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https://doi.org/10.29013/ESR-20-1.2-36-41
Suleymanov Suleyman Fayzullaevich, PhD, Senior Researcher, Associate Professor of the Chair of Microbiology, Virusology and Immunology of the Bukhara State Medical Institute,
Bukhara, Uzbekistan E-mail: ss-1961@mail.ru
CHARACTERISTICS OF THE IMMUNE SYSTEM PARAMETERS IN CHILDREN WITH COMORBIDE PATHOLOGY HIV AND CHRONIC TONSILLITIS
Abstract. We studied 39 children with comorbid pathology-chronic tonsillitis (CT) and human immunodeficiency virus (HIV). The 1st group included 21 perinatal patients, and the 2nd group included 18 children with HIV with a vertical route of infection. In both groups of children with CT, significant suppression of cellular parameters was observed against the background of HIV infection. You can also identify a disorder of the functioning of the B(CD19)-link of the immune system. If the 2nd group had more intense disorders of immunological parameters, then the 1st group of patients had more pronounced clinical symptoms.
Keywords: chronic tonsillitis, children, HIV infection, cellular immunity, humoral immunity, immunoglobulins, inversion, immunodeficiency.
It is known that chronic tonsillitis (CT) is a com- come HIV infection, the pandemic of which con-
mon pathology - 4-15% of cases from all diseases tinues to increase. HIV/AIDS is a kind of viral in-
of ENT organs. CT refers to multifactorial diseases, fection, the first acquired immunodeficiency in the
and the inflammatory process in the tonsils leads to history of medicine associated with a specific patho-
pathological changes in them and the tonsils them- gen and characterized by an epidemic spread. The
selves become a source of infection [1; 2]. first human epidemic disease caused by retroviruses
CT is also the most common bacterial infection in that exclusively infect T-helpers [6-9]. children with a normal immune system, but the fea- It has been shown that chemotherapy in acute,
tures of the course of chemotherapy are still poorly chronic and recurrent forms is often found in HIV-
understood. It has been demonstrated that with any infected children. And although in most cases the
form of chemotherapy, certain immune genetic func- etiology, symptoms and course of chemotherapy
tions of the tonsils are preserved. Damage to the im- for both HIV-infected children and children with a
mune system during HIV infection is systemic, mani- normal immune system are the same, the protracted,
fested by deep suppression of the T- and B-units of severe or unusual course of this pathology with fre-
cellular immunity, shifts in humoral immunity and quent relapses or the release of atypical pathogens
non-specific defense factors, and the functional activ- (including opportunistic infections) should alert the
ity of lymphocytes and monocytes [3-5]. doctor about possible HIV infection [10-12].
In the past two decades, the determining cause Purpose of research: to study the immunologi-
of secondary immunodeficiency in children has be- cal parameters in HIV-infected children with CT.
Material and methods. For the period from 2017 to 2019 we observed 39 children with CT and HIV from the age of 10 months to 15 years who were registered with the Bukhara Regional AIDS Center. Of these, the 1st group consisted of 21 patients infected prenatally (IPW). In the 2nd group there were 18 patients with a vertical path of infection (VPI). In the control group there were 19 practically healthy children of a similar age who did not have a history of CT and HIV.
HIV diagnosis was based on the detection of specific antibodies in standard serological tests (ELISA analysis, Western-blot modification immunoblot-ting) and a comparison of epidemiological and serological data.
Immunological studies were carried out jointly with the Research Institute of Immunology of the Academy of Sciences of the Republic of Uzbekistan. (Tashkent). The study included patients with HIV infection and CT whose parents gave informed consent to participate in this study (the work was carried out in accordance with the Helsinki Declaration of the World Medical Association (World Medical Association Declaracion of Helsinki, 1964) and approved by the Ethics Committee of the Bukhara State Medical Institute).
Phenotyping of lymphocytic cells was carried out by an indirect immunofluorescence method using monoclonal antibodies to CD receptors manufactured by Sorbent-Servis Ltd, FSBI State Research Center "Immunology" FMBA of Russia (Moscow) using a Luminal R-8 microscope. T cells were determined (general population - CD3); T-helpers (subpopulation of Th- CD4); T-suppressors (subTable 1.- Clinical manifestations taking into account the
population of Ts - CD8); T-killers (subpopulation of Tk - CD16), B-lymphocytes (subpopulation of CD19). The immunoregulatory index (IRI), the ratio of CD4/D8, was calculated.
