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Kirschner DE, Mehr R, Perelson AS. Role of the thymus in pediatric HIV-1 infection. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1998; 18:95-109. [PMID: 9637574 DOI: 10.1097/00042560-199806010-00001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several lines of evidence suggest that HIV-1 is present in the thymus during HIV-1 infection. Precursors to mature CD4+ T lymphocytes develop in the thymus, which suggests that thymic infection may play a role in the CD4+ T-cell decline observed during the course of pediatric HIV-1 infection. We illustrate, through mathematical modeling, the potential effects of thymic infection on the course of pediatric AIDS disease progression. We find that infection in the thymus not only can supplement peripheral infection but can help explain the faster progression in pediatric cases, as well as the early and high viral burden.
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Affiliation(s)
- D E Kirschner
- Department of Microbiology, University of Michigan Medical School, Ann Arbor 48109-0620, USA.
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52
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Frenkel LM, Mullins JI, Learn GH, Manns-Arcuino L, Herring BL, Kalish ML, Steketee RW, Thea DM, Nichols JE, Liu SL, Harmache A, He X, Muthui D, Madan A, Hood L, Haase AT, Zupancic M, Staskus K, Wolinsky S, Krogstad P, Zhao J, Chen I, Koup R, Ho D, Korber B, Apple RJ, Coombs RW, Pahwa S, Roberts NJ. Genetic evaluation of suspected cases of transient HIV-1 infection of infants. Science 1998; 280:1073-7. [PMID: 9582120 DOI: 10.1126/science.280.5366.1073] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Detection of human immunodeficiency virus-type 1 (HIV-1) on only one or a few occasions in infants born to infected mothers has been interpreted to indicate that infection may be transient rather than persistent. Forty-two cases of suspected transient HIV-1 viremia among 1562 perinatally exposed seroreverting infants and one mother were reanalyzed. HIV-1 env sequences were not found in specimens from 20; in specimens from 6, somatic genetic analysis revealed that specimens were mistakenly attributed to an infant; and in specimens from 17, phylogenetic analysis failed to demonstrate the expected linkage between the infant's and the mother's virus. These findings argue that transient HIV-1 infection, if it exists, will only rarely be satisfactorily documented.
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Affiliation(s)
- L M Frenkel
- Department of Pediatrics, University of Rochester, Rochester, NY 14642, USA.
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53
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Abstract
Pregnancy in individuals infected with HIV has become an important problem because of a fourfold rise of infection in women of childbearing age in the developed world. The incidence of vertical transmission varies in different continents and is highest in Africa. Transmission may occur in utero (antepartum), during delivery (intrapartum), or after birth (postpartum), occurring during the latter period, in many cases, through breastfeeding. Maternal viral burden around the time of delivery is the strongest determinant of the risk of disease transmission. While breastfeeding may account for up to one-third of cases of vertical transmission in Africa, the benefits of breastfeeding outweigh its risks, even in HIV infection, and breastfeeding is recommended in those areas. Treatment of the mother with antiretroviral agents significantly decreases the risk of vertical transmission.
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Affiliation(s)
- D P Kotler
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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54
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Economides A, Schmid I, Anisman-Posner DJ, Plaeger S, Bryson YJ, Uittenbogaart CH. Apoptosis in cord blood T lymphocytes from infants of human immunodeficiency virus-infected mothers. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1998; 5:230-4. [PMID: 9521148 PMCID: PMC121363 DOI: 10.1128/cdli.5.2.230-234.1998] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/1997] [Accepted: 12/01/1997] [Indexed: 02/06/2023]
Abstract
Apoptosis continues to be controversial in human immunodeficiency virus (HIV)-induced pathogenesis. To investigate whether apoptosis occurs with HIV exposure with or without subsequent infection, levels of apoptosis were measured in cord blood lymphocytes (CBL) from seven newborns delivered to HIV-infected mothers and seven normal, unexposed newborns. Live cells were costained with antibodies to cell surface markers and the DNA dye 7-amino actinomycin D to immunophenotype apoptotic CBL subsets. Apoptosis was measured in fresh and cultured CBL in the presence and absence of CD3 T-cell receptor stimulation. Compared to the CD4+ CBL from HIV-unexposed newborns, CD4+ CBL from six HIV-exposed, noninfected newborns demonstrated significantly greater apoptosis after overnight culture even in the absence of CD3 stimulation. Compared to HIV-unexposed controls, CD8+ CBL from the six HIV-exposed newborns also demonstrated increased levels of apoptosis after overnight culture without stimulation. The one HIV-infected newborn in this study showed the highest levels of CD4+ and CD8+ apoptotic CBL. The data suggest that levels of apoptosis are increased in infants in association with HIV infection. Furthermore, CD4+ and CD8+ cord blood lymphocytes from HIV-exposed infants behaved differently than T lymphocytes from either normal, unexposed infants or an HIV-infected infant. These results suggest that exposure to HIV or HIV-induced factors increases the levels of apoptosis in CBL.
