Покращення показників імунітету у ВІЛ-інфікованих осіб з хронічною токсоплазмовою інвазією та недостатньою імунореконституцією на тлі антиретровірусної терапії за допомогою препарату рибонуклеїнової кислоти

Aim of the work. To study the possibility of additional correction of immunologic imbalance by ribonucleic acid medication in HIV-infected persons, infested by Toxoplasma gondii, who receive antiretroviral therapy and did not attain immunoreconstitution.Methods of research. 60 HIV-infected persons, seropositive as to Toxoplasma gondii infestation were examined. All patients received antiretroviral therapy (ART) during no less than 6 months, but the number of СD4+Т-lymphocytes in them did not exceed 350 kl/mcl of blood. The immune-enzyme method was used for determination of titres of specific anti-toxoplasmosis IgG and IgМ; general IgM, IgA, IgG, and also IL-2, IL-4, IL-10, INF-γ, TNF-2α. The number of CD4+ Т –lymphocytes was determined by cytofluorimetric method. The one group of 30 persons received ribonucleic acid medication in dose 1500 mg a day during 1-st month and during 2-d and 3-d month - 750 mg a day; other group of 30 patients did not receive medication. The statistical processing was carried out in Exсel, using Student t-criterion.Results. In HIV-infected persons with toxoplasmosis infestation comparing with healthy ones were revealed the increased levels of proinflammatory cytokines - TNF-α (2,47±0,11 pg/ml against 1,90±0,04 pg/ml, P<0,001), INF-γ (10,82±0,38 pg/ml against 4,13±0,12 pg/ml, P<0,001), and anti-inflammatory ones IL -4 (1,74±0,08 pg/ml against 0,81±0,09pg/ml, P<0,001) and IL-10 (11,64±0,31 pg/ml against  6,70±0,13 pg/ml, P<0,001). The persons, who received ribonucleic acid medication comparing with ones, who did not receive it, demonstrated the increase of IL-2 (2,83±0,11 pg/ml against 2,28±0,11 pg/ml, P<0,001) and INF-γ (11,29±0,25 pg/ml against 9,98±0,26pg/ml, P<0,001), instead of it TNF-α decreased (2,25±0,08 pg/ml against 2,50±0,09 pg/ml, P<0,05). After 3-d month of treatment IL-10 (7,73±0,22 pg/ml against 9,83±0,30 pg/ml, P<0,001), TNF-α (2,23±0,10 pg/ml against 2,53±0,09 pg/ml, P<0,05)levels decreased, and INF-γ increased (10,37±0,11 pg/ml against 9,86±0,20 pg/ml, P<0,05). In the group of patients, who did not receive medication the relapse of toxoplasmatic encephalitis appeared in two cases.Conclusion. It was established, that HIV-infected persons, with Toxoplasma gondii infestation, who took ART but with insufficient immunoreconstruction, demonstrated the increased levels of several proinflammatory (TNF-α, INF-γ) and anti-inflammatory (IL-4, IL-10) cytokines. After the treatment using ribonucleic acid medication the levels of СD4 + Т-lymphocytes, IL-2 and INF-γ increased and IL-10 decreased that eliminated the risk of toxoplasmatic encephalitis developmentВстановлено, що у ВІЛ-інфікованих осіб із токсоплазмовою інвазією були підвищеними рівні цитокінів: TNF-α, INF-γ, ІЛ-4, ІЛ-10. Після застосування препарату рибонуклеїнової кислоти впродовж 1місяця спостерігалося зростання рівнів ІЛ-2 та INF-γ, натомість, знижувався TNF-α. Після 3-го місяця лікування знизилися рівні ІЛ-10 та TNF-α, зросла кількість CD4+Т-лімфоцитів та усувався ризик токсоплазмозного енцефаліт