抗逆转录病毒治疗20年对HIV感染患儿皮肤黏膜的作用

摘要

Background: Human immunodeficiency virus (HIV) infection causes a severe cellular immunodeficiency, which results in a greater susceptibility to infectious, inflammatory and malignant conditions. Among these, pathologies of the skin seem to be those most frequently observed in HIV+patients. However, there are few reports on how antiretroviral therapy affects skin disorders in HIV-infected children. Objective: To study the incidence and prevalence of skin disorders in a cohort of HIV-infected children, in relation to the antiviral therapy [nontreated, monotherapy, combined therapy and highly active antiretroviral therapy (HAART)] received, and their impact on immunological and virological markers. The treatments were those available in different calendar periods in the history of antiviral treatment. Materials and methods: A retrospective, observational study in a cohort of 210 HIV-infected children was carried out. These children were followed up every 3 months throughout 22 years. The viral load (HIV RNA copies mL-1) was quantified using reverse transcriptase-polymerase chain reaction and the viral phenotype of HIV-1 isolates was determined by in vitro culture. T-lymphocyte subsets in peripheral blood were quantified by flow cytometry. Results: Mucocutaneous manifestations were diagnosed in 17%of the untreated infected children. Of the treated children in different treatment periods, 22%in the monotherapy period, 25%in the combined therapy period but only 10%on HAART had some type of mucocutaneous manifestation, concordant with a higher number of CD4+T cells, a lower viral load and less cytopathic virus in the last group. Mucocutaneous manifestations of infectious aetiology were most frequently observed; they were detected in 13%of the children during the first calendar period (untreated children), 16%during the second and third periods (monotherapy and combined therapy) and only 5%in the last period (HAART). Interestingly, syncytium-inducing virus was present in 69%of all children with mucocutaneous manifestations of infectious aetiology. Conclusion: Only in the last calendar period (HAART) was a significant decrease observed in the prevalence of mucocutaneous manifestations with HIV infection associated with an increase in CD4+T cells. In addition, we found a strong association between children who had mucocutaneous manifestations with an infectious aetiology and a more cytopathic (X4/SI) viral phenotype.