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Affiliation(s)
- A Economides
- Department of Pediatrics, University of California Los Angeles School of Medicine, 90095-1747, USA
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55
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Bagarazzi ML, Boyer JD, Ayyavoo V, Weiner DB. Nucleic acid-based vaccines as an approach to immunization against human immunodeficiency virus type-1. Curr Top Microbiol Immunol 1998; 226:107-43. [PMID: 9479839 DOI: 10.1007/978-3-642-80475-5_8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M L Bagarazzi
- Department of Pediatrics, Allegheny University of the Health Sciences, Philadelphia, PA, USA
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56
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Nahmias A, Abramowsky C, Dobronyi I, Ibegbu C, Henderson S. Infection and immunity at the maternal-placental-fetal interface: Focus on HIV-1. Placenta 1998. [DOI: 10.1016/s0143-4004(98)80036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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57
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Abstract
Prevention of mother-to-child transmission of HIV is a significant public health priority. A regimen of zidovudine administered during pregnancy, intrapartum, and to the newborn significantly reduces transmission, and incorporation of this regimen into clinical practice has been associated with significant decreases in perinatal transmission in industrialized countries. This regimen, however, is not applicable in the developing world (where most perinatal transmission occurs), and simpler, shorter, less costly regimens are urgently needed. An understanding of the pathogenesis of perinatal transmission is crucial for the design of new preventive and therapeutic regimens, and current knowledge is reviewed in this article, with an emphasis on relevance to prevention.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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58
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Abstract
Less than half of the paediatric HIV infections recorded in Australia have resulted from perinatal transmission, but in recent years this has been the predominant mode of infection. There are 136 infants who are known to have been exposed perinatally to HIV in Australia: 49 of these are infected. Caesarean section is thought now not to reduce the risk of perinatal transmission (PNT); rather, the risk increases with duration of membrane rupture and rises rapidly after 4 h of membrane rupture. However, no data exist to show that interventions to expediate delivery after membrane rupture reduce the risk of PNT. Data such as these suggest that the majority of perinatal infections (probably about 60%) occur close to the time of delivery. While the overall risk of PNT for non-breast fed infants is approximately 20-25%, the risk of infection for the infant is considerably increased when there is evidence of increased maternal viral burden. Advanced maternal disease predicts that if the infant is infected there is more likely to be early progression of HIV than is the case for the less frequently infected infants of mothers who are asymptomatic. Bottle feeding may prevent infection of 10% of children exposed perinatally. Use of zidovudine by the mother in the third trimester and i.v. zidovudine during labour, followed by oral zidovudine for the infant for 6 weeks can reduce the PNT rate by two thirds, to about 8%. Approximately 3% of uninfected infants with perinatal HIV exposure may be found to be transiently virus positive but eventually become antibody negative and thus appear to have eliminated the virus. The risk of Pneumocystis carinii pneumonitis (PCP) cannot be predicted on the basis of CD4 count and it is recommended that all children of infected mothers commence PCP prophylaxis around the age of 6 weeks-2 months and continue that therapy until the age of 12 months or until it becomes clear that the infant is uninfected. The cumulative risk of AIDS increases rapidly during the first year of life to about 20%, then more slowly at a rate of about 2 or 3% a year. The shape of this curve reveals the bimodal progression of HIV disease in children. About 15-20% of children rapidly develop a severe immune deficiency, opportunistic infections and, in most cases, encephalopathy. There is a very high morbidity rate in this group of children, most of whom die before the age of 3 or 4 years. In contrast, 80-85% of children only become immunodeficient after a relatively long period, which is similar to or perhaps even longer than that in adults. Recent studies indicate that zidovudine antiviral monotherapy is no longer appropriate. While no clear alternative to monotherapy has emerged most would, wherever possible, commence antiretroviral therapy with a combination of two or three drugs including zidovudine plus didanosine or lamivudine. If a third drug is used it would probably be a protease inhibitor.
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Affiliation(s)
- J B Ziegler
- Department of Immunology/Allergy, Sydney Children's Hospital, Randwick, New South Wales, Australia
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59
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Deml L, Schirmbeck R, Reimann J, Wolf H, Wagner R. Recombinant human immunodeficiency Pr55gag virus-like particles presenting chimeric envelope glycoproteins induce cytotoxic T-cells and neutralizing antibodies. Virology 1997; 235:26-39. [PMID: 9300034 DOI: 10.1006/viro.1997.8668] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Very recently, we demonstrated that the replacement of the human immunodeficiency virus type-1 (HIV-1) gp41 transmembrane protein by an Epstein-Barr virus gp220/350-derived membrane anchor resulted in the incorporation of chimeric envelope (Env) oligomers into Pr55gag virus-like particles (VLPs), exceeding that of wild-type gp160 by a factor of 10. In this study, we examined the immunostimulatory properties of Pr55gag VLPs to both (i) chimeric HIV-1 gp120 external envelope proteins and (ii) full-length gp160 presented on the outer surface of the particles. Immunization studies carried out with VLPs presenting different derivatives of the chimeric and wild-type Env proteins elicited a consistent anti-Pr55gag as well as anti-Env antibody response in complete absence of additional adjuvants. In both cases, the immune sera exhibited an in vitro neutralizing activity against homologous HIV-1 infection in MT4 cells. Noteworthy, these VLPs were also capable of inducing a strong CD8+ cytotoxic T-cell (CTL) response in immunized BALB/c mice that was directed toward a known CTL epitope in the third variable domain V3 of the gp120 external glycoprotein. However, the induction of V3-loop-specific CTLs critically depended on the amounts of Env proteins that were presented by the Pr55gag VLPs. Moreover, the CD8+ CTL response was not significantly altered by adsorbing the VLPs to alum or by repeated booster immunizations. These results illustrate that Pr55gag VLPs provide a safe and effective means of enhancing neutralizing humoral responses to particle-entrapped gp120 proteins and are also capable of delivering these proteins to the MHC class I antigen processing and presentation pathway. Therefore, antigenically expanded Pr55gag VLPs represent an attractive approach in the design of vaccines for which specific stimulation of neutralizing antibodies and cytotoxic effector functions to complex glycoproteins is desired.
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Affiliation(s)
- L Deml
- Institute of Medical Microbiology, University of Regensburg, Germany
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60
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Fujii S, Obaru K, Matsushita S, Morikita T, Higuchi H, Fujimoto K, Takatsuki K. Characterization of proviral DNA from an individual with long-term, nonprogressive infection with HIV-1 and nonrecoverable virus. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1997; 15:247-56. [PMID: 9292582 DOI: 10.1097/00042560-199708010-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A small proportion of individuals infected with HIV-1 known as long-term nonprogressors (LTNPs) remain healthy and immunologically normal, with stable numbers of CD4+ lymphocytes, for prolonged periods without the administration of antiretroviral agents. The long terminal repeat (LTR) of HTV-1 proviral DNA of an LTNP from whom virus was consistently not recoverable has now been isolated by a nested polymerase chain reaction (PCR) method and shown to contain a total of 38 point mutations, only four of which affect promoter and enhancer elements, compared with the IIIB strain of HIV-1. Almost the entire HIV-1 proviral DNA was then isolated from the proband by a long PCR approach. Restriction enzyme digestion of the proviral DNA revealed no large deletions in the gag, pol, or env genes, although the loss of an Nco I site was apparent. Amplification of the env gene by long PCR also yielded a product apparently identical in size to that obtained with HIV-1 strain IIIB. Analysis by long PCR of HIV-1 proviral DNA from LTNPs with nonrecoverable virus may clarify the mechanism of long-term nonprogression and contribute to the development of HIV-1 vaccines.
