title: Immune Activation and Bacterial Translocation: A Link between Impaired Immune Recovery and Frequent Visceral Leishmaniasis Relapses in HIV-Infected Patients.
abstract: The maintenance of chronic immune activation due to leishmaniasis or even due to microbial translocation is associated with immunosenescence and may contribute to frequent relapses. Our aim was to investigate whether patients with HIV-associated visceral leishmaniasis (VL/HIV) who experience a single episode of VL have different immunological behaviors in comparison to those who experience frequent relapses. VL/HIV patients were allocated to non-relapsing (NR, n = 6) and relapsing (R, n = 11) groups and were followed from the active phase of VL up to 12 months post-treatment (mpt). The patients were receiving highly active antiretroviral therapy (HAART) and secondary prophylaxis after VL therapy. During active VL, the two groups were similar in all immunological parameters, including the parasite load. At 6 and 12 mpt, the NR group showed a significant gain of CD4+ T cells, a reduction of lymphocyte activation, and lower soluble CD14 and anti-Leishmania IgG3 levels compared to the R group. The viral load remained low, without correlation with the activation. The two groups showed elevated but similar percentages of senescent T cells. These findings suggest a decreased ability of the R group to downmodulate immune activation compared to the NR group. Such functional impairment of the effector response may be a useful indicator for predicting clinical prognosis and recommending starting or stopping secondary prophylaxis.
authors.affiliation: Laboratório Interdisciplinar de Pesquisas Médicas - Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Maria Luciana
authors.initials: ML
authors.lastname: Silva-Freitas
authors.affiliation: Laboratório de Pesquisas Clinicas e Políticas Públicas em Doenças Infecciosas e Parasitárias - Centro de Pesquisas René Rachou - FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil.|Hospital Eduardo de Menezes - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Glaucia Fernandes
authors.initials: GF
authors.lastname: Cota
authors.affiliation: Laboratório de Pesquisas Clinicas e Políticas Públicas em Doenças Infecciosas e Parasitárias - Centro de Pesquisas René Rachou - FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil.|Hospital Eduardo de Menezes - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Talia S
authors.initials: TS
authors.lastname: Machado-de-Assis
authors.affiliation: Laboratório de AIDS e Imunologia - Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Carmem
authors.initials: C
authors.lastname: Giacoia-Gripp
authors.affiliation: Laboratório de Pesquisas Clinicas e Políticas Públicas em Doenças Infecciosas e Parasitárias - Centro de Pesquisas René Rachou - FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ana
authors.initials: A
authors.lastname: Rabello
authors.affiliation: Laboratório Interdisciplinar de Pesquisas Médicas - Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Alda M
authors.initials: AM
authors.lastname: Da-Cruz
authors.affiliation: Laboratório Interdisciplinar de Pesquisas Médicas - Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil.|Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia - IFRJ, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Joanna R
authors.initials: JR
authors.lastname: Santos-Oliveira
mesh_terms: D000913:Antibodies, Protozoan / Q000276:immunology; D018988:Bacterial Translocation / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000276:immunology* / Q000821:virology; D006801:Humans; D007109:Immunity; D007074:Immunoglobulin G / Q000276:immunology; D000068884:Immunosenescence; D007898:Leishmaniasis, Visceral / Q000209:etiology* / Q000469:parasitology; D008213:Lymphocyte Activation / Q000276:immunology; D059208:Parasite Load; D012008:Recurrence; D016176:T-Lymphocyte Subsets / Q000276:immunology; D019562:Viral Load
chemical_list: D000913:Antibodies, Protozoan; D007074:Immunoglobulin G