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Trovato M, Ruggeri RM, Sciacchitano S, Vicchio TM, Picerno I, Pellicanò G, Valenti A, Visalli G. Serum interleukin-6 levels are increased in HIV-infected patients that develop autoimmune disease during long-term follow-up. Immunobiology 2017; 223:264-268. [PMID: 29055566 DOI: 10.1016/j.imbio.2017.10.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Elevated IL-6 levels have been associated with both autoimmune diseases and treated HIV-seropositive (HIV+) subjects. However, few data on classic and trans-signaling IL-6 in autoimmune thyroid diseases and HIV+ subjects developing autoimmune disorders are currently available. MATERIALS AND METHODS A total of 102 patients were included in the study. They were subdivided into two groups. Group A consisted in 51 HIV+ patients, who were followed-up for a period of five years in search of possible occurrence of autoimmune diseases. Ten of them, treated with antiretroviral therapy (ART), developed an autoimmune disorder, namely Hashimoto's thyroiditis, and psoriasis. Group B consisted in 51 patients affected by Hashimoto's thyroiditis (HT). Serum levels of the free form of IL-6 were analyzed by ELISA in all patients and for HIV+ patients at the beginning of the follow-up, before initiation of ART. RESULTS Mean serum levels of IL-6 were similar in Group A and in Group B. In Group B, IL-6 levels showed a 5.8% increase compared with assay minimum detectable dose corresponding to 1% of full serum IL-6 level. However, serum levels of free IL-6 were increased in those HIV+ patients who developed autoimmune disorders (5.8±2.8pg/ml) and in these patients, the highest levels of free IL-6 correlated with age and CD4 cellular counts. CONCLUSIONS The present study indicates a correlation between serum free IL-6 levels and the occurrence of autoimmune disease in HIV+ population, treated with ART during a long-term follow-up. The increased levels of serum free IL-6 were observed before ART treatment was initiated, indicating that IL-6 measurement in such patients may represent an early predictor of development of autoimmune disease.
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Affiliation(s)
- M Trovato
- Department of Clinical and Experimental Medicine, Messina, Italy.
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Messina, Italy
| | - S Sciacchitano
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy; Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - T M Vicchio
- Department of Clinical and Experimental Medicine, Messina, Italy
| | - I Picerno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - G Pellicanò
- Department of Human Pathology of Adult and Developmental Age 'Gaetano Barresi', Messina, Italy
| | - A Valenti
- Department of Clinical and Experimental Medicine, Messina, Italy
| | - G Visalli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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102
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LaFleur J, Bress AP, Rosenblatt L, Crook J, Sax PE, Myers J, Ritchings C. Cardiovascular outcomes among HIV-infected veterans receiving atazanavir. AIDS 2017; 31:2095-2106. [PMID: 28692532 PMCID: PMC5603981 DOI: 10.1097/qad.0000000000001594] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Patients with HIV infection have an increased risk of cardiovascular disease compared with uninfected individuals. Antiretroviral therapy with atazanavir (ATV) delays progression of atherosclerosis markers; whether this reduces cardiovascular disease event risk compared with other antiretroviral regimens is currently unknown. DESIGN Population-based, noninterventional, historical cohort study conducted from 1 July 2003 through 31 December 2015. SETTING Veterans Health Administration hospitals and clinics throughout the United States. PARTICIPANTS Treatment-naive patients with HIV infection (N = 9500). ANTIRETROVIRAL EXPOSURES Initiating antiretroviral regimens containing ATV, other protease inhibitors, nonnucleoside reverse transcriptase inhibitors (NNRTIs), or integrase strand transfer inhibitors (INSTIs). MAIN OUTCOME/EFFECT SIZE MEASURES Incidence rates of myocardial infarction (MI), stroke, and all-cause mortality within each regimen. ATV versus other protease inhibitor, NNRTI, or INSTI covariate-adjusted hazard ratios by using Cox proportional hazards models and inverse probability of treatment weighting. RESULTS Incidence rates for MI, stroke, and all-cause mortality with ATV-containing regimens (5.2, 10.4, and 16.0 per 1000 patient-years, respectively) were lower than with regimens containing other protease inhibitors (10.2, 21.9, and 23.3 per 1000 patient-years), NNRTIs (7.5, 15.9, and 17.5 per 1000 patient-years), or INSTIs (13.0, 33.1, and 21.5 per 1000 patient-years). After inverse probability of treatment weighting, adjusted hazard ratios (95% confidence intervals) for MI, stroke, and all-cause mortality with ATV-containing regimens versus all non-ATV-containing regimens were 0.59 (0.41-0.84), 0.64 (0.50-0.81), and 0.90 (0.73-1.11), respectively. CONCLUSION Among treatment-naive HIV-infected patients in the Veterans Health Administration initiating ATV-containing regimens, risk of both MI and stroke were significantly lower than in those initiating regimens containing other protease inhibitors, NNRTIs, or INSTIs.
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Affiliation(s)
- Joanne LaFleur
- Department of Pharmacotherapy, University of Utah College of Pharmacy
- Informatics, Decision-Enhancement, and Surveillance (IDEAS) Center, Salt Lake City VA Health Care System
| | - Adam P. Bress
- Informatics, Decision-Enhancement, and Surveillance (IDEAS) Center, Salt Lake City VA Health Care System
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | | | - Jacob Crook
- Informatics, Decision-Enhancement, and Surveillance (IDEAS) Center, Salt Lake City VA Health Care System
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Paul E. Sax
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joel Myers
- Bristol-Myers Squibb, Lawrenceville, New Jersey
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103
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Chastain DB, Franco-Paredes C, Stover KR. Addressing Antiretroviral Therapy-Associated Drug-Drug Interactions in Patients Requiring Treatment for Opportunistic Infections in Low-Income and Resource-Limited Settings. J Clin Pharmacol 2017; 57:1387-1399. [PMID: 28884831 DOI: 10.1002/jcph.978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/14/2017] [Indexed: 12/17/2022]
Abstract
An increasing number of human immunodeficiency virus (HIV)-infected patients are achieving virologic suppression on antiretroviral therapy (ART) limiting the use of primary and secondary antimicrobial prophylaxis. However, in low-income and resource-limited settings, half of those infected with HIV are unaware of their diagnosis, and fewer than 50% of patients on ART achieve virologic suppression. Management of comorbidities and opportunistic infections among patients on ART may lead to inevitable drug-drug interactions (DDIs) and even toxicities. Elderly patients, individuals with multiple comorbidities, those receiving complex ART, and patients living in low-income settings experience higher rates of DDIs. Management of these cytochrome P450-mediated, nonmediated, and drug transport system DDIs is critical in HIV-infected patients, particularly those in resource-limited settings with few options for ART. This article critically analyzes and provides recommendations to manage significant DDIs and drug toxicities in HIV-infected patients receiving ART.