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Affiliation(s)
- S Fujii
- Second Department of Internal Medicine, Kumamoto University School of Medicine, Japan
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61
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De Rossi A, Ometto L, Masiero S, Zanchetta M, Chieco-Bianchi L. Viral phenotype in mother-to-child HIV-1 transmission and disease progression of vertically acquired HIV-1 infection. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1997; 421:22-8. [PMID: 9240853 DOI: 10.1111/j.1651-2227.1997.tb18315.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human immunodeficiency virus-1 (HIV-1) primary isolates differ in replicative capacity on peripheral blood mononuclear cells, tropism for primary monocyte-derived macrophages (MDM) and T-cell lines and syncytium-inducing (SI) capability on MT-2 cells in vitro. To assess the role of viral phenotype in mother-to-child HIV-1 transmission and the progression of vertically acquired HIV-1 infection, we studied 57 HIV-1-infected women at the time of delivery and 24 HIV-1-infected infants. Eight mothers transmitted the infection to their children. Primary isolates, obtained from 7 and 33 transmitting and non-transmitting mothers, respectively, differed in replicative capacity and SI activity, and no significant differences between the two groups were found regarding these viral properties. However, all primary isolates from transmitting mothers, but about half of those from non-transmitting mothers, were able to infect and replicate in MDM, regardless of their replicative capacity and/or SI activity; moreover, the monocyto-macrophage tropism of the maternal isolate correlated with an increased risk of transmission. Viral isolates from HIV-1-infected children were typed before 2 months of age; all but four showed a tropism for MDM, further supporting the notion that monocyto-macrophage tropic variants are selectively transmitted from mother to child and/or selectively replicated upon transmission. Clinical follow-up disclosed that 7/11 infants with a rapid/high replicating virus but none of the 17 with a slow replicating virus developed severe symptoms of disease and/or severe immunodepression by 1 year of age. By means of competitive RNA-polymerase chain reaction (PCR), a relationship was found between viral phenotype and dynamics of HIV-1 replication early in life in children who experienced different patterns of disease progression.
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Affiliation(s)
- A De Rossi
- Department of Oncology and Surgical Sciences, InterUniversity Center for Cancer Research, University of Padova, Italy
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62
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Jansson M, Orlandi P, Scarlatti G, Moschese V, Romiti ML, Cancrini C, Mancia L, Livadiotti S, Castelli-Gattinara G, Rossi P, Halapi E. Role of immunity in maternal-infant HIV-1 transmission. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1997; 421:39-45. [PMID: 9240856 DOI: 10.1111/j.1651-2227.1997.tb18318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Factors influencing human immunodeficiency virus type 1 (HIV-1) mother-to-child transmission include both immunological and virological parameters: higher viral loads have been associated with clinical stage of HIV-1-infected individuals as well as higher risk of mother-to-child transmission. Furthermore, we have shown that transmitting mothers more frequently harbour HIV-1 isolates with rapid/high syncytium-inducing (SI) biological phenotype than non-transmitting mothers do. Genetically homogeneous virus populations have been found in HIV-1-infected children at birth, in contrast to the heterogeneous virus populations often found in their infected mothers. This observation suggests that a few virus variants are transmitted or initially are replicating in the child. By comparing the HIV-1 gp120 V3 region of sequentially obtained samples from infected children with samples obtained from their mothers at delivery we found, however, that multiple variants of HIV-1 with different outgrowth kinetics can be transmitted. In addition, we have obtained results indicating an impaired ability of the immune response to adapt to the sequence evolution of HIV-1 in transmitting mothers, as assessed by measuring serum reactivities to peptides representing selected yet closely related V3 sequences. By analysing the presence of antibodies in maternal serum at delivery, which neutralize autologous isolates as well as other primary virus isolates, we have indications that a protective immunity in HIV-1 mother-to-child transmission might exist. Immunotherapy has been assessed in infected adult individuals by passive immunization with a variety of HIV-1-specific antibody products. Data from these studies indicated a differential response to therapy according to the stage of the disease. Active vaccine strategies, including envelope glycoproteins, pursued so far in seronegative adult subjects have shown limitations because broadly neutralizing antibodies, such as can be found in infected individuals, have not been evoked. Further investigations are therefore needed to give support for the potential use of either passive and/or active immunization for the prevention of HIV-1 mother-to-child transmission.
