Immunologic Alterations during Antiretroviral Therapy : Patterns of Recovery and Reappearance of Opportunistic Infections.

María de la Paz Mireles-Vieyra, Martha López Aguilera, Sandra Delgado López y Raúl M. Cruz-Mireles. Clínicas Profin VIH A.C. Lago Enare No. 40 Col. Torreblanca, C.P. 11280 México (Mexico).

Background: It is well known in clinical practice the existence of at least two different patterns of appearance of opportunistic infections (OI) in HIV patients not under antiretroviral therapy. Once a patient  is under antiretroviral treatment his recovery from OI seems to follow very specific, geographical related, patterns of recovery. The aim of the present work was to explore the existence of patterns of recovery and reappearance of OI in HIV patients from different regions and with different social, economical, health and cultural backgrounds. Material and Methods: A retrospective, longitudinal, analytic study was carried out in Mexico, between 1992 and 2002, on 1500 HIV/AIDS patients. Information was obtained from files and clinical  evaluations. Files included all relevant clinical markers as well as medical and psychological information that approached socioeconomic, sexual and cultural patient’s characteristics (psychological files also included different variables related to affective life as well as relevant data on family relationships). Results: We found a clear, statistically significant correlation, between the type and moment of attack of different opportunistic infections and the levels of different lymphocytes subpopulations as well as psychological patient’s status. The type and magnitude of OI attacks is clearly dependent of a subset of clinical and/or psychological markers. Conclusion: The successful treatment of any HIV patient most include a proper evaluation of a subset of clinical and psychological, geographically determined, markers. Although epidemiological data are essential to this goal, other immunologic and psychological data are relevant.