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Turk T, Bachmann N, Kadelka C, Böni J, Yerly S, Aubert V, Klimkait T, Battegay M, Bernasconi E, Calmy A, Cavassini M, Furrer H, Hoffmann M, Günthard HF, Kouyos RD. Assessing the danger of self-sustained HIV epidemics in heterosexuals by population based phylogenetic cluster analysis. eLife 2017; 6:28721. [PMID: 28895527 PMCID: PMC5650480 DOI: 10.7554/elife.28721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Abstract
Assessing the danger of transition of HIV transmission from a concentrated to a generalized epidemic is of major importance for public health. In this study, we develop a phylogeny-based statistical approach to address this question. As a case study, we use this to investigate the trends and determinants of HIV transmission among Swiss heterosexuals. We extract the corresponding transmission clusters from a phylogenetic tree. To capture the incomplete sampling, the delayed introduction of imported infections to Switzerland, and potential factors associated with basic reproductive number R0, we extend the branching process model to infer transmission parameters. Overall, the R0 is estimated to be 0.44 (95%-confidence interval 0.42—0.46) and it is decreasing by 11% per 10 years (4%—17%). Our findings indicate rather diminishing HIV transmission among Swiss heterosexuals far below the epidemic threshold. Generally, our approach allows to assess the danger of self-sustained epidemics from any viral sequence data. In epidemiology, the “basic reproductive number” describes how efficiently a disease is transmitted, and represents the average number of new infections that an infected individual causes. If this number is less than one, many people do not infect anybody and hence the transmission chains die out. On the other hand, if the basic reproductive number is larger than one, an infected person infects on average more than one new individual, which leads to the virus or bacteria spreading in a self-sustained way. Turk et al. have now developed a method to estimate the basic reproductive number using the genetic sequences of the virus or bacteria, and have used it to investigate how efficiently HIV spreads among Swiss heterosexuals. The results show that the basic reproductive number of HIV in this group is far below the critical value of one and that over the last years this number has been decreasing. Furthermore, the basic reproductive number differs for different subtypes of the HIV virus, indicating that the geographical region where the infection was acquired may play a role in transmission. Turk et al. also found that people who are diagnosed later or who often have sex with occasional partners spread the virus more efficiently. These findings might be helpful for policy makers as they indicate that the risk of self-sustained transmission in this group in Switzerland is small. Furthermore the method allows HIV epidemics to be monitored at high resolution using sequence data, assesses the success of currently implemented preventive measures, and helps to target subgroups who are at higher risk of an infection – for instance, by supporting frequent HIV testing of these people. The method developed by Turk et al. could also prove useful for assessing the danger of other epidemics.
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Affiliation(s)
- Teja Turk
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Nadine Bachmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Claus Kadelka
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Aubert
- Division of Immunology and Allergy, University Hospital Lausanne, Lausanne, Switzerland
| | - Thomas Klimkait
- Molecular Virology, Department of Biomedicine - Petersplatz, University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Donnell D, Ramos E, Celum C, Baeten J, Dragavon J, Tappero J, Lingappa JR, Ronald A, Fife K, Coombs RW. The effect of oral preexposure prophylaxis on the progression of HIV-1 seroconversion. AIDS 2017; 31:2007-2016. [PMID: 28692542 PMCID: PMC5578893 DOI: 10.1097/qad.0000000000001577] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/08/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether oral preexposure prophylaxis (PrEP) alters timing and patterns of seroconversion when PrEP use continues after HIV-1 infection. DESIGN Retrospective testing of the timing of Fiebig stage HIV-1 seroconversion in the Partners PrEP Study, a randomized placebo-controlled clinical trial of PrEP conducted in Kenya and Uganda. METHODS Specimens from 138 seroconverters were collected every 3 months and when HIV-1 infection was suspected based on monthly rapid HIV-1 tests. Progression of seroconversion was compared between randomized groups (PrEP versus placebo) and per-protocol groups (placebo versus PrEP participants with detectable tenofovir during the seroconversion period) using laboratory assessment of Fiebig stage. Delay in site-detection of seroconversion and association with PrEP drug-regimen resistant virus were assessed using logistic regression. Analysis of time to each Fiebig stage used maximum likelihood estimation with a parametric model to accommodate the varying lengths of HIV-infection intervals. RESULTS There was a significant increase in delayed site detection of infection associated with PrEP (odds ratio = 3.49, P = 0.044). Delay in detection was not associated with increased risk of resistance in the PrEP arm (odds ratio = 0.93, P = 0.95). Estimated time to each Fiebig stage was elongated in seroconverters with evidence of ongoing PrEP use, significantly for only Stage 5 (28 versus 17 days, P = 0.05). Adjusted for Fiebig stage, viral RNA was ∼2/3 log lower in those assigned to PrEP compared with placebo; no differences were found in Architect signal to cut-off at any stage. CONCLUSION Ongoing PrEP use in seroconverters may delay detection of infection and elongate seroconversion, although the delay does not increase risk of resistance.
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Affiliation(s)
- Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center
- Department of Global Health
| | | | - Connie Celum
- Department of Global Health
- Department of Epidemiology
- Department of Medicine
| | - Jared Baeten
- Department of Global Health
- Department of Epidemiology
- Department of Medicine
| | | | - Jordan Tappero
- Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Jairam R. Lingappa
- Department of Global Health
- Department of Medicine
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Allan Ronald
- Departments of Medical Microbiology and Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kenneth Fife
- Department of Microbiology and immunology, Indiana University, Indianapolis, Indiana, USA
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204
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Abstract
PURPOSE OF REVIEW Understanding the characteristics of transmission during acute HIV infection (AHI) may inform targets for vaccine-induced immune interdiction. Individuals treated in AHI with a small HIV reservoir size may be ideal candidates for therapeutic HIV vaccines aiming for HIV remission (i.e. viremic control after treatment interruption). RECENT FINDINGS The AHI period is brief and peak viremia predicts a viral set point that occurs 4-5 weeks following infection. Robust HIV-specific CD8 T-cell responses lower viral set points. Phylogenetic analyses of founder viruses demonstrated unique bottleneck selections and specific genetic signatures to optimize for high-fitness variants and successful transmission events. HIV clades, route of transmission and the presence of minor variants may affect vaccine protection. Antiretroviral treatment in AHI results in smaller HIV reservoir size, better CD4 T-cell recovery and fewer virus escapes. SUMMARY The knowledge of untreated and treated AHI informs the development of vaccines, in that preventive vaccines will require broad coverage for multiple clades and antigenic variants associated with unique bottleneck selections. Vaccines that help the host to control viremia could minimize onward transmission. Therapeutic HIV vaccines aimed at HIV remission should be studied in early-treated individuals who have few or no viral escape mutants and a more preserved immune system.
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205
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Borrow P, Moody MA. Immunologic characteristics of HIV-infected individuals who make broadly neutralizing antibodies. Immunol Rev 2017; 275:62-78. [PMID: 28133804 PMCID: PMC5299500 DOI: 10.1111/imr.12504] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Induction of broadly neutralizing antibodies (bnAbs) capable of inhibiting infection with diverse variants of human immunodeficiency virus type 1 (HIV‐1) is a key, as‐yet‐unachieved goal of prophylactic HIV‐1 vaccine strategies. However, some HIV‐infected individuals develop bnAbs after approximately 2‐4 years of infection, enabling analysis of features of these antibodies and the immunological environment that enables their induction. Distinct subsets of CD4+ T cells play opposing roles in the regulation of humoral responses: T follicular helper (Tfh) cells support germinal center formation and provide help for affinity maturation and the development of memory B cells and plasma cells, while regulatory CD4+ (Treg) cells including T follicular regulatory (Tfr) cells inhibit the germinal center reaction to limit autoantibody production. BnAbs exhibit high somatic mutation frequencies, long third heavy‐chain complementarity determining regions, and/or autoreactivity, suggesting that bnAb generation is likely to be highly dependent on the activity of CD4+ Tfh cells, and may be constrained by host tolerance controls. This review discusses what is known about the immunological environment during HIV‐1 infection, in particular alterations in CD4+ Tfh, Treg, and Tfr populations and autoantibody generation, and how this is related to bnAb development, and considers the implications for HIV‐1 vaccine design.
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Affiliation(s)
- Persephone Borrow
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - M Anthony Moody
- Duke University Human Vaccine Institute and Departments of Pediatrics and Immunology, Duke University School of Medicine, Durham, NC, USA
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Bonsignori M, Liao HX, Gao F, Williams WB, Alam SM, Montefiori DC, Haynes BF. Antibody-virus co-evolution in HIV infection: paths for HIV vaccine development. Immunol Rev 2017; 275:145-160. [PMID: 28133802 PMCID: PMC5302796 DOI: 10.1111/imr.12509] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Induction of HIV-1 broadly neutralizing antibodies (bnAbs) to date has only been observed in the setting of HIV-1 infection, and then only years after HIV transmission. Thus, the concept has emerged that one path to induction of bnAbs is to define the viral and immunologic events that occur during HIV-1 infection, and then to mimic those events with a vaccine formulation. This concept has led to efforts to map both virus and antibody events that occur from the time of HIV-1 transmission to development of bnAbs. This work has revealed that a virus-antibody "arms race" occurs in which a HIV-1 transmitted/founder (TF) Env induces autologous neutralizing antibodies that can not only neutralize the TF virus but also can select virus escape mutants that in turn select affinity-matured neutralizing antibodies. From these studies has come a picture of bnAb development that has led to new insights in host-pathogen interactions and, as well, led to insight into immunologic mechanisms of control of bnAb development. Here, we review the progress to date in elucidating bnAb B cell lineages in HIV-1 infection, discuss new research leading to understanding the immunologic mechanisms of bnAb induction, and address issues relevant to the use of this information for the design of new HIV-1 sequential envelope vaccine candidates.
