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№3' 2021

INFECTIOUS DISEASES

International Medical Journal, Vol. 27., Iss. 3, 2021, P. 80−83.

DOI (https://doi.org/10.37436/2308-5274-2021-3-17)

PREDICTION OF DEVELOPMENT OF THE CENTRAL NERVOUS SYSTEM HIV-ASSOCIATED INFECTIOUS DISEASES ASSUMING VARIATIONS OF HLA-DRB1 ALLELES

Dnipro State Medical University, Ukraine

Most people living with HIV develop central nervous system diseases as immunosuppression progresses, often leading to disability and death. Studies show that HLA−DRB1 plays a role in the progression of HIV infection and development of opportunistic infections of the central nervous system. The most important components of the management of HIV−associated lesions of the nervous system are the analysis of risk factors for their development and timely adequate treatment. To develop an algorithm for predicting the development of HIV−associated infectious diseases of the central nervous system, a study was performed with the participation of 70 patients having stage 4 HIV infection. The algorithm was created on the basis of determining the prognostic value of variations of HLA DRB1 alleles, the duration of the period from HIV detection to the development of stage 4 and the initial level of CD4−T lymphocytes in blood plasma. A feature of HIV−associated diseases of the central nervous system was the presence in the patients of homozygous allelic variants DRB1 * 01 and DRB1 * 16. According to ROC−analysis, the best operational characteristics were: the initial level of CD4−T lymphocytes in blood plasma below 80 cells / μl; the duration of the period from the detection of HIV infection to the development of stage 4 HIV is less than 1 year. According to the logistic regression indices, the limit values of the total score ( s) were calculated to classify the degree of risk of neurological diseases (RND) associated with HIV infection: if es < 2, the risk is low (probability p ≤ 0.26); if +2 ≤ s ≤ +3 the risk is moderate k (p < 0,50); if +4 ≤ 5s ≤ +9 the risk is high (p 0,50−0,89); if 8s ≥ 10 the risk is very high (p ≥ 0.90). The developed algorithm makes it possible to predict a high risk of HIV−associated diseases of the central nervous system with a prognostic 78,6 % accuracy, 64,5 % sensitivity, and 89,7 % specificity.

Key words: HIV infection, HIV−associated infectious lesions of the central nervous system, prognosis, HLA DRB alleles, CD4−T lymphocytes.

REFERENCES

1. Osnovnі kharakteristiki і prognoz rozvitku epіdemії VІL−іnfektsії v Dnіpropetrovs'komu regіonі / L. R. Shostakovich−Korets'ka ta іn. // Medichnі perspektivi. 2020. T. 25, № 1. S. 166−174. doi: https://doi.org/10.26641/2307−0404.2020.1.200417

2. Bilgrami M., O'keefe P. Neurologic diseases in HIV−infected patients // In Handbook of clinical neurology. 2014. Vol. 121. P. 1321−1344. doi: https://doi.org/10.1016/B978−0−7020−4088−7.00090−0

3. Hogan C., Wilkins E. Neurological complications in HIV // Clinical Medicine. 2011. Vol. 11, № 6. P. 571−575. doi: https://doi.org/10.7861/clinmedicine.11−6−571

4. Farhadian S., Patel P., Spudich S. Neurological complications of HIV infection // Current infectious disease reports. 2017. Vol. 19, № 12. P. 50. doi: https://doi.org/10.1007/s11908−017−0606−5.

5. Impact of HLA‐DRB1 allele polymorphisms on control of HIV infection in a Peruvian MSM cohort / B. Oriol‐Tordera at al. // HLA. 2017. Vol. 90, № 4. P. 234−237. doi: https://doi.org/10.1111/tan.13085

6. MHC haplotypes affect the expression of opportunistic infections in HIV patients / P. Price et al. // Human immunology. 2001. Vol. 62, № 12. P. 157−164. doi: https://doi.org/10.1016/s0198−8859(00)00239−1

7. Do HLA class II genes protect against pulmonary tuberculosis? A systematic review and meta−analysis / A. Oliveira−Cortez et al. // Eur. J. of Clinical Microbiology & Infectious Diseases. 2011. Vol. 35, № 10. P. 1567−1580. doi: https://doi.org/10.1007/s10096−016−2713−x

8. HLA class II involvement in HIV−associated Toxoplasmic encephalitis development / A. H. de Sorrentino et al. // Clinical Immunology. 2005. Vol. 115, № 2. P. 133−137. doi: https://doi.org/10.1016/j.clim.2005.01.003

9. Litvin K. Yu., Shostakovich−Korets'ka L. R., Volіkova O. O. Prediktori rozvitku VІL−asotsіiovanikh nevrologіchnikh zakhvoryuvan' // Tuberkul'oz, legenevі khvorobi, VІL−іnfektsіya. 2019. T. 33, № 2. S. 19−25. doi: http://doi.org/10.30978/TB2018−2−19

10. Antomonov M. Yu. Matematicheskaya obrabotka i analiz mediko−biologicheskikh dannykh. 2−e izd. Kiev: MITs "Medinform", 2018. 579 s.