TCM Constitution Features Of AIDS Patients And Its Influence On The Immune Reconstitution After HAART

AIDS(Acquired immunodeficiency syndrome) is caused by human immunodeficiencyvirus (HIV). It is a chronic infectious disease which gradually damages immune system andultimately leads to opportunistic infections and malignant tumors. After HIV infection,immune abnormalities perform mainly as CD4~+T lymphocytes decreasing, functionimpairment and aberrant immune activation. HIV infection itself and the abnormal immunestatus will prompt the development of the disease.HAART(Highly active antiretroviral therapy) is the most effective way to control andtreat AIDS. It can suppress HIV-1replication and prompt immune reconstitution. Immunereconstitution refers to:1.The number of CD4~+T cells,na ve cells and memory cells increaseand reach the normal levels;2.Response of CD4~+T cells to antigen return to normal with Th2cytokines is converted to Th1cytokines;3.Aberrant immune activation of patients return tonormal with CD27and other indexs of excessive activation of T cells decrease.During theperiod of HAART treatment, some patients can not achieve good and obvious therapeuticeffect owing to virus resistance of drugs, adverse drug reactions, individual compliance andso on,which is the difficult problem of AIDS treatment.Clinical practice shows that Chinese medicine plays a unique advantage in treatment ofAIDS, mainly lies in enhancing immune function, improving clinical symptoms, signs andthe survival quality, reducing the incidence of opportunistic infection.TCM recongnizs thatbiased constitution is the the internal cause of disease,which determines the individualsusceptibility to different pathogeny and the tendency to pathological changes, and affect clinical treatment effect.Correcting or improving biased constitution can preventdiseases,delay the onset of diseases and improve the condition. Therefore, this study willanalyze TCM constitution of HIV/AIDS patients and explore the correlation between theTCM constitution and immune reconstitution after HAART, which provides a theoreticalbasis for Chinese medicine treatment of AIDS.Study purpose:1. To analyze TCM constitution of HIV/AIDS patients.2. To explore the correlation between the constitution of TCM and immune reconstitutionof HIV/AIDS patients after HAART.Study contents and results:Study one TCM constitution of HIV/AIDS patientsAnalysis TCM constitution of188HIV/AIDS patients as compared with55chronichepatitis B patients during the same period by means of "TCM constitution scale" of BeijingUniversity of Chinese Medicine.Biased constitution patients are significantly more than gentleness constitution patientsin the HIV/AIDS group(30patients are gentleness constitution and158patients are biasedconstitution), which compared with hepatitis group(31patients are gentleness constitutionand24patients are biased constitution), the difference was significant(χ~2=36.95,P<0.05).Among158biased constitution patients in HIV/AIDS group, Qi deficiency constitutionaccounted for the largest proportion (P<0.05)114cases,about72.15%.Study two Correlation between the constitution of TCM and immune reconstitution ofHIV/AIDS patients after HAART.Analysis TCM constitution of50HIV/AIDS patients who will receive HAART and thendetect viral load, the number of CD4~+T cells, the proportion of theCD4~+CD45RA~+/CD4~+CD45RO~+, and the concentration of Th1/Th2cytokine and CD27before HAART and24weeks and48weeks after HAART. Explore the correlation betweenthe constitution of TCM and immune reconstitution of HIV/AIDS patients after HAART.1. Constitue of TCM constitution Among50HIV/AIDS patients,21patients are gentleness constitution and29patientsare biased constitution.2. Virological response48weeks After HAART treatment, gentleness constitution group and biased constitutiongroup viral load both became negative.3. Immune reconstitution3.1The number of CD4~+TThe number of CD4~+T cells of gentleness constitution group and biased constitutiongroup increased gradually and were significantly higher than before but were significantlylower than healthy control group after48weeks’s treatment (P<0.05).After48weeks’streatment, there were no significant difference between the increase extent of CD4~+T cells ofgentleness constitution group and of healthy control group(P>0.05).3.2CD4~+CD45RA~+、CD4~+CD45RO~+Before treatment,the proportion of CD4~+CD45RA~+of gentleness constitution group andbiased constitution group were significantly lower than healthy control group(P<0.05) andCD4~+CD45RO~+were significantly higher than healthy control group(P<0.05). After48weeks’s treatment,there were no statistical and significant difference as compared withhealthy control group (P>0.05).3.3Th1(IL-2、IFN-γ、TNF)/Th2(IL-4、IL-6、IL-10)Before treatment,the concentration of IL-2、IFN and TNF of gentleness constitutiongroup and biased constitution group were significantly lower than healthy controlgroup(P<0.05).After48weeks’s treatment, the concentration of IL-2、IFN and TNF increasedgradually.The concentration of IFN and TNF of gentleness constitution group reached thelevels of healthy control group(P>0.05),IL-2not(P<0.05).The concentration of IL-2、IFN andTNF of biased constitution group didn’t reach the levels of healthy control(P<0.05). Duringthe period of treatment,drop extent of concentration of IL-2of gentleness constitution groupwas significant higher than biased constitution(P<0.05).Before treatment, the concentration of IL-4、IL-6、IL-10of gentleness constitution groupand biased constitution group were higher than healthy control group. There were no significant difference(P>0.05) between the concentrations of IL-4、IL-6in biased constitutiongroup and in healthy control group.After48weeks’ s treatment, the concentrations of IL-4、IL-6、IL-10of gentleness constitution group and IL-10of biased constitution group decreased,the concentrations of IL-4、IL-6of biased constitution group increased.There were nosignificant difference(P>0.05) between the concentrations of IL-4、IL-6of gentlenessconstitution group and of healthy control group and between the concentrations of IL-6ofbiased constitution group and of healthy control group.After48weeks’s treatment, theconcentration of IL-10of gentleness constitution group and IL-4、IL-10of biased constitutiongroup didn’t reach the levels of healthy control group(P<0.05).During the period oftreatment,drop extent of concentration of IL-4of gentleness constitution group wassignificant higher than biased constitution(P<0.05).3.4CD27Before treatment, the concentration of CD27of gentleness constitution group and biasedconstitution group were significantly higher than healthy control group(P<0.05). After48weeks’s treatment, the CD27decreased significantly compared with beforetreatment(P<0.05),but didn’t reach the lever of healthy control group. After48weeks’streatment, the drop extent of CD27of gentleness constitution group was significant higherthan biased constitution group(P<0.05).Conclusions:1. Qi deficiency constitution is the most common TCM constitution of HIV/AIDS patients.Most of HIV/AIDS patients are biased constitution, which is a feature of HIV/AIDSpatients.2. After HAART, gentleness constitution group and biased constitution group respectivelyachieve partial immune reconstitution,but gentleness constitution group are superior tobiased constitution group in the proportion balance of naive and memory cells,theconversion of Th2to Th1cytokines and aberrant immune activation drop. That is tosay,gentleness constitution group can achieve better immune reconstitution.