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Affiliation(s)
- Mattia Bonsignori
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hua-Xin Liao
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Feng Gao
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Wilton B Williams
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - S Munir Alam
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - David C Montefiori
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Barton F Haynes
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Immunology, Duke University School of Medicine, Durham, NC, USA
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207
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Akullian A, Bershteyn A, Klein D, Vandormael A, Bärnighausen T, Tanser F. Sexual partnership age pairings and risk of HIV acquisition in rural South Africa. AIDS 2017; 31:1755-1764. [PMID: 28590328 PMCID: PMC5508850 DOI: 10.1097/qad.0000000000001553] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the contribution of specific sexual partner age groups to the risk of HIV acquisition in men and women in a hyperendemic region of South Africa. DESIGN We conducted a population-based cohort study among women (15-49 years of age) and men (15-55 years of age) between 2004 and 2015 in KwaZulu-Natal, South Africa. METHODS Generalized additive models were used to estimate smoothed HIV incidence rates across partnership age pairings in men and women. Cox proportional hazards regression was used to estimate the relative risk of HIV acquisition by partner age group. RESULTS A total of 882 HIV seroconversions were observed in 15 935 person-years for women, incidence rate = 5.5 per 100 person-years [95% confidence interval (CI), 5.2-5.9] and 270 HIV seroconversions were observed in 9372 person-years for men, incidence rate = 2.9 per 100 person-years (95% CI, 2.6-3.2). HIV incidence was highest among 15-24-year-old women reporting partnerships with 30-34-year-old men, incidence rate = 9.7 per 100 person-years (95% CI, 7.2-13.1). Risk of HIV acquisition in women was associated with male partners aged 25-29 years (adjusted hazard ratio; aHR = 1.44, 95% CI, 1.02-2.04) and 30-34 years (aHR = 1.50, 95% CI, 1.08-2.09) relative to male partners aged 35 and above. Risk of HIV acquisition in men was associated with 25-29-year-old (aHR = 1.72, 95% CI, 1.02-2.90) and 30-34-year-old women (aHR = 2.12, 95% CI, 1.03-4.39) compared to partnerships with women aged 15-19 years. CONCLUSION Age of sexual partner is a major risk factor for HIV acquisition in both men and women, independent of one's own age. Partner age pairings play a critical role in driving the cycle of HIV transmission.
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Affiliation(s)
- Adam Akullian
- Institute for Disease Modeling, Global Good Fund, Bellevue, Washington, USA
| | - Anna Bershteyn
- Institute for Disease Modeling, Global Good Fund, Bellevue, Washington, USA
| | - Daniel Klein
- Institute for Disease Modeling, Global Good Fund, Bellevue, Washington, USA
| | - Alain Vandormael
- Africa Health Research Institute, University of KwaZulu-Natal, Mtubatuba, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, University of KwaZulu-Natal, Mtubatuba, South Africa
- Institute for Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Frank Tanser
- Department of Infection and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
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209
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Wang Y, Yu L, Kong X, Sun L. Application of nanodiagnostics in point-of-care tests for infectious diseases. Int J Nanomedicine 2017; 12:4789-4803. [PMID: 28740385 PMCID: PMC5503494 DOI: 10.2147/ijn.s137338] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although tremendous efforts have been put into the treatment of infectious diseases to prevent epidemics and mortality, it is still one of the major health care issues that have a profound impact on humankind. Therefore, the development of specific, sensitive, accurate, rapid, low-cost, and easy-to-use diagnostic tools is still in urgent demand. Nanodiagnostics, defined as the application of nanotechnology to medical diagnostics, can offer many unique opportunities for more successful and efficient diagnosis and treatment for infectious diseases. In this review, we provide an overview of the nanodiagnostics for infectious diseases from nanoparticle-based, nanodevice-based, and point-of-care test (POCT) platforms. Most importantly, emphasis focused on the recent trends in the nanotechnology-based POCT system. The current state-of-the-art and most promising point-of-care nanodiagnostic technologies, including miniaturized diagnostic magnetic resonance platform, magnetic barcode assay system, cell phone-based polarized light microscopy platform, cell phone-based dongle platform, and paper-based POCT platform, for infectious diseases were fully examined. The limitations, challenges, and future trends of the nanodiagnostics in POCTs for infectious diseases are also discussed.
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Affiliation(s)
- Yongzhong Wang
- Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei, Anhui, People's Republic of China
| | - Li Yu
- Department of Microbiology and Parasitology, Anhui Provincial Laboratory of Microbiology and Parasitology, Anhui Key Laboratory of Zoonoses, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xiaowei Kong
- Anhui Key Laboratory of Modern Biomanufacturing, School of Life Sciences, Anhui University, Hefei, Anhui, People's Republic of China
| | - Leming Sun
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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210
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Rutstein SE, Ananworanich J, Fidler S, Johnson C, Sanders EJ, Sued O, Saez-Cirion A, Pilcher CD, Fraser C, Cohen MS, Vitoria M, Doherty M, Tucker JD. Clinical and public health implications of acute and early HIV detection and treatment: a scoping review. J Int AIDS Soc 2017; 20:21579. [PMID: 28691435 PMCID: PMC5515019 DOI: 10.7448/ias.20.1.21579] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/29/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. METHODS We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. RESULTS AND DISCUSSION Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. CONCLUSIONS There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jintanat Ananworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Cheryl Johnson
- HIV Department, World Health Organization, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard J. Sanders
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Asier Saez-Cirion
- Institut Pasteur, HIV Inflammation and Persistance Unit, Paris, France
| | | | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Myron S. Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D. Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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211
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Dijkstra M, de Bree GJ, Stolte IG, Davidovich U, Sanders EJ, Prins M, Schim van der Loeff MF. Development and validation of a risk score to assist screening for acute HIV-1 infection among men who have sex with men. BMC Infect Dis 2017; 17:425. [PMID: 28615005 PMCID: PMC5471739 DOI: 10.1186/s12879-017-2508-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early treatment of acute HIV-1 infection (AHI) is beneficial for patients and could reduce onward transmission. However, guidelines on whom to test for AHI with HIV-1 RNA testing are lacking. METHODS A risk score for possible AHI based on literature and expert opinion - including symptoms associated with AHI and early HIV-1 - was evaluated using data from the Amsterdam Cohort Studies among men who have sex with men (MSM). Subsequently, we optimized the risk score by constructing two multivariable logistic regression models: one including only symptoms and one combining symptoms with known risk factors for HIV-1 seroconversion, using generalized estimating equations. Several risk scores were generated from these models and the optimal risk score was validated using data from the Multicenter AIDS Cohort Study. RESULTS Using data from 1562 MSM with 175 HIV-1 seroconversion visits and 17,271 seronegative visits in the Amsterdam Cohort Studies, the optimal risk score included four symptoms (oral thrush, fever, lymphadenopathy, weight loss) and three risk factors (self-reported gonorrhea, receptive condomless anal intercourse, more than five sexual partners, all in the preceding six months) and yielded an AUC of 0.82. Sensitivity was 76.3% and specificity 76.3%. Validation in the Multicenter AIDS Cohort Study resulted in an AUC of 0.78, sensitivity of 56.2% and specificity of 88.8%. CONCLUSIONS The optimal risk score had good overall performance in the Amsterdam Cohort Studies and performed comparable (but showed lower sensitivity) in the validation study. Screening for AHI with four symptoms and three risk factors would increase the efficiency of AHI testing and potentially enhance early diagnosis and immediate treatment.
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Affiliation(s)
- Maartje Dijkstra
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Godelieve J de Bree
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands. .,Amsterdam Institute for Global Health and Development, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.
| | - Ineke G Stolte
- Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Udi Davidovich
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Eduard J Sanders
- Amsterdam Institute for Global Health and Development, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Kenya Medical Research Institute, Centre for Geographic Medicine Research -Coast, P.O. Box 230, Kilifi, Kenya.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Maria Prins
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
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Brantley M, Schumacher C, Fields EL, Perin J, Safi AG, Ellen JM, Muvva R, Chaulk P, Jennings JM. The network structure of sex partner meeting places reported by HIV-infected MSM: Opportunities for HIV targeted control. Soc Sci Med 2017; 182:20-29. [PMID: 28411524 PMCID: PMC6598677 DOI: 10.1016/j.socscimed.2017.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 03/24/2017] [Accepted: 04/05/2017] [Indexed: 01/08/2023]
Abstract
Baltimore, Maryland ranks among U.S. cities with the highest incidence of HIV infection among men who have sex with men (MSM). HIV screening at sex partner meeting places or venues frequented by MSM with new diagnoses and/or high HIV viral load may reduce transmission by identifying and linking infected individuals to care. We investigated venue-based clustering of newly diagnosed MSM to identify high HIV transmission venues. HIV surveillance data from MSM diagnosed between October 2012-June 2014 and reporting ≥1 sex partner meeting place were examined. Venue viral load was defined according to the geometric mean viral load of the cluster of cases that reported the venue and classified as high (>50,000 copies/mL), moderate (1500-50,000 copies/mL), and low (<1500 copies/mL). 143 MSM provided information on ≥1 sex partner meeting place, accounting for 132 unique venues. Twenty-six venues were reported by > 1 MSM; of these, a tightly connected cluster of six moderate viral load sex partner meeting places emerged, representing 66% of reports. Small, dense networks of moderate to high viral load venues may be important for targeted HIV control among MSM.
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Affiliation(s)
- Meredith Brantley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Christina Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA
| | - Errol L Fields
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jamie Perin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amelia Greiner Safi
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Ellen
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Ravikiran Muvva
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA
| | - Patrick Chaulk
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA; Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jacky M Jennings
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Gelpi M, Hartling HJ, Ueland PM, Ullum H, Trøseid M, Nielsen SD. Tryptophan catabolism and immune activation in primary and chronic HIV infection. BMC Infect Dis 2017; 17:349. [PMID: 28511640 PMCID: PMC5434617 DOI: 10.1186/s12879-017-2456-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/09/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Kynurenine/Tryptophan ratio (KTR) is increased in HIV infection, and linked to immune activation. We hypothesized that early cART initiation results in lower KTR compared to late initiation. Furthermore, we hypothesized that KTR prior to cART is a predictor of the magnitude of subsequent reduction in immune activation. METHODS Prospective study including 57 HIV-infected individuals (primary HIV infection (N = 14), early presenters (>350 CD4+ T cells/μL, N = 24), late presenters (<200 CD4+ T cells/μL, N = 19)). Kynurenine and tryptophan were analysed by liquid chromatography-tandem mass spectrometry. Total CD4+ and CD8+ T cells were determined and proportion of activated CD38 + HLA-DR+ Tcells was measured using flow cytometry at baseline and after 6 and 12 months of cART. RESULTS At baseline, primary HIV infection had higher KTR than early presenters. However, similar KTR in primary HIV infection and early presenters was found after cART initiation, while late presenters had higher KTR at all time points. In primary HIV infection and early presenters, KTR was positively associated with proportion of activated cells at baseline. Furthermore, in early presenters the KTR at baseline was associated with proportion of activated cells after 6 and 12 months. Interestingly, in primary HIV infection the KTR at baseline was positively associated with reduction in proportion of CD8 + CD38 + HLA-DR T cells after 6 and 12 months. CONCLUSIONS Lower kynurenine/tryptophan ratio during follow-up was found after early initiation of cART. KTR in primary HIV infection and early presenters was positively associated with immune activation. Importantly, KTR in primary HIV infection predicted the magnitude of subsequent reduction in immune activation. Thus, a beneficial effect of early cART on KTR was suggested.