The concentration of serum immunoglobulin (Ig) A, M and G was determined by radial gel immune diffusion according to G. Mancini et al. (1965) using mono specific serums against human immunoglobulin and standard blood serum.
The data obtained were subjected to statistical processing using the Microsoft Excel 2003 computer program on an LG-Pentium IV computer. The significance of differences when comparing average values was determined by the criterion t of student. Data are presented as M ± m. Differences were considered significant at p < 0.05.
Results and discussion. It should be emphasized that in the Bukhara region and in Bukhara city, there has been a steady increase in both the rate of HIV-infected children and the number of pregnant women infected with HIV, as well as children born to HIV-positive mothers.
In approximately 70% of children with HIV infection, clinical symptoms of CT are identified after the diagnosis of HIV infection in the form of severe lymphadenopathy, hepatomegaly, recurrent acute respiratory infections complicated by sinusitis, bronchopneumonia. In 14 of them, AIDS-related diseases were recorded. Approximately 30% of patients had asymptomatic infection.
During the research, 8 children died. It is important to note that, as the disease lasted, a lesion of the tonsils occurred in the spectrum of clinical manifestations in our patients.
of CT in HIV-infected children, pathways of infection
Symptoms of the disease 1st group (n = 21) 2nd group (n = 18)
1 2 3
Sore throat 21 (100%) 2 (11%)
Difficulty swallowing 21 (100%) 8 (53,3%)
Fever 21 (100%) 12 (80%)
1 2 3
Symptom of Giza 21 (100%) 18 (100%)
Symptom of Zack 21 (100%) 18 (100%)
Symptom of Preobrajensky 21 (100%) 18 (100%)
Sepsis 17 (81%) 2 (11%)
Cramps 18 (86%) 9 (50%)
Vomiting 18 (86%) 3 (17%)
Vomiting 13 (62%) 2 (11%)
Swollen lymph nodes 12 (57%) 10 (56%)
Chills 9 (43%) 1 (6,7%)
Nasal discharge 7 (33%) 2 (11%)
Burning throat 4 (19%) 3 (17%)
Sore throat 4 (19%) 3 (17%)
Malaise 2 (10%) 2 (11%)
In children with mixed pathology of CT and HIV of the first group, such pathologies as generalized lymphadenopathy, hepatosplenomegaly, bacterial pneumonia occurred with a frequency of 100%. In the same category ofpatients, the presence ofherpes simplex virus and cytomegalovirus infection was significantly more often observed in 41% and 16% of cases, respectively. A specific lesion of the parotid glands of a non-inflammatory etiology in the form of sialadenitis, which was also characteristic of HIV infection, was rarely observed in only 3 (14%) children.
In addition, in the 1st group, 6 symptoms were met with an absolute frequency of 100%, and symptoms of CT in the form of pain when swallowing were determined in 100% of cases, sepsis in 81% of cases, and lymph nodes in 12 patients (57%), chills -in 9 (43%) (Table 1).
Children of the 2nd group infected with VPI, in addition to CT, the following symptoms were noted: delayed psychomotor development (100%), protruding frontal part, flattening of the nose (70%), elongated palpebral fissures and bluish sclera (60%) against a background of deep prematurity, microcephaly - in 50% of cases. In this group, 3 clinical symptoms were encountered with absolute frequency, and the severity of other symptoms was lower than in the 1st group.
The parameters of the cellular component of the immune status in HIV-infected children with chemotherapy are presented in (table 2). Our data indicate that patients of both groups show significant shifts in the functioning of their immune system, namely, patients of the 2 groups have a deep immunodeficiency of most parameters of the cellular component of the immune system.
