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Moosa Y, Tanko RF, Ramsuran V, Singh R, Madzivhandila M, Yende-Zuma N, Abrahams MR, Selhorst P, Gounder K, Moore PL, Williamson C, Abdool Karim SS, Garrett NJ, Burgers WA. Case report: mechanisms of HIV elite control in two African women. BMC Infect Dis 2018; 18:54. [PMID: 29370775 PMCID: PMC5785875 DOI: 10.1186/s12879-018-2961-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 01/15/2018] [Indexed: 11/21/2022] Open
Abstract
Background The majority of people living with HIV require antiretroviral therapy (ART) for controlling viral replication, however there are rare HIV controllers who spontaneously and durably control HIV in the absence of treatment. Understanding what mediates viral control in these individuals has provided us with insights into the immune mechanisms that may be important to induce for a vaccine or functional cure for HIV. To date, few African elite controllers from high incidence settings have been described. We identified virological controllers from the CAPRISA 002 cohort of HIV-1 subtype C infected women in KwaZulu Natal, South Africa, two (1%) of whom were elite controllers. We examined the genetic, clinical, immunological and virological characteristics of these two elite HIV controllers in detail, to determine whether they exhibit features of putative viral control similar to those described for elite controllers reported in the literature. Case presentation In this case report, we present clinical features, CD4+ T cell and viral load trajectories for two African women over 7 years of HIV infection. Viral load became undetectable 10 months after HIV infection in Elite Controller 1 (EC1), and after 6 weeks in Elite Controller 2 (EC2), and remained undetectable for the duration of follow-up, in the absence of ART. Both elite controllers expressed multiple HLA Class I and II haplotypes previously associated with slower disease progression (HLA-A*74:01, HLA-B*44:03, HLA-B*81:01, HLA-B*57:03, HLA-DRB1*13). Fitness assays revealed that both women were infected with replication competent viruses, and both expressed higher mRNA levels of p21, a host restriction factor associated with viral control. HIV-specific T cell responses were examined using flow cytometry. EC1 mounted high frequency HIV-specific CD8+ T cell responses, including a B*81:01-restricted Gag TL9 response. Unusually, EC2 had evidence of pre-infection HIV-specific CD4+ T cell responses. Conclusion We identified some features typical of elite controllers, including high magnitude HIV-specific responses and beneficial HLA. In addition, we made the atypical finding of pre-infection HIV-specific immunity in one elite controller, that may have contributed to very early viral control. This report highlights the importance of studying HIV controllers in high incidence settings. Electronic supplementary material The online version of this article (10.1186/s12879-018-2961-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yumna Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Ramla F Tanko
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Veron Ramsuran
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Cancer Inflammation Program, Laboratory of Experimental Immunology, Leidos-Frederick, Incorporated, Frederick National Laboratory for Cancer Research, Frederick, USA
| | - Ravesh Singh
- Department of Microbiology, National Health Laboratory Services, KZN Academic Complex, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Mashudu Madzivhandila
- Centre for HIV and STIs, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Melissa-Rose Abrahams
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Philippe Selhorst
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kamini Gounder
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Penny L Moore
- Centre for HIV and STIs, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carolyn Williamson
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nigel J Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - Wendy A Burgers
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Zhang W, Ambikan AT, Sperk M, van Domselaar R, Nowak P, Noyan K, Russom A, Sönnerborg A, Neogi U. Transcriptomics and Targeted Proteomics Analysis to Gain Insights Into the Immune-control Mechanisms of HIV-1 Infected Elite Controllers. EBioMedicine 2018; 27:40-50. [PMID: 29269040 PMCID: PMC5828548 DOI: 10.1016/j.ebiom.2017.11.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/22/2017] [Accepted: 11/30/2017] [Indexed: 12/21/2022] Open
Abstract
A small subset of HIV-1 infected individuals, the "Elite Controllers" (EC), can control viral replication and restrain progression to immunodeficiency without antiretroviral therapy (ART). In this study, a cross-sectional transcriptomics and targeted proteomics analysis were performed in a well-defined Swedish cohort of untreated EC (n=19), treatment naïve patients with viremia (VP, n=32) and HIV-1-negative healthy controls (HC, n=23). The blood transcriptome identified 151 protein-coding genes that were differentially expressed (DE) in VP compared to EC. Genes like CXCR6 and SIGLEC1 were downregulated in EC compared to VP. A definite distinction in gene expression between males and females among all patient-groups were observed. The gene expression profile between female EC and the healthy females was similar but did differ between male EC and healthy males. At targeted proteomics analysis, 90% (29/32) of VPs clustered together while EC and HC clustered separately from VP. Among the soluble factors, 33 were distinctive to be statistically significant (False discovery rate=0.02). Cell surface receptor signaling pathway, programmed cell death, response to cytokine and cytokine-mediated signaling seem to synergistically play an essential role in HIV-1 control in EC.
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Affiliation(s)
- Wang Zhang
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Solna, Stockholm, Sweden
| | - Anoop T Ambikan
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maike Sperk
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Robert van Domselaar
- Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Piotr Nowak
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kajsa Noyan
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aman Russom
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Solna, Stockholm, Sweden
| | - Anders Sönnerborg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ujjwal Neogi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Solna, Stockholm, Sweden.