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Affiliation(s)
- Marco Gelpi
- Viro-Immunology Research Unit, Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Hans J Hartling
- Viro-Immunology Research Unit, Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Per M Ueland
- Section for pharmacology, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Henrik Ullum
- Department of Clinical Immunology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Marius Trøseid
- Section of Clinical Immunology and Infectious Diseases, University Hospital Rikshospitalet, Kirkeveien 166, Oslo, Norway
| | - Susanne D Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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214
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Matsuda EM, Colpas DR, Campos NC, Coelho LPO, Carmo AMDS, Brígido LFDM. Undiagnosed acute HIV infection identified through RNA testing of pooled serum samples obtained during a dengue outbreak in São Paulo, Brazil. Rev Soc Bras Med Trop 2017; 50:110-112. [PMID: 28327811 DOI: 10.1590/0037-8682-0370-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/24/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Improving HIV diagnostics and treatment is necessary to end the AIDS epidemic. Pooled plasma can be used to identify patients with acute HIV disease, even before serological tests. During dengue outbreaks, patients having symptoms common to other acute viral diseases might seek medical care. METHODS: We evaluated HIV RNA in pooled seronegative dengue samples. RESULTS: After excluding individuals with a known HIV diagnosis, an HIV-1 prevalence of 0.73% [95% confidence interval (CI) 0.23-1.76; 4/546 samples] was found. CONCLUSIONS: Promoting strategies to diagnose these individuals and provide them with medical treatment might be instrumental for controlling the HIV epidemic.
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Affiliation(s)
- Elaine Monteiro Matsuda
- Programa de Controle das DST/AIDS, Prefeitura Municipal de Santo André, Santo André, São Paulo, Brasil
| | - Daniela Rodrigues Colpas
- Laboratório Regional, Instituto Adolfo Lutz, Governo do Estado de São Paulo, Santo André, São Paulo, Brasil
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215
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Differences in Risk Behavior and Demographic Factors Between Men Who Have Sex With Men With Acute and Nonacute Human Immunodeficiency Virus Infection in a Community-Based Testing Program in Los Angeles. J Acquir Immune Defic Syndr 2017; 74:e97-e103. [PMID: 27861243 DOI: 10.1097/qai.0000000000001233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION High viremia combined with HIV-infection status unawareness and increased sexual risk behavior contributes to a disproportionate amount of new HIV infections. METHODS From August 2011 to July 2015, the Los Angeles Lesbian, Gay, Bisexual, and Transgender Center conducted 66,546 HIV tests. We compared factors, including the presence of concomitant sexually transmitted infections, number of recent sex partners and reported condomless anal intercourse between men who have sex with men (MSM) diagnosed with an acute HIV infection and a nonacute HIV infection using multivariable logistic regression. RESULTS Of 1082 unique MSM who tested HIV-infected for the first time, 165 (15%) had an acute infection and 917 had a nonacute infection. HIV rapid antibody testing was 84.8% sensitive for detecting HIV infection (95% confidence interval (CI): 82.9% to 87.1%). Median HIV viral load among acutely infected MSM was 842,000 copies per milliliter (interquartile range = 98,200-4,897,318). MSM with acute infection had twice the number of sex partners in the prior 30 days (median = 2) and prior 3 months (median = 4) before diagnosis compared with those diagnosed with nonacute infection (P ≤ 0.0001). The odds of acute HIV infection were increased with the numbers of recent sex partners after controlling for age and race/ethnicity (adjusted odds ratio (aOR) >5 partners in past 30 days = 2.74; 95% CI: 1.46 to 5.14; aOR >10 partners in past 3 months = 2.41; 95% CI: 1.36 to 4.25). Non-African American MSM had almost double the odds of being diagnosed with an acute HIV infection compared with African American MSM (aOR = 1.97; 95% CI: 1.10 to 3.52). CONCLUSIONS MSM with acute HIV infection had nearly twice as many sex partners in the past 30 days and 3 months compared with MSM with newly diagnosed nonacute HIV infection. Those diagnosed with acute HIV infection had decreased odds of being African American MSM.
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Abstracts of the HIV & Hepatitis in the Americas 2017 - Congress. J Int AIDS Soc 2017; 20:21954. [PMID: 28440071 PMCID: PMC5625637 DOI: 10.7448/ias.20.3.21954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
OBJECTIVE HIV-1 epidemics among MSM remain unchecked despite advances in treatment and prevention paradigms. This study combined viral phylogenetic and behavioural risk data to better understand underlying factors governing the temporal growth of the HIV epidemic among MSM in Quebec (2002-2015). METHODS Phylogenetic analysis of pol sequences was used to deduce HIV-1 transmission dynamics (cluster size, size distribution and growth rate) in first genotypes of treatment-naïve MSM (2002-2015, n = 3901). Low sequence diversity of first genotypes (0-0.44% mixed base calls) was used as an indication of early-stage infection. Behavioural risk data were obtained from the Montreal rapid testing site and primary HIV-1-infection cohorts. RESULTS Phylogenetic analyses uncovered high proportion of clustering of new MSM infections. Overall, 27, 45, 48, 53 and 57% of first genotypes within one (singleton, n = 1359), 2-4 (n = 692), 5-9 (n = 367), 10-19 (n = 405) and 20+ (n = 1277) cluster size groups were early infections (<0.44% diversity). Thirty viruses within large 20+ clusters disproportionately fuelled the epidemic, representing 13, 25 and 42% of infections, first genotyped in 2004-2007 (n = 1314), 2008-2011 (n = 1356) and 2012-2015 (n = 1033), respectively. Of note, 35, 21 and 14% of MSM belonging to 20+, 2-19 and one (singleton) cluster groups were under 30 years of age, respectively. Half of persons seen at the rapid testing site (2009-2011, n = 1781) were untested in the prior year. Poor testing propensity was associated with fewer reported partnerships. CONCLUSION Addressing the heterogeneity in transmission dynamics among HIV-1-infected MSM populations may help guide testing, treatment and prevention strategies.
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Wall KM, Rida W, Haddad LB, Kamali A, Karita E, Lakhi S, Kilembe W, Allen S, Inambao M, Yang AH, Latka MH, Anzala O, Sanders EJ, Bekker LG, Edward VA, Price MA. Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries. Epidemiology 2017; 28:224-232. [PMID: 27893488 PMCID: PMC5287431 DOI: 10.1097/ede.0000000000000590] [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: 01/11/2016] [Accepted: 11/14/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. METHODS From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy. RESULTS Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different. CONCLUSIONS In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted.
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Affiliation(s)
- Kristin M. Wall
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Wasima Rida
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Lisa B. Haddad
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Anatoli Kamali
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Etienne Karita
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Shabir Lakhi
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - William Kilembe
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Susan Allen
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Mubiana Inambao
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Annie H. Yang
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Mary H. Latka
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Omu Anzala
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Eduard J. Sanders
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Linda-Gail Bekker
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Vinodh A. Edward
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Matt A. Price
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
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Kosaka PM, Pini V, Calleja M, Tamayo J. Ultrasensitive detection of HIV-1 p24 antigen by a hybrid nanomechanical-optoplasmonic platform with potential for detecting HIV-1 at first week after infection. PLoS One 2017; 12:e0171899. [PMID: 28199410 PMCID: PMC5310927 DOI: 10.1371/journal.pone.0171899] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/27/2017] [Indexed: 01/03/2023] Open
Abstract
Early detection of HIV infection is the best way to prevent spread of the disease and to improve the efficiency of the antiretroviral therapy. Nucleic acid amplification tests (NAAT) have become the gold-standard for detecting low-concentrations of the virus in blood. However, these methods are technically demanding and cost-prohibitive in developing countries. Immunoassays are more affordable and can be more easily adapted for point-of-care diagnosis. However, the sensitivity so far of these methods has been too low. We here report the development of a sandwich immunoassay that combines nanomechanical and optoplasmonic transduction methods for detecting the HIV-1 capsid antigen p24 in human serum. The immunoreactions take place on the surface of a compliant microcantilever where gold nanoparticles are used as both mechanical and plasmonic labels. The microcantilever acts as both a mechanical resonator and an optical cavity for the transduction of the mechanical and plasmonic signals. The limit of detection of the immunoassay is 10−17 g/mL that is equivalent to one virion in 10 mL of plasma. This is 5 orders of magnitude better than last generation of approved immunoassays and 2 orders of magnitude better than NAAT. This technology meets the demands to be produced en masse at low cost and the capability for miniaturization to be used at the point-of-care.
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Affiliation(s)
- Priscila M. Kosaka
- IMM–Instituto de Microelectrónica de Madrid (CNM-CSIC), Isaac Newton, 8, PTM, Tres Cantos, Madrid, Spain
- * E-mail: (JT); (PMK)
| | - Valerio Pini
- IMM–Instituto de Microelectrónica de Madrid (CNM-CSIC), Isaac Newton, 8, PTM, Tres Cantos, Madrid, Spain
| | - Montserrat Calleja
- IMM–Instituto de Microelectrónica de Madrid (CNM-CSIC), Isaac Newton, 8, PTM, Tres Cantos, Madrid, Spain
| | - Javier Tamayo
- IMM–Instituto de Microelectrónica de Madrid (CNM-CSIC), Isaac Newton, 8, PTM, Tres Cantos, Madrid, Spain
- * E-mail: (JT); (PMK)
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Abstract
Acute HIV infection (AHI) represents the first 6 to 12 weeks of the disease process, when the virus is aggressively replicating in the lymphoid tissues. Accordingly, high viral loads are often present during this phase, with declining lymphocyte levels, as the CD4+ T-cell subset is preferentially commandeered to facilitate viral reproduction. Detection at this stage is imperative-the affected are often unaware, but highly infectious. Unfortunately, correct diagnosis of AHI can be challenging because the more traditional, frequently used tests, which rely on antibody detection, will often produce false-negative results during the "window period" (usually 3 to 4 weeks from infection) due to slow production of HIV antibodies. Consequently, testing with fourth-generation antibody-antigen and viral nucleic acid polymerase chain reaction modalities, which can yield positive results within 5 to 7 days of infection, is vital in the context of any significant concern for AHI. [Pediatr Ann. 2017;46(2):e47-e50.].