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Affiliation(s)
- Daniel B Chastain
- University of Georgia College of Pharmacy, Albany, GA, USA.,Phoebe Putney Memorial Hospital, Albany, GA, USA
| | - Carlos Franco-Paredes
- Infectious Diseases Physician, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.,Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | - Kayla R Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
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104
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Melvin AJ, Warshaw M, Compagnucci A, Saidi Y, Harrison L, Turkova A, Tudor-Williams G. Hepatic, Renal, Hematologic, and Inflammatory Markers in HIV-Infected Children on Long-term Suppressive Antiretroviral Therapy. J Pediatric Infect Dis Soc 2017; 6:e109-e115. [PMID: 28903520 PMCID: PMC5907869 DOI: 10.1093/jpids/pix050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/03/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Data on long-term toxicity of antiretroviral therapy (ART) in HIV-infected children are sparse. PENPACT-1 was an open-label trial in which HIV-infected children were assigned randomly to receive protease inhibitor (PI)- or nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based ART. METHODS We examined changes in clinical, immunologic, and inflammatory markers from baseline to year 4 in the subset of children in the PENPACT-1 study who experienced viral suppression between week 24 and year 4 of ART. Liver enzyme, creatinine, and cholesterol levels and hematologic parameters were assessed during the trial. Cystatin C, high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), d-dimer, and soluble CD14 (sCD14) were assayed from cryopreserved specimens. RESULTS Ninety-nine children (52 on PI-based and 47 on NNRTI-based ART) met inclusion criteria. The median age at initiation of ART was 6.5 years (interquartile range [IQR], 3.7-13.4 years), and 22% were aged <3 years at ART initiation; 56% of the PI-treated children received lopinavir/ritonavir, and 70% of NNRTI-treated children received efavirenz initially. We found no evidence of significant clinical toxicity in either group; growth, liver, kidney, and hematologic parameters either remained unchanged or improved between baseline and year 4. Total cholesterol levels increased modestly, but no difference between the groups was found. IL-6 and hs-CRP levels decreased more after 4 years in the NNRTI-based ART group. The median change in IL-6 level was -0.35 pg/ml in the PI-based ART group and -1.0 in the NNRTI-based ART group (P = .05), and the median change in hs-CRP level was 0.25 µg/ml in the PI-based ART group and -0.95 µg/ml in the NNRTI-based ART group (P = .005). CONCLUSION These results support the safety of prolonged ART use in HIV-infected children and suggest that suppressive NNRTI-based regimens can be associated with lower levels of systemic inflammation.
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Affiliation(s)
- Ann J Melvin
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Washington and Seattle Children’s Research Institute
| | - Meredith Warshaw
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Linda Harrison
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anna Turkova
- Medical Research Council, Clinical Trials Unit, London, United Kingdom; and
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105
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Falasca F, Di Carlo D, De Vito C, Bon I, d'Ettorre G, Fantauzzi A, Mezzaroma I, Fimiani C, Re MC, Vullo V, Antonelli G, Turriziani O. Evaluation of HIV-DNA and inflammatory markers in HIV-infected individuals with different viral load patterns. BMC Infect Dis 2017; 17:581. [PMID: 28830393 PMCID: PMC5568129 DOI: 10.1186/s12879-017-2676-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Persistent residual viremia (RV) and low grade inflammation and immune activation have been associated with non-AIDS defining events. The impact of persistent RV and HIV-DNA load on immune activation/inflammation remains unclear. The purpose of this study was to gain new insights into the relation between viremia, markers of inflammation and HIV-DNA levels. METHODS Three hundred and twenty-one HIV-infected patients were studied. A retrospective analysis of viremia values, prospectively collected for 48 months, was performed. Patients were separated into three groups: 113 TND (Target Not Detected, patients with sustained undetectable viremia); 113 RV (Residual Viremia, patients who had at least three detectable viral load (VL) values <37 copies/ml); 95 LLV (Low Level Viremia, patients with at least two VL values >37 but <200 copies/ml). HIV-DNA, TNF-α, IL-6 and sCD14 were analyzed. RESULTS HIV-DNA, sCD14 and TNF-α were significantly lower in the TND group than in the RV and LLV groups. In addition, RV patients showed lower levels of HIV-DNA and sCD14 than LLV individuals. HIV-DNA load was not related to markers of inflammation. The ordinal logistic analysis showed that two independent variables were significantly associated with VL pattern: sCD14, HIV-DNA. In addition NRTIs plus NNRTIs and NRTIs plus PIs were negatively associated to VL pattern compared to INI-containing regimen. CONCLUSIONS Persistent undetectable viremia was associated with lower levels of inflammatory markers and HIV-DNA. However, the lack of normalization of these biomarkers in the TND group and the fact that HIV-DNA load was not associated with inflammation strongly suggest that other mechanisms play a major role in maintaining inflammation over time.
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Affiliation(s)
- Francesca Falasca
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy
| | - Daniele Di Carlo
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Isabella Bon
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | | | - Ivano Mezzaroma
- Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Maria Carla Re
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy
| | - Ombretta Turriziani
- Department of Molecular Medicine, "Sapienza" University of Rome, Viale dell'Università 31, 00185, Rome, Italy.
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HIV and Obesity Comorbidity Increase Interleukin 6 but Not Soluble CD14 or D-Dimer. J Acquir Immune Defic Syndr 2017; 75:500-508. [PMID: 28696344 DOI: 10.1097/qai.0000000000001444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Obesity prevalence among people living with HIV (HIV+) is rising. HIV and obesity are proinflammatory states, but their combined effect on inflammation (measured by interleukin 6, IL-6), altered coagulation (D-dimer), and monocyte activation (soluble CD14, sCD14) is unknown. We hypothesized inflammation increases when obesity and HIV infection co-occur. METHODS The Veterans Aging Cohort Study survey cohort is a prospective, observational study of predominantly male HIV+ veterans and veterans uninfected with HIV; a subset provided blood samples. Inclusion criteria for this analysis were body mass index ≥ 18.5 kg/m and biomarker measurement. Dependent variables were IL-6, sCD14, and D-dimer quartiles. Obesity/HIV status was the primary predictor. Unadjusted and adjusted logistic regression models were constructed. RESULTS Data were analyzed for 1477 HIV+ and 823 uninfected participants. Unadjusted median IL-6 levels were significantly higher and sCD14 levels significantly lower in obese/HIV+ compared with nonobese/uninfected (P <0.01 for both). In adjusted analyses, the odds ratio for increased IL-6 in obese/HIV+ patients was 1.76 (95% confidence interval: 1.18 to 2.47) compared with nonobese/uninfected, and obesity/HIV+ remained associated with lower odds of elevated sCD14. We did not detect a synergistic association of co-occurring HIV and obesity on IL-6 or sCD14 elevation. D-dimer levels did not differ significantly between body mass index/HIV status groups. CONCLUSIONS HIV-obesity comorbidity is associated with elevated IL-6, decreases in sCD14, and no significant difference in D-dimer. These findings are clinically significant, as previous studies associated these biomarkers with mortality. Future studies should assess whether other biomarkers show similar trends and potential mechanisms for unanticipated sCD14 and D-dimer findings.