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53
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Lang R, Charlton C, Beckthold B, Kadivar K, Lavoie S, Caswell D, Levett PN, Horsman GB, Kim J, Gill MJ. HIV misdiagnosis: A root cause analysis leading to improvements in HIV diagnosis and patient care. J Clin Virol 2017; 96:84-88. [PMID: 29031156 DOI: 10.1016/j.jcv.2017.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/27/2017] [Accepted: 10/07/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standard diagnostic testing for HIV infection has traditionally relied on a high sensitivity HIV antibody screening test using an enzyme-linked immunosorbent assay (ELISA) followed by a high specificity antibody confirmatory test such as a Western Blot. Recently several of the screening assays have been enhanced with an ability to identify p24 antigen thereby narrowing the diagnostic window. OBJECTIVES To explore the implications of enhanced HIV screening methods that may be leading to HIV misdiagnoses. STUDY DESIGN A patient deemed to be an HIV infected 'elite controller' was found to be misdiagnosed when undergoing detailed investigations prior to initiating antiretroviral therapy. A root cause analysis was performed to identify the causative factors of this misdiagnosis. A retrospective review of all "elite controllers" in Alberta, Canada revealed challenges of current HIV testing algorithms. RESULTS Technical and human factors were identified as being causative in this HIV misdiagnosis including (i) high rates of false reactive results on the Abbott ARCHITECT HIV-1&2 COMBO EIA, (ii) human error in reading the initial Western blot, (iii) HIV algorithmic directives in which confirmatory (Western blot) testing was not performed on a repeatedly reactive screen test. The outcome of this analysis identified opportunities for improvement, including implementation of a newly approved (automated) confirmatory assay and improved communication between the clinician and laboratory. CONCLUSIONS HIV testing remains problematic despite significant advances in HIV test performance and algorithm development, presenting new and unexpected issues. Ensuring a high-quality management system including implementation of the latest HIV technologies and algorithms along with human resources and policies are required to minimize the impact of false positive diagnoses, especially in the era of universal screening and 'test and treat' recommendations.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Carmen Charlton
- Department of Laboratory Medicine and Pathology University of Alberta, Edmonton, Canada; Provincial Laboratory of Public Health, Edmonton, Canada
| | | | - Kiana Kadivar
- National HIV Reference Laboratory, National Microbiology Laboratory, Winnipeg, Canada
| | - Stephanie Lavoie
- National HIV Reference Laboratory, National Microbiology Laboratory, Winnipeg, Canada
| | - Debbie Caswell
- Saskatchewan Disease Control Laboratory, Ministry of Health, Regina, Saskatchewan, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Ministry of Health, Regina, Saskatchewan, Canada
| | - Greg B Horsman
- Saskatchewan Disease Control Laboratory, Ministry of Health, Regina, Saskatchewan, Canada
| | - John Kim
- National HIV Reference Laboratory, National Microbiology Laboratory, Winnipeg, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Canada; Southern Alberta HIV Clinic, Calgary, Canada.
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54
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Richer gut microbiota with distinct metabolic profile in HIV infected Elite Controllers. Sci Rep 2017; 7:6269. [PMID: 28740260 PMCID: PMC5524949 DOI: 10.1038/s41598-017-06675-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/15/2017] [Indexed: 12/11/2022] Open
Abstract
Gut microbiota dysbiosis features progressive HIV infection and is a potential target for intervention. Herein, we explored the microbiome of 16 elite controllers (EC), 32 antiretroviral therapy naive progressors and 16 HIV negative controls. We found that the number of observed genera and richness indices in fecal microbiota were significantly higher in EC versus naive. Genera Succinivibrio, Sutterella, Rhizobium, Delftia, Anaerofilum and Oscillospira were more abundant in EC, whereas Blautia and Anaerostipes were depleted. Additionally, carbohydrate metabolism and secondary bile acid synthesis pathway related genes were less represented in EC. Conversely, fatty acid metabolism, PPAR-signalling and lipid biosynthesis proteins pathways were enriched in EC vs naive. The kynurenine pathway of tryptophan metabolism was altered during progressive HIV infection, and inversely associated with microbiota richness. In conclusion, EC have richer gut microbiota than untreated HIV patients, with unique bacterial signatures and a distinct metabolic profile which may contribute to control of HIV.
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55
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Gomes STM, Gomes ÉR, Dos Santos MB, Lima SS, Queiroz MAF, Machado LFA, Cayres-Vallinoto IMV, Vallinoto ACR, de O Guimarães Ishak M, Ishak R. Immunological and virological characterization of HIV-1 viremia controllers in the North Region of Brazil. BMC Infect Dis 2017; 17:381. [PMID: 28571570 PMCID: PMC5455094 DOI: 10.1186/s12879-017-2491-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 12/30/2022] Open
Abstract
Background A rare phenotype of clinical non-progressors to AIDS is not well understood and the new protocol for universal treatment, may block the understanding of viral control thus it is crucial to define this controversial group. Methods A cohort of 30 persons followed a criteria for viremia control groups 1 (VC1; n = 2) and 2 (VC2; n = 7) and non-viral controllers (NC; n = 21) including number of years of diagnosis, LTCD4+, LTCD8+ counts, plasma viral load and the absence of ART; 241 uninfected control persons were matched to age and sex. Infected persons were regularly examined and submitted to two or three annual laboratory measurements. Polymorphisms and allele frequencies of CCR5Δ32 and SDF1–3’A were detected in the genomic DNA. Plasma levels of cytokines (IL-2, IL-4, IL-5, IL-9, IL-10, IL-13, IL-17 and IFN-y) were measured. Results The group investigated is originated from a miscigenetic population and demographic and social characteristics were not significantly relevant. LTCD4+ median values were higher among VC than NC, but significantly lower than uninfected controls. Evolution of LTCD4+ and LTCD8+ counts, showed a slight increase of LTCD4+ among VC, but a significant decrease in the NC. The percentage of annual change in LTCD4+ was also significantly different between the groups. LTCD4+/LTCD8+ ratio was inverted but not significant among the VC, thus the ratio may be a useful biomarker for the VC. A clear signature indicated a change from Th1 to Th2 cytokine profiles from VC to NC, respectively. Conclusions The knowledge of viral controllers characteristics in different population groups is important to define a strict universal definition for the sake of learning about the pathogenesis of HIV-1. Data on LTCD4+ seems to be stable and repetitive from published data, but the LTCD8+ response and the significance of LTCD4+/LTCD8+ ratio values are in need to further exploration as biomarkers. The change from Th1 to Th2 cytokine profile may help to design and adjust specific treatment protocols for the group.