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Moyo S, Wilkinson E, Vandormael A, Wang R, Weng J, Kotokwe KP, Gaseitsiwe S, Musonda R, Makhema J, Essex M, Engelbrecht S, de Oliveira T, Novitsky V. Pairwise diversity and tMRCA as potential markers for HIV infection recency. Medicine (Baltimore) 2017; 96:e6041. [PMID: 28178146 PMCID: PMC5313003 DOI: 10.1097/md.0000000000006041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intrahost human immunodeficiency virus (HIV)-1 diversity increases linearly over time. We assessed the extent to which mean pairwise distances and the time to the most recent common ancestor (tMRCA) inferred from intrahost HIV-1C env sequences were associated with the estimated time of HIV infection. Data from a primary HIV-1C infection study in Botswana were used for this analysis (N = 42). A total of 2540 HIV-1C env gp120 variable loop region 1 to conserved region 5 (V1C5) of the HIV-1 envelope gp120 viral sequences were generated by single genome amplification and sequencing, with an average of 61 viral sequences per participant and 11 sequences per time point per participant. Raw pairwise distances were calculated for each time point and participant using the ape package in R software. The tMRCA was estimated using phylogenetic inference implemented in Bayesian Evolutionary Analysis by Sampling Trees v1.8.2. Pairwise distances and tMRCA were significantly associated with the estimated time since HIV infection (both P < 0.001). Taking into account multiplicity of HIV infection strengthened these associations. HIV-1C env-based pairwise distances and tMRCA can be used as potential markers for HIV recency. However, the tMRCA estimates demonstrated no advantage over the pairwise distances estimates.
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Affiliation(s)
- Sikhulile Moyo
- Division of Medical Virology, Stellenbosch University, Tygerberg, South Africa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Eduan Wilkinson
- College of Health Sciences, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Alain Vandormael
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Rui Wang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jia Weng
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Simani Gaseitsiwe
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rosemary Musonda
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Max Essex
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory Services (NHLS), Tygerberg Coastal, South Africa
| | - Tulio de Oliveira
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Republic of South Africa
- Research Department of Infection, University College London, London, United Kingdom
- College of Health Sciences, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Vladimir Novitsky
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gu WM, Hu Y, Hu WZ, Xu B. Dynamic changes in biomarkers in acute human immunodeficiency virus infections: a case report. BMC Res Notes 2017; 10:65. [PMID: 28126023 PMCID: PMC5270311 DOI: 10.1186/s13104-017-2392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background The highest incidence of human immunodeficiency virus infection in China is among men who have sex with men. This case report aims to describe the dynamic changes in biomarkers in an acute human immunodeficiency virus infection of a Han Chinese man who has sex with men, and to illustrate the possibility of using these biomarkers for the early detection of human immunodeficiency virus infection in Chinese hospital settings. Case presentation The 25-year-old Han Chinese male patient presented himself with an 8-day history of symptoms and signs of upper respiratory viral infections to a sexually transmitted infection clinic of a hospital setting in Shanghai. The viral load of human immunodeficiency virus, p24 antigen–antibody complex, and lymphocyte subsets of blood samples were repeatedly measured over the next 39 days. The human immunodeficiency virus from serum was genotyped. This patient was diagnosed as a human immunodeficiency virus infection, and the viral genotype was CRF 01_AE. The onset of the symptoms and signs was 12 days after his last reported unprotected intercourse with a human immunodeficiency virus -infected man. The patient had detectable levels of p24 antigen at his first visit, 20 days after infection, and the HIV viral load was at the highest point (8 × 106 copies/ml). A low concentration of antibody to HIV was observed in the patient’s serum 10 days after his 1st visit (30 days after infection). The confirmation of human immunodeficiency virus infection by Western blot assays was made at day 20 after his 1st visit (40 days after infection). Conclusions Symptoms of acute human immunodeficiency virus infection are non-specific. Specific laboratory markers appear shortly after HIV infections. The first biomarker detected from serum is the viral RNA and p24 antigen, followed by HIV-specific antibody. The results suggest that there are urgent needs for both human immunodeficiency virus antigen and antibody testing in routine medical practice, and that human immunodeficiency virus RNA testing should be recommended to detect early infection. Ethics approval was obtained from the Ethics Board of the Shanghai Dermatology Hospital.
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Affiliation(s)
- Wei-Ming Gu
- Shanghai Dermatology Hospital, Shanghai, 200050, China.
| | - Yi Hu
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Wei-Zhong Hu
- Shanghai Dermatology Hospital, Shanghai, 200050, China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, 200032, China
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Wandell GM, Molina Y, Sánchez H, Greer AC, Ríos J, Bain C, Segura P, Lama JR, Sánchez J, Duerr A. Knowledge and preferences concerning acute HIV testing programs among both Peruvian men who have sex with men and transgender women. Int J STD AIDS 2017; 28:1010-1017. [PMID: 28056724 DOI: 10.1177/0956462416685674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immediate antiretroviral therapy (ART) for acute HIV infection (AHI) may decrease HIV transmission in high-risk populations. This study evaluated knowledge of AHI and AHI testing program preferences in Lima, Peru through four semi-structured focus groups with high-risk men who have sex with men (MSM) ( n = 20) and transgender women (TW) ( n = 16). Using content analysis, emergent themes included knowledge of AHI symptoms, AHI transmission potential, and the HIV testing window period, and preferences concerning point of care results. Participants demonstrated low familiarity with the term AHI, but many correctly identified AHI symptoms. However, these symptoms may not motivate testing because they overlap with common viral illnesses and AIDS. Some were aware that infectiousness is highest during AHI, and believe this knowledge would facilitate HIV testing. The shortened window period with AHI testing would encourage testing following high-risk sex. Delayed result notification would not decrease AHI testing demand among MSM, although it might for some TW.
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Affiliation(s)
- Grace M Wandell
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Yamile Molina
- 2 School of Public Health, University of Illinois, Chicago, IL, USA
| | | | - Anna C Greer
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Jessica Ríos
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú
| | - Carolyn Bain
- 5 Vaccine and Infectious Disease & Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Javier R Lama
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Jorge Sánchez
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Ann Duerr
- 5 Vaccine and Infectious Disease & Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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Joore IK, Twisk DE, Vanrolleghem AM, de Ridder M, Geerlings SE, van Bergen JEAM, van den Broek IV. The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care. BMC FAMILY PRACTICE 2016; 17:161. [PMID: 27855639 PMCID: PMC5114759 DOI: 10.1186/s12875-016-0556-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/02/2016] [Indexed: 01/03/2023]
Abstract
Background European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). We aimed to investigate the incidence of ICs in primary care reported in medical records prior to HIV diagnosis. Methods We did a cross-sectional search in an electronic general practice database using a matched case-control design to identify which predefined ICs registered by Dutch GPs were most associated with an HIV-positive status prior to the time of diagnosis. Results We included 224 HIV cases diagnosed from 2009 to 2013, which were matched with 2,193 controls. Almost two thirds (n = 136, 60.7%) of cases were diagnosed with one or more ICs in the period up to five years prior to the index date compared to 18.7% (n = 411) of controls. Cases were more likely to have an IC than controls: in the one year prior to the index date, the odds ratio (OR) for at least one condition was 11.7 (95% CI: 8.3 to 16.4). No significant differences were seen in the strength of the association between HIV diagnosis and ICs when comparing genders, age groups or urbanisation levels. There is no indication that subgroups require a different testing strategy. Conclusions Our study shows that there are opportunities for IC-guided testing in primary care. We recommend that IC-guided testing be more integrated in GPs’ future guidelines and that education strategies be used to facilitate its implementation in daily practice. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0556-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ivo K Joore
- Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100, DE, Amsterdam, The Netherlands.
| | - Denise E Twisk
- National Institute for Public Health and the Environment (RIVM), Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Ann M Vanrolleghem
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan E A M van Bergen
- Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100, DE, Amsterdam, The Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
| | - Ingrid V van den Broek
- National Institute for Public Health and the Environment (RIVM), Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
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Dhamanage A, Thakar M, Paranjape R. Human Immunodeficiency Virus-1 Impairs IFN-Alpha Production Induced by TLR-7 Agonist in Plasmacytoid Dendritic Cells. Viral Immunol 2016; 30:28-34. [PMID: 27809682 DOI: 10.1089/vim.2016.0084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Plasmacytoid dendritic cells (pDCs) play an important role in innate immune response against viruses, mainly through interferon-α (IFN-α) secretion. Impaired IFN-α secretion has been observed in patients with acute human immunodeficiency virus type 1 (HIV-1) infection and the reasons for this impairment are still obscure. To know the grounds behind this situation, HIV-1 viral copy numbers similar to those found in primary HIV-1 infection were used to stimulate peripheral blood mononuclear cells (PBMCs) and pDCs in this study. Intracellular IFN-α production was seen as early as 2 h in pDCs with TLR-7 agonist (imiquimod) stimulation, but HIV-1 required 48 h to induce secretion of IFN-α in supernatants and it was 10 times less compared to imiquimod. Thus, it shows that HIV-1 delays and impairs IFN-α production from pDCs. Furthermore, the IFN-α inhibitory activity of HIV-1 was checked by stimulating PBMCs and pDCs with imiquimod either simultaneously with HIV-1 or after 2 h pre-exposure to HIV-1. Pre-exposure to HIV-1 resulted in significant reduction in IFN-α secretion by pDCs and PBMCs when compared to imiquimod alone. In addition, simultaneous stimulation of these populations with HIV-1 and imiquimod resulted in significant impairment in IFN-α production in pDCs but not in PBMCs. HIV-1 not only fails to induce IFN-α in adequate quantities but also inhibits IFN-α secretary capacity of pDCs. HIV-1 particles were found to bind CD303 receptor on pDC surface probably blocking initiation of cascade leading to IFN-α impairment. The understanding of the pathways that lead to this suppression may help in devising the HIV control strategies.
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Affiliation(s)
- Ashwini Dhamanage
- Department of Immunology, National AIDS Research Institute , Pune, India
| | - Madhuri Thakar
- Department of Immunology, National AIDS Research Institute , Pune, India
| | - Ramesh Paranjape
- Department of Immunology, National AIDS Research Institute , Pune, India
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The first 24 h: targeting the window of opportunity for antibody-mediated protection against HIV-1 transmission. Curr Opin HIV AIDS 2016; 11:561-568. [PMID: 27559708 DOI: 10.1097/coh.0000000000000319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW I will review evidence that antibodies protect against HIV-1 transmission in a short window of opportunity, involving neutralization, Fc-mediated effector function, or both. RECENT FINDINGS The last decade witnessed a dramatic progress in the understanding of antibody-mediated protection against HIV-1, including active and passive immunization studies in nonhuman primates; association between reduced infection risk and the specificities and function of antibodies in the RV144 clinical trial; identification of potent, broadly neutralizing antibodies; high-resolution structural studies of the HIV-1 envelope trimer; and an increasing appreciation that Fc-mediated effector function is critical to protection against transmission for neutralizing and nonneutralizing antibodies. Less information is known about how antibodies protect in situ, except that they must do in the first 24 h after exposure. New evidence suggests that antibodies protect in an acute innate immune environment involving the NXLRX1 inflammasome and transforming growth factor beta (TGF-β) that favors infection and rapid dissemination of CCR6RORγ Th17 cells. SUMMARY These recent findings set the stage for understanding how antibodies can prevent the transmission of HIV-1. In this context, antibodies must prevent infection in an innate immune environment that strongly favors transmission. This information is key for the development of a vaccine against HIV-1.