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107
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van den Dries L, Claassen MAA, Groothuismink ZMA, van Gorp E, Boonstra A. Immune activation in prolonged cART-suppressed HIV patients is comparable to that of healthy controls. Virology 2017. [PMID: 28644978 DOI: 10.1016/j.virol.2017.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sustained immune activation during chronic HIV infection is considered to augment co-morbidity and mortality. Effective combination antiretroviral therapy (cART) has shown to dampen immune activation especially during the first year cART, but the effects of long-term cART in patients without major comorbidities remains under-investigated. We performed a comprehensive analysis including cellular, intracellular and plasma biomarkers to study the effect of cART on immune parameters in 5 groups of 10 HIV patients. All patients were without major co-morbidities and grouped based on cART duration (0, 1, 3, 5, and 10 years). We included 10 matched healthy controls for comparison. Our data show that after the first year of cART, no additional effect on the level of inflammatory markers is observed in HIV infected patients without major co morbidities. Residual immune activation status in well-treated HIV-infection is similar to levels observed in healthy controls.
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Affiliation(s)
| | - Mark A A Claassen
- Erasmus Medical Centre, Department of Infectious Diseases, Rotterdam, The Netherlands; Erasmus Medical Centre, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands; Rijnstate Hospital, Department of Internal Medicine, Infectious Diseases Unit, Arnhem, The Netherlands
| | - Zwier M A Groothuismink
- Erasmus Medical Centre, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - Eric van Gorp
- Erasmus Medical Centre, Department of Viroscience, Rotterdam, The Netherlands; Erasmus Medical Centre, Department of Infectious Diseases, Rotterdam, The Netherlands
| | - Andre Boonstra
- Erasmus Medical Centre, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands.
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108
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Immune Activation by Mycobacterium tuberculosis in HIV-Infected and -Uninfected Subjects. J Acquir Immune Defic Syndr 2017; 74:103-111. [PMID: 27532475 DOI: 10.1097/qai.0000000000001157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study investigates the influence of Mycobacterium tuberculosis infection on immune activation biomarkers, both in HIV-infected and -uninfected subjects. METHODS Forty-eight treatment-naive HIV-infected patients and 74 HIV-uninfected subjects were recruited and divided into groups according to their M. tuberculosis infection status: latent tuberculosis infection (LTBI), active tuberculosis (TB), and no evidence of M. tuberculosis infection. The expression of cellular markers CD38 and HLA-DR on circulating CD8 T lymphocytes and the plasmatic levels of soluble markers interleukin-6, sCD14, and D-Dimer were measured and compared between groups. The HIV-infected patients with no evidence of M. tuberculosis or with LTBI who initiated antiretroviral treatment were tested again for these biomarkers once viral suppression was reached. RESULTS In both HIV-infected and -uninfected groups, patients with TB had higher levels of immune activation markers than subjects with LTBI and with no evidence of M. tuberculosis. Among the HIV-uninfected subjects, no significant difference in biomarker level was found between those presenting LTBI and those with no evidence of M. tuberculosis. The effect of LTBI on activation biomarkers in the HIV-infected groups was inconclusive because of the small number of individuals in the HIV+/LTBI group. sCD14 and D-Dimer levels were significantly higher in the TB-only group than in the HIV-only group. DISCUSSION Although TB is associated with an increase in biomarkers of immune activation, the effect of LTBI is less evident. Further investigation is warranted, and according to our results, soluble markers may offer greater sensitivity for the evaluation of M. tuberculosis-associated immune activation than cellular markers.
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Abstract
: The increased prevalence of age-related comorbidities and mortality is worrisome in ageing HIV-infected patients. Here, we aim to analyse the different ageing mechanisms with regard to HIV infection. Ageing results from the time-dependent accumulation of random cellular damage. Epigenetic modifications and mitochondrial DNA haplogroups modulate ageing. In antiretroviral treatment-controlled patients, epigenetic clock appears to be advanced, and some haplogroups are associated with HIV infection severity. Telomere shortening is enhanced in HIV-infected patients because of HIV and some nucleoside analogue reverse transcriptase inhibitors. Mitochondria-related oxidative stress and mitochondrial DNA mutations are increased during ageing and also by some nucleoside analogue reverse transcriptase inhibitors. Overall, increased inflammation or 'inflammageing' is a major driver of ageing and could result from cell senescence with secreted proinflammatory mediators, altered gut microbiota, and coinfections. In HIV-infected patients, the level of inflammation and innate immunity activation is enhanced and related to most comorbidities and to mortality. This status could result, in addition to age, from the virus itself or viral protein released from reservoirs, from HIV-enhanced gut permeability and dysbiosis, from antiretroviral treatment, from frequent cytomegalovirus and hepatitis C virus coinfections, and also from personal and environmental factors, as central fat accumulation or smoking. Adaptive immune activation and immunosenescence are associated with comorbidities and mortality in the general population but are less predictive in HIV-infected patients. Biomarkers to evaluate ageing in HIV-infected patients are required. Numerous systemic or cellular inflammatory, immune activation, oxidative stress, or senescence markers can be tested in serum or peripheral blood mononuclear cells. The novel European Study to Establish Biomarkers of Human Ageing MARK-AGE algorithm, evaluating the biological age, is currently assessed in HIV-infected patients and reveals an advanced biological age. Some enhanced inflammatory or innate immune activation markers are interesting but still not validated for the patient's follow-up. To be able to assess patients' biological age is an important objective to improve their healthspan.
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110
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Immune activation and HIV-specific T cell responses are modulated by a cyclooxygenase-2 inhibitor in untreated HIV-infected individuals: An exploratory clinical trial. PLoS One 2017; 12:e0176527. [PMID: 28464042 PMCID: PMC5413033 DOI: 10.1371/journal.pone.0176527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/09/2017] [Indexed: 12/03/2022] Open
Abstract
Pathologically elevated immune activation and inflammation contribute to HIV disease progression and immunodeficiency, potentially mediated by elevated levels of prostaglandin E2, which suppress HIV-specific T cell responses. We have previously shown that a high dose of the cyclooxygenase-2 inhibitor celecoxib can reduce HIV-associated immune activation and improve IgG responses to T cell-dependent vaccines. In this follow-up study, we included 56 HIV-infected adults, 28 antiretroviral therapy (ART)-naïve and 28 on ART with undetectable plasma viremia but CD4 counts below 500 cells/μL. Patients in each of the two study groups were randomized to receive 90 mg qd of the cyclooxygenase-2 inhibitor etoricoxib for six months, two weeks or to a control arm, respectively. T cell activation status, HIV Gag-specific T cell responses and plasma inflammatory markers, tryptophan metabolism and thrombin generation were analyzed at baseline and after four months. In addition, patients received tetanus toxoid, conjugated pneumococcal and seasonal influenza vaccines, to which IgG responses were determined after four weeks. In ART-naïve patients, etoricoxib reduced the density of the activation marker CD38 in multiple CD8+ T cell subsets, improved Gag-specific T cell responses, and reduced in vitro plasma thrombin generation, while no effects were seen on plasma markers of inflammation or tryptophan metabolism. No significant immunological effects of etoricoxib were observed in ART-treated patients. Patients receiving long-term etoricoxib treatment had poorer tetanus toxoid and conjugated pneumococcal vaccine responses than those receiving short-course etoricoxib. Cyclooxygenase-2 inhibitors may attenuate harmful immune activation in HIV-infected patients without access to ART.