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Affiliation(s)
- M Jansson
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
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63
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Mandelbrot L. Timing of in utero HIV infection: implications for prenatal diagnosis and management of pregnancy. AIDS Patient Care STDS 1997; 11:139-47. [PMID: 11361787 DOI: 10.1089/apc.1997.11.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Mandelbrot
- Gynecologic and Obstetric Service, Hospital Cochin-Port Royal, Paris, France
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64
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Mofenson LM. Interaction between timing of perinatal human immunodeficiency virus infection and the design of preventive and therapeutic interventions. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1997; 421:1-9. [PMID: 9240849 DOI: 10.1111/j.1651-2227.1997.tb18311.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In 1994, the hypothesis that transmission of human immunodeficiency virus (HIV) from mother to child could be interrupted became a reality when it was shown that a regimen of zidovudine given to HIV-infected pregnant women and their newborn infants could reduce the risk of perinatal transmission by two-thirds. An understanding of the pathogenesis of transmission is crucial for interpreting these results, for design of future interventions and for understanding the natural history of perinatal HIV infection. This paper will review current information regarding the timing of and risk factors for perinatal HIV transmission, and the relationship between the timing of transmission and design of efforts to interrupt transmission and to slow disease progression in infected infants.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent & Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Rockville, MD 20852, USA
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65
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O'Neil LL, Burkhard MJ, Obert LA, Hoover EA. Regression of feline immunodeficiency virus infection. AIDS Res Hum Retroviruses 1997; 13:713-8. [PMID: 9168240 DOI: 10.1089/aid.1997.13.713] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Regression of feline immunodeficiency virus (FIV) infection was observed in seven of nine vertically infected kittens born to two chronically infected mother cats. Both provirus and nonmaternal FIV antibody were detected in all kittens by 4 weeks of age but only three of the seven kittens were positive by blood mononuclear cell coculture. Between 10 and 14 months of age blood mononuclear cells from each of the seven cats were negative at least once by polymerase chain reaction (PCR), but evidence of virus infection was detected by coculture and/or PCR in biopsied lymph node or bone marrow from five of the seven cats. Despite this evidence of persistent tissue provirus, antibody production did not persist in any of the cats beyond 1 year of age. All seven cats remained asymptomatic although CD4 and CD8 T cell counts were in the low normal range throughout the study. By contrast, two additional perinatally infected littermates that were persistently virus isolation positive developed rapid CD4 depletion and progressed to terminal immunodeficiency by 9 weeks of age. Thus FIV infection can be downregulated and/or sequestered to extremely low levels barely detectable with the assays available, although absolute clearance of virus may not occur. These observations are relevant to human immunodeficiency virus (HIV) infection in paralleling both the apparent "regression" of HIV infection reported in some perinatally infected infants and the low-level, apparently stable, infection established by attenuated simian immunodeficiency viruses.
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Affiliation(s)
- L L O'Neil
- Department of Pathology, Colorado State University, Fort Collins 80523, USA
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66
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Luzuriaga K, Bryson Y, Krogstad P, Robinson J, Stechenberg B, Lamson M, Cort S, Sullivan JL. Combination treatment with zidovudine, didanosine, and nevirapine in infants with human immunodeficiency virus type 1 infection. N Engl J Med 1997; 336:1343-9. [PMID: 9134874 DOI: 10.1056/nejm199705083361902] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In infants and children with maternally acquired human immunodeficiency virus type 1 (HIV-1) infection, treatment with a single antiretroviral agent has limited efficacy. We evaluated the safety and efficacy of a three-drug regimen in a small group of maternally infected infants. METHODS Zidovudine, didanosine, and nevirapine were administered in combination orally to eight infants 2 to 16 months of age. The efficacy of antiretroviral treatment was evaluated by serial measurements of plasma HIV-1 RNA, quantitative plasma cultures, and quantitative cultures of peripheral-blood mononuclear cells. RESULTS The three-drug regimen was well tolerated, without clinically important adverse events. Within four weeks, there were reductions in plasma levels of HIV-1 RNA of at least 96 percent (1.5 log) in seven of the eight study patients. Over the 6-month study period, replication of HIV-1 was controlled in two infants who began therapy at 2 1/2 months of age. Plasma RNA levels were reduced by 0.5 to 1.5 log in five of the other six infants. CONCLUSIONS Although further observations are needed, it appears that in infants with maternally acquired HIV-1 infection, combined treatment with zidovudine, didanosine, and nevirapine is well tolerated and has sustained efficacy against HIV-1.
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Affiliation(s)
- K Luzuriaga
- Department of Pediatrics, University of Massachusetts Medical School, Worcester 01605, USA
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67
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Rich KC, Siegel JN, Jennings C, Rydman RJ, Landay AL. Function and phenotype of immature CD4+ lymphocytes in healthy infants and early lymphocyte activation in uninfected infants of human immunodeficiency virus-infected mothers. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1997; 4:358-61. [PMID: 9144377 PMCID: PMC170532 DOI: 10.1128/cdli.4.3.358-361.1997] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The function and phenotypes of CD4+ lymphocytes in infants are different than in adults and are modulated by maturational changes and exposure to environmental antigens. Infants of non-human immunodeficiency virus (HIV)-infected mothers and uninfected infants of HIV-infected mothers, 0 to 6 months of age, were examined for CD4+ lymphocyte function by in vitro interleukin-2 (IL-2) production and for CD4+ phenotypes by three-color flow cytometry. A minority of these uninfected infants (28%) had functional responses similar to those of healthy adult women (IL-2 production in response to anti-CD3, alloantigen, and mitogen), while the remainder were capable of responding to alloantigen and mitogen but not to anti-CD3. We did demonstrate reduced phytohemagglutinin-stimulated IL-2 production in uninfected infants born to HIV-seropositive mothers compared to that in infants from seronegative mothers. The proportions of CD3+ CD4+, CD4+ HLA-DR- CD38+, and CD4+ CD45RA+ RO- (naive) lymphocytes were much higher in infants than in adults, and the proportions of CD4+ CD45RA- RO+ (memory) and CD4+ CD25+ (IL-2 receptor-bearing) lymphocytes were lower in infants than in adults. The proportions of activated (CD4+ HLA-DR+ CD38+) and memory (CD4+ CD45RA- RO+) lymphocytes were increased in uninfected infants of HIV-infected mothers compared to infants of uninfected mothers. Therefore, T-helper-cell function is immature in many infants, but the CD4+ lymphocytes of some HIV-exposed, uninfected infants have been stimulated by antigen at an early age.
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Affiliation(s)
- K C Rich
- Department of Pediatrics, University of Illinois at Chicago, USA
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68
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Willett BJ, Flynn JN, Hosie MJ. FIV infection of the domestic cat: an animal model for AIDS. IMMUNOLOGY TODAY 1997; 18:182-9. [PMID: 9136455 DOI: 10.1016/s0167-5699(97)84665-8] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B J Willett
- Dept of Veterinary Pathology, University of Glasgow Veterinary School, UK.