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Abstract
BACKGROUND AND OBJECTIVE Acute and early human immunodeficiency virus infection (AEH) is accompanied by neuroinflammatory processes as well as impairment in neurocognitive and everyday functions, but little is known about the frequency and clinical correlates of the neurobehavioral disturbances during this period. We compared pre-seroconversion with current levels of apathy, disinhibition, and executive dysfunction; we also examined everyday function and HIV disease correlates of neuropsychiatric impairment in individuals with AEH. METHODS In this study, 34 individuals with AEH and 39 HIV-seronegative participants completed neuromedical and neuropsychological assessments, a structured psychiatric interview, and the apathy, disinhibition, and executive dysfunction subscales of the Frontal Systems Behavioral Scale. RESULTS Independent of any substance use and mood disorders, the AEH group had significantly higher levels of current apathy and executive dysfunction than the controls, but not greater disinhibition. Retrospective ratings of pre-seroconversion levels of apathy, disinhibition, and executive dysfunction were all higher in the AEH group than the controls. After seroconversion, the AEH cohort had increases in current apathy and executive dysfunction, but not disinhibition. In the AEH cohort, higher current global neurobehavioral dysfunction was significantly associated with lower nadir CD4 counts, slowed information processing speed, and more everyday function problems. CONCLUSIONS These data suggest that individuals who have recently acquired HIV experienced higher-than-normal premorbid levels of neurobehavioral disturbance. Apathy and executive dysfunction are exacerbated during AEH, particularly in association with lower CD4 counts.
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228
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Immune activation during acute HIV infection and the impact of early antiretroviral therapy. Curr Opin HIV AIDS 2016; 11:163-72. [PMID: 26599167 DOI: 10.1097/coh.0000000000000228] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline recent data pertaining to mechanisms of immune activation in acute infection and describe new developments that seek to determine if early antiretroviral treatment can mitigate chronic immune activation. RECENT FINDINGS Following the detection of HIV RNA, highly activated CD8 T cells expand and peak approximately 2 weeks following peak viral load whereas levels of proinflammatory soluble markers coincide with a rise in viral load. Immune activation during acute infection is driven by many factors including pyroptosis, replicative capacity of the infecting virus, and loss of Th17 cells within the gut. Early antiretroviral therapy (ART), particularly if initiated in Fiebig I (HIV IgM-), preserved mucosal CD4 T cells, possibly preventing the release of microbial products associated with immune activation. Viral reservoirs were restricted by the early initiation of ART, and heightened systemic immune activation was partially prevented compared with chronic HIV infection. A strong correlation was found between the size of the viral reservoir and cellular immune activation. SUMMARY The timing of immune activation during acute infection occurs shortly after exposure. Recent studies demonstrated that ART mitigates inflammatory responses, preserves CD4 T cells, and limits reservoir seeding if provided early in acute HIV infection.
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Abstract
OBJECTIVE Estimates for the contribution of transmission arising from acute HIV infections (AHIs) to overall HIV incidence vary significantly. Furthermore, little is known about AHI-attributable transmission among people who inject drugs (PWID), including the extent to which interventions targeting chronic infections (e.g. HAART as prevention) are limited by AHI transmission. Thus, we estimated the proportion of transmission events attributable to AHI within the mature HIV epidemic among PWID in New York City (NYC). DESIGN Modeling study. METHODS We constructed an interactive sexual and injecting transmission network using an agent-based model simulating the HIV epidemic in NYC between 1996 and 2012. Using stochastic microsimulations, we cataloged transmission from PWID based on the disease stage of index agents to determine the proportion of infections transmitted during AHI (in primary analyses, assumed to last 3 months). RESULTS Our calibrated model approximated the epidemiological features of the mature HIV epidemic in NYC between 1996 and 2012. Annual HIV incidence among PWID dropped from approximately 1.8% in 1996 to 0.7% in 2012. Over the 16-year period, AHI accounted for 4.9% (10th/90th percentile: 0.1-12.3%) of incident HIV cases among PWID. The annualized contribution of AHI increased over this period from 3.6% in 1996 to 5.9% in 2012. CONCLUSION Our results suggest that, in mature epidemics such as NYC, between 3% and 6% of transmission events are attributable to AHI among PWID. Current HIV treatment as prevention strategies are unlikely to be substantially affected by AHI-attributable transmission among PWID populations in mature epidemic settings.
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231
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Gelpi M, Hartling HJ, Thorsteinsson K, Gerstoft J, Ullum H, Nielsen SD. Immune recovery in acute and chronic HIV infection and the impact of thymic stromal lymphopoietin. BMC Infect Dis 2016; 16:591. [PMID: 27769179 PMCID: PMC5073883 DOI: 10.1186/s12879-016-1930-3] [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: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 02/06/2023] Open
Abstract
Background Symptomatic primary HIV infection is associated with an adverse prognosis, and immediate initiation of combination antiretroviral therapy (cART) is recommended. However, little is known about immunological predictors of immune recovery. Thymic Stromal Lymphopoietin (TSLP) is a cytokine that promotes CD4+ T cells homeostatic polyclonal proliferation and regulates Th17/regulatory T-cell balance, immunological functions known to be affected during primary HIV infection. The aim of this study was to describe immune recovery in primary and chronic HIV infection and possible impact of TSLP. Methods Prospective study including 100 HIV-infected individuals (primary HIV infection (N = 14), early presenters (>350 CD4+ T cells/μL, N = 42), late presenters without advanced disease (200–350 CD4+ T cells/μL, N = 24) and with advanced disease (<200 CD4+ T cells/μL, N = 20) and). Immune recovery was defined as increase in CD4+ T cells count from baseline to a given time of follow-up. Plasma TSLP was determined using ELISA and CD4+ T cell subpopulations (recent thymic emigrants, naïve and memory cells) were measured using flow cytometry at baseline and after 6, 12 and 24 months of cART. Results Immune recovery was comparable in all groups, and no differences in immune homeostasis were found between primary HIV infection and early presenters, whereas differences in absolute counts and proportions of CD4+ T cell subpopulations were found between primary HIV infection and late presenters. TSLP was elevated in primary HIV infection at baseline and after 24 months of cART. Interestingly, TSLP was negatively associated with proportion of recent thymic emigrants (correlation coefficient −0.60, p = 0.030). TSLP was not associated with immune recovery in primary HIV infection. Conclusions Immune recovery was comparable in primary and chronic HIV infection whereas differences in absolute counts and proportions of CD4+ T cell subpopulations were found between primary HIV infection and late presenters supporting early initiation of cART. Higher plasma TSLP was found in primary HIV infection, and TSLP was associated with lower thymic output, but not with immune recovery. These findings indicate a possible role of TSLP in immune homeostasis in HIV infection but do not support TSLP to affect immune recovery in primary HIV infection.
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Affiliation(s)
- Marco Gelpi
- Department of Infectious Diseases, Viro-Immunology Research Unit, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Hans J Hartling
- Department of Infectious Diseases, Viro-Immunology Research Unit, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Kristina Thorsteinsson
- Department of Infectious Disease, University Hospital of Copenhagen Hvidovre, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Viro-Immunology Research Unit, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Viro-Immunology Research Unit, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.
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Fallet B, Narr K, Ertuna YI, Remy M, Sommerstein R, Cornille K, Kreutzfeldt M, Page N, Zimmer G, Geier F, Straub T, Pircher H, Larimore K, Greenberg PD, Merkler D, Pinschewer DD. Interferon-driven deletion of antiviral B cells at the onset of chronic infection. Sci Immunol 2016; 1:eaah6817. [PMID: 27872905 PMCID: PMC5115616 DOI: 10.1126/sciimmunol.aah6817] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Inadequate antibody responses and perturbed B cell compartments represent hallmarks of persistent microbial infections, but the mechanisms whereby persisting pathogens suppress humoral immunity remain poorly defined. Using adoptive transfer experiments in the context of a chronic lymphocytic choriomeningitis virus (LCMV) infection of mice, we have documented rapid depletion of virus-specific B cells that coincided with the early type I interferon response to infection. We found that the loss of activated B cells was driven by type I interferon (IFN-I) signaling to several cell types including dendritic cells, T cells and myeloid cells. Intriguingly, this process was independent of B cell-intrinsic IFN-I sensing and resulted from biased differentiation of naïve B cells into short-lived antibody-secreting cells. The ability to generate robust B cell responses was restored upon IFN-I receptor blockade or, partially, when experimentally depleting myeloid cells or the IFN-I-induced cytokines interleukin 10 and tumor necrosis factor alpha. We have termed this IFN-I-driven depletion of B cells "B cell decimation". Strategies to counter "B cell decimation" should thus help us better leverage humoral immunity in the combat against persistent microbial diseases.