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111
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Hove-Skovsgaard M, Gaardbo JC, Kolte L, Winding K, Seljeflot I, Svardal A, Berge RK, Gerstoft J, Ullum H, Trøseid M, Nielsen SD. HIV-infected persons with type 2 diabetes show evidence of endothelial dysfunction and increased inflammation. BMC Infect Dis 2017; 17:234. [PMID: 28356058 PMCID: PMC5372333 DOI: 10.1186/s12879-017-2334-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/21/2017] [Indexed: 12/11/2022] Open
Abstract
Background Increased incidence of cardiovascular diseases (CVD) in both HIV infection and type 2 diabetes (T2D) compared to the general population has been described. Little is known about the combined effect of HIV infection and T2D on inflammation and endothelial function, both of which may contribute to elevated risk of CVD. Methods Cross-sectional study including 50 HIV-infected persons on combination anti-retroviral therapy (cART), with HIV RNA <200 copies/mL (n = 25 with T2D (HIV + T2D+), n = 25 without T2D (HIV + T2D-)) and 50 uninfected persons (n = 22 with T2D (HIV-T2D+) and n = 28 without T2D (HIV-T2D-)). Groups were matched on age and sex. High sensitive C-reactive protein (hsCRP) was used to determine inflammation (cut-off 3 mg/L). The marker of endothelial dysfunction asymmetric dimethylarginine (ADMA) was measured using high performance liquid chromatography. Trimethylamine-N-oxide (TMAO), a microbiota-dependent, pro-atherogenic marker was measured using stable isotope dilution LC/MS/MS. Results The percentage of HIV + T2D+, HIV + T2D-, HIV-T2D+, and HIV-T2D- with hsCRP above cut-off was 50%, 19%, 47%, and 11%, respectively. HIV + T2D+ had elevated ADMA (0.67 μM (0.63-0.72) compared to HIV + T2D- (0.60 μM (0.57-0.64) p = 0.017), HIV-T2D+ (0.57 μM (0.51-63) p = 0.008), and HIV-T2D- (0.55 μM (0.52-0.58) p < 0.001). No differences in TMAO between groups were found. However, a positive correlation between ADMA and TMAO was found in the total population (rs = 0.32, p = 0.001), which was mainly driven by a close correlation in HIV + T2D+ (rs = 0.63, p = 0.001). Conclusion Elevated inflammation and evidence of endothelial dysfunction was found in HIV-infected persons with T2D. The effect on inflammation was mainly driven by T2D, while both HIV infection and T2D may contribute to endothelial dysfunction. Whether gut microbiota is a contributing factor to this remains to be determined. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2334-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malene Hove-Skovsgaard
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, opgang 86, 3 sal, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Julie Christine Gaardbo
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, opgang 86, 3 sal, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Lilian Kolte
- Department of Infectious Diseases, Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kamilla Winding
- Centre of Inflammation and Metabolism, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Asbjørn Svardal
- Department of Clinical Science, University of Bergen, N-5020, Bergen, Norway
| | - Rolf Kristian Berge
- Department of Clinical Science, University of Bergen, N-5020, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, opgang 86, 3 sal, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Marius Trøseid
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Copenhagen, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, opgang 86, 3 sal, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.
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Adiponectin, Leptin and Inflammatory Markers in HIV-associated Metabolic Syndrome in Children and Adolescents. Pediatr Infect Dis J 2017; 36:e31-e37. [PMID: 27832021 DOI: 10.1097/inf.0000000000001394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is more common in HIV-infected adults and children than in the general population. Adipocytokines and inflammatory markers may contribute to the pathophysiology of this condition and could be useful indices for monitoring MetS. The objective of this study was to provide information on the prevalence of MetS and investigate the role of adipocytokines and other biomarkers in this syndrome in HIV-infected pediatric patients. METHODS A cross-sectional study was conducted between October 2013 and March 2014 in the outpatient clinics of 2 tertiary pediatric referral hospitals. Fifty-four HIV-infected children and adolescents were included. MetS was defined according to the International Diabetes Federation and modified National Cholesterol Education Program Adult Treatment Panel III criteria. Measurements included anthropometry, waist circumference, blood pressure, fasting lipids, glucose and insulin, adiponectin, leptin, interleukin-6, vitamin D and C-reactive protein and clinical lipodystrophy assessment. RESULTS Among the total, 3.7% of patients met the International Diabetes Federation criteria for MetS and 7.4% met the National Cholesterol Education Program Adult Treatment Panel III criteria. C-reactive protein and leptin levels were significantly higher and adiponectin level significantly lower in patients with MetS, regardless of the criteria used. Insulin resistance was observed in 40.7% of patients; abnormal quantitative insulin sensitivity check index values were found in 88.9%. Eighteen patients (33.3%) had vitamin D deficiency. CONCLUSIONS The prevalence of MetS was similar to that observed in larger cohorts of HIV-infected patients in our setting. Adipocytokine dysregulation seems to be related to MetS in HIV-infected children. A high percentage of patients showed insulin resistance, which should be strictly monitored.
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Abstract
OBJECTIVE Tenofovir (TDF) affects bone health and is widely used in pregnancy but data are limited on the effects of TDF exposure in utero. We examined the association between duration of in-utero TDF exposure and linear growth in HIV-exposed, uninfected (HEU) infants. DESIGN A prospective cohort of pregnant women initiating TDF-containing regimens at primary care services in Cape Town, South Africa, were enrolled and followed with their breastfeeding infants through 12 months postpartum. METHODS Length-for-age z scores (LAZ) were calculated from infant lengths reported at birth and measured at 6, 12, 24, 36 and 48 weeks, using Fenton and WHO standards. Linear mixed-effects models were used to examine the association between duration of TDF exposure and LAZ over time. RESULTS In 464 singleton mother-infant pairs (median CD4 at ART initiation, 346 cells/μl; viral load (VL), 4.0 log10 copies/ml), the median duration of in-utero TDF exposure was 16.7 weeks (interquartile range, IQR 11.0-22.0) with 31, 44 and 25% of infants exposed to less than 12, 12-22 and more than 22 weeks of TDF, respectively. Overall, 12% of children were stunted (LAZ < -2) at 48 weeks. Duration of exposure was not associated with LAZ: adjusted mean difference for more than 22 vs less than 12 weeks, -0.12 (95% CI -0.47 to 0.23); 12-22 vs less than 12 weeks, -0.06 (95% CI -0.35 to 0.24). Mean LAZ was 0.15 lower per log increase in maternal VL at ART initiation (95% CI -0.29 to -0.0001). CONCLUSION These data suggest no association between duration of TDF exposure in utero and early linear growth.
