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Effects of clinical and environmental factors on bronchoalveolar antibody responses to Pneumocystis jirovecii: A prospective cohort study of HIV+ patients
Journal article   Open access   Peer reviewed

Effects of clinical and environmental factors on bronchoalveolar antibody responses to Pneumocystis jirovecii: A prospective cohort study of HIV+ patients

Robert J Blount, Kieran R Daly, Serena Fong, Emily Chang, Katherine Grieco, Meredith Greene, Stephen Stone, John Balmes, Robert F Miller, Peter D Walzer, …
PloS one, Vol.12(7), pp.e0180212-e0180212
2017
DOI: 10.1371/journal.pone.0180212
PMCID: PMC5503245
PMID: 28692651
url
https://doi.org/10.1371/journal.pone.0180212View
Published (Version of record) Open Access

Abstract

Humoral immunity plays an important role against Pneumocystis jirovecii infection, yet clinical and environmental factors that impact bronchoalveolar antibody responses to P. jirovecii remain uncertain. From October 2008-December 2011 we enrolled consecutive HIV-infected adults admitted to San Francisco General Hospital (SFGH) who underwent bronchoscopy for suspected Pneumocystis pneumonia (PCP). We used local air quality monitoring data to assign ozone, nitrogen dioxide, and fine particulate matter exposures within 14 days prior to hospital admission. We quantified serum and bronchoalveolar lavage fluid (BALF) antibody responses to P. jirovecii major surface glycoprotein (Msg) recombinant constructs using ELISA. We then fit linear regression models to determine whether PCP and ambient air pollutants were associated with bronchoalveolar antibody responses to Msg. Of 81 HIV-infected patients enrolled, 47 (58%) were diagnosed with current PCP and 9 (11%) had a prior history of PCP. The median CD4+ count was 51 cells/μl (IQR 15-129) and 44% were current smokers. Serum antibody responses to Msg were statistically significantly predictive of BALF antibody responses, with the exception of IgG responses to MsgC8 and MsgC9. Prior PCP was associated with increased BALF IgA responses to Msg and current PCP was associated with decreased IgA responses. For instance, among patients without current PCP, those with prior PCP had a median 73.2 U (IQR 19.2-169) IgA response to MsgC1 compared to a 5.00 U (3.52-12.6) response among those without prior PCP. Additionally, current PCP predicted a 22.5 U (95%CI -39.2, -5.82) lower IgA response to MsgC1. Ambient ozone within the two weeks prior to hospital admission was associated with decreased BALF IgA responses to Msg while nitrogen dioxide was associated with increased IgA responses. PCP and ambient air pollutants were associated with BALF IgA responses to P. jirovecii in HIV-infected patients evaluated for suspected PCP.
Bronchoalveolar Lavage Fluid Pneumonia, Pneumocystis - complications Air Pollutants - analysis Bronchi - microbiology Prospective Studies Pneumonia, Pneumocystis - diagnosis Humans Middle Aged Pneumocystis carinii - immunology Male Pulmonary Alveoli - microbiology Bronchi - immunology HIV Infections - immunology Fungal Proteins - immunology Adult Female Membrane Glycoproteins - immunology Bronchi - pathology Antibody Formation - immunology Pulmonary Alveoli - pathology Pneumonia, Pneumocystis - immunology Treatment Outcome Environmental Exposure HIV Infections - complications Immunoglobulin A - blood Environment Pneumonia, Pneumocystis - microbiology Pulmonary Alveoli - immunology

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