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Affiliation(s)
- Benedict Fallet
- Department of Biomedicine, Division of Experimental Virology, University of Basel, 4003 Basel, Switzerland
| | - Kerstin Narr
- Department of Biomedicine, Division of Experimental Virology, University of Basel, 4003 Basel, Switzerland
| | - Yusuf I. Ertuna
- Department of Biomedicine, Division of Experimental Virology, University of Basel, 4003 Basel, Switzerland
| | - Melissa Remy
- Department of Biomedicine, Division of Experimental Virology, University of Basel, 4003 Basel, Switzerland
| | - Rami Sommerstein
- Department of Pathology and Immunology, Geneva Faculty of Medicine, 1211 Geneva 4, Switzerland
| | - Karen Cornille
- Department of Biomedicine, Division of Experimental Virology, University of Basel, 4003 Basel, Switzerland
| | - Mario Kreutzfeldt
- Department of Pathology and Immunology, Geneva Faculty of Medicine, 1211 Geneva 4, Switzerland
- Division of Clinical Pathology, University Hospital Geneva, 1 rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Nicolas Page
- Department of Pathology and Immunology, Geneva Faculty of Medicine, 1211 Geneva 4, Switzerland
| | - Gert Zimmer
- Institute of Virology and Immunology IVI, 3147 Mittelhäusern, Switzerland
| | - Florian Geier
- Department of Biomedicine, Bioinformatics Core Facility, University Hospital Basel, 4031 Basel, Switzerland
| | - Tobias Straub
- Institute for Immunology, Department for Medical Microbiology and Hygiene, University Medical Center Freiburg, 79104 Freiburg, Germany
| | - Hanspeter Pircher
- Institute for Immunology, Department for Medical Microbiology and Hygiene, University Medical Center Freiburg, 79104 Freiburg, Germany
| | - Kevin Larimore
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, USA
- Department of Immunology, University of Washington, Seattle, Washington, WA 98109, USA
| | - Philip D. Greenberg
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, USA
- Department of Immunology, University of Washington, Seattle, Washington, WA 98109, USA
| | - Doron Merkler
- Department of Pathology and Immunology, Geneva Faculty of Medicine, 1211 Geneva 4, Switzerland
- Division of Clinical Pathology, University Hospital Geneva, 1 rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Daniel D. Pinschewer
- Department of Biomedicine, Division of Experimental Virology, University of Basel, 4003 Basel, Switzerland
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Mayaphi SH, Martin DJ, Quinn TC, Laeyendecker O, Olorunju SAS, Tintinger GR, Stoltz AC. Detection of Acute and Early HIV-1 Infections in an HIV Hyper-Endemic Area with Limited Resources. PLoS One 2016; 11:e0164943. [PMID: 27764165 PMCID: PMC5072595 DOI: 10.1371/journal.pone.0164943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/20/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Two thirds of the world's new HIV infections are in sub-Saharan Africa. Acute HIV infection (AHI) is the time of virus acquisition until the appearance of HIV antibodies. Early HIV infection, which includes AHI, is the interval between virus acquisition and establishment of viral load set-point. This study aimed to detect acute and early HIV infections in a hyper-endemic setting. METHODS This was a cross-sectional diagnostic study that enrolled individuals who had negative rapid HIV results in five clinics in South Africa. Pooled nucleic acid amplification testing (NAAT) was performed, followed by individual sample testing in positive pools. NAAT-positive participants were recalled to the clinics for confirmatory testing and appropriate management. HIV antibody, p24 antigen, Western Blot and avidity tests were performed for characterization of NAAT-positive samples. RESULTS The study enrolled 6910 individuals with negative rapid HIV results. Median age was 27 years (interquartile range {IQR}: 23-31). NAAT was positive in 55 samples, resulting in 0.8% newly diagnosed HIV-infected individuals (95% confidence interval {CI}: 0.6-1.0). The negative predictive value for rapid HIV testing was 99.2% (95% CI: 99.0-99.4). Characterization of NAAT-positive samples revealed that 0.04% (95% CI: 0.000-0.001) had AHI, 0.3% (95% CI: 0.1-0.4) had early HIV infection, and 0.5% (95% CI: 0.5-0.7) had chronic HIV infection. Forty-seven (86%) of NAAT-positive participants returned for follow-up at a median of 4 weeks (IQR: 2-8). Follow-up rapid tests were positive in 96% of these participants. CONCLUSIONS NAAT demonstrated that a substantial number of HIV-infected individuals are misdiagnosed at South African points-of-care. Follow-up rapid tests done within a 4 week interval detected early and chronic HIV infections initially missed by rapid HIV testing. This may be a practical and affordable strategy for earlier detection of these infections in resource-constrained settings. Newer molecular tests that can be used at the points-of-care should be evaluated for routine diagnosis of HIV in hyper-endemic settings.
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Affiliation(s)
- Simnikiwe H. Mayaphi
- Department of Medical Virology, University of Pretoria, City of Tshwane, South Africa
- National Health Laboratory Service-Tshwane Academic Division (NHLS-TAD), City of Tshwane, South Africa
| | - Desmond J. Martin
- Department of Medical Virology, University of Pretoria, City of Tshwane, South Africa
- Toga Laboratories, Johannesburg, South Africa
| | - Thomas C. Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | | | - Gregory R. Tintinger
- Department of Internal Medicine, University of Pretoria, City of Tshwane, South Africa
| | - Anton C. Stoltz
- Department of Internal Medicine, University of Pretoria, City of Tshwane, South Africa
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234
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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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Delaney KP, Hanson DL, Masciotra S, Ethridge SF, Wesolowski L, Owen SM. Time Until Emergence of HIV Test Reactivity Following Infection With HIV-1: Implications for Interpreting Test Results and Retesting After Exposure. Clin Infect Dis 2016; 64:53-59. [PMID: 27737954 DOI: 10.1093/cid/ciw666] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/16/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the period of time between an exposure resulting in infection with human immunodeficiency virus (HIV) and when a test can reliably detect the presence of that infection, that is, the test window period, may benefit testing programs and clinicians in counseling patients about when the clinician and the patient can be confident a suspected exposure did not result in HIV infection. METHODS We evaluated the intervals between reactivity of the Aptima HIV-1 RNA test (Aptima) and 20 US Food and Drug Administration-approved HIV immunoassays using 222 longitudinally collected plasma specimens from HIV-1 seroconverters from the United States. Using interval-censored survival and binomial regression approaches a multi-model framework was implemented to estimate the relative emergence of test reactivity, referred to here as an inter-test reactivity interval (ITRI). We then combined ITRI results with simulated data for the eclipse period, the time between exposure and detection of HIV virus by Aptima, to estimate the window period for each test. RESULTS The estimated ITRIs were shorter with each new class of HIV tests, ranging from 5.9 to 24.8 days. The 99th percentiles of the window period probability distribution ranged from 44 days for laboratory screening tests that detect both antigen and antibody to 65 days for the Western blot test. CONCLUSIONS Our directly comparable estimates of the emergence of reactivity for 20 immunoassays are valuable to testing providers for interpreting negative HIV test results obtained shortly after exposure, and for counseling individuals on when to retest after an exposure.
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Affiliation(s)
| | | | | | | | | | - Sherry Michele Owen
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ratmann O, Hodcroft EB, Pickles M, Cori A, Hall M, Lycett S, Colijn C, Dearlove B, Didelot X, Frost S, Hossain ASMM, Joy JB, Kendall M, Kühnert D, Leventhal GE, Liang R, Plazzotta G, Poon AFY, Rasmussen DA, Stadler T, Volz E, Weis C, Leigh Brown AJ, Fraser C. Phylogenetic Tools for Generalized HIV-1 Epidemics: Findings from the PANGEA-HIV Methods Comparison. Mol Biol Evol 2016; 34:185-203. [PMID: 28053012 PMCID: PMC5854118 DOI: 10.1093/molbev/msw217] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Viral phylogenetic methods contribute to understanding how HIV spreads in populations, and thereby help guide the design of prevention interventions. So far, most analyses have been applied to well-sampled concentrated HIV-1 epidemics in wealthy countries. To direct the use of phylogenetic tools to where the impact of HIV-1 is greatest, the Phylogenetics And Networks for Generalized HIV Epidemics in Africa (PANGEA-HIV) consortium generates full-genome viral sequences from across sub-Saharan Africa. Analyzing these data presents new challenges, since epidemics are principally driven by heterosexual transmission and a smaller fraction of cases is sampled. Here, we show that viral phylogenetic tools can be adapted and used to estimate epidemiological quantities of central importance to HIV-1 prevention in sub-Saharan Africa. We used a community-wide methods comparison exercise on simulated data, where participants were blinded to the true dynamics they were inferring. Two distinct simulations captured generalized HIV-1 epidemics, before and after a large community-level intervention that reduced infection levels. Five research groups participated. Structured coalescent modeling approaches were most successful: phylogenetic estimates of HIV-1 incidence, incidence reductions, and the proportion of transmissions from individuals in their first 3 months of infection correlated with the true values (Pearson correlation > 90%), with small bias. However, on some simulations, true values were markedly outside reported confidence or credibility intervals. The blinded comparison revealed current limits and strengths in using HIV phylogenetics in challenging settings, provided benchmarks for future methods' development, and supports using the latest generation of phylogenetic tools to advance HIV surveillance and prevention.
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Affiliation(s)
- Oliver Ratmann
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, United Kingdom
| | - Emma B Hodcroft
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael Pickles
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, United Kingdom
| | - Anne Cori
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, United Kingdom
| | - Matthew Hall
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom.,Nuffield Department of Medicine, Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Samantha Lycett
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom.,The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline Colijn
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Bethany Dearlove
- Department of Veterinary Medicine, Cambridge Veterinary School, Cambridge, United Kingdom
| | - Xavier Didelot
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, United Kingdom
| | - Simon Frost
- Department of Veterinary Medicine, Cambridge Veterinary School, Cambridge, United Kingdom
| | | | - Jeffrey B Joy
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Michelle Kendall
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Denise Kühnert
- Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland.,Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - Gabriel E Leventhal
- Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland.,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA
| | - Richard Liang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Giacomo Plazzotta
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Art F Y Poon
- Department of Pathology & Laboratory Medicine, Western University, Ontario, Canada
| | - David A Rasmussen
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - Tanja Stadler
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - Erik Volz
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, United Kingdom
| | - Caroline Weis
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - Andrew J Leigh Brown
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - Christophe Fraser
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analyses and Modelling, School of Public Health, Imperial College London, London, United Kingdom.,Nuffield Department of Medicine, Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, United Kingdom
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Ratmann O, van Sighem A, Bezemer D, Gavryushkina A, Jurriaans S, Wensing A, de Wolf F, Reiss P, Fraser C. Sources of HIV infection among men having sex with men and implications for prevention. Sci Transl Med 2016; 8:320ra2. [PMID: 26738795 DOI: 10.1126/scitranslmed.aad1863] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
New HIV diagnoses among men having sex with men (MSM) have not decreased appreciably in most countries, even though care and prevention services have been scaled up substantially in the past 20 years. To maximize the impact of prevention strategies, it is crucial to quantify the sources of transmission at the population level. We used viral sequence and clinical patient data from one of Europe's nationwide cohort studies to estimate probable sources of transmission for 617 recently infected MSM. Seventy-one percent of transmissions were from undiagnosed men, 6% from men who had initiated antiretroviral therapy (ART), 1% from men with no contact to care for at least 18 months, and 43% from those in their first year of infection. The lack of substantial reductions in incidence among Dutch MSM is not a result of ineffective ART provision or inadequate retention in care. In counterfactual modeling scenarios, 19% of these past cases could have been averted with current annual testing coverage and immediate ART to those testing positive. Sixty-six percent of these cases could have been averted with available antiretrovirals (immediate ART provided to all MSM testing positive, and preexposure antiretroviral prophylaxis taken by half of all who test negative for HIV), but only if half of all men at risk of transmission had tested annually. With increasing sequence coverage, molecular epidemiological analyses can be a key tool to direct HIV prevention strategies to the predominant sources of infection, and help send HIV epidemics among MSM into a decisive decline.
