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Goto N, Futamura K, Okada M, Yamamoto T, Tsujita M, Hiramitsu T, Narumi S, Watarai Y. Management of Pneumocystis jirovecii Pneumonia in Kidney Transplantation to Prevent Further Outbreak. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:81-90. [PMID: 26609250 PMCID: PMC4648609 DOI: 10.4137/ccrpm.s23317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/19/2022]
Abstract
The outbreak of Pneumocystis jirovecii pneumonia (PJP) among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death. Owing to the large number of kidney transplant recipients compared to other types of organ transplantation, there are greater opportunities for them to share the same time and space. Although the use of trimethoprim-sulfamethoxazole (TMP-SMX) as first choice in PJP prophylaxis is valuable for PJP that develops from infections by trophic forms, it cannot prevent or clear colonization, in which cysts are dominant. Colonization of P. jirovecii is cleared by macrophages. While recent immunosuppressive therapies have decreased the rate of rejection, over-suppressed macrophages caused by the higher levels of immunosuppression may decrease the eradication rate of colonization. Once a PJP cluster enters these populations, which are gathered in one place and uniformly undergoing immunosuppressive therapy for kidney transplantation, an outbreak can occur easily. Quick actions for PJP patients, other recipients, and medical staff of transplant centers are required. In future, lifelong prophylaxis may be required even in kidney transplant recipients.
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Affiliation(s)
- Norihiko Goto
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takayuki Yamamoto
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Makoto Tsujita
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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202
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Bigna JJR, Sime PSD, Koulla-Shiro S. HIV related pulmonary arterial hypertension: epidemiology in Africa, physiopathology, and role of antiretroviral treatment. AIDS Res Ther 2015; 12:36. [PMID: 26566389 PMCID: PMC4642627 DOI: 10.1186/s12981-015-0078-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/29/2015] [Indexed: 01/28/2023] Open
Abstract
The development of HIV related pulmonary arterial hypertension (PAH) reduces the probability of survival by half as compared with HIV-infected individuals without HIV related PAH. HIV infected patients have a greater incidence of PAH compared to general population and have a 2500-fold increased risk of developing PAH. It is therefore important to have a recent overview of the problem in Africa, the most HIV affected part of the world (70 % of all HIV infection in the world). First, we discussed the epidemiology of HIV-related PAH in Africa. Second, the current understanding of the HIV-related PAH pathogenesis has been covered. Third, role of highly active antiretroviral therapy on HIV-related PAH has been revisited. There are few data concerning epidemiology of HIV related pulmonary hypertension in Africa leading to necessity to conduct further prospective large studies. The prevalence of PAH among HIV infected people in Africa varies from 5 to 13 %. The prevalence of HIV-related PAH in Africa is notably high compared to those in developed countries and in general population. The pathogenesis of PAH is clearly complex, and probably results from the interaction of multiple modulating genes with environmental factors. The physiopathology includes cytokines secretion increase which induces dysregulation of endothelial and vascular smooth muscle cell growth and imbalance of endogenous vasodilators and constrictors; HIV viral proteins which induces vascular oxidative stress, smooth myocyte proliferation and migration, and endothelial injury and genetic predisposition due to some major histocompatibility complex alleles, particularly HDL-DR6 and HLA-DR5. Histologically, HIV related PAH has the same characteristics with other types PAH. Antiretroviral therapy have a beneficial effect on the outcome of HIV related pulmonary hypertension, but it lacks evidence from large prospective studies.
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203
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Kunisaki KM, Niewoehner DE, Collins G, Nixon DE, Tedaldi E, Akolo C, Kityo C, Klinker H, La Rosa A, Connett JE. Pulmonary function in an international sample of HIV-positive, treatment-naïve adults with CD4 counts > 500 cells/μL: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:119-28. [PMID: 25711330 DOI: 10.1111/hiv.12240] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of the study was to describe the prevalence and correlates of chronic obstructive pulmonary disease (COPD) in a multicentre international cohort of persons living with HIV (PLWH). METHODS We performed a cross-sectional analysis of adult PLWH, naïve to HIV treatment, with baseline CD4 cell count > 500 cells/μL enrolled in the Pulmonary Substudy of the Strategic Timing of AntiRetroviral Treatment (START) trial. We collected standardized, quality-controlled spirometry. COPD was defined as forced expiratory volume in 1 s:forced vital capacity (FEV1 :FVC) ratio less than the lower limit of normal. RESULTS Among 1026 participants from 80 sites and 20 countries, the median age was 36 [interquartile range (IQR) 30, 44] years, 29% were female, and the median time since HIV diagnosis was 1.2 (IQR 0.4, 3.5) years. Baseline median CD4 cell count was 648 (IQR 583, 767) cells/μL, median viral load was 4.2 (IQR 3.5, 4.7) log10 HIV-1 RNA copies/mL, and 10% had a viral load ≤ 400 copies/mL despite lack of HIV treatment. Current/former/never smokers comprised 28%/11%/61% of the cohort, respectively. COPD was present in 6.8% of participants, and varied by age, smoking status and region. Forty-eight per cent of those with COPD reported lifelong nonsmoking. In multivariable regression, age and pack-years of smoking had the strongest associations with FEV1 :FVC ratio (P < 0.0001). There was a significant effect of region on FEV1 :FVC ratio (P = 0.010). CONCLUSIONS Our data suggest that, among PLWH who were naïve to HIV treatment and had CD4 cell counts > 500 cells/μL, smoking and age were important factors related to COPD. Smoking cessation should remain a high global priority for clinical care and research in PLWH.
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Affiliation(s)
- K M Kunisaki
- Minneapolis VA Health Care System, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
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204
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Báez-Saldaña R, Villafuerte-García A, Cruz-Hervert P, Delgado-Sánchez G, Ferreyra-Reyes L, Ferreira-Guerrero E, Mongua-Rodríguez N, Montero-Campos R, Melchor-Romero A, García-García L. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series. PLoS One 2015; 10:e0138115. [PMID: 26379281 PMCID: PMC4574922 DOI: 10.1371/journal.pone.0138115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases. OBJECTIVE To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS. MATERIAL AND METHODS We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions. RESULTS We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30-150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08-0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06-0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses. CONCLUSIONS HAART for 180 days or more was associated with 79% decrease in all-cause in-hospital mortality and lower frequency of PJP as discharge diagnosis. The prevalence of poorly controlled HIV was high, regardless of whether HIV was diagnosed before or during admission. HIV diagnosis and treatment resources should be improved, and strengthening of HAART program needs to be promoted.
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Affiliation(s)
- Renata Báez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México; Servicio Clínico de Neumología Oncológica, Instituto Nacional de Enfermedades Respiratorias, México, Distrito Federal, México; División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, México, Distrito Federal, México
| | - Adriana Villafuerte-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México; División de Posgrado, Facultad de Odontología, Universidad Nacional Autónoma de México, México, Distrito Federal, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México; División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, México, Distrito Federal, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Ada Melchor-Romero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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205
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Drummond MB, Huang L, Diaz PT, Kirk GD, Kleerup EC, Morris A, Rom W, Weiden MD, Zhao E, Thompson B, Crothers K. Factors associated with abnormal spirometry among HIV-infected individuals. AIDS 2015; 29:1691-700. [PMID: 26372280 PMCID: PMC4571285 DOI: 10.1097/qad.0000000000000750] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE HIV-infected individuals are susceptible to development of chronic lung diseases, but little is known regarding the prevalence and risk factors associated with different spirometric abnormalities in this population. We sought to determine the prevalence, risk factors and performance characteristics of risk factors for spirometric abnormalities among HIV-infected individuals. DESIGN Cross-sectional cohort study. METHODS We analyzed cross-sectional US data from the NHLBI-funded Lung-HIV consortium - a multicenter observational study of heterogeneous groups of HIV-infected participants in diverse geographic sites. Logistic regression analysis was performed to determine factors statistically significantly associated with spirometry patterns. RESULTS A total of 908 HIV-infected individuals were included. The median age of the cohort was 50 years, 78% were men and 68% current smokers. An abnormal spirometry pattern was present in 37% of the cohort: 27% had obstructed and 10% had restricted spirometry patterns. Overall, age, smoking status and intensity, history of Pneumocystis infection, asthma diagnosis and presence of respiratory symptoms were independently associated with an abnormal spirometry pattern. Regardless of the presence of respiratory symptoms, five HIV-infected participants would need to be screened with spirometry to diagnose two individuals with any abnormal spirometry pattern. CONCLUSIONS Nearly 40% of a diverse US cohort of HIV-infected individuals had an abnormal spirometry pattern. Specific characteristics including age, smoking status, respiratory infection history and respiratory symptoms can identify those at risk for abnormal spirometry. The high prevalence of abnormal spirometry and the poor predictive capability of respiratory symptoms to identify abnormal spirometry should prompt clinicians to consider screening spirometry in HIV-infected populations.
