aidsВИЧ-инфекция и иммуносупрессииHIV Infection and Immunosuppressive Disorders2077-9828Baltic Medical Education Center10.22328/2077-9828-2019-11-1-16-30aids-404Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОРANALYTICAL REVIEWДИСКОРДАНТНЫЙ ОТВЕТ CD4+ T-ЛИМФОЦИТОВ НА АНТИРЕТРОВИРУСНУЮ ТЕРАПИЮDISCORDANT RESPONSE OF CD4+ T LYMPHOCYTES TO ANTIRETROVIRAL THERAPYШмагельК. В.ShmagelK. V.

зав. лабораторией экологической иммунологии Института экологии и генетики микроорганизмов Уральского отделения Российской академии наук — филиал ФГБУН «Пермский федеральный исследовательский центр Уральского отделения Российской академии наук»;

профессор кафедры микробиологии и иммунологии ФГБОУ ВО «Пермский государственный национальный исследовательский университет»

shmagel@iegm.ruПермский федеральный исследовательский центр Уральского отделения Российской академии наук; Пермский государственный национальный исследовательский университетРоссияPerm Federal Research Center of the Ural Branch of the Russian Academy of Sciences; Perm State National Research UniversityRussian Federation2019070420191111630Copyright © Шмагель К.В., 20192019Шмагель К.В.Shmagel K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hiv.bmoc-spb.ru/jour/article/view/404

Стандартным результатом проведения антиретровирусной терапии у ВИЧ-инфицированных пациентов является подавление репликации вируса и восстановление численности CD4+ T-лимфоцитов. Однако у части больных (приблизительно у 20%) на фоне низкой вирусной нагрузки отмечается нарушение регенерации иммунокомпетентных клеток. В литературе для них был введен термин «immunological nonresponders» (англ.)  — «иммунологические неответчики». Причиной развития дискордантного иммунологического ответа на терапию может быть как усиление гибели, так и уменьшение образования CD4+ T-клеток. Однако механизмы формирования низкого восстановительного потенциала иммунитета остаются недостаточно изученными. Известно, что у иммунологических неответчиков, по сравнению с пациентами, которые демонстрируют конкордантный ответ на лечение, наблюдается усиленная пролиферация лимфоцитов, повышенная иммунная активация, сокращение времени жизни CD4+ T-лимфоцитов. Состояние их иммунной системы характеризуется более яркими проявлениями истощения и старения. Это приводит к раннему и частому появлению СПИД-ассоциированных заболеваний. Кроме того, иммунологические неответчики подвержены высокому риску возникновения не ассоциированных со СПИДом болезней, что обусловлено развитием выраженного системного воспаления. Представленный обзор направлен на освещение важной проблемы, нередко возникающей при проведении антиретровирусной терапии, и привлечение к ее решению внимания специалистов.

 

Antiretroviral therapy (ART) in HIV infected patients generally results in the suppression of viral replication and reconstitution of CD4+ T lymphocytes cell counts. In some patients (about 20%), however, a disturbance in regeneration of immune competent cells with a background of low viral load occurs. The term «immunological nonresponders» has been used to describe this phenomenon. Discordant immune response to antiviral therapy may be caused by increasing of depletion and reducing of production of CD4+ T cells. However, mechanisms for low immune reconstitution are not currently well understood. «Immunological nonresponders» exhibit booster lymphocyte proliferation, increased immune activation and reducing of CD4+ T lymphocytes survival time in comparison with patients with concordant response to the therapy. Their immune system is characterized by more pronounced aging and exhaustion. This leads to early and frequent manifestation of AIDSrelated diseases. Besides, immunological nonresponders have an increased risk of non-AIDS-related diseases due to pronounced systemic inflammation. The objective of the present review was to highlight the important problem that is rather common on аntiretroviral therapy and to enlist the specialists to the solving of this issue.

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The authors declare that there are no conflicts of interest present.