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Affiliation(s)
- Oliver Ratmann
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W21PG, UK.
| | - Ard van Sighem
- Stichting HIV Monitoring, 1105 BD Amsterdam, the Netherlands
| | - Daniela Bezemer
- Stichting HIV Monitoring, 1105 BD Amsterdam, the Netherlands
| | | | - Suzanne Jurriaans
- Department of Medical Microbiology, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - Annemarie Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Frank de Wolf
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W21PG, UK
| | - Peter Reiss
- Stichting HIV Monitoring, 1105 BD Amsterdam, the Netherlands. Department of Global Health, Academic Medical Center, 1105 BM Amsterdam, the Netherlands
| | - Christophe Fraser
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W21PG, UK
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238
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Roberts CP, Klausner JD. Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men. Expert Rev Anti Infect Ther 2016; 14:1037-1046. [PMID: 27626361 DOI: 10.1080/14787210.2016.1236683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Syphilis and human immunodeficiency virus (HIV) coinfection disproportionately affects men who have sex with men (MSM), and the rate of coinfection has been increasing over the last decade. HIV and syphilis coinfection is particularly challenging because the infections interact synergistically thereby increasing the risk of acquisition and transmission as well as accelerating disease progression. Areas covered: This paper reviews and summarizes the epidemiology, pathogenesis, diagnosis, clinical management and prevention of HIV and syphilis coinfection among MSM. Expert commentary: Research does not support a different syphilis treatment for coinfected individuals; however, coinfection may warrant a recommendation for antiretroviral therapy. In order to reverse the epidemic of syphilis and HIV coinfection, there needs to be greater awareness, improved cultural sensitivity among health care providers, improved access to preventative services and increased screening for syphilis and HIV.
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Affiliation(s)
- Chelsea P Roberts
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA
| | - Jeffrey D Klausner
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Division of Infectious Diseases, Department of Medicine , University of California, Los Angeles , Los Angeles , CA , USA
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239
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Ambrosioni J, Nicolás D, Manzardo C, Agüero F, Blanco JL, Mosquera MM, Peñafiel J, Gatell JM, Marcos MA, Miró JM. Integrase strand-transfer inhibitor polymorphic and accessory resistance substitutions in patients with acute/recent HIV infection. J Antimicrob Chemother 2016; 72:205-209. [PMID: 27624569 DOI: 10.1093/jac/dkw376] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/01/2016] [Accepted: 08/10/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The most recent guidelines suggest using integrase strand-transfer inhibitors (InSTIs) as the preferred antiretroviral regimens for naive HIV-infected individuals. However, resistance to InSTIs is not monitored in many centres at baseline. This study aimed to evaluate the prevalence of InSTI resistance substitutions in newly diagnosed patients with acute/recent HIV infection. METHODS Genotypic drug resistance tests were performed in all consecutive patients prospectively enrolled with a documented infection of <6 months, from 12 May 2015 to 12 May 2016. Sequences were obtained by high-throughput sequencing. RESULTS Five out of 36 consecutive patients (13.89%, 95% CI = 4.67-29.5) with acute/recent HIV infection were detected to have strains carrying InSTI polymorphisms or substitutions conferring low-level resistance to raltegravir and elvitegravir. Four patients had the 157Q polymorphism and one patient had the Q95K substitution. All cases were MSM patients infected with subtype B strains. Viral loads ranged from 2.92 to 6.95 log10 copies/mL. In all cases, the mutational viral load was high. Three patients initiated dolutegravir-based regimens and became undetectable at first viral load control. There were no major viral or epidemiological differences when compared with patients without InSTI substitutions. CONCLUSIONS Although signature InSTI substitutions (such as Y143R/C, N155H or Q148K/R/H) were not detected, polymorphisms and substitutions conferring low-level resistance to raltegravir and elvitegravir were frequently found in a baseline genotypic test. All cases were infected with subtype B, the most frequent in Europe. In the context of primary HIV infection, virological response should be carefully monitored to evaluate the impact of these InSTI polymorphisms and substitutions.
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Affiliation(s)
- J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - D Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J L Blanco
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M M Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - J Peñafiel
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M A Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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240
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Rapid HIV Viral Load Suppression in those Initiating Antiretroviral Therapy at First Visit after HIV Diagnosis. Sci Rep 2016; 6:32947. [PMID: 27597312 PMCID: PMC5011704 DOI: 10.1038/srep32947] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/18/2016] [Indexed: 01/01/2023] Open
Abstract
Expert guidelines for antiretroviral therapy (ART) now recommend ART as soon as possible in all HIV infected persons to reduce the risk of disease progression and prevent transmission. The goal of this observational study was to evaluate the impact of very early ART initiation and regimen type on time to viral suppression. We evaluated time to viral suppression among 86 persons with newly-diagnosed HIV infection who initiated ART within 30 days of diagnosis. A total of 36 (42%) had acute, 27 (31%) early, and 23 (27%) had established HIV infection. The median time from an offer of immediate ART to starting ART was 8 days. A total of 56/86 (65%) initiated an integrase inhibitor-based regimen and 30/86 (35%) a protease inhibitor-based regimen. The time to viral suppression was significantly shorter in those receiving an integrase inhibitor- versus a protease inhibitor-based regimen (p = 0.022). Twenty-two (26%) initiated ART at their HIV care intake visit and 79% of these participants achieved viral suppression at week 12, 82% at week 24 and 88% at week 48. ART initiated at the intake visit led to rapid and reliable viral suppression in acute, early and chronic HIV infection, in particular when integrase inhibitor-based regimens were used.
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241
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Girometti N, Nwokolo N, McOwan A, Whitlock G. Outcomes of acutely HIV-1-infected individuals following rapid antiretroviral therapy initiation. Antivir Ther 2016; 22:77-80. [PMID: 27585954 DOI: 10.3851/imp3080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Few data exist on the benefits and acceptability of rapid initiation of antiretroviral treatment in acute HIV infection (AHI). We analysed a large cohort of acutely infected HIV patients starting antiretroviral therapy (ART) to determine uptake, linkage into care and time to achieve viral suppression. METHODS Case notes of all individuals diagnosed with AHI between May 2014 and October 2015 at 56 Dean Street, a sexual health clinic in London, UK were reviewed. AHI was defined through documentation of plasma HIV RNA positivity only, plasma HIV RNA and p24 antigen positivity with a negative HIV enzyme immunoassay (EIA) test or HIV EIA test switching from negative to positive within 6 weeks. Between-group comparisons of time to viral suppression according to ART chosen were performed using the log-rank test. RESULTS We identified 113 individuals with AHI. Linkage to care was 95%. 77% of patients started ART at first medical appointment: all men who have sex with men, median age 35 years, median viral load (VL) log10 6.45, median CD4+ T-cell count 483 cells/mm3. Median time from diagnosis to ART initiation was 20 days. At 24 weeks, no patients had discontinued ART; 99% of patients achieved viral suppression by 24 weeks, with a median time to documented VL suppression of 74 days. Viral suppression was more rapid with integrase inhibitors compared with other regimens (median 41 versus 88.5 days, P<0.05). CONCLUSIONS In acute HIV infection, individuals demonstrated high ART uptake and rapid VL suppression suggesting that early treatment with antiretrovirals is acceptable and efficacious.
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Affiliation(s)
- Nicolò Girometti
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.,Department of Medical Sciences and Surgery, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nneka Nwokolo
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan McOwan
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
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242
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Denouement. Pediatr Infect Dis J 2016; 35:1055-6. [PMID: 27518754 DOI: 10.1097/inf.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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243
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Hoenigl M, Chaillon A, Mehta SR, Smith DM, Graff-Zivin J, Little SJ. Screening for acute HIV infection in community-based settings: Cost-effectiveness and impact on transmissions. J Infect 2016; 73:476-484. [PMID: 27521468 DOI: 10.1016/j.jinf.2016.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/30/2016] [Accepted: 07/30/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine cost-effectiveness of three community-based acute HIV infection (AHI) testing algorithms compared to HIV antibody testing alone by focusing on the potential of averting new infections occurring within a one-year time horizon among men who have sex with men (MSM). METHODS Data sources for model parameters included actual cost and prevalence data derived from a community-based AHI screening program in San Diego, and published studies. Main outcome measure was costs per infection averted (IA). The lower end of the cost range of discounted lifetime costs of an HIV infection (i.e. $236,948) was used for defining cost-effectiveness. RESULTS The most sensitive algorithm for AHI detection, which was based on HIV nucleic acid amplification testing, was estimated to prevent between 5 and 45 transmissions, with simulated costs per infection averted between $965 and $141,256 when compared to HIV antibody testing alone. CONCLUSION AHI testing was cost-effective in preventing new HIV infections among at risk MSM in San Diego, and also among other MSM populations with similar HIV prevalence but lower proportions of AHI diagnoses. These results indicate that community-based AHI testing among MSM in the United States can pay for itself over the long run.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Antoine Chaillon
- Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States
| | - Sanjay R Mehta
- Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Davey M Smith
- Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Joshua Graff-Zivin
- School of International Relations and Pacific Studies, Department of Economics, UCSD, 9500 Gilman Dr. # 0520, La Jolla, CA 92093, United States
| | - Susan J Little
- Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States
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244
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Ling Z, Jin C, Xie T, Cheng Y, Li L, Wu N. Alterations in the Fecal Microbiota of Patients with HIV-1 Infection: An Observational Study in A Chinese Population. Sci Rep 2016; 6:30673. [PMID: 27477587 PMCID: PMC4967929 DOI: 10.1038/srep30673] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/08/2016] [Indexed: 02/06/2023] Open
Abstract
The available evidence suggests that alterations in gut microbiota may be tightly linked to the increase in microbial translocation and systemic inflammation in patients with human immunodeficiency virus 1 (HIV-1) infection. We profiled the fecal microbiota as a proxy of gut microbiota by parallel barcoded 454-pyrosequencing in 67 HIV-1-infected patients (32 receiving highly active antiretroviral therapy [HAART] and 35 HAART naïve) and 16 healthy controls from a Chinese population. We showed that α-diversity indices did not differ significantly between the healthy control and HIV-1-infected patients. The ratio of Firmicutes/Bacteroidetes increased significantly in HIV-1-infected patients. Several key bacterial phylotypes, including Prevotella, were prevalent in HIV-1-infected patients; whereas Phascolarctobacterium, Clostridium XIVb, Dialister and Megamonas were significantly correlated with systemic inflammatory cytokines. After short-term, effective HAART, the viral loads of HIV-1 were reduced; however, the diversity and composition of the fecal microbiota were not completely restored. and the dysbiosis remained among HIV-1-infected subjects undergoing HAART. Our detailed analysis demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection. Thus, new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in HIV-1-infected patients.
