Novel approaches to etiological diagnosis of central nervous system lesions in patients with HIV
- 作者: Shakhgildyan V.I.1, Yadrikhinskaya M.S.2, Domonova E.A.3, Orlovsky A.A.4, Tishkevich O.A.5, Yarovaya E.B.4
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隶属关系:
- МоCentral Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
- Moscow City Center for AIDS Prevention and Control
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
- M.V. Lomonosov Moscow State University
- Clinical Infectious Diseases Hospital Two
- 期: 卷 13, 编号 1 (2023)
- 页面: 46-54
- 栏目: Original Investigations
- URL: https://journals.eco-vector.com/2226-6976/article/view/321915
- DOI: https://doi.org/10.18565/epidem.2023.13.1.46–54
- ID: 321915
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Objective. To identify the spectrum of central nervous system (CNS) lesions, by determining the detection rate and quantitative characteristics of the DNA of the causative agents of neuroinfections and RNA of the human immunodeficiency virus (HIV) in the cerebrospinal fluid (CSF) of inpatients with HIV infection.
Subjects and methods. Clinical observations were conducted in 5485 inpatients with HIV infection and their case histories were analyzed. Of these, 3333 patients had Stage 4B AIDS; 1310 patients had CNS lesions. The patients underwent contrast-enhanced brain MRI and diagnostic lumbar puncture. A total of 1667 CSF samples were studied using real time RT-PCR with the qualitative or quantitative determination of secondary disease pathogen DNA and HIV RNA. The reagent kits made by the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, were used. The authors applied Statistica version 10.0 and SPSS version 20 statistical software packages, R was a programming language. Associations were examined by making a contingency table analysis using Pearson’s χ2 test. The significance level for the tested statistical hypotheses was taken equal to 0.05.
Results. The paper presents the quantitative measures of blood and CSF HIV RNA. Statistically significant associations were found between the blood and CSF HIV RNA levels. CNS lesions as encephalitis, meningoencephalitis, or meningitis were diagnosed in 1310 patients with HIV infection (23.8% of the total number of inpatients, 39.3% of those having Stage 4B AIDS, and 62.7% among the deceased). Among the patients with CNS lesions, there was a significant proportion (53.7%) of cases having encephalitis of unclear etiology. The presence of CSF neuroinfection pathogen DNA and HIV RNA were shown to have a high diagnostic sensitivity and the etiological role of the pathogen could be excluded in the absence of CSF. The qualitative detection of the DNAs of T. gondii, M. tuberculosis, C. neoformans, and human polyomavirus 2 (JCPyV) was shown to have a high diagnostic specificity. On the contrary, the fact of detecting the DNAs of cytomegalovirus, Epstein-Barr virus, human herpes virus type 6 (HHV-6 A/B type), fungi of the genus Candida, and HIV RNA was insufficient to confirm the etiological role of these pathogens in brain lesions. A wide CSF concentration range of these pathogens was established.in HIV-infected patients.
Conclusion. The absence of neuroinfection pathogen DNA and HIV RNA in the CSF excludes the corresponding etiology of brain damage. Detection of CSF T. gondii, M. tuberculosis, C. neoformans, or JCPyV DNAs confirms the nature of encephalitis. Quantitative determination should be used when examining CSF for EBV, CMV, HHV-6A/B, and Candida fungi DNAs and HIV RNA,
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作者简介
Vasily Shakhgildyan
МоCentral Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
编辑信件的主要联系方式.
Email: vishakh@yandex.ru
ORCID iD: 0000-0002-8686-0487
Cand. Med. Sci., Senior Researcher
俄罗斯联邦, MoscowMarina Yadrikhinskaya
Moscow City Center for AIDS Prevention and Control
Email: rusalo4ka_88@mail.ru
ORCID iD: 0000-0002-9649-8522
Resident
俄罗斯联邦, MoscowElvira Domonova
Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
Email: elvira.domonova@pcr.ms
ORCID iD: 0000-0001-8262-3938
Cand. Biol. Sci. Head, Scientific Group for Development of New Methods for Diagnosing Opportunistic and Papillomavirus Infections, Department for Molecular Diagnosis and Epidemiology
俄罗斯联邦, MoscowAleksey Orlovsky
M.V. Lomonosov Moscow State University
Email: leha-orl@yandex.by
ORCID iD: 0000-0002-0794-4683
Laboratory Researcher, Laboratory for Monitoring Programs for Reduction of Mortality from Cardiovascular Diseases, National Medical Research Center of Cardiology, Ministry of Health of Russia
俄罗斯联邦, MoscowOleg Tishkevich
Clinical Infectious Diseases Hospital Two
Email: tishol@mail.ru
ORCID iD: 0000-0002-0789-7709
Pathologist, Clinical Infectious Diseases Hospital Two, Moscow City Healthcare Department
俄罗斯联邦, MoscowElena Yarovaya
M.V. Lomonosov Moscow State University
Email: yarovaya@mech.math.msu.su
Pathologist, Clinical Infectious Diseases Hospital Two, Moscow City Healthcare Department
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