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Abstract
PURPOSE OF REVIEW To review the newest research about the effects of combination antiretroviral therapy (cART) on cancer risk. RECENT FINDINGS HIV+ persons are at increased risk of cancer. As this risk is higher for malignancies driven by viral and bacterial coinfections, classifying malignancies into infection-related and infection-unrelated has been an emerging trend. Cohorts have detected major reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) following cART initiation among immunosuppressed HIV+ persons. However, recent randomized data indicate that cART reduces risk of Kaposi sarcoma and NHL also during early HIV infection before overt immunosuppression occurs. Long-term effects of cART exposure on cancer risk are not well defined; according to basic and epidemiological research, there might be specific associations of each cART class with distinct patterns of cancer risk. SUMMARY The relationship between cART exposure and cancer risk is complex and nuanced. It is an intriguing fact that, whether initiated during severe immunosuppression or not, cART reduces risk of Kaposi sarcoma and NHL. Further research should identify mediators of the benefit of immediate cART initiation in reducing cancer risk, understand the relationship between long-term cART exposure and cancer incidence and assess whether adjuvant anti-inflammatory therapies can reduce cancer risk during treated HIV infection.
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Affiliation(s)
- Álvaro H Borges
- Centre for Health and Infectious Diseases Research, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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115
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Wing EJ. HIV and aging. Int J Infect Dis 2016; 53:61-68. [PMID: 27756678 DOI: 10.1016/j.ijid.2016.10.004] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/09/2016] [Accepted: 10/06/2016] [Indexed: 01/03/2023] Open
Abstract
With the wider availability of antiretrovirals, the world's HIV population is aging. More than 10% of the 34.5 million HIV-positive individuals worldwide are over the age of 50 years and the average age continues to increase. In the USA more than 50% of the 1.3 million people with HIV are over 50 years old and by the year 2030 it is estimated that 70% will be over the age of 50 years. Although the life expectancy of HIV-positive people has increased dramatically, it still lags behind that of HIV-negative individuals. There is controversy about whether HIV itself accelerates the aging process. Elevated rates of inflammation seen in people with HIV, even if their viral loads are suppressed and their CD4 counts are preserved, are associated with greater rates of cardiovascular, renal, neurocognitive, oncological, and osteoporotic disease. These conditions increase exponentially in the elderly and will represent a major challenge for HIV patients. In addition, conditions such as geriatric syndromes including frailty are also seen at higher rates. Management of the aging HIV patient includes an emphasis on early diagnosis and treatment, preventative measures for co-morbidities, and avoiding polypharmacy. Finally, the issue of quality of life, prioritization of medical issues, and end of life care become increasingly important as the patient grows older.
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Affiliation(s)
- Edward J Wing
- The Miriam Hospital, Brown University, 164 Summit Avenue, Providence, RI 02906, USA.
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Borges ÁH, O'Connor JL, Phillips AN, Neaton JD, Grund B, Neuhaus J, Vjecha MJ, Calmy A, Koelsch KK, Lundgren JD. Interleukin 6 Is a Stronger Predictor of Clinical Events Than High-Sensitivity C-Reactive Protein or D-Dimer During HIV Infection. J Infect Dis 2016; 214:408-16. [PMID: 27132283 DOI: 10.1093/infdis/jiw173] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/25/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer levels are linked to adverse outcomes in human immunodeficiency virus (HIV) infection, but the strength of their associations with different clinical end points warrants investigation. METHODS Participants receiving standard of care in 2 HIV trials with measured biomarker levels were followed to ascertain all-cause death, non-AIDS-related death, AIDS, cardiovascular disease (CVD), and non-AIDS-defining malignancies. Hazard ratios (HRs) and 95% confidence intervals (CIs) of each end point for quartiles and log2-transformed IL-6, hsCRP, and D-dimer levels were calculated using Cox models. Marginal models modelling multiple events tested for equal effects of biomarker levels on different end points. RESULTS Among 4304 participants, there were 157 all-cause deaths, 117 non-AIDS-related deaths, 101 AIDS cases, 121 CVD cases, and 99 non-AIDS-defining malignancies. IL-6 was more strongly associated with most end points, compared with hsCRP. IL-6 appeared to be a stronger predictor than D-dimer for CVD and non-AIDS-defining malignancies, but 95% CIs overlapped. Independent associations of IL-6 were stronger for non-AIDS-related death (HR, 1.71; 95% CI, 1.43-2.04) and all-cause death (HR, 1.56; 95% CI, 1.33-1.84) and similar for CVD (HR, 1.35; 95% CI, 1.12-1.62) and non-AIDS-defining malignancies (HR, 1.30; 95% CI, 1.06-1.61). There was heterogeneity of IL-6 (P < .001) but not hsCRP (P = .15) or D-dimer (P = .20) as a predictor for different end points. CONCLUSIONS IL-6 is a stronger predictor of fatal events than of CVD and non-AIDS-defining malignancies. Adjuvant antiinflammatory and antithrombotic therapies should be tested in HIV-infected individuals.