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Affiliation(s)
- M Bradley Drummond
- aDepartment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland bDepartment of Medicine, School of Medicine, University of California San Francisco, San Francisco, California cDepartment of Medicine, Ohio State University, Columbus, Ohio dDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland eDepartment of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California fDepartments of Medicine and Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania gDivision of Pulmonary & Critical Care Medicine, Departments of Medicine and Environmental Medicine, New York University School of Medicine, New York hClinical Trials and Survey Corporation, Owings Mills, Maryland iDepartment of Medicine, University of Washington, Seattle, Washington, USA
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206
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Besutti G, Raggi P, Zona S, Scaglioni R, Santoro A, Orlando G, Ligabue G, Leipsic J, Sin DD, Man SFP, Guaraldi G. Independent association of subclinical coronary artery disease and emphysema in HIV-infected patients. HIV Med 2015; 17:178-87. [PMID: 26268373 DOI: 10.1111/hiv.12289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) and coronary artery disease are inflammatory states with a significant clinical impact. The relationship between them has not been investigated in patients with HIV infection. We assessed the presence of subclinical emphysema and coronary artery disease using chest computed tomography (CT) imaging in a cohort of HIV-infected patients receiving antiretroviral therapy. METHODS Gated chest CT scans were performed in 1446 consecutive patients to assess the presence and severity of coronary artery calcium (CAC) (classified as a score of 0, 1-100 or > 100) and emphysema (classified using a visual semiquantitative scale: 0, absent; 1-4, mild to moderate; > 4, severe). Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with CAC and emphysema. RESULTS The emphysema score was significantly higher in patients with CAC scores of 1-100 and > 100 compared with those with a CAC score of 0. After adjustments for age, sex, smoking status, pack-years of smoking, visceral adiposity and duration of HIV infection, the presence of any emphysema was significantly associated with a CAC score > 0 [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.08-1.88; P = 0.012]. The association persisted after adjustment for the Framingham risk score (OR 1.52; 95% CI 1.16-1.99; P = 0.002). There was a dose-dependent effect in the association between emphysema score and CAC score. CONCLUSIONS In this cross-sectional study of HIV-infected patients, there was an independent association between emphysema and CAC, after adjustment for traditional cardiovascular risk factors, suggesting a common pathogenesis of these chronic inflammatory conditions in a chronic inflammatory disease such as HIV infection.
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Affiliation(s)
- G Besutti
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - S Zona
- Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy
| | - R Scaglioni
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - A Santoro
- Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy
| | - G Orlando
- Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy
| | - G Ligabue
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - D D Sin
- Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada.,UBC James Hogg Research Center, St Paul's Hospital, Vancouver, BC, Canada
| | - S F P Man
- Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada.,UBC James Hogg Research Center, St Paul's Hospital, Vancouver, BC, Canada
| | - G Guaraldi
- Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy
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207
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Mongardon N, Geri G, Deye N, Sonneville R, Boissier F, Perbet S, Camous L, Lemiale V, Thirion M, Mathonnet A, Argaud L, Bodson L, Gaudry S, Kimmoun A, Legriel S, Lerolle N, Luis D, Luyt CE, Mayaux J, Guidet B, Pène F, Mira JP, Cariou A. Etiologies, clinical features and outcome of cardiac arrest in HIV-infected patients. Int J Cardiol 2015; 201:302-7. [PMID: 26301665 DOI: 10.1016/j.ijcard.2015.08.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/29/2015] [Accepted: 08/01/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012). Characteristics and outcome of HIV-infected patients were compared to those of a large cohort of HIV-uninfected patients admitted after CA in the Cochin Hospital ICU during the same period. RESULTS 99 patients were included (median CD4 lymphocyte count 233/mm(3), viral load 43 copies/ml). When compared with the control cohort of 1701 patients, HIV-infected patients were younger, with a predominance of male, a majority of in-hospital CA (52%), and non-shockable initial rhythm (80.8%). CA was mostly related to respiratory cause (n=36, including 23 pneumonia), cardiac cause (n=33, including 16 acute myocardial infarction), neurologic cause (n=8) and toxic cause (n=5). CA was deemed directly related to HIV infection in 18 cases. Seventy-one patients died in the ICU, mostly for care withdrawal after post-anoxic encephalopathy. After propensity score matching, ICU mortality was not significantly affected by HIV infection. Similarly, HIV disease characteristics had no impact on ICU outcome. CONCLUSIONS Etiologies of CA in HIV-infected patients are miscellaneous and mostly not related to HIV infection. Outcome remains bleak but is similar to outcome of HIV-negative patients.
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Affiliation(s)
- Nicolas Mongardon
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U970, Sudden Death Expertise Centre, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Sonneville
- Medical Intensive Care Unit, Bichat University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Florence Boissier
- Medical Intensive Care Unit, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; Medical Intensive Care Unit, Georges Pompidou European University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sébastien Perbet
- Intensive Care Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurent Camous
- Medical Intensive Care Unit, Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marina Thirion
- Intensive Care Unit, Victor Dupouy Hospital, Argenteuil, France
| | | | - Laurent Argaud
- Intensive Care Unit, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Bodson
- Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Stéphane Gaudry
- Medical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique - Hôpitaux de Paris, Colombes, France
| | - Antoine Kimmoun
- Medical Intensive Care Unit, Nancy-Brabois University Hospital, Nancy, France
| | | | - Nicolas Lerolle
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - David Luis
- Intensive Care Unit, Raymond Poincaré University Hospital, Assistance Publique - Hôpitaux de Paris, Garches, France
| | - Charles-Edouard Luyt
- Medical Intensive Care Unit, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Julien Mayaux
- Pulmonary Medicine and Medical Intensive Care Unit, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U970, Sudden Death Expertise Centre, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, France.
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208
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Putcha N, Drummond MB, Wise RA, Hansel NN. Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management. Semin Respir Crit Care Med 2015; 36:575-91. [PMID: 26238643 DOI: 10.1055/s-0035-1556063] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities impact a large proportion of patients with chronic obstructive pulmonary disease (COPD), with over 80% of patients with COPD estimated to have at least one comorbid chronic condition. Guidelines for the treatment of COPD are just now incorporating comorbidities to their management recommendations of COPD, and it is becoming increasingly clear that multimorbidity as well as specific comorbidities have strong associations with mortality and clinical outcomes in COPD, including dyspnea, exercise capacity, quality of life, healthcare utilization, and exacerbation risk. Appropriately, there has been an increased focus upon describing the burden of comorbidity in the COPD population and incorporating this information into existing efforts to better understand the clinical and phenotypic heterogeneity of this group. In this article, we summarize existing knowledge about comorbidity burden and specific comorbidities in COPD, focusing on prevalence estimates, association with outcomes, and existing knowledge about treatment strategies.
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Affiliation(s)
- Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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209
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HIV Infection Is Associated With Increased Risk for Acute Exacerbation of COPD. J Acquir Immune Defic Syndr 2015; 69:68-74. [PMID: 25942460 DOI: 10.1097/qai.0000000000000552] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Poorly controlled HIV infection is associated with increased risk for chronic obstructive pulmonary disease (COPD). Acute exacerbations of COPD (AECOPD) are major contributors to morbidity and mortality. Little is known about the association between HIV infection and AECOPD. METHODS We identified 167 individuals with spirometry-confirmed COPD from a longitudinal study of current or former injection drug users at risk or with HIV infection. AECOPD, defined as self-report of worsening breathing requiring treatment with antibiotics or steroids, was assessed at 6-month study visits. Multivariable logistic regression identified factors associated with AECOPD. RESULTS Of 167 participants, the mean age was 52 years; 89% were black, 30% female, and 32% HIV infected (median CD4 count: 312 cells per milliliter, 46% with detectable HIV RNA). After adjusting for age, gender, smoking history, comorbidity treatment, and airflow obstruction severity, HIV was independently associated with a 2.47 increased odds of AECOPD [95% confidence interval (CI): 1.22 to 5.00]. Compared with HIV-uninfected persons, HIV-infected persons with undetectable (<50 copies/mL) HIV RNA levels and those with a CD4 count ≥350 cells per cubic millimeter demonstrated increased AECOPD (odds ratio, 2.91; 95% CI: 1.26 to 6.71; odds ratio, 4.16; 95% CI: 1.87 to 9.27, respectively). Higher AECOPD risk was observed with higher CD4 counts irrespective of treatment for comorbid diseases. CONCLUSIONS HIV infection is independently associated with increased odds of AECOPD, potentially due to differences in treatment access and to variable disease manifestation by immune status. Providers should be aware that HIV infection may increase risk for AECOPD and that symptom may be more discernible with intact immune function.
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210
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Roux A, Canet E, Valade S, Gangneux-Robert F, Hamane S, Lafabrie A, Maubon D, Debourgogne A, Le Gal S, Dalle F, Leterrier M, Toubas D, Pomares C, Bellanger AP, Bonhomme J, Berry A, Durand-Joly I, Magne D, Pons D, Hennequin C, Maury E, Roux P, Azoulay É. Pneumocystis jirovecii pneumonia in patients with or without AIDS, France. Emerg Infect Dis 2015; 20:1490-7. [PMID: 25148074 PMCID: PMC4178412 DOI: 10.3201/eid2009.131668] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Immunosuppressed patients without AIDS had longer time to treatment and a higher rate of death than did patients with AIDS. Pneumocystis jirovecii pneumonia (PCP) in patients without AIDS is increasingly common. We conducted a prospective cohort study of consecutive patients with proven PCP; of 544 patients, 223 (41%) had AIDS (AIDS patients) and 321 (59%) had other immunosuppressive disorders (non-AIDS patients). Fewer AIDS than non-AIDS patients required intensive care or ventilation, and the rate of hospital deaths—17.4% overall—was significantly lower for AIDS versus non-AIDS patients (4% vs. 27%; p<0.0001). Multivariable analysis showed the odds of hospital death increased with older age, receipt of allogeneic bone marrow transplant, immediate use of oxygen, need for mechanical ventilation, and longer time to treatment; HIV-positive status or receipt of a solid organ transplant decreased odds for death. PCP is more often fatal in non-AIDS patients, but time to diagnosis affects survival and is longer for non-AIDS patients. Clinicians must maintain a high index of suspicion for PCP in immunocompromised patients who do not have AIDS.