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69
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Biggar RJ, Miley W, Miotti P, Taha TE, Butcher A, Spadoro J, Waters D. Blood collection on filter paper: a practical approach to sample collection for studies of perinatal HIV transmission. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1997; 14:368-73. [PMID: 9111480 DOI: 10.1097/00042560-199704010-00010] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of dried blood spots lends itself to widespread application in large field studies, especially in remote areas. We present experience gained during a perinatal HIV transmission study in southern Africa in which dried blood spot samples were used for polymerase chain reaction (PCR) tests. In this study, 15,810 filter paper cards with dried blood spots were collected. Infants were seen at age 6 and 12 weeks, and PCR was routinely done in duplicate on each sample. Of 186 negative controls (infants born to HIV-negative women), two (1.1%) had a single strongly reactive PCR result; the repeated duplicates were both negative. In contrast, all 24 known positive samples were strongly positive in both tests. Results were available from 1,976 duplicate tests on 1,235 infants born to HIV-infected women. Based on the PCR result on a later sample, the positive predictive value was 97.6% if both replicates were strongly positive (absorbance: 0.8 OD450 U), 100% when one of the replicates was strongly positive, and 27% when one or both replicates were weakly positive (but none strongly positive). When both replicates were negative, the negative predictive value was > or = 96.2%. Thus, when a single HIV PCR test has a strongly positive result, the infant is very likely to be infected. A positive PCR result after age 1 month was 98.9% accurate in predicting antibody positivity after 15 months. Suggestions for sample collection, storage, and PCR testing are provided.
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Affiliation(s)
- R J Biggar
- Viral Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA
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70
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71
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Schell LM. Using patterns of child growth and development to assess communitywide effects of low-level exposure to toxic materials. Toxicol Ind Health 1997; 13:373-8. [PMID: 9200802 DOI: 10.1177/074823379701300221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Child growth is a low tech method for assessing a socially valued health outcome, and its assessment focuses attention on the early portion of the lifespan. It is easily measured and sensitive to a variety of influences including chemical ones. As summary measure of health, it does not signify that a particular chemical is present, but it is a response to a variety of them. When used in conjunction with other epidemiologic methods, child growth assessment constitutes a practical, socially meaningful and biologically reasonable tool to assess the impact on community health and well being of chronic low-level exposures to toxic materials.
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Affiliation(s)
- L M Schell
- School of Public Health, University at Albany, State University of New York 12222, USA.
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72
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Pathogenesis of HIV infection in children. PROGRESS IN PEDIATRIC CARDIOLOGY 1997. [DOI: 10.1016/s1058-9813(97)00198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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73
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Okamoto Y, Shiosaki K, Eda Y, Tokiyoshi S, Yamaguchi Y, Gojobori T, Hachimori T, Yamazaki S, Hondo M. Father-to-mother-to-infant transmission of HIV-1: clonally transmitted isolate of infant mutates more rapidly than that of the mother and rapidly loses reactivity with neutralizing antibody. Microbiol Immunol 1997; 41:131-8. [PMID: 9087955 DOI: 10.1111/j.1348-0421.1997.tb01178.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sequences of the V3 loop and surrounding regions of human immunodeficiency virus type-1 from a father-to-mother-to-infant trimmer were studied and the horizontal and vertical transmissions compared. The father's virus was variable for reactivity with neutralizing antibody and sequences of the V3 loop central core sequence. In contrast, the mother's viral sequences were much less diverse and reacted with a virus neutralizing antibody. The infant's viral sequences were also less diverse than those of the father, and N-glycosylation sites were conserved. By phylogenetic analysis, the major clone, of which V3-peptide reacted with the neutralizing antibody, was found to be transmitted from the mother to her infant; however, the mutated minor clones did not bind to the antibody. These findings suggest that both horizontal and vertical virus transmission were selective, and that the clonally transmitted virus in infants mutates more rapidly than viruses in the mother, to whom the virus was horizontally transmitted.
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Affiliation(s)
- Y Okamoto
- Laboratory of Immunology, AIDS Research Center, National Institute of Health, Tokyo, Japan
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74
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Paxton WA, Koup RA. Mechanisms of resistance to HIV infection. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1997; 18:323-40. [PMID: 9089952 DOI: 10.1007/bf00813501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- W A Paxton
- Aaron Diamond AIDS Research Center, New York, NY 10016, USA
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75
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Clancy RL, Benson EM. If this vaccine can prevent AIDS why is it not being used? Med J Aust 1996; 165:539. [PMID: 8941237 DOI: 10.5694/j.1326-5377.1996.tb138637.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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76
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Abstract
Developments in the prevention and treatment of HIV infection in pregnant women and their children are encouraging. Perinatal ZDV therapy can reduce the maternal-infant transmission rate by two thirds in select populations. New therapies and the development of diagnostic assays to monitor HIV viral burden have renewed hope that, by aggressively controlling viremia, the progressive immunodeficiency can be delayed or even prevented. The general pediatric approach of preventing illnesses through aggressive vaccination and education policies must be actively incorporated into an approach to this epidemic. Success in controlling the pediatric HIV epidemic requires a concerted, coordinated effort by public policy makers, health care providers, basic science researchers, and those who are HIV-infected.
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Affiliation(s)
- A A Wiznia
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
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77
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Hosie MJ, Flynn JN. Feline immunodeficiency virus vaccination: characterization of the immune correlates of protection. J Virol 1996; 70:7561-8. [PMID: 8892875 PMCID: PMC190824 DOI: 10.1128/jvi.70.11.7561-7568.1996] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Whole inactivated virus (WIV) vaccines derived from the FL4 cell line protect cats against challenge with feline immunodeficiency virus (FIV). To investigate the correlates of protective immunity induced by WIV, we established an immunization regimen which protected a proportion of the vaccinates against challenge. A strong correlation was observed between high virus neutralizing antibody titers and protection following challenge. To investigate further the immune mechanisms responsible for immunity, all of the vaccinates were rechallenged 35 weeks following the initial challenge. Results of virus isolation from peripheral blood mononuclear cells indicated that 9 of 10 vaccinates were protected from viremia following the second challenge, suggesting that vaccine-induced immunity to FIV persisted for at least 8 months. However, more stringent analysis for evidence of infection revealed that 5 of 10 vaccinates harbored virus in lymphoid tissues. Unlike the protection observed immediately following vaccination, which correlated positively with virus neutralizing antibody titer, the ability to resist a second challenge with FIV was more closely correlated with the induction of Env-specific cytotoxic T-cell activity. The results indicate that both virus-specific humoral immunity and cellular immunity play a role in the protection induced in cats by WIV immunization but their relative importance may be dependent on the interval between vaccination and exposure to virus.