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Affiliation(s)
- Álvaro H Borges
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases, Rigshospitalet-University of Copenhagen, Denmark
| | - Jemma L O'Connor
- Research Department of Infection and Population Health, University College London, United Kingdom
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, United Kingdom
| | | | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis
| | | | - Michael J Vjecha
- Institute for Clinical Research Veterans Affairs Medical Center, Washington D.C
| | - Alexandra Calmy
- HIV Unit, Division of Infectious Diseases, Geneva University Hospitals, Switzerland
| | - Kersten K Koelsch
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, and St. Vincent's Hospital, Sydney, Australia
| | - Jens D Lundgren
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases, Rigshospitalet-University of Copenhagen, Denmark
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Kohli P, Ganz P, Ma Y, Scherzer R, Hur S, Weigel B, Grunfeld C, Deeks S, Wasserman S, Scott R, Hsue PY. HIV and Hepatitis C-Coinfected Patients Have Lower Low-Density Lipoprotein Cholesterol Despite Higher Proprotein Convertase Subtilisin Kexin 9 (PCSK9): An Apparent "PCSK9-Lipid Paradox". J Am Heart Assoc 2016; 5:JAHA.115.002683. [PMID: 27130349 PMCID: PMC4889164 DOI: 10.1161/jaha.115.002683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors reduce low‐density lipoprotein cholesterol (LDL‐C) and improve outcomes in the general population. HIV‐infected individuals are at increased risk for cardiovascular events and have high rates of dyslipidemia and hepatitis C virus (HCV) coinfection, making PCSK9 inhibition a potentially attractive therapy. Methods and Results We studied 567 participants from a clinic‐based cohort to compare PCSK9 levels in patients with HIV/HCV coinfection (n=110) with those with HIV infection alone (n=385) and with uninfected controls (n=72). The mean age was 49 years, and the median LDL‐C level was 100 mg/dL (IQR 77–124 mg/dL); 21% were taking statins. The 3 groups had similar rates of traditional risk factors. Total cholesterol, LDL‐C, and high‐density lipoprotein cholesterol levels were lower in coinfected patients compared with controls (P<0.001). PCSK9 was 21% higher in HIV/HCV‐coinfected patients versus controls (95% CI 9–34%, P<0.001) and 11% higher in coinfected individuals versus those with HIV infection alone (95% CI 3–20%, P=0.008). After adjustment for cardiovascular risk factors, HIV/HCV coinfection remained significantly associated with 20% higher PCSK9 levels versus controls (95% CI 8–33%, P=0.001). Interleukin‐6 levels increased in a stepwise fashion from controls (lowest) to HIV‐infected to HIV/HCV‐coinfected individuals (highest) and correlated with PCSK9 (r=0.11, P=0.018). Conclusions Despite having lower LDL‐C, circulating PCSK9 levels were increased in patients coinfected with HIV and HCV in parallel with elevations in the inflammatory, proatherogenic cytokine interleukin‐6. Clinical trials should be conducted to determine the efficacy of targeted PCSK9 inhibition in the setting of HIV/HCV coinfection.
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Affiliation(s)
- Payal Kohli
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Peter Ganz
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Yifei Ma
- Department of Medicine UCSF, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA
| | - Rebecca Scherzer
- Department of Medicine UCSF, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA
| | - Sophia Hur
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Bernard Weigel
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Carl Grunfeld
- Department of Medicine UCSF, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA
| | - Steven Deeks
- The Positive Health Program, San Francisco General Hospital, San Francisco, CA
| | | | | | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
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Okeke NL, Davy T, Eron JJ, Napravnik S. Hypertension Among HIV-infected Patients in Clinical Care, 1996-2013. Clin Infect Dis 2016; 63:242-8. [PMID: 27090989 DOI: 10.1093/cid/ciw223] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/03/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Persons infected with human immunodeficiency virus (HIV) are at higher risk for major cardiovascular disease (CVD) events than uninfected persons. Understanding the epidemiology of major traditional CVD risk determinants, particularly hypertension, in this population is needed. METHODS The study population included HIV-infected patients participating in the UNC CFAR HIV Clinical Cohort from 1996 to 2013. Annual incidence rates of hypertension were calculated. Multivariable Poisson models were fit to identify factors associated with incident hypertension. RESULTS 3141 patients contributed 21 956 person-years (PY) of follow-up. Overall, 57% patients were black, 28% were women, and the median age was 35 years. Hypertension age-standardized incidence rates increased from 1.68 cases per 100 PYs in 1996 to 5.35 cases per 100 PYs in 2013 (P < .001). In adjusted analyses, hypertension rates were higher among obese patients (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI], 1.43-2.02), and those with diabetes mellitus (IRR 1.44, 95% CI, 1.14-1.83) and renal insufficiency (IRR 1.36, 95% CI, 1.16-1.61), but lower among patients with a CD4 nadir of ≥500 cells/mm(3) (IRR 0.73, 95% CI, .53-1.01). CONCLUSIONS The incidence of hypertension increased from 1996 to 2013, alongside increases in traditional hypertension risk determinants. Notably, HIV-related immunosuppression and ongoing viral replication may contribute to an increased hypertension risk. Aggressive CVD risk factor management, early HIV diagnosis, linkage to care, antiretroviral therapy initiation, and durable viral suppression, will be important components of a comprehensive primary CVD prevention strategy in HIV-infected persons.
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Affiliation(s)
- Nwora Lance Okeke
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, Duke University, Durham
| | - Thibaut Davy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Joseph J Eron
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
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sCD14 is not a bona-fide biomarker of microbial translocation in HIV-1-infected Africans living in Belgium. AIDS 2016; 30:921-4. [PMID: 26636930 DOI: 10.1097/qad.0000000000000996] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare microbial translocation and its biomarkers in HIV-1-infected African and White patients of the Liège AIDS Reference Center. DESIGN The study is based on a cross-sectional dataset of HIV-infected patients treated at the Liège AIDS Reference Center. Groups of white and African patients have been randomly selected to be identical for sex, age and duration of treatment. METHODS sCD14, lipopolysaccharide (LPS), lipopolysaccharide-binding protein (LBP) and routine HIV-follow-up parameters were measured on plasma samples. RESULTS High values of LPS and LBP were observed in both groups of patients without significant difference between them. High values of sCD14 were observed in 53.1% of whites and only in 18.8% of African patients (P = 0.0042). A correlation between LPS and sCD14 was observed in whites but not African patients. CONCLUSION Our observation suggests that factors not related to microbial translocation are responsible for lower sCD14 value in Africans.
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Okeke NL, Hicks CB, McKellar MS, Fowler VG, Federspiel JJ. History of AIDS in HIV-Infected Patients Is Associated With Higher In-Hospital Mortality Following Admission for Acute Myocardial Infarction and Stroke. J Infect Dis 2016; 213:1955-61. [PMID: 26941281 DOI: 10.1093/infdis/jiw082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/23/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV)-infected persons are at increased risk for major cardiovascular events, short-term prognosis after these events is unclear. METHODS To determine the association between HIV infection and acute myocardial infarction (AMI) and stroke outcomes, we analyzed hospital discharge data from the Nationwide Inpatient Sample (NIS) between 2002 and 2012. Multivariable logistic regression was used to evaluate the association between HIV infection and in-hospital death after AMI or stroke. RESULTS Overall, 18 369 785 AMI/stroke hospitalizations were included in the analysis. Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke (odds ratio, 3.03 [95% confidence interval {CI}, 1.71-5.38] for AMI and 2.59 [95% CI, 1.97-3.41] for stroke). Additionally, patients with AIDS were more likely than HIV-uninfected patients to be discharged to nonhospital inpatient facilities after admission for AMI (OR, 3.14 [95% CI, 1.72-5.74]) or stroke (OR, 1.45; 95% CI, 1.12-1.87). There was a minimal difference in either outcome between HIV-infected patients without a history of AIDS and uninfected patients. CONCLUSIONS Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke. This disparity was not observed when infected patients without a history of AIDS were compared to uninfected patients, implying that preserving immune function may improve cardiovascular outcomes in HIV-infected persons.
