Prevalência de Citomegalovírus entre pacientes com insuficiência renal crônica em tratamento dialítico e transplantados renais : estudo de associação com marcadores genéticos (HLA)

Abstract

Abstract: Human cytomegalovirus (HCMV) is an adenovirus that is present in most healthy subjects in a latent form, and it is a risk when they become immunocompromised. It is a major cause of morbidity and mortality in immunosuppressed patients, a situation where the activation of viral replication occurs. Among individuals with immunosuppression there are transplant recipients, who may experience acute graft rejection. Among dialysis patients, in addition to compromising the body's defense mechanism, possible blood transfusions also occur, increasing the likelihood of infection. The literature makes little reference to the seroprevalence of HCMV and its relationship with the individual's immune system that is mediated by the Major Histocompatibility Complex (MHC), which in humans is defined as Human Leukocyte Antigens - HLA system. Considering the need to obtain more knowledge about the influence of genetic factors in the HCMV entrainment, we proposed this study to identify the presence of HCMV in patients with CRF undergoing dialysis therapy and kidney transplant patients, and evaluate their association with HLA markers. The identification of HCMV was made through the technique of microparticle enzyme immunoassay (MEIA) and One Lambda LABType®SSO kit was used in combination with the Luminex technology for HLA typing. The study population involved 203 dialysis patients, 53 kidney transplant recipients attended at two reference centers in the city of Maringá, in the state of Paraná and 73 healthy volunteers. The data were statistically analyzed to identify the level of significance. The results showed no relationship between the gender variable and seroprevalence of HCMV in both groups. There was no correlation between the presence of the virus and blood transfusion in the dialysis group. Regarding the proportion of chronic infection (anti-HCMV IgG) and acute infection (anti-HCMV IgM), there were no significant differences in the two groups regarding gender. Comparing the results for both with those observed for the control group it was found statistically significant differences when the age variable was correlated with the frequency of anti-HCMV antibodies (IgG and IgM). When correlating the frequency of HCMV-IgG with HLA genes (A, B and DRB1 loci) for both groups the most frequent allele observed was the A*02, although not statistically significant. It was observed that the presence of the B*57 allele found in the transplant group showed a trend for association (p = 0233) with the prevalence of HCMV-IgM. From the data obtained, it can be concluded that the frequency of HCMV is higher in immunocompromised patients and the association between the seroprevalence of HCMV and blood transfusion has not been established. The data suggest the involvement of an HLA class I allele in the susceptibility to virus acquisition, however further studies are needed in new populations, in order to confirm these findings.