Approximately 100 new cases per year of
cryptococcosis in HIV+ patients are observed in Muñiz Hospital, 35% of them suffer a fatal outcome within the first four weeks after diagnosis in spite of treatment. Apparently there is not a useful parameter that allows a clear prediction of this early fatal outcome of the disease. The aim of this study is to determine some
cytokine levels and several lymphocyte subpopulations counts in order to correlate these results with the evolution of the disease. Forty HIV+ patients suffering culture confirmed
cryptococcosis were enrolled in this study, 8 HIV+ patients without
cryptococcosis and 8 healthy individuals with negative serology for HIV were included as controls. The following determinations were done in all cases: CD3+, CD4+, CD8+, CD16+CD3-, CD19+ cell counts, IL-1;
IL-12,
TNFalpha in serum and
TNFalpha in CSF. Ten cases with
cryptococcosis and
AIDS were controlled three months
after treatment. The average of CD4+ and NK cell counts in patients before treatment were 22/microl and 90/microl respectively;
IL-1 levels were higher in the patients than in the healthy control group, conversely
IL-12 levels did not show significant differences in the three studied groups. Serum concentrations of
TNFalpha were higher in patients than in the control group and were not modified
after treatment, conversely antifungal medication diminished
IL-1 concentration and remarkably increased NK cell counts. At the same time
antigen levels in serum and CSF decreased. The results obtained seem to show that the immunological alterations observed in these patients are those characteristically exhibited in severe HIV disease and that some parameters such as CD8+ cell counts lower than 200/microl, less than 50 CD4+/microl, more than 50 pg/ml of
TNF-alpha and serum capsular
antigen titer higher than 1:5000 seem to predict a rapidly fatal course of
infection.