Avaliação imunológica em 60 crianças com AIDS

Abstract

Objective

To study immunologic abnormalities in 60 children with AIDS, in Florianópolis, Santa Catarina, Brazil, as immunologic defects in children with HIV infection are important indicators for diagnosis and therapeutic response. Methods: Serum immunoglobulin levels were determined by nephelometry and compared with the normal pattern for Brazilian children. Lymphocyte T helper (CD4+) and lymphocyte T suppressor (CD8+) count and percentage, and the ratio between them, determined by flow cytometry, were compared with the pattern for healthy children of HIV-positive mothers. Results: The mean serum IgG levels were higher in children with AIDS (P<0.005). The mean serum IgM levels were higher in children with AIDS in the age group 13 to 108 months old (P <0.005). The CD4+ lymphocyte count was below the lower limit of the 95% confidence interval of the median reference values for each age group in 50 (84.7%) of the 59 determinations. The CD4+ lymphocyte percentage was much lower than the reference percentages. The graph curve of the medians of the ratio between lymphocytes CD4+ and CD8+ for each age group was below the fifth percentile of the graph curve of the reference medians. Conclusions: The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection. We recommend the immunologic evaluation of the HIV-positive children, even those younger than 18 months.

Methods

Serum immunoglobulin levels were determined by nephelometry and compared with the normal pattern for Brazilian children. Lymphocyte T helper (CD4+) and lymphocyte T suppressor (CD8+) count and percentage, and the ratio between them, determined by flow cytometry, were compared with the pattern for healthy children of HIV-positive mothers. Results: The mean serum IgG levels were higher in children with AIDS (P<0.005). The mean serum IgM levels were higher in children with AIDS in the age group 13 to 108 months old (P <0.005). The CD4+ lymphocyte count was below the lower limit of the 95% confidence interval of the median reference values for each age group in 50 (84.7%) of the 59 determinations. The CD4+ lymphocyte percentage was much lower than the reference percentages. The graph curve of the medians of the ratio between lymphocytes CD4+ and CD8+ for each age group was below the fifth percentile of the graph curve of the reference medians. Conclusions: The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection. We recommend the immunologic evaluation of the HIV-positive children, even those younger than 18 months.

Results

The mean serum IgG levels were higher in children with AIDS (P<0.005). The mean serum IgM levels were higher in children with AIDS in the age group 13 to 108 months old (P <0.005). The CD4+ lymphocyte count was below the lower limit of the 95% confidence interval of the median reference values for each age group in 50 (84.7%) of the 59 determinations. The CD4+ lymphocyte percentage was much lower than the reference percentages. The graph curve of the medians of the ratio between lymphocytes CD4+ and CD8+ for each age group was below the fifth percentile of the graph curve of the reference medians. Conclusions: The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection. We recommend the immunologic evaluation of the HIV-positive children, even those younger than 18 months.

Conclusions

The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection. We recommend the immunologic evaluation of the HIV-positive children, even those younger than 18 months.

Resumen

Objetivo

As alterações imunológicos que ocorrem na criança infectada pelo HIV constituem importantes provas para o diagnóstico e a resposta terapêutica. Objetivou-se verificar o comprometimento imunológico em 60 crianças com AIDS em Florianópolis, Estado de Santa Catarina.

Métodos

Realizou-se dosagem de imunoglobulinas séricas pela técnica de nefelometria, comparando-se com um padrão normal para crianças brasileiras. A contagem e porcentagem de linfócitos T auxiliares, supressores, e a relação auxiliares/supressores, realizada por meio de citometria de fluxo, foram comparadas com um padrão para crianças não infectadas, geradas por mães portadoras do vírus.

Resultados

A média das dosagens de IgG foi mais elevada nas crianças com AIDS (p<0,005). A média das dosagens de IgM foi mais elevada nas faixas etárias entre 13 e 108 meses (p<0,005). A contagem de linfócitos CD4+ foi inferior ao valor mínimo do intervalo de confiança de 95% dos valores medianos de referência para cada faixa etária em 50 (84,7%) das 59 determinações. Os valores relativos de linfócitos CD4+ foram bem inferiores às porcentagens de referência. A curva das medianas dos valores da relação CD4+/CD8+ para cada faixa etária situou-se abaixo do percentil 5 das medianas dos valores de referência.

Conclusões

A hipergamaglobulinemia e a contagem e porcentagem de linfócitos CD4+ constituem-se em indicadores sensíveis de infecção pelo HIV, observado também na presente casuística. Recomenda-se a avaliação imunológica nas crianças soro-positivas para o HIV, inclusive abaixo de 18 meses de idade.