ДИСКОРДАНТНЫЙ ОТВЕТ CD4+ T-ЛИМФОЦИТОВ НА АНТИРЕТРОВИРУСНУЮ ТЕРАПИЮ

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.

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