Dynamics Of T-cell Subsets And Their Relationship With Oral And Systemic Opportunistic Infections In HIV/AIDS Patients During The First Year Of Haart

Purpose: To analyze the dynamic changes in Th1, Th2, Tc1 and Tc2 of HIV/AIDS patients during the first year of HAART and to explore their relationship with oral and systemic opportunistic infections, a cohort study was carried out among HIV/AIDS patients in Guangxi, the second HIV-highprevalence area of China.Methods: Ninety HIV/AIDS patients and 30 healthy controls(HC) were included. The enrolled HIV/AIDS patients were examined at baseline and after 3,6and 12 months of HAART. On each visit, oral manifestations and systemic opportunistic infections were recorded, oral Candida loads were counted by oral rinse technique, plasma viral load(VL) measurements, differential T-cell counts and flow cytometric analysis of T-cell subsets were performed.Results: During the first year of HAART, the total number of opportunistic infections decreased steadily, with the change in oral candidiasis(OC) the most representative. Plasma viral load and oral Candida load decreased significantly during HAART. At 12 months, the plasma viral load of most patients dropped below the detectable limit(50copies/m L), oral Candida load showed no statistically significant difference with that of healthy controls. The number of CD4+ T cells increased continuously(baseline 221.1±116.3, 12 m 373.3±153.6) and CD8+ T cells decreased continuously(baseline 906.9±481.8, 12 m 799.4±392.1) after HAART.A significant Th1→Th2 switch(Th1/Th2 ratio 0.23±0.12, HC 1.45±0.38) were found at baseline, and received slow mitigation after HAART.Although Th1 percentages of HIV/AIDS patients increased and Th2 percentages decreased continuously, the Th1/Th2 switch phenomenon was still obvious at 12months(Th1/Th2 0.62±0.21). A slight Tc1→Tc2 shift(Tc1/Tc2 ratio 0.93±0.29, HC 1.13±0.33) were found at baseline, but Tc1/Tc2 ratio was always close to 1:1. Percentages of Tc1 and Tc2 were both higher than in healthy controls at baseline, and then showed a simultaneous descending trend after HAART. Lg CFU and clinical OC were correlated positively with both Lg VL and clinical stage(p < 0.05) at baseline. Lg CFU was also correlated positively with clinical stage at all four time points(p < 0.05). At baseline, lg VLwas also correlated negatively with Tc1 and Tc2(P < 0.001). In multiple factor analysis, Th1 was confirmed to be correlated negatively with Lg VL(Std.B =-0.295, p = 0.025) and Lg CFU(Std.B =-0.227, p < 0.001) at baseline. While after HAART, Lg CFU and clinical stage were only correlated negatively with CD4 when all factors were included.Conclusions: During the first year of HAART, oral candidiasis and oral Candida load exhibited a parallel relationship with systemic clinical stage, and oral candidiasis and oral Candida load could be useful clinical markers in the evaluation of HIV/AIDS patients. Th1 may play an important role against oral and systemic opportunistic infections.Tc1 and Tc2 both showed positive roles in the control of viremia without HAART.