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Affiliation(s)
- M J Hosie
- MRC Retrovirus Research Laboratory, Department of Veterinary Pathology, University of Glasgow, Bearsden, United Kingdom.
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78
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Chen MY, Hung CC, Lin YG, Lin RY, Twu SJ, Ko YC, Ho HN, Lin CP, Huang SF, Kerrigan ME, Whang-Peng J, Chuang CY, Chang KS, Sung JL, Chang HJ, Shih YT, Chang PY. Reappraisal of the early diagnostic value of serial analyses of western blot patterns for HIV infection in neonates. Int J Infect Dis 1996. [DOI: 10.1016/s1201-9712(96)90058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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79
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Abstract
As the HIV-1 epidemic continues to spread world wide, the need for an effective vaccine remains urgent. Efforts to develop such a vaccine have been hampered by three main factors: (a) the extraordinary ability of the virus to mutate; (b) inability of most known specificities of anti-HIV antibodies to neutralise HIV primary isolates consistently; and (c) lack of understanding of the correlates of protective immunity to HIV infection. In view of the complex biology of HIV-host interactions, the most fruitful avenue may be development of multivalent HIV immunogens tailored to HIV isolates in specific geographical locations.
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Affiliation(s)
- B F Haynes
- Duke University AIDS Center, Durham, North Carolina, USA
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80
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Abstract
By the year 2000 there will be six million pregnant women and five to ten million children infected with HIV-1. Intervention strategies have been planned and in some instances already started. A timely and cost-effective strategy needs to take into account that most HIV-1 infected individuals reside in developing countries. Further studies are needed on immunological and virological factors affecting HIV-1 transmission from mother to child, on differential disease progression in affected children, and on transient infection.
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Affiliation(s)
- G Scarlatti
- Laboratory of Immunobiology, Centro San Luigi, San Raffaele Scientific Institute, Milan, Italy
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81
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Chakrabarti BK, Maitra RK, Ma XZ, Kestler HW. A candidate live inactivatable attenuated vaccine for AIDS. Proc Natl Acad Sci U S A 1996; 93:9810-5. [PMID: 8790413 PMCID: PMC38511 DOI: 10.1073/pnas.93.18.9810] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The recent discovery of long term AIDS nonprogressors who harbor nef-attenuated HIV suggests that a naturally occurring live vaccine for AIDS may already exist. Animal models have shown that a live vaccine for AIDS, attenuated in nef, is the best candidate vaccine. There are considerable risks, real and perceived, with the use of live HIV vaccines. We have introduced a conditional lethal genetic element into HIV-1 and simian immunodeficiency virus (SIV) molecular clones deleted in nef. The antiviral strategy we employed targets both virus replication and the survival of the infected cell. The suicide gene, herpes simplex virus thymidine kinase (tk), was expressed and maintained in HIV over long periods of time. Herpes simplex virus tk confers sensitivity to the antiviral activity of acyclic nucleosides such as ganciclovir (GCV). HIV-tk and SIV-tk replication were sensitive to GCV at subtoxic concentrations, and virus-infected cells were eliminated from tumor cell lines as well as primary cell cultures. We found the HIV-tk virus to be remarkably stable even after being cultured in media containing a low concentration of GCV and then challenged with the higher dose and that while GCV resistant escape mutants did arise, a significant fraction of the virus remained sensitive to GCV.
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Affiliation(s)
- B K Chakrabarti
- Department of Molecular Biology, Cleveland Clinic Foundation, OH 44195, USA
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82
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Lee BN, Lu JG, Kline MW, Paul M, Doyle M, Kozinetz C, Shearer WT, Reuben JM. Type 1 and type 2 cytokine profiles in children exposed to or infected with vertically transmitted human immunodeficiency virus. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1996; 3:493-9. [PMID: 8877124 PMCID: PMC170395 DOI: 10.1128/cdli.3.5.493-499.1996] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In human immunodeficiency virus (HIV)-infected adults, cytokine production profiles switch from predominantly type 1 (interleukin-2 [IL-2] and gamma interferon [IFN-gamma]) to type 2 (IL-4 and IL-10) cytokines with disease progression. To test this hypothesis in vertically HIV-infected children, we measured cytokine transcription and production in rapid progressors (RPs), seroreverters (SRs), and those children exposed to HIV in utero (P0s). Production of type 1 and type 2 cytokines was measured in peripheral blood mononuclear cell cultures of 8 SR, 25 P0, and 11 RP children. Unstimulated cultures, irrespective of infection and stage of disease, produced similar levels of IL-2, IFN-gamma, IL-4, and IL-10. Upon stimulation with phytohemagglutinin (PHA) plus phorbol-12-myristate-13-acetate (PMA), RP children produced less IL-2 (P < 0.01) and IFN-gamma (P < 0.02) than SR children and also expressed significantly less IFN-gamma mRNA (P < 0.01) than SR children. RP children expressed significantly higher levels of IL-4 mRNA than P0 children (P < 0.03). There were no differences in the production of IL-10 by PHA-PMA-stimulated peripheral blood mononuclear cell cultures among the three groups of children. Our data with these pediatric patients suggest that a deficiency in mitogen-stimulated type 1 cytokine production and excess type 2 cytokine (IL-4) transcription correlate with disease progression. Additional studies with larger sample sizes are needed to test further the hypothesis of the type 1-to-type 2 cytokine switch in children infected with HIV.
