categorical variable.Multiple variables using Kraskal-Wallis H test for rank sum test,the correlation analysis of Binary variables was done by Spearman correlation test.Two-tailed probability was used in all statistical tests. The significant level was set as 0.05.Results1 The clinical manifestations and the incidence of opportunistic infectionsThere were 105 in 131 cases of AIDS patients(80.15%) and 19 in 27 cases (70.37%) HIV infected subjects showed clinical symptoms,visual disorder(37.34%), weight loss(34.81%),deadlimb(32.28%) were the most common symptoms in HIV/AIDS patients.Among 158 HIV/AIDS patients,83 patients had various types infection at different levels,fungous infection(21.52%),tuberculosis(16.46%), herpesvirus infection(12.03%) were also the common general symptoms in HIV/AIDS patients.2 CD₄⁺ T lymphocyte count and opportunistic infectionOpportunistic infections occurred mainly in the skin tissue.The most common type of skin infection was dermatogic disease caused by viral infection,including 52 cases of herpes zoster(32.9%) and 13 cases of herpes simplex(8.2%).In the five groups classified as CD₄⁺T count,the distribution of opportunistic infections in the lungs,gastrointestinal tract,eye,and CNS were significantly different,(P＜0.01).The less the CD₄⁺T lymphocyte was,the more types of concurrent infection were.The difference was statistically significant(P=0.002).All above five kinds of opportunistic infections simultaneously happened in one case which was in the condition of CD₄⁺T lymphocytes＜200/μl.With the decreasing number of CD₄⁺T lymphocytes,the case number of four or three kinds of opportunistic infections was increased,and occurred mainly in the CD₄⁺T lymphocytes＜200/μl.The correlation analysis of CD₄⁺T cell counts and the frequency of opportunistic infections shows that correlation coefficient r=-0.345,P=0.015,with statistical significance.3 Relationship between CD₄⁺T lymphocyte count and serum Zn,Fe,Ca,Mg contentThe content of CD₃⁺T,CD₄⁺T,CD₈⁺T lymphoid values,CD₄⁺T/CD₈⁺T ratio and the Zn,Fe among the four groups of HIV-infected people,AIDS patients(taking medication or not) and the normal population were significantly different,P＜0.05.The significant differences of the CD₄⁺T cells and CD₄⁺T/CD₈⁺T ratio were found among the groups of newly(less than three years) and earlier(more than three years) infected of HIV/AIDS patients.(P＜0.05).The plasma levels of CD₃⁺ T cell and Zinc were significantly different between HIV infection and AIDS patients infected longer than three years(P＜0.05).The consequence of the second survey showed that the plasma levels of CD₄⁺ T cells(P＜0.05),Zn(P＜0.01),Mg(P＜0.05) of HIV-infected people were significantly different from the levels in the initial survey six month ago.The plasma levels of CD₄⁺ T cells(P＜0.05),Zn(P＜0.01),Mg(P＜0.01),Fe(P＜0.05) and Ca(P＜0.01) of patients with AIDS were also significantly different from the levels in the initial survey six month ago.The plasma levels of iron and zinc were significantly different among the four groups which were grouped according to the CD₄⁺T count.Zinc:F=3.634,P=0.026: Iron:F=2.391,P=0.048.ConclusionImpacted vision,weight loss and deadlimb were the most common general symptoms in HIV/AIDS patients.Respiratory system,gastrointestinal system,derma and mucosa were the most common involved systems of opportunistic infections. Correlation were found on the incidence of opportunistic infections and the CD₄⁺ T lymphocyte count.Along with the decreasing of CD₄⁺T lymphocyte count,the incidence rate of opportunistic infections was increased.The type and location of opportunistic infection also had a very close relationship with the CD₄⁺ T lymphocyte count.The mineral content in blood plasma was related to the disease phase.Zn,Fe decreased with the progress in course.The status of mineral imbalance woule be further affected during the transmission process to AIDS.