Revenko H. The influence of HIV infection on the state of specific antitoxic immunity against diphtheria and tetanus in adults

The work is devoted to the study of socio-demographic and clinical-laboratory predictors that affect the intensity of diphtheria and tetanus immunity in HIV-infected adults, with further development of a plan for individual vaccination against these infectious diseases. Aim. Determination of influence of HIV-infection on the state of immunity against diphtheria and tetanus in adults with consideration of the factors which influence its formation for optimization of approaches of immunological prophylaxis. The study involved 169 people. Decreased levels of B-lymphocytes in HIV-infected adults have been reported: 0.16 (1.10-0.25) G/l against 0.43 (0.22-0.48) G/l in the control group (pU<0.001). There is an increase in the number of B-lymphocytes when taking ART (rs=0.26; p=0.012), especially with early appointment of ART (rs=0.21; p=0.048); as well as with the presence of an earlier stage of HIV infection (rs=0.21; p=0.048) and low viral load of HIV RNA (rs=0.36; p<0.001). Using the methods of correlation, ROC and logistic regression analysis, the predictor capabilities of 9 indicators were evaluated to predict the risk (probability) of immunological insecurity (II) against tetanus. These include: the female sex of an HIV-infected person (Se=68.1%; Sp=55.8%), the fact of smoking (Se=80.9%; Sp=62.8%), living in the city (Se=74.5%; Sp=58.1%), the presence of hairy leukoplakia of the tongue (Se=63.8%; Sp=81.4%) and recurrent ≥2 times a year VZV infection (Se=68.1%; Sp=95.3%), BMI ≤18.2 kg/m2 (Se=89.4%; Sp=76.7%), hemoglobin level in the blood ≤118 g/l (Se=76.6%; Sp=60.5%), platelet count ≤174 G/l (Se=91.5%; Sp=83.7%), the level of T-helpers (nadir) ≤106 cells/μl (Se=88.6%; Sp=52.9%). To determine the high risk of II against diphtheria in HIV-infected adults, a mathematical model based on the predictor role of 8 leading traits. These include: age of HIV-infected person ≥45 years (Se=25.0%; Sp=100%; p<0.001), the fact of smoking (Se=61.9%; Sp=83.3%; p=0.013), BMI ≤18.5 kg/m2 (Se=71.4%; Sp=100%; p<0.001), the presence of hairy leukoplakia of the tongue (Se=45.2%; Sp=100%; p<0.001) and oropharyngeal candidiasis (Se=39.3%; Sp=100%; p<0.001), hemoglobin level in the blood ≤120 g/l (Se=70.2%; Sp=83.3%; p=0.004), platelet count ≤200 G/l (Se=89.3%; Sp=83.3%; p<0.001), T-helper level (nadir) ≤126 cells/μl (Se=81.5%; Sp=100%; p<0.001). Mathematical models were built that allow to accurately assess the likelihood of immunological protection against diphtheria (Se=96.4%; Sp=83.3%; De=95.5%) and tetanus (Se=91.5%; Sp=86.1%; De=88.9%) in HIV patients using combinations of the above markers.