BMC Infectious Diseases (Aug 2021)

Immunologic biomarkers, morbidity and mortality among HIV patients hospitalised in a Tertiary Care Hospital in the Brazilian Amazon

  • Wellington Mota Gama,
  • Carlos Henrique Michiles Frank,
  • Taynná Vernalha Rocha Almeida,
  • Daniel Silva dos Santos,
  • Yury Oliveira Chaves,
  • Danielle Furtado da Silva,
  • Patrícia Puccinelli Orlandi,
  • Flávio Ribeiro Pereira,
  • Gleicienne Feliz Magalhães,
  • Bárbara Jóse Baptista,
  • Viviane Lago de Oliveira Silva,
  • Antônio Alcirley da Silva Balieiro,
  • Monique Freire Santana,
  • Roberta Lins Gonçalves,
  • Allyson Guimarães da Costa,
  • Marcelo Cordeiro dos Santos,
  • Luís Carlos de Lima Ferreira,
  • Marcus Vinicius Guimaraes Lacerda,
  • Paulo Afonso Nogueira

DOI
https://doi.org/10.1186/s12879-021-06566-x
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 9

Abstract

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Abstract Background The irregular use of antiretroviral therapy (ART) and late diagnosis still account for a large part of HIV-associated mortality in people living with HIV (PLHIV). Herein, we describe HIV-associated morbidity among hospitalised HIV/AIDS patients with advanced immunosuppression and assess the comorbidities, laboratory parameters, and immunological markers associated with mortality. Methods The cross-sectional study was conducted at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus, Brazil. In all, 83 participants aged between 12 and 70 years were enrolled by convenience within 72 h of their hospitalisation. Clinical and laboratory data were obtained from electronic medical records. We prospectively measured the cytokines Th1/Th2/Th17 and inflammatory cytokines IL-8, IL-1β, and IL-12 using cytometric bead array, and the soluble CD14 using in-house enzyme-linked immunosorbent assay. Results The HIV/AIDS inpatients presented a scenario of respiratory syndromes as the most prevalent comorbidity. Almost all patients had CD4 T counts below 350 cells/mL and the mortality rate was 20.5%. Pulmonary tuberculosis, neurotoxoplasmosis and oropharyngeal–esophageal candidiasis were the most prevalent opportunistic infections. TB and weight loss were more prevalent in HIV/AIDS inpatients who died. The Mann Whitney analysis showed that those who died had higher platelet distribution width (PDW) on admission, which is suggestive for platelet activation. The Poisson multivariate analysis showed the prevalence of TB, digestive syndrome and increases in IL-8 and lactate dehydrogenase (LDH) associated to death. Conclusions The advanced immunosuppression characterized by the opportunistic infections presented in these HIV/AIDS inpatients was the major factor of mortality. The role of platelet activation in worse outcomes of hospitalisation and the IL-8 associated with the context of advanced immunosuppression may be promising markers in the prediction of mortality in HIV/AIDS patients.

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