Inflammatory responses in blood samples of human immunodeficiency virus-infected patients with pulmonary infections.
We analyzed the characteristics of the inflammatory response occurring in blood during pulmonary infections in human immunodeficiency virus (HIV)-infected patients. A prospective study of consecutive hospital admissions of HIV-infected patients with new-onset radiologic pulmonary infiltrates was carried out in a tertiary university hospital from April 1998 to May 2001. Plasma cyclic AMP receptor protein (CRP), interleukin 1beta (IL-1beta), IL-6, IL-8, IL-10, and tumor necrosis factor alpha (TNF-alpha) levels were determined at the time of admission and 4, 5, and 6 days later. Patients were included in a protocol addressed to study etiology and outcome of disease. A total of 249 episodes of infection were included, with the main diagnoses being bacterial pneumonia (BP) (118 episodes), Pneumocystis carinii pneumonia (PCP) (41 episodes), and mycobacteriosis (36 episodes). For these three patient groups, at the time of admission the median CRP and cytokine levels were as follows: CRP, 10.2, 3.8 and 5 mg/dl, respectively (P = 0.0001); IL-8, 19, 3, and 2.9 pg/ml (P = 0.045); and TNF-alpha, 46.4, 44, and 75 pg/ml, respectively (P = 0.029). There were no significant differences in levels of IL-1beta, IL-6, or IL-10 among the patient groups. A total of 23 patients died. At the time of admission, HIV-infected patients with BP had higher plasma CRP and IL-8 levels than did PCP and mycobacteriosis patients. TNF-alpha levels were higher in patients with mycobacteriosis. An elevated IL-8 level (>61 pg/ml) at the time of admission was an independent factor associated with higher mortality (odds ratio, 12; 95% confidence interval, 1.2 to 235.5).
Benito
Natividad
N
Service of Infectious Diseases, Institut Clínic de Infeccions i Inmunologia, Clinic Hospital-IDIBAPS, Villarroel 170, 08036 Barcelona, Spain. nbenito@clinic.ub.es
Moreno
Asunción
A
Filella
Xavier
X
Miró
José M
JM
González
Julià
J
Pumarola
Tomás
T
Valls
María Eugenia
ME
Luna
Montserrat
M
García
Felipe
F
Rañó
Ana
A
Torres
Antoni
A
Gatell
José M
JM
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D002373:Cyclic AMP Receptor Protein / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000378:metabolism; D007378:Interleukins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis; D018579:Patient Selection; D011014:Pneumonia / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D018410:Pneumonia, Bacterial / Q000097:blood / Q000150:complications / Q000175:diagnosis; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D019562:Viral Load
D002373:Cyclic AMP Receptor Protein; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha