Perm Medical JournalPerm Medical Journal0136-14492687-1408Eco-Vector1432410.17816/pmj36251-59Research ArticleMorphological characteristic of inguinal lymph nodes in HIV infectionGulyaevaN. I.bizon55@mail.ruFreindG. G.bizon55@mail.ruShmagelN. G.bizon55@mail.ruKorolevskayaL. B.bizon55@mail.ruSaidakovaE. V.bizon55@mail.ruShmagelK. V.bizon55@mail.ruE.A. Vagner Perm State Medical UniversityPerm Regional Center for Prevention and Fight against AIDS and Infectious DiseasesInstitute of Ecology and Genetics of Microorganisms of the Ural Branch of RAS2306201936251592306201923062019Copyright © 2019, Gulyaeva N.I., Freind G.G., Shmagel N.G., Korolevskaya L.B., Saidakova E.V., Shmagel K.V.2019<p><strong>Aim.</strong> To assess the morphological changes in inguinal lymph nodes among patients with stage 4a HIV infection, who receive antiretroviral therapy.</p>
<p><strong>Materials and methods.</strong> There were examined 12 HIV-infected patients with stage 4a, treated at Perm Regional Center for Prevention and Fight against AIDS and Infectious Diseases, who received antiretroviral therapy for 2 years. Two groups of patients were formed: group I 6 persons, whose CD<sup>+</sup> blood lymphocyte number was more than 350 in 1 mcl; group II 6 persons with CD<sup>+</sup> blood lymphocyte number less than 350 in 1 mcl. Inguinal lymph nodes (ILN) were taken under local anesthesia, histological preparations were prepared by traditional scheme, stained with hematoxylin and eosin using Masson three-colour staining. In immunohistochemical reactions expression of Ki-67 and CD<sup>+</sup> markers was estimated.</p>
<p><strong>Results.</strong>Histoarchitectonics of lymph nodes was changed as a result of massive development of sclerosis in the region of hilum, capsule and trabecules. Against the background of sclerosis, there occurred lymphocyte depletion, change in structure of stromal cells and neoangiogenesis in all the zones of the lymph node. In the regions of sclerosis, death of lymphocytes was revealed. In patients of the second group, more active development of follicles with the centers of reproduction in the lymph node cortical substance, as well as growth of the number of Ki-67 maker-expressing cells was established</p>
<p><strong>Conclusions.</strong>In the inguinal lymph nodes, the development of sclerotic processes causes the death of T-lymphocytes, which, in their turn, are the source of lymphotoxin- formation. Loss of CD<sup>+</sup>-T-lymphocytes is accompanied by deficit of lymphotoxin- and induces the loss of fibroblastic reticular cells themselves, which through the production of IL-7 support the vital activity of T-cells.</p>HIV infectionantiretroviral therapyinguinal lymph nodeslymph node sclerosisstromal cellsCD+lymphocytesВИЧ-инфекцияантиретровирусная терапияпаховые лимфатические узлысклероз лимфоузластромальные клеткиCD4+-лимфоциты[Должанский О.В., Каабах М.М., Соловьева С.Е. и др. Диссеминированный комбинированный мелкоклеточный рак с поражением трансплантатов после пересадки почек от умершего донора двум больным. Архив патологии 2017; 6: 53–59.][Зюзя Ю.Р., Бархина Т.Г., Пархоменко Ю.Г., Черников В.П. Гистологические и ультраструктурные изменения в легких при ВИЧ-инфекции в сочетании с туберкулезом. Архив патологии 2015; 1: 23–29.][Иммунология: учеб. Под ред. А.А. Ярилина. М.: ГОЭТАР-Медиа 2010; 752.][Козлов А.В. Гомеостатическая пролиферация как основа неизбежного формирования тотального иммунодефицита. Медицинская иммунология 2014; 5: 403–407.][Леенман Е.Е., Мухина М.С., Гиршович М.М. и др. Место дендритных клеток в микроокружении при лимфоме Ходжкина. Архив патологии 2010; 2: 3–7.][Морфологические аспекты ВИЧ-инфекции. Под ред. Ю.Г. Пархоменко, Ю.Р. Зюзя, А.И. Мазус. М.: Литтерра 2016; 168.][Раденска-Лоповок С.Г., Корзенёва Е.Г., Алекперов Р.Т. Ангиогенез и его связь с воспалением и фиброзом в ходе развития системной склеродермии. Архив патологии 2015; 2: 56–60.][Цинзерлинг В.А., Комарова Д.В., Васильева М.В. и др. Патологическая анатомия ВИЧ-инфекции по материалам Санкт-Петербурга. Архив патологии 2003; 1: 42–44.][Шмагель К.В., Королевская Л.Б., Черешнев В.А. Роль иммунных комплексов в активации иммунокомпетентных клеток при ВИЧ-инфекции (гипотеза). Иммунология 2014; 2: 117–120.][Шмагель К.В., Шмагель Н.Г., Королевская Л.Б. и др. Сравнение субпопуляционного состава T-лимфоцитов периферической крови и лимфатических узлов у ВИЧ-инфицированных пациентов. Российский иммунологический журнал 2016; 2 (1): 404–406.][Шмагель Н.Г., Шмагель К.В., Королевская Л.Б. и др. Системное воспаление и повреждение кишечного барьера при эффективном лечении ВИЧ-инфекции. Клиническая медицина 2016; 1: 47–51.][Черешнев В.А., Шмагель К.В., Королевская Л.Б и др. Влияние коинфекции вирусом гепатита на активацию и апоптоз Т-лимфоцитов у ВИЧ-инфицированных пациентов, получающих антиретровирусную терапию. Иммунология 2013; 4: 236–241.][Anthony K.B., Yoder C., Metcalf J.A. Incomplete CD4 T cell recovery in HIV-1 infection after 12 months of highly active antiretroviral therapy is associated with ongoing increased CD4 T cell activation and turnover. Immunology 2003; 2: 125–133.][Doitsh G., Galloway N.L.K., Geng X. Cell death by pyroptosis drives CD4 T-cell depletion in HIV-1 infection. Nature 2014; 7484: 509–514.][Durudas A., Milush J.M., Chen H.L. Elevated levels of innate immune modulators in lymph nodes and blood are associated with more-rapid disease progression in simian immunodeficiency virus-infected monkeys. J Virol 2009; 23: 12229–12240.][Fletcher A.L., Acton S.A., Knoblich K. Lymph node fibroblastic reticular cells in health and disease. Nature Reviews Immunology 22 May 2015. DOI: 10.1038/nri3846][Jacob D. E., Haaseb A.T., Schacker T.W. The role of collagen deposition in depleting CD4+ T cells and limiting reconstitution in HIV-1 and SIV infections through damage to the secondary lymphoid organ niche. Seminars in Immunology 2008; 20: 181–186.][Link A., Vogt T.K., Favre S. Fibroblastic reticular cells in lymph nodes regulate the homeostasis of naive T cells. Nat Immunol 2007; 11: 1255–1265.][Zeng M., Smith A.J., Wietgrefe S.W. Cumulative mechanisms of lymphoid tissue fibrosis and T cell depletion in HIV-1 and SIV infections. J Clin Invest 2011; 3: 998–1008.]