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Affiliation(s)
- B N Lee
- Division of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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83
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Affiliation(s)
- MI Johnston
- The International AIDS Vaccine Initiative, c/o The Rockefeller Foundation, 420 Fifth Avenue, New York, NY 10018-2702, USA
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84
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Affiliation(s)
- Stephen J Kent
- Macfarlane Burnet Centre for Medical ResearchMelbourneVIC
| | | | - Gordon L Ada
- John Curtin School of Medical ResearchAustralian National UniversityCanberraACT
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85
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Long SS, Lischner HW. Early and accurate detection of infection with human immunodeficiency virus type 1 in vertically exposed infants. J Pediatr 1996; 129:189-90. [PMID: 8765613 DOI: 10.1016/s0022-3476(96)70239-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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86
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Affiliation(s)
- M Malkovsky
- Department of Medical Microbiology and Immunology, University of Wisconsin Medical School, Madison 53706, USA
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87
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Affiliation(s)
- B R Bloom
- Howard Hughes Medical Institute, Department of Microbiology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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88
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Detels R, Mann D, Carrington M, Hennessey K, Wu Z, Hirji KF, Wiley D, Visscher BR, Giorgi JV. Persistently seronegative men from whom HIV-1 has been isolated are genetically and immunologically distinct. Immunol Lett 1996; 51:29-33. [PMID: 8811341 DOI: 10.1016/0165-2478(96)02551-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Studies in both monkeys and humans have suggested that transient infection with HIV-1 can occur without provoking a measurable humoral immune response. The objective of this study was to look for genetic and immunologic correlates of transient HIV-1 infection in antibody-negative men from whom HIV-1 had been isolated. The distributions of MHC class I, class II, and TAP (transporter protein associated with antigen processing) region genes were compared between 23 persistently seronegative men from whom HIV-1 was isolated at least once (isol+/Ab-) and 137 men who seroconverted. A subset of 13 of the 23 isol+/Ab- men were compared to 27 seronegative men for distribution of CD25+CD4+ and CD25+CD8+ cells in the absence of exogenous immunologic stimulation. The prevalences of the TAP1.4, and a combination of TAP1.4, and TAP2.3 variants were significantly higher in the isol+/Ab- men. The proportion of CD8+ cells that expressed CD25+ antigen was also significantly higher in the isol+/Ab- men than in the seronegative men. We conclude that isol+/Ab- men may be genetically and immunologically distinct from HIV-1 susceptible men. We hypothesize that activated CD8+ cells may have cleared HIV-1 infection in these men through genetically mediated influences of the TAP genes on the presentation of peptides by HLA class I molecules.
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Affiliation(s)
- R Detels
- Los Angeles Center of the Multicenter AIDS Cohort Study, Department of Epidemiology, UCLA School of Public Health, USA
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89
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Affiliation(s)
- John B Ziegler
- Department of Immunology and AllergySydney Children's HospitalSydneyNSW
| | - Stéphane Blanche
- Unité d'Immunologie–Hématologie PédiatriqueHôpital Necker‐Enfants MaladesParisFrance
| | - Richard Loh
- Department of ImmunologyPrincess Margaret Hospital for ChildrenPerthWA
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90
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Abstract
Normal immunocytes including T and B cells are equilibrated by a reciprocal attacking mechanism called a network. Continuous disequilibrium of this network results in general immunodeficiency with oligo- and polyclonal hyperimmunity, for example, T-cell activation due to spontaneous reticuloendotheliosis, paraneoplastic autoimmune syndromes, and human immunodeficiency virus infection. In these disorders, reciprocal self-reactivity, including autologous graft-versus-host reaction, plays a role in the immunodeficiency. A priori self-targeting immunity is a key mechanism to explain autoimmunity in the acquired immunodeficiency syndrome. In the treatment of the immunodeficiency due to hyperimmunity, I propose immunological suppression by agents and reconstitution of the network by bone-marrow transplantation.
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Affiliation(s)
- M Chigira
- Department of Orthopedic Surgery, Gunma University School of Medicine, Japan
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91
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Koff WC, Schultz AM. Progress and challenges toward an AIDS vaccine: Brother, can you spare a paradigm? J Clin Immunol 1996; 16:127-33. [PMID: 8734355 DOI: 10.1007/bf01540910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The development of a safe and effective vaccine for prevention of AIDS has thus far proven to be exceedingly difficult due to the complexities associated with HIV pathogenesis including but not limited to antigenic hypervariability, multiple routes and modes of transmission, a lack of defined correlates of protective immunity, and a tropism for infection of immunoregulatory cells which are essential for orchestrating an effective host immune response. Recent observations, including the identification of significant differences between primary isolates of HIV circulating in the population and laboratory-adapted isolates, animal model protection studies demonstrating prevention of AIDS-like disease progression in nonhuman primates in the absence of sterilizing immunity, and epidemiologic studies which question the current dogma surrounding HIV variation and control, have led to the development of novel approaches for antigen presentation and adjuvant development targeted at AIDS vaccine development. The goal of developing a safe and effective AIDS vaccine will likely occur when continued advances in understanding the immunopathogenesis of HIV is balanced with a healthy dose of empirical testing of innovative candidate AIDS vaccines.
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Affiliation(s)
- W C Koff
- United Biomedical, Inc., Hauppauge, New York 11788, USA
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92
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Zhu T, Wang N, Carr A, Nam DS, Moor-Jankowski R, Cooper DA, Ho DD. Genetic characterization of human immunodeficiency virus type 1 in blood and genital secretions: evidence for viral compartmentalization and selection during sexual transmission. J Virol 1996; 70:3098-107. [PMID: 8627789 PMCID: PMC190172 DOI: 10.1128/jvi.70.5.3098-3107.1996] [Citation(s) in RCA: 342] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To explore the mechanism of sexual transmission of human immunodeficiency virus type 1 (HIV-1), we compared HIV-1 gp120 sequences in longitudinal samples from five acute seroconvertors with those from their corresponding sexual partners (transmitters). We used a quantitative homoduplex tracking assay to compare the overall genetic composition of HIV-1 quasispecies in each transmission pair and to track the transmitted viruses during the acute and asymptomatic stages of HIV-1 infection. In the chronically infected transmitters, HIV-1 variants in genital secretions differed from those in blood and variants in cells differed from those in cell-free plasma, indicating remarkable sequence heterogeneity in these subjects as well as compartmentalization of the virus in different bodily sites. Conversely, two of five seroconvertors had only a few related variants and three of five harbored only one viral population, indicating that in these subjects the transmitted viruses were typically homogeneous. Transmitted viruses were evident in the donor's seminal plasma (one of five cases) and even more so in their seminal cells (three of five cases), suggesting that both cell-associated and cell-free viruses can be transmitted. In every pair studied, the transmitted variant(s) represents only a minor population in the semen of the corresponding transmitter, thereby providing evidence that HIV-1 selection indeed occurs during sexual transmission.