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Affiliation(s)
| | - Charles B Hicks
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego
| | | | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jerome J Federspiel
- Duke Clinical Research Institute, Duke University Medical Center, Durham Department of Health Policy and Management, Gillings School of Global Public Health School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Masiá M, Padilla S, Barber X, Sanchis M, Terol G, Lidón F, Gutiérrez F. Comparative Impact of Suppressive Antiretroviral Regimens on the CD4/CD8 T-Cell Ratio: A Cohort Study. Medicine (Baltimore) 2016; 95:e3108. [PMID: 26986155 PMCID: PMC4839936 DOI: 10.1097/md.0000000000003108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although different factors have been implicated in the CD4/CD8 T-cell ratio recovery in HIV-infected patients who receive effective antiretroviral therapy (ART), limited information exists on the influence of the regimen composition. A longitudinal study carried out in a prospective, single-center cohort of HIV-infected patients. ART regimens including non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), or integrase strand transfer inhibitors (INSTI) from patients who achieved long-term (≥6-month duration) virological suppression (HIV-RNA < 400 copies/mL) from January 1998 to June 2014 were analyzed. The impact of ART composition on the changes of the CD4/CD8 T-cell ratio was modeled using a mixed linear approach with adjustment for possible confounders. A total of 1068 ART regimens from 570 patients were analyzed. Mean (SD) age of the patients was 42.15 (10.68) years and 276 (48.42%) had hepatitis C virus (HCV) coinfection. Five hundred fifty-eight (52.25%) regimens were PI-based, 439 (40.10%) NNRTI-based, and 71 (6.65%) INSTI-based; 487 (45.60%) were initial regimens, 476 (44.57%) simplification, and 105 (9.83%) salvage regimens. Median (IQR) number of regimens was 1 (1-2) per patient, of 29 (14-58) months duration, and 4 (3-7) CD4/CD8 measurements per regimen. The median baseline CD4/CD8 ratio was 0.42, 0.50, and 0.54, respectively, with the PI-, NNRTI-, and INSTI-based regimens (P = 0.0073). Overall median (IQR) increase of CD4/CD8 ratio was 0.0245 (-0.0352-0.0690) per year, and a CD4/CD8 ratio ≥1 was achieved in 19.35% of the cases with PI-based, 25.97% with NNRTI-based, and 22.54% with INSTI-based regimens (P = 0.1406). In the adjusted model, the mean CD4/CD8 T-cell ratio increase was higher with NNRTI-based regimens compared for PI-based (estimated coefficient for PI [95% CI], -0.0912 [-0.1604 to -0.0219], P = 0.009). Also, a higher CD4/CD8 baseline ratio was associated with higher CD4/CD8 increase in the adjusted model (P = 0.001); by contrast, higher age (P = 0.020) and simplification of ART regimen (P = 0.003) had a negative impact on the CD4/CD8 ratio. Antiretroviral regimen composition has a differential impact on the CD4/CD8 T-cell ratio; NNRTI-based regimens are associated with enhanced CD4/CD8 T-cell ratio recovery compared to PI-based antiretroviral regimens.
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Affiliation(s)
- Mar Masiá
- From the Infectious Diseases Unit, Hospital General de Elche (MM, SP, GT, FL, FG), Universidad Miguel Hernández, Spain; and Statistics (XB, MS), Centro de Investigación Operativa, Universidad Miguel Hernández, Elche, Alicante, Spain
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Aounallah M, Dagenais-Lussier X, El-Far M, Mehraj V, Jenabian MA, Routy JP, van Grevenynghe J. Current topics in HIV pathogenesis, part 2: Inflammation drives a Warburg-like effect on the metabolism of HIV-infected subjects. Cytokine Growth Factor Rev 2016; 28:1-10. [PMID: 26851985 DOI: 10.1016/j.cytogfr.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/01/2016] [Accepted: 01/13/2016] [Indexed: 02/07/2023]
Abstract
HIV-1 infection leads to a depletion of CD4 T-cells associated with a persistent immune inflammation and changes in cellular metabolism. Most effort of managing HIV infection with combination of antiretroviral therapies (ART) has been focused on CD4 T-cell recovery, while control of persistent immune inflammation and metabolism were relatively underappreciated in the past. Recent discoveries on the interplay between innate immunity, inflammation (especially the inflammasome) and metabolic changes in the context of cancer and autoimmunity provide an emerging field for chronic viral infections including HIV-1. In a previous review, we described the deregulated metabolism contributing to immune dysfunctions such as alteration of memory T-cell responses, mucosal protection, and dendritic cell-related antigen presentation. Here, we summarize the latest knowledge on the detrimental influence of long-lasting inflammation and inflammasome activation induced by HIV-1, gut dysbiosis, and bacterial translocation, on metabolism during the course of viral infection. We also report on the inability of ART to fully counteract inflammation, resulting in partial metabolic improvement and leading to an insufficient decrease in the risk of non-AIDS events. Further advances in our understanding of the relationship between inflammation, altered metabolism, and long-term ART is warranted. Additionally, there is a critical need for developing new strategies to regulate the pro-inflammatory signals to enhance cellular metabolism and immune functions in order to improve the quality of life of individuals living with HIV-1.