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211
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Cui L, Lucht L, Tipton L, Rogers MB, Fitch A, Kessinger C, Camp D, Kingsley L, Leo N, Greenblatt RM, Fong S, Stone S, Dermand JC, Kleerup EC, Huang L, Morris A, Ghedin E. Topographic diversity of the respiratory tract mycobiome and alteration in HIV and lung disease. Am J Respir Crit Care Med 2015; 191:932-42. [PMID: 25603113 DOI: 10.1164/rccm.201409-1583oc] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Microbiome studies typically focus on bacteria, but fungal species are common in many body sites and can have profound effects on the host. Wide gaps exist in the understanding of the fungal microbiome (mycobiome) and its relationship to lung disease. OBJECTIVES To characterize the mycobiome at different respiratory tract levels in persons with and without HIV infection and in HIV-infected individuals with chronic obstructive pulmonary disease (COPD). METHODS Oral washes (OW), induced sputa (IS), and bronchoalveolar lavages (BAL) were collected from 56 participants. We performed 18S and internal transcribed spacer sequencing and used the neutral model to identify fungal species that are likely residents of the lung. We used ubiquity-ubiquity plots, random forest, logistic regression, and metastats to compare fungal communities by HIV status and presence of COPD. MEASUREMENTS AND MAIN RESULTS Mycobiomes of OW, IS, and BAL shared common organisms, but each also had distinct members. Candida was dominant in OW and IS, but BAL had 39 fungal species that were disproportionately more abundant than in the OW. Fungal communities in BAL differed significantly by HIV status and by COPD, with Pneumocystis jirovecii significantly overrepresented in both groups. Other fungal species were also identified as differing in HIV and COPD. CONCLUSIONS This study systematically examined the respiratory tract mycobiome in a relatively large group. By identifying Pneumocystis and other fungal species as overrepresented in the lung in HIV and in COPD, it is the first to determine alterations in fungal communities associated with lung dysfunction and/or HIV, highlighting the clinical relevance of these findings. Clinical trial registered with www.clinicaltrials.gov (NCT00870857).
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212
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Hessol NA, Martínez-Maza O, Levine AM, Morris A, Margolick JB, Cohen MH, Jacobson LP, Seaberg EC. Lung cancer incidence and survival among HIV-infected and uninfected women and men. AIDS 2015; 29:1183-93. [PMID: 25888645 PMCID: PMC4457511 DOI: 10.1097/qad.0000000000000690] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To determine the lung cancer incidence and survival time among HIV-infected and uninfected women and men. DESIGN Two longitudinal studies of HIV infection in the United States. METHODS Data from 2549 women in the Women's Interagency HIV Study (WIHS) and 4274 men in the Multicenter AIDS Cohort Study (MACS), all with a history of cigarette smoking, were analyzed. Lung cancer incidence rates and incidence rate ratios were calculated using Poisson regression analyses. Survival time was assessed using Kaplan-Meier and Cox proportional-hazard analyses. RESULTS Thirty-seven women and 23 men developed lung cancer (46 HIV-infected and 14 HIV-uninfected) during study follow-up. In multivariable analyses, the factors that were found to be independently associated with a higher lung cancer incidence rate ratios were older age, less education, 10 or more pack-years of smoking, and a prior diagnosis of AIDS pneumonia (vs. HIV-uninfected women). In an adjusted Cox model that allowed different hazard functions for each cohort, a history of injection drug use was associated with shorter survival, and a lung cancer diagnosis after 2001 was associated with longer survival. In an adjusted Cox model restricted to HIV-infected participants, nadir CD4 lymphocyte cell count less than 200 was associated with shorter survival time. CONCLUSIONS Our data suggest that pulmonary damage and inflammation associated with HIV infection may be causative for the increased risk of lung cancer. Encouraging and assisting younger HIV-infected smokers to quit and to sustain cessation of smoking is imperative to reduce the lung cancer burden in this population.
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Affiliation(s)
- Nancy A Hessol
- aDepartments of Clinical Pharmacy & Medicine, University of California, San Francisco bDepartments of Obstetrics & Gynecology and Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine at UCLA, and Department of Epidemiology, UCLA Fielding School of Public Health cCity of Hope National Medical Center, Duarte, and the Keck School of Medicine, University of Southern California, Los Angeles, California dDepartments of Medicine and Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania eDepartment of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland fDepartments of Medicine, Stroger Hospital and Rush University, Chicago, Illinois gDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Many chronic pulmonary diseases, including those that are not primarily infectious in etiology, have some aspects of their pathogenesis that are influenced by infectious organisms. Microorganisms may contribute to chronic lung diseases, either directly (i.e., overt infection) or indirectly, via the amplification of inflammatory pathways that are critical to host defense. As techniques for detecting and characterizing microorganisms have advanced, investigations of both infecting and colonizing organisms have yielded new insights into mechanisms of pulmonary disease. In addition, changes in patterns of infection and microbial resistance have important implications for treatment. Examples of these infectious-pulmonary associations, including Haemophilus influenzae infection and chronic obstructive pulmonary disease, nontuberculous mycobacteria and bronchiectasis, and human immunodeficiency virus and obstructive lung disease, are reviewed.
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214
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Barakat LA, Juthani-Mehta M, Allore H, Trentalange M, Tate J, Rimland D, Pisani M, Akgün KM, Goetz MB, Butt AA, Rodriguez-Barradas M, Duggal M, Crothers K, Justice AC, Quagliarello VJ. Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia. HIV Med 2015; 16:421-30. [PMID: 25959543 DOI: 10.1111/hiv.12244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear. METHODS Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models. RESULTS Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714). CONCLUSION Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.
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Affiliation(s)
- L A Barakat
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Juthani-Mehta
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - H Allore
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Trentalange
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Tate
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - D Rimland
- Infectious Disease, VA Medical Center, Decatur, GA, USA
| | - M Pisani
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - K M Akgün
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - M B Goetz
- Infectious Disease, VA Greater Los Angles Healthcare System, Los Angelos, CA, USA
| | - A A Butt
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Rodriguez-Barradas
- Infectious Diseases (MS 111G), Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - M Duggal
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - K Crothers
- Pulmonary Disease and Critical Care, University of Washington, Seattle, WA, USA
| | - A C Justice
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - V J Quagliarello
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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215
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Shirley DK, Kaner RJ, Glesby MJ. Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study. AIDS Patient Care STDS 2015; 29:232-9. [PMID: 25723842 DOI: 10.1089/apc.2014.0265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Increased smoking and a detrimental response to tobacco smoke in the lungs of HIV/AIDS patients result in an increased risk for COPD. We aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. Subjects at least 35 years of age at an HIV clinic in New York City completed a COPD screening questionnaire and peak flow measurement. Those with abnormal results and a random one-third of normal screens had spirometry. 235 individuals were included and 89 completed spirometry. Eleven (12%) had undiagnosed airway obstruction and 5 had COPD. A combination of a positive questionnaire and abnormal peak flow yielded a sensitivity of 20% (specificity 93%) for detection of COPD. Peak flow alone had a sensitivity of 80% (specificity 80%). Abnormal peak flow was associated with an AIDS diagnosis (p=0.04), lower nadir (p=0.001), and current CD4 counts (p=0.001). Nadir CD4 remained associated in multivariate analysis (p=0.05). Decreased FEV1 (<80% predicted) was associated with lower CD4 count nadir (p=0.04) and detectable current HIV viral load (p=0.01) in multivariate analysis. Questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.
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Affiliation(s)
- Daniel K Shirley
- 1 Divisions of Infectious Disease and Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
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216
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Liu JCY, Leung JM, Ngan DA, Nashta NF, Guillemi S, Harris M, Lima VD, Um SJ, Li Y, Tam S, Shaipanich T, Raju R, Hague C, Leipsic JA, Bourbeau J, Tan WC, Harrigan PR, Sin DD, Montaner J, Man SFP. Absolute leukocyte telomere length in HIV-infected and uninfected individuals: evidence of accelerated cell senescence in HIV-associated chronic obstructive pulmonary disease. PLoS One 2015; 10:e0124426. [PMID: 25885433 PMCID: PMC4401786 DOI: 10.1371/journal.pone.0124426] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 03/13/2015] [Indexed: 11/30/2022] Open
Abstract
Combination antiretroviral therapy (cART) has extended the longevity of human immunodeficiency virus (HIV)-infected individuals. However, this has resulted in greater awareness of age-associated diseases such as chronic obstructive pulmonary disease (COPD). Accelerated cellular senescence may be responsible, but its magnitude as measured by leukocyte telomere length is unknown and its relationship to HIV-associated COPD has not yet been established. We measured absolute telomere length (aTL) in peripheral leukocytes from 231 HIV-infected adults. Comparisons were made to 691 HIV-uninfected individuals from a population-based sample. Subject quartiles of aTL were assessed for relationships with measures of HIV disease severity, airflow obstruction, and emphysema severity on computed tomographic (CT) imaging. Multivariable regression models identified factors associated with shortened aTL. Compared to HIV-uninfected subjects, the mean aTL in HIV-infected patients was markedly shorter by 27 kbp/genome (p<0.001); however, the slopes of aTL vs. age were not different (p=0.469). Patients with longer known durations of HIV infection (p=0.019) and lower nadir CD4 cell counts (p=0.023) had shorter aTL. Shorter aTL were also associated with older age (p=0.026), smoking (p=0.005), reduced forced expiratory volume in one second (p=0.030), and worse CT emphysema severity score (p=0.049). HIV-infected subjects demonstrate advanced cellular aging, yet in a cART-treated cohort, the relationship between aTL and age appears no different from that of HIV-uninfected subjects.