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Affiliation(s)
- T Zhu
- Aaron Diamond AIDS Research Center, New York, New York 10016, USA
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93
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94
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Viza D. AIDS and transfer factor: myths, certainties and realities. BIOTHERAPY (DORDRECHT, NETHERLANDS) 1996; 9:17-26. [PMID: 8993753 DOI: 10.1007/bf02628652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
At the end of the 20th century, the triumph of biology is as indisputable as that of physics was at the end of the 19th century, and so is the might of the inductive thought. Virtually all diseases have been seemingly conquered and HIV, the cause of AIDS, has been fully described ten years after the onset of the epidemic. However, the triumph of biological science is far from being complete. The toll of several diseases, such as cancer, continues to rise and the pathogenesis of AIDS remains elusive. In the realm of inductive science, the dominant paradigm can seldom be challenged in a frontal attack, especially when it is apparently successful, and only what Kuhn calls "scientific revolutions" can overthrow it. Thus, it is hardly surprising that the concept of transfer factor is considered with contempt, and the existence of the moiety improbable: over forty years after the introduction of the concept, not only its molecular structure remains unknown, but also its putative mode of action contravenes dogmas of both immunology and molecular biology. And when facts challenge established dogmas, be in religion, philosophy or science, they must be suppressed. Thus, results of heterodox research become henceforth nisi-i.e., valid unless cause is shown for rescinding them, because they challenge the prevalent paradigm. However, when observations pertain to lethal disorders, their suppression in the name of dogmas may become criminal. Because of the failure of medical science to manage the AIDS pandemic, transfer factor, which has been successfully used for treating or preventing viral infections, may today overcome a priori prejudice and rejection more swiftly. In science, as in life, certainties always end up by dying, and Copernicus' vision by replacing that of Ptolemy.
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Affiliation(s)
- D Viza
- Laboratoire d'Immunobiologie, URA 1294 CNRS, Faculté de Médecine des Saints-Pères, Paris, France
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95
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Grady C, Kelly G. STATE OF THE SCIENCE. Nurs Clin North Am 1996. [DOI: 10.1016/s0029-6465(22)00387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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96
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Affiliation(s)
- Rosemary Ffrench
- Department of Clinical Immunology and AllergyWestmead HospitalSydneyNSW
| | - Graeme J Stewart
- Department of Clinical Immunology and AllergyWestmead HospitalSydneyNSW
| | | | - Jay A Levy
- University of California School of MedicineSan FranciscoCaliforniaUSA
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97
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Rudin C, Senn HP, Schaad UB. Transient infection in human immunodeficiency virus type 1-exposed infants. Pediatr Infect Dis J 1996; 15:182. [PMID: 8822301 DOI: 10.1097/00006454-199602000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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98
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Newell ML, Dunn D, De Maria A, Ferrazin A, De Rossi A, Giaquinto C, Levy J, Alimenti A, Ehrnst A, Bohlin AB. Detection of virus in vertically exposed HIV-antibody-negative children. Lancet 1996; 347:213-5. [PMID: 8551878 DOI: 10.1016/s0140-6736(96)90401-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND HIV-infected mothers can transmit their infection to their children in utero or at delivery (vertical transmission). There have been cases of children who were reported as acquiring infection vertically and later clearing the infection. We report the frequency of this phenomenon in a European cohort study. METHODS In four centres of the European Collaborative Study of children born to HIV-infected mothers, 299 children became HIV-antibody-negative and 264 of these had been followed up with virus culture and PCR for viral DNA at least once. FINDINGS Nine of the 264 children were positive by virus culture or PCR, and subsequently seroreverted. Two of the nine tested virus-positive after they became antibody-negative. Six cases were virus-positive early in life and became negative thereafter, which is consistent with clearance of infection. The pattern was less clear in the other three. The nine cases had had their last virus test at age 16-101 months. All nine children had been bottlefed only. Eight had been delivered vaginally. The children had no HIV-related symptoms and received no anti-HIV treatments. Based on only those children who had two or more positive virological tests, we estimate that 2.7% (6/219) cleared or "tolerated" the virus. INTERPRETATION The detection of virus or viral DNA in "uninfected" children born to HIV-infected mothers was rare and was not associated with clinical disease or immunological abnormalities. The timing of samples will affect the documentation of clearance since, in uninfected children of HIV-positive mothers who cleared the virus, viraemia was intermittent. Current paediatric opinion is to inform parents of children who serorevert that the child is not HIV-infected.
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99
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Haynes BF, Pantaleo G, Fauci AS. Toward an understanding of the correlates of protective immunity to HIV infection. Science 1996; 271:324-8. [PMID: 8553066 DOI: 10.1126/science.271.5247.324] [Citation(s) in RCA: 316] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Considerable progress has been made recently in understanding the genetic, immunologic and virologic factors in human immunodeficiency virus (HIV)-infected individuals who either rapidly progress or do not progress to acquired immunodeficiency syndrome (AIDS). In addition, detection of HIV-specific immune responses in HIV-negative individuals who have been exposed to the virus multiple times suggests that natural immune responses to HIV may be protective in rare individuals. Understanding the correlates of protective immunity to HIV infection is critical to efforts to develop preventive HIV vaccines as well as to determine the feasibility of treating HIV infection by boosting immunity to HIV.
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Affiliation(s)
- B F Haynes
- Department of Medicine, Duke Medical Center, Durham, NC 27710, USA
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100
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Shearer GM, Clerici M. Protective immunity against HIV infection: has nature done the experiment for us? IMMUNOLOGY TODAY 1996; 17:21-4. [PMID: 8652046 DOI: 10.1016/0167-5699(96)80564-0] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G M Shearer
- National Cancer Institute, Bethesda, MD 20892, USA.
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