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Affiliation(s)
- Zongxin Ling
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Changzhong Jin
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Tiansheng Xie
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Yiwen Cheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Lanjuan Li
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Nanping Wu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
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The well-tempered SIV infection: Pathogenesis of SIV infection in natural hosts in the wild, with emphasis on virus transmission and early events post-infection that may contribute to protection from disease progression. INFECTION GENETICS AND EVOLUTION 2016; 46:308-323. [PMID: 27394696 DOI: 10.1016/j.meegid.2016.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 12/25/2022]
Abstract
African NHPs are infected by over 40 different simian immunodeficiency viruses. These viruses have coevolved with their hosts for long periods of time and, unlike HIV in humans, infection does not generally lead to disease progression. Chronic viral replication is maintained for the natural lifespan of the host, without loss of overall immune function. Lack of disease progression is not correlated with transmission, as SIV infection is highly prevalent in many African NHP species in the wild. The exact mechanisms by which these natural hosts of SIV avoid disease progression are still unclear, but a number of factors might play a role, including: (i) avoidance of microbial translocation from the gut lumen by preventing or repairing damage to the gut epithelium; (ii) control of immune activation and apoptosis following infection; (iii) establishment of an anti-inflammatory response that resolves chronic inflammation; (iv) maintenance of homeostasis of various immune cell populations, including NK cells, monocytes/macrophages, dendritic cells, Tregs, Th17 T-cells, and γδ T-cells; (v) restriction of CCR5 availability at mucosal sites; (vi) preservation of T-cell function associated with down-regulation of CD4 receptor. Some of these mechanisms might also be involved in protection of natural hosts from mother-to-infant SIV transmission during breastfeeding. The difficulty of performing invasive studies in the wild has prohibited investigation of the exact events surrounding transmission in natural hosts. Increased understanding of the mechanisms of SIV transmission in natural hosts, and of the early events post-transmission which may contribute to avoidance of disease progression, along with better comprehension of the factors involved in protection from SIV breastfeeding transmission in the natural hosts, could prove invaluable for the development of new prevention strategies for HIV.
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Sempa JB, Dushoff J, Daniels MJ, Castelnuovo B, Kiragga AN, Nieuwoudt M, Bellan SE. Reevaluating Cumulative HIV-1 Viral Load as a Prognostic Predictor: Predicting Opportunistic Infection Incidence and Mortality in a Ugandan Cohort. Am J Epidemiol 2016; 184:67-77. [PMID: 27188943 DOI: 10.1093/aje/kwv303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/29/2015] [Indexed: 11/12/2022] Open
Abstract
Recent studies have evaluated cumulative human immunodeficiency virus type 1 (HIV-1) viral load (cVL) for predicting disease outcomes, with discrepant results. We reviewed the disparate methodological approaches taken and evaluated the prognostic utility of cVL in a resource-limited setting. Using data on the Infectious Diseases Institute (Makerere University, Kampala, Uganda) cohort, who initiated antiretroviral therapy in 2004-2005 and were followed up for 9 years, we calculated patients' time-updated cVL by summing the area under their viral load curves on either a linear scale (cVL1) or a logarithmic scale (cVL2). Using Cox proportional hazards models, we evaluated both metrics as predictors of incident opportunistic infections and mortality. Among 489 patients analyzed, neither cVL measure was a statistically significant predictor of opportunistic infection risk. In contrast, cVL2 (but not cVL1) was a statistically significant predictor of mortality, with each log10 increase corresponding to a 1.63-fold (95% confidence interval: 1.02, 2.60) elevation in mortality risk when cVL2 was accumulated from baseline. However, whether cVL is predictive or not hinges on difficult choices surrounding the cVL metric and statistical model employed. Previous studies may have suffered from confounding bias due to their focus on cVL1, which strongly correlates with other variables. Further methodological development is needed to illuminate whether the inconsistent predictive utility of cVL arises from causal relationships or from statistical artifacts.
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247
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Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi. J Acquir Immune Defic Syndr 2016; 71:272-80. [PMID: 26428231 PMCID: PMC4752378 DOI: 10.1097/qai.0000000000000853] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Objectives: Integrating acute HIV-infection (AHI) testing into clinical settings is critical to prevent transmission, and realize potential treatment-as-prevention benefits. We evaluated acceptability of AHI testing and compared AHI prevalence at sexually transmitted infection (STI) clinics and HIV testing and counseling (HTC) clinics in Lilongwe, Malawi. Methods: We conducted HIV RNA testing for HIV-seronegative patients visiting STI and HTC clinics. AHI was defined as positive RNA and negative/discordant rapid antibody tests. We evaluated demographic, behavioral, and transmission-risk differences between STI and HTC patients and assessed performance of a risk-score for targeted screening. Results: Nearly two-thirds (62.8%, 9280/14,755) of eligible patients consented to AHI testing. We identified 59 persons with AHI (prevalence = 0.64%)–a 0.9% case-identification increase. Prevalence was higher at STI [1.03% (44/4255)] than at HTC clinics [0.3% (15/5025), P < 0.01], accounting for 2.3% of new diagnoses vs 0.3% at HTC clinic. Median viral load (VL) was 758,050 copies per milliliter; 25% (15/59) had VL ≥10,000,000 copies per milliliter. Median VL was higher at STI (1,000,000 copies/mL) compared with HTC (153,125 copies/mL, P = 0.2). Among persons with AHI, those tested at STI clinics were more likely to report genital sores compared with those tested at HTC clinics (54.6% vs 6.7%, P < 0.01). The risk score algorithm performed well in identifying persons with AHI at HTC clinics (sensitivity = 73%, specificity = 89%). Conclusions: The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC clinics. Remarkably high VLs and concomitant genital scores demonstrate the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered.
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248
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Nikolopoulos GK, Kostaki EG, Paraskevis D. Overview of HIV molecular epidemiology among people who inject drugs in Europe and Asia. INFECTION GENETICS AND EVOLUTION 2016; 46:256-268. [PMID: 27287560 DOI: 10.1016/j.meegid.2016.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/01/2016] [Accepted: 06/05/2016] [Indexed: 01/14/2023]
Abstract
HIV strains continuously evolve, tend to recombine, and new circulating variants are being discovered. Novel strains complicate efforts to develop a vaccine against HIV and may exhibit higher transmission efficiency and virulence, and elevated resistance to antiretroviral agents. The United Nations Joint Programme on HIV/AIDS (UNAIDS) set an ambitious goal to end HIV as a public health threat by 2030 through comprehensive strategies that include epidemiological input as the first step of the process. In this context, molecular epidemiology becomes invaluable as it captures trends in HIV evolution rates that shape epidemiological pictures across several geographical areas. This review briefly summarizes the molecular epidemiology of HIV among people who inject drugs (PWID) in Europe and Asia. Following high transmission rates of subtype G and CRF14_BG among PWID in Portugal and Spain, two European countries, Greece and Romania, experienced recent HIV outbreaks in PWID that consisted of multiple transmission clusters including subtypes B, A, F1, and recombinants CRF14_BG and CRF35_AD. The latter was first identified in Afghanistan. Russia, Ukraine, and other Former Soviet Union (FSU) states are still facing the devastating effects of epidemics in PWID produced by AFSU (also known as IDU-A), BFSU (known as IDU-B), and CRF03_AB. In Asia, CRF01_AE and subtype B (Western B and Thai B) travelled from PWID in Thailand to neighboring countries. Recombination hotspots in South China, Northern Myanmar, and Malaysia have been generating several intersubtype and inter-CRF recombinants (e.g. CRF07_BC, CRF08_BC, CRF33_01B etc.), increasing the complexity of HIV molecular patterns.
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Affiliation(s)
- Georgios K Nikolopoulos
- Hellenic Centre for Diseases Control and Prevention, Amarousio, Greece; Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Transmission Reduction Intervention Project-Athens site, Athens, Greece.
| | - Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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First Evidence for the Disease-Stage, Cell-Type, and Virus Specificity of microRNAs during Human Immunodeficiency Virus Type-1 Infection. Med Sci (Basel) 2016; 4:medsci4020010. [PMID: 29083374 PMCID: PMC5635779 DOI: 10.3390/medsci4020010] [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: 02/25/2016] [Revised: 03/29/2016] [Accepted: 04/15/2016] [Indexed: 01/08/2023] Open
Abstract
The potential involvement of host microRNAs (miRNAs) in HIV infection is well documented, and evidence suggests that HIV modulates and also dysregulates host miRNAs involved in maintaining the host innate immune system. Moreover, the dysregulation of host miRNAs by HIV also effectively interferes directly with the host gene expression. In this study, we have simultaneously evaluated the expression of host miRNAs in both CD4+ and CD8+ T-cells derived from HIV-positive (HIV+) individuals (viremic and aviremic individuals while receiving highly active antiretroviral therapy (HAART), therapy-naïve long-term non-progressors (LTNP), and HIV-negative (HIV-) healthy controls. miRNAs were run on Affymetrix V2 chips, and the differential expression between HIV+ and HIV- samples, along with intergroup comparisons, was derived using PARTEK software, using an FDR of 5% and an adjusted p-value < 0.05. The miR-199a-5p was found to be HIV-specific and expressed in all HIV+ groups as opposed to HIV- controls. Moreover, these are the first studies to reveal clearly the highly discriminatory miRNAs at the level of the disease state, cell type, and HIV-specific miRNAs.
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250
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Rana AI, van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30:178-84. [PMID: 27028183 DOI: 10.1089/apc.2016.0025] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Less than half of the 1.2 million HIV-infected individuals in the United States are in consistent medical care, with only a third receiving treatment resulting in viral suppression. Novel interventions to improve engagement are necessary to ensure medical adherence, improve long-term outcomes, and reduce HIV transmission. Mobile health (mHealth) strategies including cell phone and text messaging have shown success in the developing world for medical adherence, yet mHealth interventions have not been developed and evaluated to improve retention in HIV care in the United States. We conducted a 6-month pilot study investigating the use of a clinic-based bi-directional texting intervention to enhance engagement in HIV care among those with higher risk of loss to follow up, including those with a recent HIV diagnosis or those re-engaging in HIV care at a large urban clinic in New England.
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Affiliation(s)
- Aadia I. Rana
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Jacob J. van den Berg
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Eric Lamy
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Curt G. Beckwith
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island
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