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Affiliation(s)
- Samara Tatielle M Gomes
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Érica R Gomes
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Mike B Dos Santos
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Sandra S Lima
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Maria Alice F Queiroz
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Luiz Fernando A Machado
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Izaura M V Cayres-Vallinoto
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Antonio Carlos R Vallinoto
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Marluísa de O Guimarães Ishak
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil
| | - Ricardo Ishak
- Federal University of Para, Institute of Biological Sciences, Virus Laboratory, Campus Belem, Belem, Para, 66000-000, Brazil.
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Abstract
OBJECTIVES HIV-1-infected persons spontaneously controlling viremia without treatment (SCV) are rare. Sex and race effects on prevalence and outcome are poorly defined, and it is unclear whether SCV qualitatively or quantitatively differs from typical infection. These issues are examined in this article. DESIGN Medical records of 46 524 persons receiving outpatient care for HIV-1 infection were reviewed. Of these, 29 811 had adequate viremia testing for SCV screening. METHODS SCV was defined as at least three consecutive plasma viremia measurements <50 RNA copies/ml spanning at least 1 year without treatment. SCV loss was defined as at least three consecutive viremia measurements ≥50 RNA copies/ml or one ≥1000 RNA copies/ml. Demographics of persons with SCV were compared with the total population. Viremia and blood CD4 T-cell levels during SCV were compared between demographic subgroups and persons who maintained or lost SCV during observation. RESULTS In total, 53 persons (0.18%) met SCV criteria. Prevalence was higher for women versus men and blacks versus whites; these appeared independent. Loss of SCV was observed at 1.22% per year, and significantly associated with viremia 'blips'. Blip magnitudes fit log-normal distributions with means below 50 RNA copies/ml. CONCLUSION Our novel observation of higher SCV prevalence in women and blacks is consistent with prior studies of typical chronic infection. Viremia blips correspond to greater risk of loss of SCV, likely reflecting higher set-point viremia under the limit of detection. Our findings suggest that SCV represents an extreme along a continuum of HIV-1 infection, and not qualitative difference.
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Zhang W, Morshed MM, Noyan K, Russom A, Sönnerborg A, Neogi U. Quantitative humoral profiling of the HIV-1 proteome in elite controllers and patients with very long-term efficient antiretroviral therapy. Sci Rep 2017; 7:666. [PMID: 28386076 PMCID: PMC5429677 DOI: 10.1038/s41598-017-00759-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/09/2017] [Indexed: 12/31/2022] Open
Abstract
A major challenge in evaluating the success of HIV eradication approaches is the need for accurate measurement of persistent HIV during effective antiretroviral therapy (ART). Previous studies have reported that the anti-HIV antibody assay “luciferase immuno-precipitation systems (LIPS)” can distinguish HIV-infected individuals harboring different sizes of the viral reservoirs. We performed antibody profiling of HIV-1 proteomes using LIPS in viremic progressors (n = 38), elite controllers (ECs; n = 19) and patients with fully suppressive long-term antiretroviral therapy (ART) (n = 19) (mean 17 years). IgG was quantified against six HIV-1 fusion proteins: p24, gp41, RT, Tat, integrase and protease. Lower antibody levels to all six-fusion proteins were observed in long-term ART patients compared to viremics (p < 0.05). In contrast ECs had lower antibody levels only against Tat and Integrase (p < 0.05). Principal component analysis and cluster-network analysis identified that 68% (13/19) of the long-term ART patients clustered together with 26% (5/19) ECs. The remaining ECs clustered together with the viremics indicating non-homogeneity among the ECs. The low anti-HIV levels in the long-term treated patients may indicate a restricted remaining viral replication. In contrast, the higher levels in ECs suggest a continuous viral expression with a limited concomitant release of extracellular virus.
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Affiliation(s)
- Wang Zhang
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Solna, Stockholm, Sweden
| | - Mohammed M Morshed
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Kajsa Noyan
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Aman Russom
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Solna, Stockholm, Sweden
| | - Anders Sönnerborg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ujjwal Neogi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.
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58
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Canouï E, Lécuroux C, Avettand-Fenoël V, Gousset M, Rouzioux C, Saez-Cirion A, Meyer L, Boufassa F, Lambotte O, Noël N. A Subset of Extreme Human Immunodeficiency Virus (HIV) Controllers Is Characterized by a Small HIV Blood Reservoir and a Weak T-Cell Activation Level. Open Forum Infect Dis 2017; 4:ofx064. [PMID: 28584850 PMCID: PMC5450900 DOI: 10.1093/ofid/ofx064] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/30/2017] [Indexed: 11/15/2022] Open
Abstract
Background Human immunodeficiency virus controllers (HICs) form a heterogeneous group of patients with regard to formal definitions, immunologic characteristics, and changes over time in viral load. Patients and Methods The HICs with undetectable viral load ([uHICs] ie, for whom a viral load had never been detected with routine assays; n = 52) were compared with 178 HICs with blips during the follow up (bHICs). Clinical characteristics, ultrasensitive HIV-ribonucleic acid (RNA) and HIV-deoxyribonucleic acid (DNA) loads, HIV1-Western blot profiles, and immune parameters were analyzed. Results Relative to bHICs, uHICs had significantly lower ultrasensitive plasma HIV-RNA loads (P < .0001) and HIV-DNA levels in peripheral blood mononuclear cells (P = .0004), higher CD4+ T-cell count (P = .04) at enrollment, and lower T-cell activation levels. Between diagnosis and inclusion in the cohort, the CD4+ T-cell count had not changed in uHICs but had significantly decreased in bHICs. Twenty-one percent of the uHICs lacked specific anti-HIV immunoglobulin G antibodies, and these individuals also had very low levels of HIV-DNA. Half of the uHICs had a protective human leukocyte antigen (HLA) allele (-B57/58/B27), a weak CD8+ T-cell response, and very small HIV-DNA reservoir. Conclusions We suggest that an interesting HIC phenotype combines protective HLA alleles, low level of HIV blood reservoirs, and reduced immune activation. Prospective studies aimed at evaluating the benefit of combined antiretroviral therapy in HICs might take into account the identification of uHICs and bHICs.