Indicator Healthy (n = 19) 1st group (n = 21) 2nd group (n = 18)
1 2 3 4
White blood cells, cells/^l 6100±187 3446 ± 283*** 3261 ± 247***
Lymphocytes,% 30.9 ± 1.4 21.4 ± 3.5* 18.8 ± 3.1**
Lymphocytes, abs. 1884 ± 41.3 712 ± 84*** 612 ± 63***
T(CD3),% 58.6 ± 2.1 33.1 ± 3.2*** 30.5 ± 3.8***
T(CD3), abs. 1071.5 ± 53 243 ± 36.4*** 176 ± 24.7***
Th(CD4),% 32.6 ± 1.7 14.6 ± 2.7*** 12.4 ± 2.1***
Ts(CD8),% 20.3 ± 1.2 24.8 ± 2.3* 23.1 ± 2.9
Table 2. - Cellular parameters of the immune system in HIV-infected children with CT
1 2 3 4
IRI (CD4/CD8) 1.6 ± 0.13 0.57 ± 0.26*** 0.51 ± 0.21***
Tk(CD16),% 16.5 ± 1.4 18.1 ± 2.3 18.8 ± 3.1
B(CD19),% 26.3 ± 3.2 20.4 ± 2.9 22.7 ± 2.3
B(CD19), abs. 485.7 ± 31.6 147.3 ± 33.5*** 132.7 ± 31.7***
Note: in the numerator data before treatment, in the denominator - after treatment; * -p < 0.05; ** - p < 0.01; ' -p < 0.001 - compared with the control group
They revealed significant suppression of the total pool of T(CD3)-lymphocytes and its subpopulation -Th with the CD4 marker in relative and absolute terms with a high level of confidence - p < 0.001. In patients of the 2nd group with VPI, these two parameters were even lower compared to the 1st group (Table 2).
It is also possible to distinguish the inversion of the IRI parameter in the downward direction in both groups, which was associated with a significant decrease in cells with the Th(CD4) phenotype and a parallel increase in the relative proportion of Ts(CD8)-cells with suppressor function, and this, in turn, indicates on the adverse course of immune processes in the immune system in HIV-infected children with CT. An increase in Ts(CD8) cells and inversion of IRI can be attributed to negative immune predictors that have a definite effect on the immune system of patients with this mixed pathology in children. Our data are completely consistent and confirmed by data of other authors in assessing the role
of Th(CD4) lymphocytes as the central pathogenesis link in HIV infection in children. They investigated the evidence in favor of such a version that the rapid development of deep immune suppression in children with HIV infection contributes to the transition of the disease to stage 4B. After 4-6 years from the onset of HIV infection, against the background of a significant decrease in Th(CD4) lymphocytes, attachment of various nosological forms of opportunistic infections and then its generalized forms was noted, which caused the formation of severe multiple organ failure and death [9].
In relation to Tk(CD16) in patients of both groups, their slight increase can be noted, which can be explained by the fact that this type of cell takes on a certain protective function due to the inadequate functioning of other types of cells.
It is also possible to isolate the disruption of the B (CD19) - cellular component of the immune system, but this was not statistically confirmed (Table 2).
Table 3. - Humoral parameters of the immune system in HIV-infected children with CT
Indicator Healthy (n = 19) 1st group (n = 21) 2nd group (n = 18)
IgA, mg% 121.3 ± 11.7 89.4 ± 14.5* 79.7 ± 12.2**
IgM, mg% 90.1 ± 12.3 134.2 ± 20.7* 127.8 ± 23.3*
IgG, mg% 1093.2 ± 65.6 876.7 ± 44.52** 1084.3 ± 60.6
Note: in the numerator data before treatment, in the denominator - after treatment; *- p<0.05; ** - p<0.01; ' -p<0.001 - compared with the control group.
It should be noted that the immune deficiency in the B-cell system of immunity was reflected in the spectrum of immunoglobulins. So, for example, in the 1st group, we revealed a tendency to a decrease in IgA and IgG with different levels of confidence (p < 0.05 and p < 0.01, respectively) and an increase
in the level of IgM, then only a decrease was observed in the 2nd group Ig A.
A comparative analysis with the data of other researchers showed that in children suffering only chemotherapy (without mixed pathologies), the level of IgA was within normal limits, i.e. here, as it
were, "there was no second pathology in the form of AIDS," which would affect the values of this IgA immunoglobulin and reduce it [3; 4].
On the contrary, the IgM level in patients of the 2nd group with VPI was higher compared with the control group, which was probably of a compensatory nature.
So, in sick children with mixed pathology of HIV and CT there are serious changes in their immune system, characterized by deep immune suppression and immune deficiency, with the development of a variety of clinical symptoms.
Thus, the presented results indicate the specific features of the clinical and immunological course of chemotherapy in HIV-infected children, depending on the route of infection. In patients of the 1st group with PPI, the characteristic symptoms of CT were frequent bacterial infections, generalized lymph-adenopathies, viral infections and other symptoms against the background of deep prematurity. In patients of the 2nd group with VPI, chemotherapy was accompanied by more pronounced immune suppression and a relatively lower frequency of occurrence of clinical symptoms.
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