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Affiliation(s)
| | | | - David A. Ngan
- Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Negar F. Nashta
- AIDS Research Program, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Silvia Guillemi
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marianne Harris
- AIDS Research Program, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D. Lima
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Soo-Jung Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Dong-A University, Busan, South Korea
| | - Yuexin Li
- Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Sheena Tam
- Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Tawimas Shaipanich
- UBC Department of Medicine and Division of Respiratory Medicine, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Rekha Raju
- Department of Radiology and Diagnostic Imaging, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Cameron Hague
- Department of Radiology and Diagnostic Imaging, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Jonathon A. Leipsic
- Department of Radiology and Diagnostic Imaging, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Wan C. Tan
- Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - P. Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, Vancouver, BC, Canada
- UBC Department of Medicine and Division of Respiratory Medicine, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Julio Montaner
- Division of HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - S. F. Paul Man
- Centre for Heart Lung Innovation, Vancouver, BC, Canada
- UBC Department of Medicine and Division of Respiratory Medicine, St. Paul’s Hospital, Vancouver, BC, Canada
- * E-mail:
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217
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Neff CP, Chain JL, MaWhinney S, Martin AK, Linderman DJ, Flores SC, Campbell TB, Palmer BE, Fontenot AP. Lymphocytic alveolitis is associated with the accumulation of functionally impaired HIV-specific T cells in the lung of antiretroviral therapy-naive subjects. Am J Respir Crit Care Med 2015; 191:464-73. [PMID: 25536276 DOI: 10.1164/rccm.201408-1521oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
RATIONALE Lymphocytic alveolitis in HIV-1-infected individuals is associated with multiple pulmonary complications and a poor prognosis. Although lymphocytic alveolitis has been associated with viremia and an increased number of CD8(+) T cells in the lung, its exact cause is unknown. OBJECTIVES To determine if HIV-1-specific T cells are associated with lymphocytic alveolitis in HIV-1-infected individuals. METHODS Using blood and bronchoalveolar lavage (BAL) cells from normal control subjects and untreated HIV-1-infected individuals, we examined the frequency and functional capacity of HIV-1-specific T cells. MEASUREMENTS AND MAIN RESULTS We found that HIV-1-specific T cells were significantly elevated in the BAL compared with blood of HIV-1-infected individuals and strongly correlated with T-cell alveolitis. Expression of Ki67, a marker of in vivo proliferation, was significantly reduced on HIV-1-specific T cells in BAL compared with blood, suggesting a diminished proliferative capacity. In addition, HIV-1-specific CD4(+) and CD8(+) T cells in BAL had higher expression of programmed death 1 (PD-1) and lower cytotoxic T-lymphocyte antigen 4 (CTLA-4) expression than those in the blood. A strong correlation between PD-1, but not CTLA-4, and HIV-1-specific T-cell proliferation was seen, and blockade of the PD-1/PD-L1 pathway augmented HIV-1-specific T-cell proliferation, suggesting that the PD-1 pathway was the main cause of reduced proliferation in the lung. CONCLUSIONS These findings suggest that alveolitis associated with HIV-1 infection is caused by the recruitment of HIV-1-specific CD4(+) and CD8(+) T cells to the lung. These antigen-specific T cells display an impaired proliferative capacity that is caused by increased expression of PD-1.
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218
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Gingo MR, Zhang Y, Ghebrehawariat KB, Jeong JH, Chu Y, Yang Q, Lucht L, Hanna DB, Lazar JM, Gladwin MT, Morris A. Elevated NT-pro-brain natriuretic peptide level is independently associated with all-cause mortality in HIV-infected women in the early and recent HAART eras in the Women's Interagency HIV Study cohort. PLoS One 2015; 10:e0123389. [PMID: 25811188 PMCID: PMC4374715 DOI: 10.1371/journal.pone.0123389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/18/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND HIV-infected individuals are at increased risk of right and left heart dysfunction. N-terminal-pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac ventricular strain and systolic dysfunction, may be associated with all-cause mortality in HIV-infected women. The aim of this study was to determine if elevated levels of NT-proBNP is associated with increased mortality in HIV-infected women. DESIGN Prospective cohort study. METHODS AND RESULTS We measured NT-proBNP in 936 HIV-infected and 387 age-matched HIV-uninfected women early (10/11/94 to 7/17/97) and 1082 HIV-infected and 448 HIV-uninfected women late (4/1/08 to 10/7/08) in the highly active antiretroviral therapy (HAART) periods in the Women's Interagency HIV Study. An NT-proBNP >75th percentile was more likely in HIV-infected persons, but only statistically significant in the late period (27% vs. 21%, unadjusted p = 0.03). In HIV-infected participants, NT-proBNP>75th percentile was independently associated with worse 5-year survival in the early HAART period (HR 1.8, 95% CI 1.3-2.4, p<0.001) and remained a predictor of mortality in the late HAART period (HR 2.8, 95% CI 1.4-5.5, p = 0.002) independent of other established risk covariates (age, race/ethnicity, body mass index, smoking, hepatitis C serostatus, hypertension, renal function, and hemoglobin). NT-proBNP level was not associated with mortality in HIV-uninfected women. CONCLUSION NT-proBNP is a novel independent marker of mortality in HIV-infected women both when HAART was first introduced and currently. As NT-proBNP is often associated with both pulmonary hypertension and left ventricular dysfunction, these findings suggest that these conditions may contribute significantly to adverse outcomes in this population, requiring further definition of causes and treatments of elevated NT-proBNP in HIV-infected women.
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Affiliation(s)
- Matthew R. Gingo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- * E-mail:
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Kidane B. Ghebrehawariat
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
| | - Jong-Hyeon Jeong
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
| | - Yanxia Chu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Quanwei Yang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Lorrie Lucht
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Jason M. Lazar
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, United States of America
| | - Mark T. Gladwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and UPMC, Pittsburgh, PA, United States of America
| | - Alison Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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Wallach-Dayan SB, Elkayam L, Golan-Gerstl R, Konikov J, Zisman P, Dayan MR, Arish N, Breuer R. Cutting edge: FasL(+) immune cells promote resolution of fibrosis. J Autoimmun 2015; 59:67-76. [PMID: 25812467 DOI: 10.1016/j.jaut.2015.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/26/2015] [Accepted: 02/23/2015] [Indexed: 01/07/2023]
Abstract
Immune cells, particularly those expressing the ligand of the Fas-death receptor (FasL), e.g. cytotoxic T cells, induce apoptosis in 'undesirable' self- and non-self-cells, including lung fibroblasts, thus providing a means of immune surveillance. We aimed to validate this mechanism in resolution of lung fibrosis. In particular, we elucidated whether FasL(+) immune cells possess antifibrotic capabilities by induction of FasL-dependent myofibroblast apoptosis and whether antagonists of membrane (m) and soluble (s) FasL can inhibit these capabilities. Myofibroblast interaction with immune cells and its FasL-dependency, were investigated in vitro in coculture with T cells and in vivo, following transplantation into lungs of immune-deficient syngeneic Rag-/- as well as allogeneic SCID mice, and into lungs and air pouches of FasL-deficient (gld) mice, before and after reconstitution of the mice with wild-type (wt), FasL(+) immune cells. We found that myofibroblasts from lungs resolving fibrosis undergo FasL-dependent T cell-induced apoptosis in vitro and demonstrate susceptibility to in vivo immune surveillance in lungs of reconstituted, immune- and FasL-deficient, mice. However, immune-deficient Rag-/- and SCID mice, and gld-mice with FasL-deficiency, endure the accumulation of transplanted myofibroblasts in their lungs with subsequent development of fibrosis. Concomitantly, gld mice, in contrast to chimeric FasL-deficient mice with wt immune cells, accumulated transplanted myofibroblasts in the air pouch model. In humans we found that myofibroblasts from fibrotic lungs secrete sFasL and resist T cell-induced apoptosis, whereas normal lung myofibroblasts are susceptible to apoptosis but acquire resistance upon addition of anti-s/mFasL to the coculture. Immune surveillance, particularly functional FasL(+) immune cells, may represent an important extrinsic component in myofibroblast apoptosis and serve as a barrier to fibrosis. Factors interfering with Fas/FasL-immune cell-myofibroblast interaction such as sFasL secreted by fibrotic-lung myofibroblasts, may abrogate immune surveillance during fibrosis. Annulling these factors may pave a new direction to control human lung fibrosis.
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Affiliation(s)
- Shulamit B Wallach-Dayan
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | - Liron Elkayam
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | - Regina Golan-Gerstl
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | - Jenya Konikov
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | - Philip Zisman
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | - Mark Richter Dayan
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Nissim Arish
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | - Raphael Breuer
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel; Department of Pathology, Boston University School of Medicine, Boston, MA, USA.
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220
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Cai Y, Sugimoto C, Liu DX, Midkiff CC, Alvarez X, Lackner AA, Kim WK, Didier ES, Kuroda MJ. Increased monocyte turnover is associated with interstitial macrophage accumulation and pulmonary tissue damage in SIV-infected rhesus macaques. J Leukoc Biol 2015; 97:1147-53. [PMID: 25780057 DOI: 10.1189/jlb.4a0914-441r] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/25/2015] [Indexed: 12/30/2022] Open
Abstract
We recently reported that increasing blood monocyte turnover that was associated with tissue macrophage death better predicts terminal disease progression in adult SIV-infected macaques than does declining CD4(+) T cell levels. To understand better mechanisms of pathogenesis, this study relates severity of lung-tissue damage to the ratio, distribution, and inflammatory responses of lung macrophage subsets during SIV infection in rhesus macaques exhibiting varying rates of monocyte turnover. In vivo BrdU incorporation was used to evaluate kinetics of monocyte/tissue macrophage turnover. Tissue damage was scored microscopically from H&E-stained lung-tissue sections, and cytokine expression was examined via immunohistochemistry and confocal microscopy. Increased monocyte turnover in SIV-infected rhesus macaques significantly correlated with severity of lung-tissue damage, as exhibited by perivasculitis, vasculitis, interstitial pneumonia, alveolar histiocytosis, foamy macrophages, multinucleated giant cells, fibrin, and edema in the alveoli. In addition, the higher monocyte turnover correlated with declining AI ratio, increased accumulation of IM in the perivascular region of the lung, and higher expression of IL-6 in the IM of the lung tissue exposed to a LPS, calcium ionophore, and tumor promoter combination stimulation ex vivo. Accumulation of IM associated with increasing monocyte turnover during SIV infection appears to contribute to chronic pulmonary inflammation and tissue damage during disease progression to AIDS.