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Affiliation(s)
- Etienne Canouï
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin-Bicêtre, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Direction des sciences du vivant/Institut des maladies émergentes et des thérapies innovantes (DSV/iMETI), Division of Immuno-Virology, Infectious Disease Models and Innovative Therapies (IDMIT), France.,Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Camille Lécuroux
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin-Bicêtre, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Direction des sciences du vivant/Institut des maladies émergentes et des thérapies innovantes (DSV/iMETI), Division of Immuno-Virology, Infectious Disease Models and Innovative Therapies (IDMIT), France.,Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Véronique Avettand-Fenoël
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France AP-HP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Marine Gousset
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France AP-HP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Christine Rouzioux
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France AP-HP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Asier Saez-Cirion
- Institut Pasteur, Unité HIV Inflammation et Persistance, Paris, France
| | - Laurence Meyer
- Université Paris Sud, Le Kremlin-Bicêtre, France.,INSERM CESP U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Le Kremlin-Bicêtre, France; and.,AP-HP, Service d'Epidémiologie et de Santé Publique, Hôpitaux Universitaires Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Faroudy Boufassa
- Université Paris Sud, Le Kremlin-Bicêtre, France.,INSERM CESP U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Le Kremlin-Bicêtre, France; and
| | - Olivier Lambotte
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin-Bicêtre, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Direction des sciences du vivant/Institut des maladies émergentes et des thérapies innovantes (DSV/iMETI), Division of Immuno-Virology, Infectious Disease Models and Innovative Therapies (IDMIT), France.,Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Nicolas Noël
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin-Bicêtre, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Direction des sciences du vivant/Institut des maladies émergentes et des thérapies innovantes (DSV/iMETI), Division of Immuno-Virology, Infectious Disease Models and Innovative Therapies (IDMIT), France.,Université Paris Sud, Le Kremlin-Bicêtre, France
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Wirden M, Charpentier C, Tubiana R, Le MP, Desire N, Dionou S, Pichon F, Valantin MA, Yasdanpanah Y, Descamps D, Peytavin G, Katlama C, Calvez V, Marcelin AG. HIV-1 diagnosis with unquantifiable viraemia: don't be naive, look for antiretroviral drugs. J Antimicrob Chemother 2016; 72:630-632. [PMID: 27999067 DOI: 10.1093/jac/dkw474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marc Wirden
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Charlotte Charpentier
- INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Roland Tubiana
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Minh Patrick Le
- AP-HP, Groupe Hospitalier X Bichat-C Bernard, laboratoire de toxicologie, Paris, France
| | - Nathalie Desire
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
| | - Sie Dionou
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Interne, Paris, France
| | - François Pichon
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Interne, Paris, France
| | - Marc Antoine Valantin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Yazdan Yasdanpanah
- INSERM UMR1137, Université Paris Diderot, AP-HP, Service des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Paris, France
| | - Diane Descamps
- INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Gilles Peytavin
- AP-HP, Groupe Hospitalier X Bichat-C Bernard, laboratoire de toxicologie, Paris, France
| | - Christine Katlama
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Vincent Calvez
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Anne-Genevieve Marcelin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
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Scarpelini B, Zanoni M, Sucupira MCA, Truong HHM, Janini LMR, Segurado IDC, Diaz RS. Plasma Metabolomics Biosignature According to HIV Stage of Infection, Pace of Disease Progression, Viremia Level and Immunological Response to Treatment. PLoS One 2016; 11:e0161920. [PMID: 27941971 PMCID: PMC5152829 DOI: 10.1371/journal.pone.0161920] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/15/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We evaluated plasma samples HIV-infected individuals with different phenotypic profile among five HIV-infected elite controllers and five rapid progressors after recent HIV infection and one year later and from 10 individuals subjected to antiretroviral therapy, five of whom were immunological non-responders (INR), before and after one year of antiretroviral treatment compared to 175 samples from HIV-negative patients. A targeted quantitative tandem mass spectrometry metabolomics approach was used in order to determine plasma metabolomics biosignature that may relate to HIV infection, pace of HIV disease progression, and immunological response to treatment. RESULTS Twenty-five unique metabolites were identified, including five metabolites that could distinguish rapid progressors and INRs at baseline. Severe deregulation in acylcarnitine and sphingomyelin metabolism compatible with mitochondrial deficiencies was observed. β-oxidation and sphingosine-1-phosphate-phosphatase-1 activity were down-regulated, whereas acyl-alkyl-containing phosphatidylcholines and alkylglyceronephosphate synthase levels were elevated in INRs. Evidence that elite controllers harbor an inborn error of metabolism (late-onset multiple acyl-coenzyme A dehydrogenase deficiency [MADD]) was detected. CONCLUSIONS Blood-based markers from metabolomics show a very high accuracy of discriminating HIV infection between varieties of controls and have the ability to predict rapid disease progression or poor antiretroviral immunological response. These metabolites can be used as biomarkers of HIV natural evolution or treatment response and provide insight into the mechanisms of the disease.
