title: Esophageal mucosa in HIV infection: A"deeper" look at this little spoken organ.
abstract: OBJECTIVE
  Although the esophagus is a common site of opportunistic infection in AIDS patients, little is known about the impact of HIV as well as opportunistic infection in the esophageal mucosa. Our aim is to analyze the esophageal immune profile in HIV+ patients with different immunological status with and without the opportunistic Candida infection.
  
  
  METHODS
  Immunohistochemistry to CD4+and CD8+T-cells, γ-interferon, transforming growth factor-β, interleukin (IL)-4, IL-6, IL-13, and IL-17 was performed in esophageal samples of 40 chronically HIV+ patients under highly active antiretroviral therapy (16 with Candida esophagitis, 12 virologically non-supressed with blood CD4 count < 500, and 12 virologically suppressed with blood CD4 count > 500; the latter two groups without esophageal candidiasis). The controls were 12 HIV-negative healthy individuals.
  
  
  RESULTS
  Esophageal CD4+T-cell expression in HIV+ patients did not differ from the control group (P = 0.50). Mucosal CD8+T-cell expression was significantly increased in HIV+ patients (P = 0.0018). Candida esophagitis and virologically non-supressed HIV+ patients with CD4 < 500 showed an increased expression of IL-17 and IL-6 with fewer expressions of γ-interferon, more attenuated in the latter group. Transforming growth factor-β was increased only in virologically suppressed HIV+ patients with CD4 > 500. IL-4 and IL-13 were similar to the control group.
  
  
  CONCLUSIONS
  In contrast to CD8+T-cell expression, esophageal CD4+T-cell expression does not reflect the HIV+ patient's immunological status. T-helper 17 (Th17) response seems to play a role in the esophageal mucosa of virologically non-supressed HIV+ patients with blood CD4 < 500. Candida esophagitis showed a Th1/Th17 response but seems to be dominantly regulated by the Th17 pathway.
authors.affiliation: Casa da AIDS-Infectious Disease Division, University of São Paulo, São Paulo, Brazil.|Department of Gastroenterology, Clinical Division, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ana Luiza
authors.identifier: http://orcid.org/0000-0002-2505-8394
authors.initials: AL
authors.lastname: Werneck-Silva
authors.affiliation: Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, University of São Paulo, São Paulo, Brazil.
authors.forename: Carla
authors.identifier: http://orcid.org/0000-0002-7759-9598
authors.initials: C
authors.lastname: Pagliari
authors.affiliation: Disciplina de Patologia, University of São Paulo, São Paulo, Brazil.
authors.forename: Roseli A
authors.initials: RA
authors.lastname: Patzina
authors.affiliation: Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, University of São Paulo, São Paulo, Brazil.
authors.forename: Cleusa Fumica Hirata
authors.initials: CFH
authors.lastname: Takakura
authors.affiliation: Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Irma
authors.initials: MI
authors.lastname: Duarte
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D002177:Candidiasis / Q000150:complications* / Q000276:immunology; D000071041:Esophageal Mucosa / Q000276:immunology*; D004941:Esophagitis / Q000276:immunology / Q000382:microbiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D020381:Interleukin-17; D015850:Interleukin-6; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000276:immunology; D016212:Transforming Growth Factor beta
chemical_list: D020381:Interleukin-17; D015850:Interleukin-6; D016212:Transforming Growth Factor beta
keywords: HIV; candidiasis; esophagus; human; immunohistochemistry; mucosal immunity