Association Between Plasma Antibody Responses and Risk for Cryptococcus-Associated Immune Reconstitution Inflammatory Syndrome

作者：Yoon, Hyun Ah; Nakouzi, Antonio; Chang, Christina C.; Kuniholm, Mark H.; Carreno, Leandro J.; Wang, Tao; Ndung'u, Thumbi; Lewin, Sharon R.; French, Martyn A.; Pirofski, Liise-anne^*

来源：Journal of Infectious Diseases, 2019, 219(3): 420-428.

DOI：10.1093/infdis/jiy447

• HIV
• cryptococcal meningitis
• Cryptococcus-associated immune reconstitution inflammatory syndrome
• IgM
• IgG
• memory B cells
• laminarin
• GXM

Background. Initiation of antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected individuals with cryptococcal meningitis places them at risk for Cryptococcus-associated immune reconstitution inflammatory syndrome (C-IRIS). The relationship between antibody immunity and C-IRIS risk has not been investigated.
We compared plasma levels of immunoglobulins, C. neoformans glucuronoxylomannan (GXM) capsule-specific and laminarin (Lam)-binding IgM and IgG, and percentages of peripheral blood total and memory B cells between 27 HIV-infected patients with CM who developed C-IRIS and 63 who did not, and evaluated associations of these parameters with risk of C-IRIS.
Prior to initiation of ART, plasma IgM, Lam-binding IgM (Lam-IgM), Lam-IgG, and GXM-IgM levels were significantly lower in patients who developed C-IRIS than those who did not. Multivariate analysis revealed significant inverse associations between C-IRIS and IgM (P = .0003), Lam-IgM (P = .0005), Lam-IgG (P = .002), and GXM-IgM (P = .002) independent of age, sex, HIV viral load, CD4(+) T-cell count, and cerebrospinal fluid fungal burden. There were no associations between C-IRIS and total or memory B cells.
Antibody profiles that include plasma IgM, Lam-IgM, Lam-IgG, and/or GXM-IgM may have value in furthering our understanding of C-IRIS pathogenesis and hold promise as candidate biomarkers of C-IRIS risk.Plasma IgM, glucuronoxylomannan-IgM, and -glucan-binding IgM at the time of ART initiation were lower in HIV-infected individuals with cryptococcal meningitis who go on to develop C-IRIS than those who did not and inversely associated with development of C-IRIS.

• 出版日期2019-2-1
• 单位MIT