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Affiliation(s)
- Bruno Scarpelini
- Federal University of Sao Paulo, Department of Medicine, Sao Paulo—SP, Brazil
| | - Michelle Zanoni
- Federal University of Sao Paulo, Department of Medicine, Sao Paulo—SP, Brazil
| | | | - Hong-Ha M. Truong
- University of California at San Francisco, Department of Medicine, San Francisco, CA, United States of America
| | - Luiz Mario Ramos Janini
- Federal University of Sao Paulo, Department of Medicine, Sao Paulo—SP, Brazil
- Federal University of Sao Paulo, Department of Microbiology, Sao Paulo—SP, Brazil
| | | | - Ricardo Sobhie Diaz
- Federal University of Sao Paulo, Department of Medicine, Sao Paulo—SP, Brazil
- * E-mail:
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Kim AA, Mukui I, Young PW, Mirjahangir J, Mwanyumba S, Wamicwe J, Bowen N, Wiesner L, Ng’ang’a L, De Cock KM. Undisclosed HIV infection and antiretroviral therapy use in the Kenya AIDS indicator survey 2012: relevance to national targets for HIV diagnosis and treatment. AIDS 2016; 30:2685-2695. [PMID: 27782965 PMCID: PMC6559732 DOI: 10.1097/qad.0000000000001227] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This analysis assessed the impact of undisclosed HIV infection and antiretroviral therapy (ART) on national estimates of diagnosed HIV and ART coverage in Kenya. METHODS HIV-positive dried blood spot samples from Kenya's second AIDS Indicator Survey were tested for an antiretroviral biomarker by liquid chromatography-tandem mass spectrometry. Weighted estimates of diagnosed HIV and ART coverage based on self-report were compared with those corrected for undisclosed HIV infection and ART use based on antiretroviral test results. Multivariate analysis determined factors associated with undisclosed HIV infection and ART use among persons on ART. RESULTS The antiretroviral biomarker was detected in 42.5% [confidence interval (CI) 37.4-47.7] of HIV-infected persons. Antiretroviral drugs were present in 90.7% (CI 86.1-95.2) of HIV-infected persons reporting HIV-positive status and receiving ART, 66.7% (CI 59.9-73.4) reporting HIV-positive status irrespective of ART use, 21.0% (CI 13.4-28.6) reporting HIV-negative status, and 19.3% (CI 9.0-29.5) reporting no previous HIV test. After correcting for undisclosed HIV infection and ART use, diagnosed HIV increased from 46.9 to 57.2% and ART coverage increased from 31.8 to 42.8%. Undisclosed HIV infection while on ART was associated with being aged 25-39 years and not visiting a health provider in the past year, while younger age and higher wealth were associated with undisclosed ART use. CONCLUSION Substantial levels of undisclosed HIV infection and ART use among persons on ART were observed, resulting in diagnosed HIV underestimated by approximately 112000 persons and ART coverage by approximately 131000 persons. Supplementing self-reported ART status with objective measures of ART use in national population-based serosurveys can improve monitoring of HIV diagnosis and treatment targets in countries.
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Affiliation(s)
- Andrea A. Kim
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
| | - Irene Mukui
- Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Peter W. Young
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
| | - Joy Mirjahangir
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sophie Mwanyumba
- Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Joyce Wamicwe
- Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Nancy Bowen
- Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucy Ng’ang’a
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
| | - Kevin M. De Cock
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi
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Yaseen MM, Yaseen MM, Alqudah MA. Broadly neutralizing antibodies: An approach to control HIV-1 infection. Int Rev Immunol 2016; 36:31-40. [PMID: 27739924 DOI: 10.1080/08830185.2016.1225301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although available antiretroviral therapy (ART) has changed human immunodeficiency virus (HIV)-1 infection to a non-fatal chronic disease, the economic burden of lifelong therapy, severe adverse ART effects, daily ART adherence, and emergence of ART-resistant HIV-1 mutants require prospecting for alternative therapeutic modalities. Indeed, a growing body of evidence suggests that broadly neutralizing anti-HIV-1 antibodies (BNAbs) may offer one such feasible alternative. To evaluate their therapeutic potential in established HIV-1 infection, we sought to address recent advances in pre-clinical and clinical investigations in this area of HIV-1 research. In addition, we addressed the obstacles that may impede the success of such immunotherapeutic approach, suggested strategic solutions, and briefly compared this approach with the currently used ART to open new insights for potential future passive immunotherapy for HIV-1 infection.