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Affiliation(s)
- Yanhui Cai
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Chie Sugimoto
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - David Xianhong Liu
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Cecily C Midkiff
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Xavier Alvarez
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Andrew A Lackner
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Woong-Ki Kim
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Elizabeth S Didier
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Marcelo J Kuroda
- Divisions of *Immunology, Comparative Pathology, and Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA; Departments of Microbiology and Immunology, School of Medicine, and Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; and Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Attia EF, Akgün KM, Wongtrakool C, Goetz MB, Rodriguez-Barradas MC, Rimland D, Brown ST, Soo Hoo GW, Kim J, Lee PJ, Schnapp LM, Sharafkhaneh A, Justice AC, Crothers K. Increased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4. Chest 2015; 146:1543-1553. [PMID: 25080158 DOI: 10.1378/chest.14-0543] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The association between HIV and emphysema remains incompletely understood. We sought to determine whether HIV is an independent risk factor for emphysema severity and whether markers of HIV severity and systemic biomarkers of inflammation (IL-6), altered coagulation (D-dimer), and immune activation (soluble CD14) are associated with emphysema. METHODS We performed a cross-sectional analysis of 114 participants with HIV infection and 89 participants without HIV infection in the Examinations of HIV-Associated Lung Emphysema (EXHALE) study. Participants underwent chest CT imaging with blinded semiquantitative interpretation of emphysema severity, distribution, and type. We generated multivariable logistic regression models to determine the risk of HIV for radiographic emphysema, defined as > 10% lung involvement. Similar analyses examined associations of plasma biomarkers, HIV RNA, and recent and nadir CD4 cell counts with emphysema among participants with HIV infection. RESULTS Participants with HIV infection had greater radiographic emphysema severity with increased lower lung zone and diffuse involvement. HIV was associated with significantly increased risk for > 10% emphysema in analyses adjusted for cigarette smoking pack-years (OR, 2.24; 95% CI, 1.12-4.48). In multivariable analyses restricted to participants with HIV infection, nadir CD4 < 200 cells/μL (OR, 2.98; 95% CI, 1.14-7.81), and high soluble CD14 level (upper 25th percentile) (OR, 2.55; 95% CI, 1.04-6.22) were associated with increased risk of > 10% emphysema. IL-6 and D-dimer were not associated with emphysema in HIV. CONCLUSIONS HIV is an independent risk factor for radiographic emphysema. Emphysema severity was significantly greater among participants with HIV infection. Among those with HIV, nadir CD4 < 200 cells/μL and elevated soluble CD14 level were associated with emphysema, highlighting potential mechanisms linking HIV with emphysema.
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Affiliation(s)
- Engi F Attia
- Department of Medicine, University of Washington, Seattle, WA
| | - Kathleen M Akgün
- Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT; Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Cherry Wongtrakool
- Atlanta Veterans Affairs Medical Center, Atlanta, GA; Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Matthew Bidwell Goetz
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - David Rimland
- Atlanta Veterans Affairs Medical Center, Atlanta, GA; Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Sheldon T Brown
- Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Medicine, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Guy W Soo Hoo
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joon Kim
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Patty J Lee
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Lynn M Schnapp
- Department of Medicine, University of Washington, Seattle, WA
| | - Amir Sharafkhaneh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Amy C Justice
- Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT; Department of Medicine, Yale School of Medicine, New Haven, CT
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Scourfield AT, Doffman SR, Miller RF. Chronic obstructive pulmonary disease in patients with HIV: an emerging problem. Br J Hosp Med (Lond) 2015; 75:678-84. [PMID: 25488530 DOI: 10.12968/hmed.2014.75.12.678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
People with well-controlled HIV now have normal life expectancies and physicians managing these patients are increasingly encountering co-existing chronic obstructive pulmonary disease. This article reviews similarities with this disease in the general population and highlights key differences including significant drug-drug interactions.
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Affiliation(s)
- Andrew T Scourfield
- Respiratory Registrar in the Department of Respiratory Medicine, University College Hospital London, London NW1 2BU
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223
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Gingo MR. The changing landscape of HIV-related lung disease: non-AIDS lung malignancy as a player in the field. Respirology 2015; 19:300-2. [PMID: 24620759 DOI: 10.1111/resp.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Matthew R Gingo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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224
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Pefura-Yone EW, Fodjeu G, kengne AP, Roche N, Kuaban C. Prevalence and determinants of chronic obstructive pulmonary disease in HIV infected patients in an African country with low level of tobacco smoking. Respir Med 2015; 109:247-54. [DOI: 10.1016/j.rmed.2014.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/12/2014] [Accepted: 12/03/2014] [Indexed: 11/15/2022]
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Abstract
Human immunodeficiency virus type 1 (HIV-1) is the retrovirus responsible for the development of AIDS. Its profound impact on the immune system leaves the host vulnerable to a wide range of opportunistic infections not seen in individuals with a competent immune system. Pulmonary infections dominated the presentations in the early years of the epidemic, and infectious and noninfectious lung diseases remain the leading causes of morbidity and mortality in persons living with HIV despite the development of effective antiretroviral therapy. In addition to the long known immunosuppression and infection risks, it is becoming increasingly recognized that HIV promotes the risk of noninfectious pulmonary diseases through a number of different mechanisms, including direct tissue toxicity by HIV-related viral proteins and the secondary effects of coinfections. Diseases of the airways, lung parenchyma and the pulmonary vasculature, as well as pulmonary malignancies, are either more frequent in persons living with HIV or have atypical presentations. As the pulmonary infectious complications of HIV are generally well known and have been reviewed extensively, this review will focus on the breadth of noninfectious pulmonary diseases that occur in HIV-infected individuals as these may be more difficult to recognize by general medical physicians and subspecialists caring for this large and uniquely vulnerable population.
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226
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Akanbi MO, Taiwo BO, Achenbach CJ, Ozoh OB, Obaseki DO, Sule H, Agbaji OO, Ukoli CO. HIV Associated Chronic Obstructive Pulmonary Disease in Nigeria. ACTA ACUST UNITED AC 2015; 6. [PMID: 26236557 DOI: 10.4172/2155-6113.1000453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) among HIV-infected adults in Nigeria. DESIGN Cross-sectional study. METHODS HIV-infected adults aged ≥ 30 years with no acute ailments accessing care at the antiretroviral therapy clinic of Jos University Teaching Hospital were enrolled consecutively. Participants were interviewed to obtain pertinent demographic and clinical information, including exposure to risk factors for COPD. Post-bronchodilator spirometry was carried out. HIV related information was retrieved from the clinic medical records. COPD case-definition was based on the Global Initiative for Obstructive Lung Disease (GOLD) criteria using post-bronchodilator FEV1/FVC <0.7. COPD prevalence was also calculated using the lower limit of normal for FEV1/FVC criteria (LLN) from the European Respiratory Society normative equation. Factors associated with COPD were determined using logistic regression models. RESULTS Study population comprised 356 HIV infected adults with mean age of 44.5 (standard deviation, 7.1) years and 59% were female. The mean time elapsed since HIV diagnosis was 7.0 (SD, 2.6) years and 97.5% of the respondents were on stable ART with virologic suppression present in 67.2%. Prevalence of COPD were 15.4% (95% confidence interval [CI] 11.7-19.2), 12.07% (95% CI 8.67-15.48), 22.19% (95% CI 18.16-26.83) using GOLD, ERS LLN and GLI LLN diagnostic criteria respectively. In multivariate analyses adjusting for gender, exposure to cigarette smoke or biomass, history of pulmonary tuberculosis, use of antiretroviral therapy, current CD4 T-cell count and HIV RNA, only age > 50 years was independently associated with COPD with OR 3.4; 95% CI 1.42-8.17 when compared to ages 30-40 years. CONCLUSION HIV-associated COPD is common in our population of HIV patients.
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Affiliation(s)
- Maxwell O Akanbi
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | | | | | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Daniel O Obaseki
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Halima Sule
- Department of Family Medicine, Jos University Teaching Hospital, Nigeria
| | - Oche O Agbaji
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
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Gnoni M, Otero D, Friedstrom S, Blatt S, Ramirez J. Possible role of tetracyclines on decreasing the accelerated aging process of well-controlled HIV patients on antiretroviral therapy. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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228
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Segal LN, Weiden MD, Horowitz HW. Acute Exacerbations of Chronic Obstructive Pulmonary Disease. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152150 DOI: 10.1016/b978-1-4557-4801-3.00067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cribbs SK, Lennox J, Caliendo AM, Brown LA, Guidot DM. Healthy HIV-1-infected individuals on highly active antiretroviral therapy harbor HIV-1 in their alveolar macrophages. AIDS Res Hum Retroviruses 2015; 31:64-70. [PMID: 25134819 DOI: 10.1089/aid.2014.0133] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In a prospective cross-sectional study we quantified HIV viral load within the alveolar macrophage in a cohort of healthy HIV-infected subjects who did not have medical comorbidities or smoke cigarettes to determine if alveolar macrophage proviral DNA was associated with alveolar macrophage phagocytic immune dysfunction. We enrolled 23 subjects who underwent bronchoscopy and bronchoalveolar lavage. Alveolar macrophages were isolated and HIV-1 RNA was quantified in the cells using the Abbott RealTime HIV-1 Assay. Proviral DNA was qualitatively measured using a modified version of the HIV-1 RNA assay. Phagocytosis measured by incubating alveolar macrophages with FITC-labeled Staphylococcus aureus and determining fluorescence with a Zeiss inverted microscope. Phagocytic index was calculated as (% positive cells × mean channel fluorescence)/100. Sixteen subjects had (+) proviral DNA and seven had (-) proviral DNA in their alveolar macrophages. Of all subjects 100% in both groups were on highly active antiretroviral therapy (HAART). The median plasma viral load was 0 in both groups. HIV-1-infected subjects with (+) proviral DNA in their alveolar macrophages had a significantly lower median alveolar macrophage phagocytic index compared to those with (-) proviral DNA in their alveolar macrophages [11.8 (IQR 4.8-39.0) vs. 64.9 (IQR 14.0-166.0), p = 0.05]. Alveolar macrophages harbor HIV even in otherwise healthy subjects with undetectable plasma viral loads, representing a potential reservoir for the virus. In addition, HIV viral replication within the macrophage may impair phagocytosis and other immune functions in the lung, leading to an increased risk for lung infection.
