免疫缺陷/失调相关的淋巴细胞扩散,艾滋病毒感染者的EBV+
Johanna Cevallos1, Carmen Lome-Maldonado1, Leticia Quintanilla-Martínez2
1Department of Hematopathology, Instituto Nacional de Cancerología, Mexico City, Mexico.
概括
艾滋病毒感染者的免疫缺陷/失调相关的淋巴细胞增殖 (IDD-ALP) 往往被误诊. 艾滋病毒患者的爱斯坦-巴尔病毒阳性IDD-ALP,特别是卡波西肉瘤患者,在抗逆转录病毒疗法下显示出良好的预后.
科学领域:
- 血液学 血液学 血液学
- 传染性疾病 传染性疾病
- 在瘤学瘤学.
背景情况:
- 世界卫生组织血淋巴瘤分类第五版在艾滋病毒环境中引入了免疫缺陷/失调 (IDD) 相关的淋巴细胞扩散 (IDD-ALP).
- 关于艾滋病毒感染者 (PLWH) 的IDD-ALP信息很少,导致诊断不足和误诊.
研究的目的:
- 确定艾普斯坦-巴尔病毒阳性 (EBV+) IDD-ALP患者的临床表现,组织病理和患者结局,这些患者不是接受器官移植,而是接受抗逆转录病毒治疗 (ART) 的PLWH患者.
- 调查临床数据和诊断结果之间的相关性,包括EBV和LMP1基因状态.
主要方法:
- 在墨西哥学术医疗中心 (2016-2019) 对27名被诊断患有IDD-ALP的HIV阳性患者的回顾性分析.
- 诊断方法包括免疫组织化学,现场杂交和PCR用于EBV和LMP1基因删除.
- 临床数据,包括CD4+ T细胞计数,CD4+/CD8+比率,HIV病毒载量,以及诸如卡波西肉瘤之类的并发症,与本病理学发现相关.
主要成果:
- 该研究包括27名男性患者,主要是与男性发生性关系的男性,平均年龄为36岁. 严重免疫抑制状态 (中位数CD4+T细胞113/毫升,CD4+/CD8+比0.15,高艾滋病毒病毒载量) 被注意到.
- 最常见的诊断是EBV+ IDD-ALP激增血细胞类型 (74.07%),其中81.4%具有同步的卡波西肉瘤. 两名患者被诊断患有霍奇金淋巴瘤.
- 随访时间中位数为228周,有6例死亡 (22.2%) 与IDD-ALP无关.
结论:
- 阳性EBV的IDD-ALP主要发生在严重免疫抑制的HIV阳性患者中,通常与卡波西肉瘤同时发生.
- 仅用ART治疗的患者表现出良好的预后,这表明ART在治疗这些疾病中的有效性.
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