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Affiliation(s)
- Mahmoud Mohammad Yaseen
- a Department of Medical Laboratory Sciences , College of Applied Medical Sciences, Jordan University of Science and Technology , Irbid , Jordan
| | - Mohammad Mahmoud Yaseen
- b Department of Public Health, College of Nursing , University of Benghazi , Benghazi , Libya
| | - Mohammad Ali Alqudah
- c Department of Clinical Pharmacy , College of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
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Watters SA, Mlcochova P, Maldarelli F, Goonetilleke N, Pillay D, Gupta RK. Sequential CCR5-Tropic HIV-1 Reactivation from Distinct Cellular Reservoirs following Perturbation of Elite Control. PLoS One 2016; 11:e0158854. [PMID: 27403738 PMCID: PMC4942039 DOI: 10.1371/journal.pone.0158854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/22/2016] [Indexed: 12/31/2022] Open
Abstract
Background HIV Elite Controllers may reveal insights into virus persistence given they harbour small reservoir sizes, akin to HIV non-controllers treated early with combination antiretroviral therapy. Both groups of patients represent the most promising candidates for interventions aimed at sustained remission or ‘cure’. Analytic treatment interruption (ATI) in the latter group leads to stochastic rebound of virus, though it is unclear whether loss of elite control is also associated with similar rebound characteristics. Methods We studied three discrete periods of virus rebound during myeloma related immune disruption over 2.5 years in an elite controller who previously underwent autologous stem cell transplantation (ASCT) in the absence of any antiretroviral therapy. Single genome sequencing of the V1-V4 region of env in PBMC and plasma was performed and phylogenies reconstructed. Average pairwise distance (APD) was calculated and non-parametric methods used to assess compartmentalisation. Coreceptor usage was predicted based on genotypic algorithms. Results 122 single genome sequences were obtained (median 26 sequences per rebound). The initial rebounding plasma env sequences following ASCT represented two distinct lineages, and clustered with proviral DNA sequences isolated prior to ASCT. One of the lineages was monophyletic, possibly indicating reactivation from clonally expanded cells. The second rebound occurred 470 days after spontaneous control of the first rebound and was phylogenetically distinct from the first, confirmed by compartmentalisation analysis, with a different cellular origin rather than ongoing replication. By contrast, third rebound viruses clustered with second rebound viruses, with evidence for ongoing evolution that was associated with lymphopenia and myeloma progression. Following ASCT a shift in tropism from CXCR4-tropic viruses to a CCR5-tropic population was observed to persist through to the third rebound. Conclusions Our data highlight similarities in the viral reservoir between elite and non-controllers undergoing ATI following allogeneic transplantation. The lack of propagation of CXCR4 using viruses following transplantation warrants further study.
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Affiliation(s)
- Sarah A. Watters
- Division of Infection and Immunity, University College London, London, United Kingdom
- HIV Dynamics and Replication Program, NCI, Frederick, Maryland, United States of America
| | - Petra Mlcochova
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Frank Maldarelli
- HIV Dynamics and Replication Program, NCI, Frederick, Maryland, United States of America
| | - Nilu Goonetilleke
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, United Kingdom
- Africa Centre for Health and Population Studies, Durban, KwaZulu-Natal, South Africa
| | - Ravindra K. Gupta
- Division of Infection and Immunity, University College London, London, United Kingdom
- * E-mail:
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Platten M, Jung N, Trapp S, Flossdorf P, Meyer-Olson D, Schulze zur Wiesch J, Stephan C, Mauss S, Weiss V, von Bergwelt-Baildon M, Rockstroh J, Fätkenheuer G, Lehmann C. Cytokine and Chemokine Signature in Elite Versus Viremic Controllers Infected with HIV. AIDS Res Hum Retroviruses 2016; 32:579-87. [PMID: 26751176 DOI: 10.1089/aid.2015.0226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
HIV long-term nonprogressors (LTNPs) maintaining high CD4(+) T-cell counts without antiretroviral therapy (ART) are divided into elite controllers (ECs) with undetectable and viremic controllers (VCs) with low viral loads. Little is known about the long-term changes of T-cell subsets and inflammation patterns in ECs versus VCs. The aim of the study was to explore the long-term evolution of CD4(+) T-cell levels in LTNPs and to analyze cytokine profiles in ECs versus VCs. Nineteen ECs and 15 VCs were enrolled from the natural virus controller cohort (NaViC). T-cell counts were monitored over years, the mean annual change was calculated, and plasma concentrations of 25 cytokines were evaluated using a multiplex bead array. While absolute numbers of T cells did not differ between ECs and VCs over time, we observed a significant decrease of CD4(+) T-cell percentages in VCs, but not in ECs (median [interquartile range]: ECs: 37% [28-41] vs. VCs: 29% [25-34]; p = .02). ECs had lower levels of macrophage inflammatory protein-1β (MIP-1β, p = .003), interferon γ-induced protein-10 (IP-10, p = .03), and monokine induced by interferon-γ (MIG, p = .02). CD4(+) T-cell percentages inversely correlated with MIP 1-β (r = -0.42, p = .017) and IP-10 (r = -0.77, p < .0001). A subtle decline of CD4(+) T-cell percentages could be observed in VCs, but not in ECs, which was associated with higher plasma levels of proinflammatory cytokines. Hence, even low levels of HIV replication might go along with a progressive decline in CD4(+) T-cell counts in LTNPs.
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Affiliation(s)
- Martin Platten
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Norma Jung
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Susanna Trapp
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Pia Flossdorf
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Dirk Meyer-Olson
- Department of Internal Medicine and Rheumatology, m&i Specialty Hospital Bad Pyrmont, Bad Pyrmont, Germany
| | - Julian Schulze zur Wiesch
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Infectious Disease Unit, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Dusseldorf, Germany
| | - Verena Weiss
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | | | - Jürgen Rockstroh
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Department of Medicine, University Medical Center, Bonn, Germany
| | - Gerd Fätkenheuer
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Clara Lehmann
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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Abstract
BACKGROUND The proportion of HIV controllers developing virologic, immunological or clinical progression and the baseline predictors of these outcomes have not been assessed in large cohorts. METHODS A multicenter cohort of HIV controllers was followed from baseline (the first of the three HIV-1 RNA levels < 50 in elite controller or from 50 to 2000 copies/ml in viremic controllers) up to August 2011, to the development of a progression event (loss of viral load control, CD4 decline, AIDS or death) or to the censoring date (lost to follow-up or initiation of antiretroviral therapy). Predictive models of progression at baseline and a risk score for the combined HIV-1 progression end point were calculated. RESULTS Four hundred and seventy-five HIV-1 controllers of whom 204 (42.9%) were elite controller with 2972 person-years of follow-up were identified. One hundred and forty-one (29.7%) patients lost viral load control. CD4 cell count declined in 229 (48.2%) patients. Thirteen patients developed an AIDS event and four died. Two hundred and eighty-seven (60.4%) developed a combined HIV-1 progression. Baseline predictors for the progression end points and for elite and viremic controller patients were very similar: risk for HIV-1 acquisition, baseline calendar year, CD4 nadir, viral load before baseline and hepatitis C virus coinfection. The probability of a combined HIV-1 progression at 5 years was 70% for elite controllers with the highest score compared with 13% for those with the lowest. CONCLUSION HIV-1 disease progression in elite and viremic controllers is frequent. We propose a baseline clinical score to easily classify these patients according to risk of progression. This score could be instrumental for taking clinical decisions and performing pathogenic studies.