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Affiliation(s)
- Sushma K. Cribbs
- Pulmonary Medicine, Department of Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, Georgia
| | - Jeffrey Lennox
- Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia
| | - Angela M. Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lou Ann Brown
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia
| | - David M. Guidot
- Pulmonary Medicine, Department of Veterans Affairs Medical Center, Atlanta, Georgia
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, Georgia
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230
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Goodman MD. Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_44-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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231
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Gómez-Cerquera JM, Hernando-López E, Blanco-Ramos JR. Insuficiencia suprarrenal iatrogénica por la interacción entre ritonavir y fluticasona inhalada. Revisión de la literatura. Enferm Infecc Microbiol Clin 2014; 32:662-5. [DOI: 10.1016/j.eimc.2013.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 12/16/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
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Akgün KM, Tate JP, Crothers K, Crystal S, Leaf DA, Womack J, Brown TT, Justice AC, Oursler KK. An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals. J Acquir Immune Defic Syndr 2014; 67:397-404. [PMID: 25202921 PMCID: PMC4213242 DOI: 10.1097/qai.0000000000000341] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Frailty is a geriatric syndrome of decreased physiologic reserve and a risk factor for hospitalization and mortality. We hypothesized that an adapted survey-based frailty-related phenotype (aFRP) predicts hospitalization and mortality among HIV-infected and uninfected individuals in adjusted models but is uncommon among those achieving undetectable HIV-1 RNA. METHODS Defined from self-reported domains of physical shrinking, exhaustion, slowness, and low physical activity in Veterans Aging Cohort Study (VACS) participants, aFRP was considered present with ≥3 domains and prefrailty with 1-2 domains. Cox survival analysis determined hazard ratios (HRs) for 5-year hospitalization and mortality risk adjusting for frailty states, demographics, health behaviors, comorbidities, and a validated risk index incorporating HIV-specific and general organ system biomarkers, the VACS Index. Model discrimination was assessed. RESULTS Participants with complete data were included [6515/7324 (89%)]. Of these, 3.9% of HIV-infected individuals with HIV-1 RNA >400 copies per milliliter; 2.0% of HIV-infected individuals with HIV-1 RNA ≤400 copies per milliliter; and 2.8% of uninfected individuals met aFRP criteria (P = 0.01). After adjustment for other covariates, aFRP was associated with hospitalization (HR = 1.78; 95% confidence interval: 1.48 to 2.13) and mortality (HR = 1.75; 95% confidence interval: 1.28 to 2.40). C-statistics for the VACS Index for hospitalization (0.633) and for mortality (0.756) were higher than for aFRP (0.565 and 0.584, respectively). C-statistic for hospitalization improved modestly when VACS Index and aFRP were both included (0.646) and minimally for mortality (0.761). CONCLUSIONS aFRP was independently associated with adverse health outcomes among HIV-infected and uninfected individuals. aFRP modestly improved prediction for hospitalization. However, the aFRP is rare among HIV-infected individuals with undetectable HIV-1 RNA.
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Affiliation(s)
- Kathleen M Akgün
- *Department of Internal Medicine and General Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; †Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‡Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; §Department of Medicine, University of Washington School of Medicine, Seattle, WA; ‖Institute for Health, Healthcare Policy and Aging Research, Rutgers University, New Brunswick, NJ; ¶Department of Medicine, VA Greater Los Angeles Healthcare System, UCLA School of Medicine, Los Angeles, CA; #Yale School of Nursing, New Haven, CT; **Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD; and ††Department of Medicine, VA Maryland Health Care System, University of Maryland SOM, Baltimore, MD
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Relationships of pulmonary function, inflammation, and T-cell activation and senescence in an HIV-infected cohort. AIDS 2014; 28:2505-15. [PMID: 25574956 DOI: 10.1097/qad.0000000000000471] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine associations between circulating markers of immune activation, immune cell senescence, and inflammation with HIV-associated abnormalities of pulmonary function. DESIGN HIV infection is an independent risk factor for abnormal pulmonary function. Immune activation, immune senescence, and chronic inflammation are characteristics of chronic HIV infection that have been associated with other HIV-associated comorbidities and may be related to pulmonary disease in this population. METHODS Participants from an HIV-infected cohort (n = 147) completed pulmonary function testing (PFT). Markers of T-cell activation and senescence were determined by flow cytometry, and plasma levels of interleukin-6, interleukin-8, and C-reactive protein (CRP) were measured, as was telomere length of peripheral blood mononuclear cells (PBMC). Regression models adjusting for clinical risk factors were constructed to examine relationships between biomarkers and PFT outcomes. RESULTS Activated CD25(+) T cells and activated/senescent CD69(+)/CD57(+)/CD28(null) CD4(+) T cells, interleukin-6, and CRP were associated with PFT abnormalities. Shortening of PBMC telomere length correlated with airflow obstruction and diffusing impairment. Paradoxically, circulating senescent CD57(+)/CD28(null) CD8(+) T cells were associated with better PFT outcomes. CONCLUSION Circulating T cells expressing markers of activation and inflammatory cytokine levels are independently correlated with PFT abnormalities in HIV-infected persons. Overall telomere shortening was also associated with pulmonary dysfunction. The paradoxical association of senescent CD8(+) T cells and better PFT outcomes could suggest an unrecognized beneficial compensatory function of such cells or a redistribution of these cells from the circulation to local compartments. Further studies are needed to differentiate and characterize functional subsets of local pulmonary and circulating T-cell populations in HIV-associated pulmonary dysfunction.
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Simonetti JA, Gingo MR, Kingsley L, Kessinger C, Lucht L, Balasubramani GK, Leader JK, Huang L, Greenblatt RM, Dermand J, Kleerup EC, Morris A. Pulmonary Function in HIV-Infected Recreational Drug Users in the Era of Anti-Retroviral Therapy. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 5:365. [PMID: 25664201 PMCID: PMC4318265 DOI: 10.4172/2155-6113.1000365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Individuals with HIV infection commonly have pulmonary function abnormalities, including airflow obstruction and diffusion impairment, which may be more prevalent among recreational drug users. To date, the relationship between drug use and pulmonary function abnormalities among those with HIV remains unclear. OBJECTIVE To determine associations between recreational drug use and airflow obstruction, diffusion impairment, and radiographic emphysema in men and women with HIV. METHODS Cross-sectional analysis of pulmonary function and self-reported recreational drug use data from a cohort of 121 men and 63 women with HIV. Primary outcomes were the presence (yes/no) of: 1) airflow obstruction, (pre- or post-bronchodilator forced expiratory volume in 1 second/forced vital capacity<0.70); 2) moderate diffusion impairment (diffusing capacity for carbon monoxide <60% predicted); and 3) radiographic emphysema (>1% of lung voxels <-950 Hounsfield units). Exposures of interest were frequency of recreational drug use, recent (since last study visit) drug use, and any lifetime drug use. We used logistic regression to determine associations between recreational drug use and the primary outcomes. RESULTS HIV-infected men and women reported recent recreational drug use at 56.0% and 31.0% of their study visits, respectively, and 48.8% of men and 39.7% of women reported drug use since their last study visit. Drug use was not associated with airway obstruction or radiographic emphysema in men or women. Recent crack cocaine use was independently associated with moderate diffusion impairment in women (odds ratio 17.6; 95% confidence interval 1.3-249.6, p=0.03). CONCLUSIONS In this cross-sectional analysis, we found that recreational drug use was common among HIV-infected men and women and recent crack cocaine use was associated with moderate diffusion impairment in women. Given the increasing prevalence of HIV infection, any relationship between drug use and prevalence or severity of chronic pulmonary diseases could have a significant impact on HIV and chronic disease management.
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Affiliation(s)
- Joseph A Simonetti
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew R Gingo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lawrence Kingsley
- Division of Infectious Diseases and Microbiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cathy Kessinger
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lorrie Lucht
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - GK Balasubramani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph K Leader
- Imaging Research Division, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laurence Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ruth M Greenblatt
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - John Dermand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eric C Kleerup
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Alison Morris
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
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Makinson A, Hayot M, Eymard-Duvernay S, Quesnoy M, Raffi F, Thirard L, Bonnet F, Tattevin P, Abgrall S, Quantin X, Léna H, Bommart S, Reynes J, Le Moing V. High prevalence of undiagnosed COPD in a cohort of HIV-infected smokers. Eur Respir J 2014; 45:828-31. [DOI: 10.1183/09031936.00154914] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Temporal trends in critical events complicating HIV infection: 1999-2010 multicentre cohort study in France. Intensive Care Med 2014; 40:1906-15. [PMID: 25236542 DOI: 10.1007/s00134-014-3481-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/01/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE Multicentre data are limited to appraise the management and prognosis of critically ill human immunodeficiency virus (HIV)-infected patients. We sought to describe temporal trends in demographic and clinical characteristics, indications for intensive care and outcome in this patient population. METHODS We conducted a cohort study of unselected HIV-infected patients admitted between 1999 and 2010 to 34 French ICUs contributing to the CUB-Réa prospective database. RESULTS We included 6,373 consecutive patients. Over the 12-year period, increases occurred in median age (39 years in 1999-2001; 47 years in 2008-2010, p < 0.0001) and prevalence of comorbidities (notably malignancies, from 6.7 to 16.4%, p < 0.0001). Admissions for respiratory failure (39.8% overall), shock (8.1%) and coma (22.7%) decreased (p < 0.0001), while those for sepsis (19.3%) remained stable. The main final diagnoses were bacterial sepsis (24.6%) and non-bacterial acquired immune deficiency syndrome (AIDS)-defining diseases (steady decline from 26.0 to 17.5%, p < 0.0001). Patients increasingly received mechanical ventilation (from 42.9 to 54.0%) and renal replacement therapy (from 9.6 to 16.8%) (p < 0.0001), whereas vasopressor use remained stable (27.4%). ICU readmissions increased after 2004 (p < 0.0001). ICU and hospital mortality (17.6 and 26.9%, respectively) dropped markedly in the most severely ill patients requiring multiple life-sustaining therapies. Malignancies and chronic liver disease were heavily associated with hospital mortality by multivariate analysis, while the most common AIDS-defining complications (Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis and tuberculosis) had no independent impact. CONCLUSIONS Progressive ageing, increasing prevalence of comorbidities (mainly malignancies), a steady decline in AIDS-related illnesses and improved benefits from life-sustaining therapies were the main temporal trends in HIV-infected patients requiring ICU admission.
