Воспалительный синдром восстановления иммунитета и лимфома Ходжкина

ОБЗОРЫ ,

А.В. Пивник1, А.М. Вукович2, А.А. Петренко3,4

1 СМ-клиника, Волгоградский пр-т, д. 42, корп. 12, Москва, Российская Федерация, 109548

2 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России, ул. Трубецкая, д. 8, стр. 2, Москва, Российская Федерация, 119991

3 ГБУЗ «Городская клиническая больница им. С.П. Боткина» ДЗМ, 2-й Боткинский пр-д, д. 5, Москва, Российская Федерация, 125284

4 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, ул. Баррикадная, д. 2/1, Москва, Российская Федерация, 125993

Для переписки: Александр Васильевич Пивник, д-р мед. наук, профессор, Волгоградский пр-т, д. 42, корп. 12, Москва, Российская Федерация, 109548; тел.: +7(906)065-99-32; e-mail: pivnikav@gmail.com

Для цитирования: Пивник А.В., Вукович А.М., Петренко А.А. Воспалительный синдром восстановления иммунитета и лимфома Ходжкина. Клиническая онкогематология. 2021;14(3):378–85.

DOI: 10.21320/2500-2139-2021-14-3-378-385

РЕФЕРАТ

Воспалительный синдром восстановления иммунитета (ВСВИ) определяется как клинически значимое обострение известных малосимптомных серьезных, чаще инфекционных, заболеваний в условиях значительного повышения уровня Т-лимфоцитов CD4+ в ответ на высокоактивную антиретровирусную терапию (ВААРТ) ВИЧ-инфекции. В обзоре подробно обсуждается проблема туберкулеза у ВИЧ-инфицированных пациентов, получающих ВААРТ. В рекомендациях на эту тему имеются строгие указания на обязательное первоначальное лечение туберкулеза и только затем назначение ВААРТ. Такие же рекомендации по этиотропной терапии, предшествующей ВААРТ, предусмотрены при других оппортунистических инфекциях (грибковых, криптококковой, паразитозах, контагиозном моллюске, токсоплазмозе, вирусе опоясывающего лишая, лейшманиозе, сифилисе, лепре). Без предшествующей этиотропной терапии оппортунистической инфекции ее обострение с выраженной клинической картиной в период проведения ВААРТ может иметь фатальные последствия для пациента. Лимфомы, включая лимфому Ходжкина (ЛХ), рассматриваются в рамках именно этой проблемы. Однако остаются открытыми вопросы специфичности направленного действия Т-лимфоцитов микроокружения к не выясненным до настоящего времени причинным антигенам опухоли. В отличие от других злокачественных лимфоидных опухолей, которые возникают при низком содержании Т-лимфоцитов CD4+, ЛХ развивается при повышенном уровне Т-лимфоцитов CD4+ в ответ на ВААРТ у ВИЧ-инфицированных пациентов в первые месяцы от начала антиретровирусного лечения. ЛХ диагностируется у 8 % ВИЧ-инфицированных лиц без ВААРТ. После назначения ВААРТ частота ЛХ возрастает до 17 %. Эти данные позволяют рассматривать ВСВИ в качестве основной проблемы при изучении этиологии и патогенеза ЛХ у ВИЧ-инфицированных пациентов. В такой ситуации необходимость продолжения исследований в этом направлении становится не только очевидной, но и практически востребованной.

Ключевые слова: воспалительный синдром восстановления иммунитета (ВСВИ), высокоактивная антиретровирусная терапия (ВААРТ), лимфома Ходжкина.

Получено: 19 января 2021 г.

Принято в печать: 22 апреля 2021 г.

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