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Rabie H, Cotton MF. Hope of post-treatment control after perinatal infection? Lancet HIV 2015; 3:e6-8. [PMID: 26762995 DOI: 10.1016/s2352-3018(15)00245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Helena Rabie
- Department of Paediatrics and Child Health and Family Clinical Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.
| | - Mark F Cotton
- Department of Paediatrics and Child Health and Family Clinical Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
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Zaidi A, Meng Q, Popkin D. Can We Repurpose FDA-Approved Alefacept to Diminish the HIV Reservoir? IMMUNOTHERAPY (LOS ANGELES, CALIF.) 2015; 1:104. [PMID: 27110598 PMCID: PMC4841618 DOI: 10.4172/imt.1000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Current anti-retroviral treatment (ART) for HIV is effective in maintaining HIV at undetectable levels. However, cessation of ART results in immediate and brisk rebound of viremia to high levels. This rebound is driven by an HIV reservoir mainly enriched in memory CD4+ T cells. In order to provide any form of functional HIV Cure, elimination of this viral reservoir has become the focus of current HIV cure strategies. Alefacept was initially developed for the treatment of chronic plaque psoriasis. Alefacept is a chimeric fusion protein consisting of the CD2-binding portion of human leukocyte function antigen-3 (LFA3) linked to the Fc region of human IgG1 (LFA3-Fc). Alefacept was designed to inhibit memory T cell activation that contributes to the chronic autoimmune disease psoriasis by blocking the CD2 coreceptor. However, it was found to deplete memory T cells that express high levels of CD2 via NK cell-mediated antibody dependent cell cytotoxicity (ADCC) in vivo. Phase II and phase III clinical trials of alefacept with psoriasis patients demonstrated promising results and an excellent safety profile. Subsequently, alefacept has been successfully repurposed for other memory T cell-mediated autoimmune diseases including skin diseases other than psoriasis, organ transplantation and type I diabetes (T1D). Herein, we review our specific strategy to repurpose the FDA approved biologic alefacept to decrease and hopefully someday eliminate the HIV reservoir, for which CD2hi memory CD4+ T cells are a significant contributor.
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Affiliation(s)
- Asifa Zaidi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Qinglai Meng
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Daniel Popkin
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Abstract
BACKGROUND HIV elite controllers suppress HIV viremia without antiretroviral therapy (ART), yet previous studies demonstrated that elite controllers maintain an activated T-cell phenotype. Chronic immune activation has detrimental consequences and thus ART has been advocated for all elite controllers. However, elite controllers are not a clinically homogenous group. Since CD4% is among the best predictors of AIDS-related events, in the current study, we assessed whether this marker can be used to stratify elite controllers needing ART. METHODS Sixteen elite controllers were divided into two groups based on CD4% (EC > 40% and EC ≤40%), and T-cell subsets were analyzed for markers of memory/differentiation (CD45RA, CCR7, CD28), activation (CD38/HLA-DR), immunosenescence (CD57), costimulation (CD73, CD28) and exhaustion (PD-1, CD160, Tim-3). Monocyte subsets (CD14, CD16) were also analyzed and sCD14 levels were quantified using ELISA. RESULTS In the EC group, expression of activation, exhaustion, and immunosensescence markers on T cells were significantly reduced compared with the EC group and similar to the seronegative controls. The EC group expressed higher levels of costimulatory molecules CD28 and CD73 and had lower levels of monocyte activation (HLA-DR expression) with a reduced frequency of inflammatory monocyte (CD14 CD16) subset. Furthermore, the EC group maintained a stable CD4% during a median follow-up of 6 years. CONCLUSION Elite controllers with preserved CD4T cells (EC) have normal T-cell and monocyte phenotypes and therefore may have limited benefit from ART. CD4% can be an important marker for evaluating future studies aimed at determining the need for ART in this group of individuals.
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Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4+ T-cell recovery once HIV-1 suppression is achieved? AIDS 2015; 29:2323-33. [PMID: 26544704 PMCID: PMC5629982 DOI: 10.1097/qad.0000000000000805] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: This article compares trends in CD4+ T-cell recovery and proportions achieving optimal restoration (≥500 cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4+ less than 200 cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4+ T-cell count at cART start (baseline), rapid progressors experienced faster CD4+ T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1–18 [−0.05 (−0.06; −0.03)] and no significant differences in 18–60 months [−0.003 (−0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4+ T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively. Conclusion: Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4+ T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4+ T-cell counts at cART initiation.
