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. 2020 Dec 23;15(12):e0242438.
doi: 10.1371/journal.pone.0242438. eCollection 2020.

Deficiency of mannose-binding lectin is a risk of Pneumocystis jirovecii pneumonia in a natural history cohort of people living with HIV/AIDS in Northern Thailand

Kunio Yanagisawa  1   2 , Nuanjun Wichukchinda  3 , Naho Tsuchiya  4 , Michio Yasunami  5 , Archawin Rojanawiwat  3 , Hidenori Tanaka  6 , Hiroh Saji  6 , Yoshiyuki Ogawa  1 , Hiroshi Handa  1 , Panita Pathipvanich  7 , Koya Ariyoshi  8 , Pathom Sawanpanyalert  3
Affiliations

Deficiency of mannose-binding lectin is a risk of Pneumocystis jirovecii pneumonia in a natural history cohort of people living with HIV/AIDS in Northern Thailand

Kunio Yanagisawa et al. PLoS One. .

Abstract

Background: Mannose-binding lectin (MBL) plays a pivotal role in innate immunity; however, its impact on susceptibility to opportunistic infections (OIs) has not yet been examined in a natural history cohort of people living with HIV/AIDS.

Methods: We used archived samples to analyze the association between MBL expression types and risk of major OIs including Pneumocystis jirovecii pneumonia (PCP), cryptococcosis, talaromycosis, toxoplasmosis, and tuberculosis in a prospective cohort in Northern Thailand conducted from 1 July 2000 to 15 October 2002 before the national antiretroviral treatment programme was launched.

Results: Of 632 patients, PCP was diagnosed in 96 (15.2%) patients, including 45 patients with new episodes during the follow-up period (1006.5 person-years). The total history of PCP was significantly associated with low MBL expression type: high/intermediate (81/587, 13.8%), low (10/33, 30.3%) and deficient (5/12, 41.7%) (p = 0.001), whereas the history of other OIs showed no relation with any MBL expression type. Kaplan-Meier analysis (n = 569; log-rank p = 0.011) and Cox's proportional hazards model revealed that deficient genotype dramatically increased the risk of PCP, which is independent upon sex, age, CD4 count, HIV-1 viral load and hepatitis B and C status (adjusted hazard ratio 7.93, 95% confidence interval 2.19-28.67, p = 0.002).

Conclusions: Deficiency of MBL expression is a strong risk factor determining the incidence of PCP but not other major OIs.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cumulative probability curves of PCP during follow-up periods.
Kaplan–Meier curves for registered Pneumocystis jirovecii Pneumonia (PCP) patients. (a) Total patients (n = 569), (b) baseline CD4 count <200/μl (n = 293), and (c) baseline CD4 count ≧200/μl (n = 274). Dashed line indicates deficient expression type of Mannose-binding Lectin (MBL), dotted line indicates low and solid line indicates high/intermediate MBL expression types combined. The log-rank test was used to compare group.
Fig 2
Fig 2. Box plots of plasma MBL concentrations of patients (n = 273) according to MBL expression type.
Box plots of plasma Mannose-binding Lectin (MBL) concentrations of patients (n = 273) according to MBL expression type. The Mann–Whitney U test and Kruskal–Wallis test were used for analyzing the differences of plasma MBL concentrations in each MBL expression type.
See this image and copyright information in PMC

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