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Affiliation(s)
- Mouna Aounallah
- INRS-Institut Armand Frappier, Laval, Quebec H7V 1B7, Canada
| | | | | | - Vikram Mehraj
- Division of Hematology and Chronic Viral Illness Service, McGill University Health Centre, Glen site, Montreal, Quebec H4A 3J1, Canada
| | | | - Jean-Pierre Routy
- Division of Hematology and Chronic Viral Illness Service, McGill University Health Centre, Glen site, Montreal, Quebec H4A 3J1, Canada
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Ghislain M, Bastard JP, Meyer L, Capeau J, Fellahi S, Gérard L, May T, Simon A, Vigouroux C, Goujard C. Late Antiretroviral Therapy (ART) Initiation Is Associated with Long-Term Persistence of Systemic Inflammation and Metabolic Abnormalities. PLoS One 2015; 10:e0144317. [PMID: 26636578 PMCID: PMC4670073 DOI: 10.1371/journal.pone.0144317] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/15/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives HIV-induced immunodeficiency is associated with metabolic abnormalities and systemic inflammation. We investigated the effect of antiretroviral therapy (ART) on restoration of insulin sensitivity, markers of immune activation and inflammation. Methods Immunological, metabolic and inflammatory status was assessed at antiretroviral therapy initiation and three years later in 208 patients from the ANRS-COPANA cohort. Patients were compared according to their pre-ART CD4+ cell count (group 1: ≤ 200/mm3, n = 66 vs. group 2: > 200/mm3, n = 142). Results Median CD4+ cell count increased in both groups after 3 years of successful ART but remained significantly lower in group 1 than in group 2 (404 vs 572 cells/mm3). Triglyceride and insulin levels were higher or tended to be higher in group 1 than in group 2 at ART initiation (median: 1.32 vs 0.97 mmol/l, p = 0.04 and 7.6 vs 6.8 IU, p = 0.09, respectively) and remained higher after three years of ART (1.42 vs 1.16 mmol/L, p = 0.0009 and 8.9 vs 7.2 IU, p = 0.01). After adjustment for individual characteristics and antiretroviral therapy regimens (protease inhibitor (PI), zidovudine), insulin levels remained significantly higher in patients with low baseline CD4+ cell count. Baseline IL-6, sCD14 and sTNFR2 levels were higher in group 1 than in group 2. Most biomarkers of immune activation/inflammation declined during ART, but IL-6 and hsCRP levels remained higher in patients with low baseline CD4+ cell count than in the other patients (median are respectively 1.4 vs 1.1 pg/ml, p = 0.03 and 2.1 vs 1.3 mg/ml, p = 0.07). Conclusion After three years of successful ART, low pretreatment CD4+ T cell count remained associated with elevated insulin, triglyceride, IL-6 and hsCRP levels. These persistent metabolic and inflammatory abnormalities could contribute to an increased risk of cardiovascular and metabolic disease.
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Affiliation(s)
- Mathilde Ghislain
- Inserm UMRS1018, CESP, Epidemiology of HIV and STI, Le Kremlin-Bicêtre, France
- * E-mail:
| | - Jean-Philippe Bastard
- Tenon Hospital, AP-HP, Department of Biochemistry and Hormonology, Paris, France
- Inserm UMRS 938, Centre de Recherche Saint-Antoine, Paris, France
- Sorbonne Universities, UPMC, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Laurence Meyer
- Inserm UMRS1018, CESP, Epidemiology of HIV and STI, Le Kremlin-Bicêtre, France
- Paris-Sud university, Le Kremlin-Bicêtre, France
- Bicêtre Hospital, AP-HP, Department of Public Health, Le Kremlin-Bicêtre, France
| | - Jacqueline Capeau
- Tenon Hospital, AP-HP, Department of Biochemistry and Hormonology, Paris, France
- Inserm UMRS 938, Centre de Recherche Saint-Antoine, Paris, France
- Sorbonne Universities, UPMC, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Soraya Fellahi
- Tenon Hospital, AP-HP, Department of Biochemistry and Hormonology, Paris, France
- Inserm UMRS 938, Centre de Recherche Saint-Antoine, Paris, France
- Sorbonne Universities, UPMC, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Laurence Gérard
- Saint-Louis Hospital, AP-HP, Department of Clinic Immunopathology, Paris, France
| | - Thierry May
- Teaching hospital of Nancy, Brabois Hospitals, Department of Infectious and Tropical Diseases, Vandoeuvre les Nancy, France
| | - Anne Simon
- Pitié-Salpétrière Hospital, AP-HP, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Corinne Vigouroux
- Inserm UMRS 938, Centre de Recherche Saint-Antoine, Paris, France
- Sorbonne Universities, UPMC, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Saint-Antoine Hospital, AP-HP, Common Laboratory of Biology and Molecular Genetics, Paris, France
| | - Cécile Goujard
- Inserm UMRS1018, CESP, Epidemiology of HIV and STI, Le Kremlin-Bicêtre, France
- Paris-Sud university, Le Kremlin-Bicêtre, France
- Bicêtre Hospital, AP-HP, Department of Internal Medicine, Le Kremlin-Bicêtre, France
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Raffetti E, Donato F, Castelli F, Maggiolo F, Carosi G, Quiros-Roldan E. The predictive role of NLR and PLR for solid non-AIDS defining cancer incidence in HIV-infected subjects: a MASTER cohort study. Infect Agent Cancer 2015; 10:34. [PMID: 26442127 PMCID: PMC4593208 DOI: 10.1186/s13027-015-0032-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/02/2015] [Indexed: 12/18/2022] Open
Abstract
Background The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), two low cost, routinely available inflammatory indices, have been found to be associated with risk of death in patients with solid cancer, in both general population and HIV-positive subjects. However, no study investigated the role of NLR and PLR as predictive of cancer incidence so far. Methods The aim of our study was to assess the association of PLR and NLR with risk of developing solid non-AIDS defining cancer (NADC) in HIV-infected subjects. We conducted a multicenter Italian cohort study from 2000 to 2012 including HIV-infected subjects naïve at antiretroviral treatment at enrollment. The associations of NLR and PLR with NADC incidence were evaluated by univariate and multivariate analyses using both time independent and time dependent Cox proportional hazard models. Results Thirteen thousand five hundred fifty-nine patients (73.3 % males) with a mean age of 36.0 years (SD 10.0) were included. The median (inter-quartile range) of NLR and PLR at baseline were 1.47 (1.03–2.17) and 109.9 (79.6–155.3), respectively. During a median follow-up of 3.9 years, 337 subjects had a first diagnosis of solid NADC. The crude and age- and gender-standardized incidence rates were 3.57 and 3.91 per 1000 person-years, respectively. No statistically significant association was found between NLR and PLR and NADC incidence, using multivariate models, including also time-dependent Cox models with a cubic-spline for NLR and PLR. Conclusion This study does not sustain the hypothesis that NRL and PLR may be useful for predicting the risk of cancer in HIV positive subjects. Electronic supplementary material The online version of this article (doi:10.1186/s13027-015-0032-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Raffetti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Francesco Donato
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Franco Maggiolo
- Clinical Infectious Diseases, Ospedale Papa Giovanni XXIII of Bergamo, Bergamo, Italy
| | - Giampiero Carosi
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italy
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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Abstract
Interleukin-6 (IL-6) is a pleiotropic cytokine implicated in the pathogenesis of many immune-mediated disorders including several types of non-infectious uveitis. These uveitic conditions include Vogt-Koyanagi-Harada syndrome, uveitis associated with Behçet disease, and sarcoidosis. This review summarizes the role of IL-6 in immunity, highlighting its effect on Th17, Th1, and plasmablast differentiation. It reviews the downstream mediators activated in the process of IL-6 binding to its receptor complex. This review also summarizes the biologics targeting either IL-6 or the IL-6 receptor, including tocilizumab, sarilumab, sirukumab, olokizumab, clazakizumab, and siltuximab. The target, dosage, potential side effects, and potential uses of these biologics are summarized in this article based on the existing literature. In summary, anti-IL-6 therapy for non-infectious uveitis shows promise in terms of efficacy and side effect profile.
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Affiliation(s)
- Phoebe Lin
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
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