The influence of comorbid pathology on the course of HIV infection in children and the dynamics of of immunocompetent cells activation markers

The goal is to improve the prediction of HIV infection course in children and the dynamics of immunocompetent cells activation markers, taking into account comorbid pathology.

Research methods. We examined 91 children who were 1—4 months old at the time of HIV infection diagnosis (Me 3 months, ICI 1—4.5 months) there was a subclinical stage (41) or a stage of secondary diseases (50).

Results. In patients at the stage of secondary diseases, in addition to HIV-associated symptoms, opportunistic infections of bacterial, viral and fungal etiology developed. These children were more often diagnosed with comorbid pathology (100% and 85.4%; p = 0.0067). In this group, a higher HIV blood viral load, a low number of CD4+ lymphocytes and other significant disorders in the immune system were detected. These patients showed increased expression of the immunocompetent cell activation marker (HLA-DR), the apoptosis readiness receptor (CD95), as well as the number of cells at the stage of early (AnV+) and late apoptosis (AnV+/Pr+). When analyzing the frequency of various comorbid pathologies in a multivariate mathematical logistic regression model, it was found that an independent predictor of HIV infection rapid progression in children was the presence of active form of congenital infection (OR 4.8; 95% CI 1.1—24.7; p = 0,0233).

Conclusion. In 55% of children, rapid progression of HIV infection occurs. The reasons for the unfavorable course of the disease are active replication of HIV and the development of immune status profound disorders, including hyperactivation and apoptosis of immunocompetent cells. An independent predictor of disease rapid progression is the presence of an active form of congenital infection, and therefore early diagnosis and treatment are necessary. 

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