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237
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Kunisaki KM, Akgün KM, Fiellin DA, Gibert CL, Kim JW, Rimland D, Rodriguez-Barradas MC, Yaggi HK, Crothers K. Prevalence and correlates of obstructive sleep apnoea among patients with and without HIV infection. HIV Med 2014; 16:105-13. [PMID: 25230851 DOI: 10.1111/hiv.12182] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES In HIV-uninfected populations, obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease, metabolic syndrome, and cognitive impairment. These comorbidities are common in HIV-infected patients, but there are scarce data regarding OSA in HIV-infected patients. Therefore, we examined the prevalence and correlates of OSA in a cohort of HIV-infected and uninfected patients. METHODS An observational cohort study was carried out. Electronic medical record and self-report data were examined in patients enrolled in the Veterans Aging Cohort Study (VACS) between 2002 and 2008 and followed until 2010. The primary outcome was OSA diagnosis, determined using International Classification of Diseases, 9th edition (ICD-9) codes, in HIV-infected compared with uninfected individuals. We used regression analyses to determine the association between OSA diagnosis, symptoms and comorbidities in adjusted models. RESULTS Of 3683 HIV-infected and 3641 uninfected patients, 143 (3.9%) and 453 (12.4%) had a diagnosis of OSA (p<0.0001), respectively. HIV-infected patients were more likely to report symptoms associated with OSA such as tiredness and fatigue. Compared with uninfected patients with OSA, HIV-infected patients with OSA were younger, had lower body mass indexes (BMIs), and were less likely to have hypertension. In models adjusting for these traditional OSA risk factors, HIV infection was associated with markedly reduced odds of OSA diagnosis (odds ratio 0.48; 95% confidence interval 0.39-0.60). CONCLUSIONS HIV-infected patients are less likely to receive a diagnosis of OSA. Future studies are needed to determine whether the lower prevalence of OSA diagnoses in HIV-infected patients is attributable to decreased screening and detection or to a truly decreased likelihood of OSA in the setting of HIV infection.
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Affiliation(s)
- K M Kunisaki
- Minneapolis VA Health Care System, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
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238
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Bloomfield GS, Khazanie P, Morris A, Rabadán-Diehl C, Benjamin LA, Murdoch D, Radcliff VS, Velazquez EJ, Hicks C. HIV and noncommunicable cardiovascular and pulmonary diseases in low- and middle-income countries in the ART era: what we know and best directions for future research. J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S40-53. [PMID: 25117960 PMCID: PMC4133739 DOI: 10.1097/qai.0000000000000257] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With the advent of effective antiretroviral therapy (ART), HIV is becoming a chronic disease. HIV-seropositive (+) patients on ART can expect to live longer and, as a result, they are at risk of developing chronic noncommunicable diseases related to factors, such as aging, lifestyle, long-term HIV infection, and the potential adverse effects of ART. Although data are incomplete, evidence suggests that even in low- and middle-income countries (LMICs), chronic cardiovascular and pulmonary diseases are increasing in HIV-positive patients. This review summarizes evidence-linking HIV infection to the most commonly cited chronic cardiovascular and pulmonary conditions in LMICs: heart failure, hypertension, coronary artery disease/myocardial infarction, stroke, obstructive lung diseases, and pulmonary arterial hypertension. We describe the observed epidemiology of these conditions, factors affecting expression in LMICs, and key populations that may be at higher risk (ie, illicit drug users and children), and finally, we suggest that strategic areas of research and training intended to counter these conditions effectively. As access to ART in LMICs increases, long-term outcomes among HIV-positive persons will increasingly be determined by a range of associated chronic cardiovascular and pulmonary complications. Actions taken now to identify those conditions that contribute to long-term morbidity and mortality optimize early recognition and diagnosis and implement effective prevention strategies and/or disease interventions are likely to have the greatest impact on limiting cardiovascular and pulmonary disease comorbidity and improving population health among HIV-positive patients in LMICs.
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Affiliation(s)
- Gerald S. Bloomfield
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Prateeti Khazanie
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Alison Morris
- Departments of Medicine and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cristina Rabadán-Diehl
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura A. Benjamin
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
- Malawi-Liverpool-Wellcome Major Overseas Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - David Murdoch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Virginia S. Radcliff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Eric J. Velazquez
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Charles Hicks
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
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Ferrand H, Crockett F, Naccache JM, Rioux C, Mayaud C, Yazdanpanah Y, Cadranel J. [Pulmonary manifestations in HIV-infected patients: a diagnostic approach]. Rev Mal Respir 2014; 31:903-15. [PMID: 25496788 DOI: 10.1016/j.rmr.2014.04.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/25/2014] [Indexed: 01/12/2023]
Abstract
The spectrum of pulmonary diseases that can affect human immunodeficiency virus (HIV)-infected patients is wide and includes both HIV and non-HIV-related conditions. Opportunistic infections and neoplasms remain a major concern even in the current era of combination antiretroviral therapy. Although these diseases have characteristic clinical and radiological features, there can be considerable variation in these depending on the patient's CD4 lymphocyte count. The patient's history, physical examination, CD4 count and chest radiograph features must be considered in establishing an appropriate diagnostic algorithm. In this article, we propose different diagnostic approaches HIV infected to patients with respiratory symptoms depending on their clinico-radiological pattern.
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Affiliation(s)
- H Ferrand
- Service de pneumologie, hôpital Tenon, université P&M Curie, AP-HP, 4, rue de la Chine, 75970 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, université Denis-Diderot, AP-HP, Paris, France
| | - F Crockett
- Service de pneumologie, hôpital Tenon, université P&M Curie, AP-HP, 4, rue de la Chine, 75970 Paris, France
| | - J-M Naccache
- Service de pneumologie, hôpital Tenon, université P&M Curie, AP-HP, 4, rue de la Chine, 75970 Paris, France
| | - C Rioux
- Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, université Denis-Diderot, AP-HP, Paris, France
| | - C Mayaud
- Service de pneumologie, hôpital Tenon, université P&M Curie, AP-HP, 4, rue de la Chine, 75970 Paris, France
| | - Y Yazdanpanah
- Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, université Denis-Diderot, AP-HP, Paris, France
| | - J Cadranel
- Service de pneumologie, hôpital Tenon, université P&M Curie, AP-HP, 4, rue de la Chine, 75970 Paris, France.
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Kern RM, Seethamraju H, Blanc PD, Sinha N, Loebe M, Golden J, Kukreja J, Scheinin S, Hays S, Kleinhenz ME, Leard L, Hoopes C, Singer JP. The feasibility of lung transplantation in HIV-seropositive patients. Ann Am Thorac Soc 2014; 11:882-9. [PMID: 24964265 PMCID: PMC4213997 DOI: 10.1513/annalsats.201402-083oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/11/2014] [Indexed: 12/11/2022] Open
Abstract
RATIONALE HIV seropositivity has long been considered a contraindication to lung transplantation, primarily because of the potential risks of added immunosuppression. In the past decade, however, experience with kidney and liver transplantation in the setting of HIV infection, with achievement of satisfactory outcomes, has grown considerably. This promising development has created a need to reconsider this contraindication to lung transplantation. OBJECTIVES There is presently limited evidence upon which to base medical decision-making regarding lung transplantation in individuals with HIV infection. In our present study, we wished to extend the existing literature by reporting the outcomes of three individuals with HIV infection who underwent lung transplantation at two centers. METHODS We compiled data for a case series of three HIV-infected subjects undergoing lung transplantation at two centers. MEASUREMENTS AND MAIN RESULTS We reviewed medical records to investigate the effects of lung transplantation on the course of HIV infection, the development of HIV-related opportunistic infections or malignancies, the occurrence of lung transplant and HIV drug interactions, and the extent of acute rejection. Subject 1, who underwent transplantation for HIV-associated pulmonary arterial hypertension, experienced recalcitrant acute rejection requiring a lymphocyte-depleting agent with subsequent rapid development of bronchiolitis obliterans syndrome. Subjects 2 and 3, who underwent transplantation for idiopathic pulmonary fibrosis, experienced mild acute rejection but remain free from chronic rejection at 4 and 2 years after transplant, respectively. CONCLUSIONS Lung transplantation may be feasible for carefully selected patients in the setting of controlled HIV infection. On the basis of our experience with three patients, we caution that acute graft rejection may be more common in such patients.
