Effect Of Nutritional Intervention On Immune Function And Intestinal Barrier Of AIDS Patients With Immunological Non-response

Objective(s):Acquired immunodeficiency syndrome(AIDS)has been a major infectious disease threatening human health.With the emergence of antiretroviral therapy(ART),the immune function of AIDS patients has been restored,and the mortality rate has decreased.However,even if HIV is continuously suppressed,the immune function of some AIDS patients can not be recovered,resulting in immunological non-response,resulting in continuous immune activation and chronic inflammation.The survey found that immunological non-response was closely related to nutritional status in AIDS patients,and low CD4+T cell count was significantly positively correlated with malnutrition.There is a vicious circle between HIV infection and malnutrition,which seriously damages the immune system.Therefore,nutritional intervention should be an essential treatment for AIDS patients.Previous studies have shown that AIDS patients can benefit from nutritional intervention,but lack special nutritional agents for AIDS patients.This study explored the effects of special nutritional preparation for AIDS patients on nutritional status,immune function,inflammatory cytokines and intestinal barrier of AIDS patients with immunological non-response after ART.The recovery of energy provides a new therapeutic basis and theory.Methods:A total of 66 AIDS patients who met the inclusion criteria were recruited in the second people’s Hospital of Dali city.They were given nutrition intervention for 3 months from July 2019 to November 2019 with pre-digested nutritional preparation.Fasting venous blood samples were collected before and 3 months after the nutritional intervention.Blood routine,blood biochemistry,CD4,CD8 and CD4/CD8 ratio were detected in the laboratory of Dali Second People’s hospital.The human body composition before and after 3 months of the intervention was measured InBody S10.The inflammatory cytokines(including TNF-α,TNF-β,IP-10,IL-la,MCP-1,IL-6,CD14,D-dimer,CRP)were detected by the MILLIPLEX analysis system.The serum IL-1β level was detected by the ELISA method.The activities of DAO,D-LA and LPS in blood were quantitatively detected by "JY-DLT intestinal barrier function biochemical index analysis system" and "diamine oxidase/lactic acid/bacterial endotoxin test kit(enzyme method)".Results:After 3 months nutritional interyention,the weight(W)(t=-3.491,P=0.001),body mass index(BMI)(z=-3.162,P=0.002),albumin(ALB)(t=-2.269,P=0.031),hemoglobin(Hb)(t=-5.202,P=0.000)were significantly increased(P<0.05).Compared with before nutrition intervention,the levels of CD4+T(z=-4.093,P=0.000),CD8+T(z=-3.780,P=0.001),WBC(t=-2.538,P=0.016)and neutrophils(t=-2.322,P=0.026)in AIDS patients were significantly increased after nutritional intervention(P<0.05).Among the cytokines,serum TNF-p(z=-2.694,P=0.007)level was significantly higher than that before nutrition intervention(P<0.05),only IL-1β(t=11.413,P=0.000)was significantly decreased(P<0.05).In addition,after nutritional intervention,serum DAO(t=5.906,P=0.000),D-LA(t=9.972,P=0.000)and LPS(t=12.562,P=0.000)levels in AIDS patients with immune reconstruction dysfunction were significantly decreased(P<0.05).we found that the recovery of CD4+T cells was negatively correlated with blood DAO(P=0.004,r=-0.343)and D-LA(P=0.037,r=-0.250)(P<0.05).IL-1β was positively correlated with DAO(P=0.000,r=0.445),D-LA(P=0.000,r=0.523)and LPS(P=0.000,r=0.622)through correlation analysis.Conclusion(s):1.Pre-digested nutritional preparation can effectively increase the weight,BMI,ALB and Hb of patients,significantly improve the nutritional status of HIV/AIDS patients with immunological non-response,and help to correct malnutrition.2.Pre-digested nutritional preparations can increase the number of WBC,CD4+T and neutrophils in the blood of HIV/AIDS patients with immunological non-response,which is helpful to the recovery of immune function.3.Pre-digestive nutrition can reduce the level of IL-1β in patients with immunological non-response,which is beneficial to reduce the inflammatory reaction to a certain extent.4.The levels of serum intestinal injury markers DAO,D-LA and LPS in HIV/AIDS patients with immunological non-response were significantly decreased by pre-digested nutrients,suggesting that pre-digested nutrients are beneficial to repair the damaged intestinal barrier.5.The increase of CD4+T cells was significantly correlated with the decrease of serum DAOand D-LA levels,and the decrease of IL-1β was significantly correlated with the decrease of DAO,D-LA and LPS levels,suggesting that the repair of intestinal barrier is conducive to the recovery of CD4+T cells and the decrease of IL-1β levels.