In a prospective comparative observational study to determine the characteristics of the course of HIV infection combined а chronic reactivated EBV infection 110 HIV patients were recruited, of these 57 patients who had clinical and laboratory confirmation of the presence of co-infection with the Epstein-Barr virus (main group) and 53 HIV-infected without co-infection EBV infections (comparison group). The research stages included the study of epidemiological, demographic and clinical and laboratory characteristics of EBV infection in patients with HIV; determination of options for clinical and laboratory presentation of EBV -associated lymphomas and risk factors for their development; analysis of the nature of relationships between clinical patterns, immunological and virological parameters in patients with co-infection with EBV and HIV, taking into account ART; assessment of the effect of ART on virological and immunological parameters in patients with EBV and HIV co-infection; identification of the most informative predictors of unfavorable course of the disease and development of algorithms for early detection of a chronic reactivated EBV infection, and predicting the development of EBV-associated lymphomas in patients with HIV and EBV co-infection.
The main group included 57 HIV-infected patients with EBV co-infection, including 29 men (50,9%) and 28 (49,1%) women aged from 26 to 57 years (mean age 38,4±1,0 years). Eight patients (14,0%) had clinical stages I-II, 35 patients (61,4%) had clinical stage III and 14 patients (24,6%) had clinical stage IV. The average length of stay of patients registered for HIV infection in this group was 3,9±0,4 years; the predominant route of HIV infection is parenteral (32 patients – 56,1%). The main group were divided into 2 subgroups. The first subgroup (subgroup 1A) included 38 patients who were receiving antiretroviral therapy at the time of the study. Antiretroviral therapy was prescribed according to the recommendations of the clinical protocol for the treatment of HIV infection in adults and adolescents, approved by the order of the Ministry of Health of Ukraine from 12.07.2010 № 551. The second subgroup (1B) included HIV-infected patients with EBV co-infection who were not receiving ART at the time of the study, but who were planning to prescribe antiretroviral drugs in the near future. The comparison group was formed of 53 patients with HIV infection without clinical and laboratory signs of the presence of replicative forms of EBV infection. Men accounted for 64,2% (34 patients), women – 35,8% (19 patients), the average age is 37,8 ± 0,8 years. Eight patients (15,1%) had clinical stage I-II, 28 patients (52,8%) had clinical stage III, and 17 patients (32,1%) had stage IV disease. The predominant route of HIV infection was also parenteral ̶ 36 (67,9%). 36 (67,9%) patients received ART. Both groups of HIV-infected patients were statistically compared by age (p =0,653), sex (p=0,160), length of stay under surveillance for HIV infection (p =0,435), routes of infection (p =0,204), number of patients, who received ART (p =0,888), and the distribution by clinical stages of HIV infection (p =0,820). It was found that Epstein-Barr virus infection in HIV patients is characterized by: a significant number of cases among young people under the age of 40 (61,4%), the dominance of the parenteral route of HIV infection (56,1%), a high percentage of patients with stage ІІІ and ІV HIV-associated diseases (86,0%), increasing the probability of detecting a high viral load of EBV DNA in the serum at high titers of specific total antibodies to VCA Ig G EBV (p <0,001), established links between the detection of high concentrations of Epstein-Barr virus DNA in the blood and the development of non-Hodgkin's lymphoma (p =0,002). On the basis of the developed multifactorial mathematical models, algorithms were created for detecting chronic reactivated EBV infection in HIV-infected patients with a diagnostic efficiency of 66,4-70,9% and predicting a high risk of developing lymphomas in patients with EBV and HIV co-infection according to a total score of 7 indicators with a predictive accuracy of 91,0%.