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Immunologic and Virologic Progression in HIV Controllers: The Role of Viral "Blips" and Immune Activation in the ANRS CO21 CODEX Study. PLoS One 2015; 10:e0131922. [PMID: 26146823 PMCID: PMC4493076 DOI: 10.1371/journal.pone.0131922] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 06/08/2015] [Indexed: 12/23/2022] Open
Abstract
Some HIV controllers (HICs) experience CD4+T cell count loss and/or lose their ability to control HIV. In this study, we investigated the rate of immunologic and/or virologic progression (ImmP/VirP) and its determinants in the ANRS CO21/CODEX cohort. Immunologic progression was defined as a lasting fall in CD4+T cell count below 350/mm(3) or more than 200/mm(3) with a baseline count below 600/mm(3). Virologic progression was defined as a HIV viral load (VL) above 2000 copies/mL on two consecutive determinations. Clinical characteristics, immune activation, ultrasensitive HIV VL and total HIV DNA were analyzed. Disease progression was observed in 15 of the 217 patients followed up between 2009 and 2013 (ImmP, n = 10; VirP, n = 5). Progressors had higher ultrasensitive HIV RNA levels at inclusion (i.e. 1-2 years before progression) than non-progressors. ImmP had also lower CD4+T cell nadir and CD4+T cell count at inclusion, and VirP had higher HIV DNA levels in blood. T cell activation and IP10 levels at inclusion were significantly higher in ImmP than in non-progressors. In summary, the lasting loss of CD4+T cells, residual HIV replication and basal levels of immune activation appear to be major determinants of progression in HICs. These factors should be considered for adjusting their follow-up.
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Mitchell RM, Schukken Y, Koets A, Weber M, Bakker D, Stabel J, Whitlock RH, Louzoun Y. Differences in intermittent and continuous fecal shedding patterns between natural and experimental Mycobacterium avium subspecies paratuberculosis infections in cattle. Vet Res 2015; 46:66. [PMID: 26092571 PMCID: PMC4474556 DOI: 10.1186/s13567-015-0188-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/14/2015] [Indexed: 11/17/2022] Open
Abstract
The objective of this paper is to study shedding patterns of cows infected with Mycobacterium avium subsp. paratuberculosis (MAP). While multiple single farm studies of MAP dynamics were reported, there is not large scale meta-analysis of both natural and experimental infections. Large difference in shedding patterns between experimentally and naturally infected cows were observed. Experimental infections are thus probably driven by different pathological mechanisms. For further evaluations of shedding patterns only natural infections were used. Within such infections, the transition to high shedding was studied as a proxy to the development of a clinical disease. The majority of studied cows never developed high shedding levels. Those that do, typically never reduced their shedding level to low or no shedding. Cows that eventually became high shedders showed a pattern of continuous shedding. In contrast, cows with an intermittent shedding pattern had a low probability to ever become high shedders. In addition, cows that start shedding at a younger age (less than three years of age) have a lower hazard of becoming high shedders compared to cows starting to shed at an older age. These data suggest the presence of three categories of immune control. Cows that are intermittent shedders have the infection process under control (no progressive infection). Cows that start shedding persistently at a young age partially control the infection, but eventually will be high shedders (slow progressive infection), while cows that start shedding persistently at an older age cannot effectively control the infection and become high shedders rapidly.
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Affiliation(s)
- Rebecca M Mitchell
- Centers for Disease Control and Prevention, Atlanta, Georgia. .,Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.
| | - Ynte Schukken
- Department of Bacteriology and TSE, Central Veterinary Institute part of Wageningen UR, Lelystad, The Netherlands. .,GD Animal Health, Deventer, The Netherlands.
| | - Ad Koets
- GD Animal Health, Deventer, The Netherlands. .,Central Institute for Animal Disease Control, Lelystad, The Netherlands.
| | | | - Douwe Bakker
- Central Institute for Animal Disease Control, Lelystad, The Netherlands.
| | - Judy Stabel
- National Animal Diseases Center Ames, 2300 Dayton Avenue, Ames, IA, 50010, USA.
| | - Robert H Whitlock
- Department of Clinical Studies, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Yoram Louzoun
- Gonda Brain Research Center and Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel.
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Telisinghe L, Hippner P, Churchyard GJ, Gresak G, Grant AD, Charalambous S, Fielding KL. Outcomes of on-site antiretroviral therapy provision in a South African correctional facility. Int J STD AIDS 2015; 27:1153-1161. [PMID: 25941052 DOI: 10.1177/0956462415584467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/31/2015] [Indexed: 12/15/2022]
Abstract
We evaluated a novel on-site antiretroviral therapy (ART) programme in a South African correctional facility using routinely collected programme data, from a retrospective cohort of adult inmates starting ART between 03/2007 and 03/2009 followed-up to 09/2009. We report (1) mortality (using survival analysis); (2) retention in the programme (to 09/2009); and (3) virological suppression at six and 12 months (<400 copies/ml) following ART initiation. In total, 404 started ART (median age 33 years; 91.3% men; median baseline CD4 cell count 152 cells/µl [interquartile range 85-225]). Among 299 starting ART for the first time (ART-naïve), 23 deaths occurred during 252 person-years (median follow-up nine months). Mortality rates were 17.2 at 0-6 months (95% confidence interval 10.9-26.9) and 2.8 at >6 months (95% confidence interval 1.1-7.5)/100 person-years; p < 0.001. At 09/2009, 35.6% (144/404) remained in the correctional facility, with 94.4% (136/144) retained in the programme; 38.4% (155/404) were released; and 20.0% (81/404) transferred to another facility. ART-naïve patients in care six and 12 months after ART initiation, 94.7% (124/131) and 92.5% (74/80) were virologically suppressed, respectively. High early mortality warrants the early identification and management of HIV-positive inmates. The high mobility of inmates necessitates systems for facilitating continuity of care. Good virological responses and retention supports decentralising HIV care to correctional facilities.
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Affiliation(s)
- Lilanganee Telisinghe
- The Aurum Institute, Johannesburg, South Africa .,CAPRISA, University of KwaZulu-Natal, Durban, South Africa
| | | | - Gavin J Churchyard
- The Aurum Institute, Johannesburg, South Africa.,London School of Hygiene and Tropical Medicine, London, UK.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Alison D Grant
- London School of Hygiene and Tropical Medicine, London, UK
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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