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Affiliation(s)
- Ryan M. Kern
- Division of Pulmonary, Critical Care, Allergy
and Sleep Medicine
| | - Harish Seethamraju
- Division of Pulmonary, Critical Care and Sleep
Medicine, Department of Medicine, and
| | - Paul D. Blanc
- Division of Pulmonary, Critical Care, Allergy
and Sleep Medicine
- Division of Occupational Medicine, Department
of Medicine, and
| | - Niraj Sinha
- Department of Medicine, Division of Pulmonary,
Critical Care and Transplant Medicine, Houston Methodist Hospital, Houston, Texas;
and
| | - Matthias Loebe
- Houston Methodist DeBakey Heart &
Vascular Center, Houston Methodist J. C. Walter Transplant Center, Houston,
Texas
| | - Jeff Golden
- Division of Pulmonary, Critical Care, Allergy
and Sleep Medicine
| | - Jasleen Kukreja
- Division of Adult Cardiothoracic Surgery,
Department of Surgery, University of California, San Francisco
| | - Scott Scheinin
- Houston Methodist DeBakey Heart &
Vascular Center, Houston Methodist J. C. Walter Transplant Center, Houston,
Texas
| | - Steven Hays
- Division of Pulmonary, Critical Care, Allergy
and Sleep Medicine
| | | | - Lorri Leard
- Division of Pulmonary, Critical Care, Allergy
and Sleep Medicine
| | - Charles Hoopes
- Department of Surgery, University of Kentucky
College of Medicine, Lexington, Kentucky; and
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Cribbs SK, Park Y, Guidot DM, Martin GS, Brown LA, Lennox J, Jones DP. Metabolomics of bronchoalveolar lavage differentiate healthy HIV-1-infected subjects from controls. AIDS Res Hum Retroviruses 2014; 30:579-85. [PMID: 24417396 DOI: 10.1089/aid.2013.0198] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite antiretroviral therapy, pneumonias from pathogens such as pneumococcus continue to cause significant morbidity and mortality in HIV-1-infected individuals. Respiratory infections occur despite high CD4 counts and low viral loads; therefore, better understanding of lung immunity and infection predictors is necessary. We tested whether metabolomics, an integrated biosystems approach to molecular fingerprinting, could differentiate such individual characteristics. Bronchoalveolar lavage fluid (BALf ) was collected from otherwise healthy HIV-1-infected individuals and healthy controls. A liquid chromatography-high-resolution mass spectrometry method was used to detect metabolites in BALf. Statistical and bioinformatic analyses used false discovery rate (FDR) and orthogonally corrected partial least-squares discriminant analysis (OPLS-DA) to identify groupwise discriminatory factors as the top 5% of metabolites contributing to 95% separation of HIV-1 and control. We enrolled 24 subjects with HIV-1 (median CD4=432) and 24 controls. A total of 115 accurate mass m/z features from C18 and AE analysis were significantly different between HIV-1 subjects and controls (FDR=0.05). Hierarchical cluster analysis revealed clusters of metabolites, which discriminated the samples according to HIV-1 status (FDR=0.05). Several of these did not match any metabolites in metabolomics databases; mass-to-charge 325.065 ([M+H](+)) was significantly higher (FDR=0.05) in the BAL of HIV-1-infected subjects and matched pyochelin, a siderophore-produced Pseudomonas aeruginosa. Metabolic profiles in BALf differentiated healthy HIV-1-infected subjects and controls. The lack of association with known human metabolites and inclusion of a match to a bacterial metabolite suggest that the differences could reflect the host's lung microbiome and/or be related to subclinical infection in HIV-1-infected patients.
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Affiliation(s)
- Sushma K. Cribbs
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia
| | - Youngja Park
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia
- College of Pharmacy, Korea University, Sejong City, Korea
| | - David M. Guidot
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia
| | - Greg S. Martin
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia
| | - Lou Ann Brown
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia
| | - Jeffrey Lennox
- Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia
| | - Dean P. Jones
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia
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HIV-associated obstructive lung diseases: insights and implications for the clinician. THE LANCET RESPIRATORY MEDICINE 2014; 2:583-92. [PMID: 24831854 DOI: 10.1016/s2213-2600(14)70017-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The effectiveness of antiretroviral therapy to control HIV infection has led to the emergence of an older HIV population who are at risk of chronic diseases. Through a comprehensive search of major databases, this Review summarises information about the associations between chronic obstructive pulmonary disease (COPD), asthma, and HIV infection. Asthma and COPD are more prevalent in HIV-infected populations; 16-20% of individuals with HIV infection have asthma or COPD, and poorly controlled HIV infection worsens spirometric and diffusing capacity measurements, and accelerates lung function decline by about 55-75 mL/year. Up to 21% of HIV-infected individuals have obstructive ventilatory defects and reduced diffusing capacity is seen in more than 50% of HIV-infected populations. Specific pharmacotherapy considerations are needed to care for HIV-infected populations with asthma or COPD-protease inhibitor regimens to treat HIV (such as ritonavir) can result in systemic accumulation of inhaled corticosteroids and might increase pneumonia risk, exacerbating the toxicity of this therapy. Therefore, it is essential for clinicians to have a heightened awareness of the increased risk and manifestations of obstructive lung diseases in HIV-infected patients and specific therapeutic considerations to care for this population. Screening spirometry and tests of diffusing capacity might be beneficial in HIV-infected people with a history of smoking or respiratory symptoms.
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243
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Almodovar S. The complexity of HIV persistence and pathogenesis in the lung under antiretroviral therapy: challenges beyond AIDS. Viral Immunol 2014; 27:186-99. [PMID: 24797368 DOI: 10.1089/vim.2013.0130] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Antiretroviral therapy (ART) represents a significant milestone in the battle against AIDS. However, we continue learning about HIV and confronting challenges 30 years after its discovery. HIV has cleverly tricked both the host immune system and ART. First, the many HIV subtypes and recombinant forms have different susceptibilities to antiretroviral drugs, which may represent an issue in countries where ART is just being introduced. Second, even under the suppressive pressures of ART, HIV still increases inflammatory mediators, deregulates apoptosis and proliferation, and induces oxidative stress in the host. Third, the preference of HIV for CXCR4 as a co-receptor may also have noxious outcomes, including potential malignancies. Furthermore, HIV still replicates cryptically in anatomical reservoirs, including the lung. HIV impairs bronchoalveolar T-lymphocyte and macrophage immune responses, rendering the lung susceptible to comorbidities. In addition, HIV-infected individuals are significantly more susceptible to long-term HIV-associated complications. This review focuses on chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, and lung cancer. Almost two decades after the advent of highly active ART, we now know that HIV-infected individuals on ART live as long as the uninfected population. Fortunately, its availability is rapidly increasing in low- and middle-income countries. Nevertheless, ART is not risk-free: the developed world is facing issues with antiretroviral drug toxicity, resistance, and drug-drug interactions, while developing countries are confronting issues with immune reconstitution inflammatory syndrome. Several aspects of the complexity of HIV persistence and challenges with ART are discussed, as well as suggestions for new avenues of research.
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Affiliation(s)
- Sharilyn Almodovar
- Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
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244
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Leung JM, Liu JC, Mtambo A, Ngan D, Nashta N, Guillemi S, Harris M, Lima VD, Mattman A, Shaipanich T, Raju R, Hague C, Leipsic JA, Sin DD, Montaner JS, Man SP. The determinants of poor respiratory health status in adults living with human immunodeficiency virus infection. AIDS Patient Care STDS 2014; 28:240-7. [PMID: 24742270 DOI: 10.1089/apc.2013.0373] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The increased longevity afforded by combination antiretroviral therapy in developed countries has led to an increased concern regarding senescence-related diseases in patients with human immunodeficiency virus (HIV) infection. Previous epidemiologic analyses have demonstrated an increased risk of chronic obstructive pulmonary disease, as well as a significant burden of respiratory symptoms in HIV-infected patients. We performed the St. George's Respiratory Questionnaire (SGRQ) in 199 HIV-positive men, and determined the predominant factors contributing to poor respiratory-related health status. In univariate analyses, worse SGRQ scores were associated with respiratory-related variables such as greater smoking pack-year history (p=0.028), lower forced expiratory volume in 1 second (FEV1) (p<0.001), and worse emphysema severity as quantified by computed tomographic imaging (p=0.017). In addition, HIV-specific variables, such as a history of plasma viral load >100,000 copies/mL (p=0.043), lower nadir CD4 cell count (p=0.040), and current CD4 cell count ≤350 cells/μL (p=0.005), as well as elevated levels of inflammatory markers, specifically plasma interleukin (IL)-6 (p=0.002) and alpha-1 antitrypsin (p=0.005) were also associated with worse SGRQ scores. In a multiple regression model, FEV1, current CD4 count ≤350 cells/μL, and IL-6 levels remained significant contributors to reduced respiratory-related health status. HIV disease activity as measured by HIV-related immunosuppression in conjunction with the triggering of key inflammatory pathways may be important determinants of worse respiratory health status among HIV-infected individuals. Limitations of this analysis include the absence of available echocardiograms, diffusion capacity and lung volume testing, and an all-male cohort due to the demographics of the clinic population.
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Affiliation(s)
| | - Joseph C. Liu
- UBC James Hogg Research Centre, Vancouver, BC, Canada
| | - Andy Mtambo
- AIDS Research Program, St. Paul's Hospital, Vancouver, BC, Canada
| | - David Ngan
- UBC James Hogg Research Centre, Vancouver, BC, Canada
| | - Negar Nashta
- AIDS Research Program, St. Paul's Hospital, Vancouver, BC, Canada
| | - Silvia Guillemi
- AIDS Research Program, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Harris
- AIDS Research Program, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Viviane D. Lima
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tawimas Shaipanich
- UBC Department of Medicine and Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Rekha Raju
- Department of Radiology and Diagnostic Imaging, St. Paul's Hospital, Vancouver, BC, Canada
| | - Cameron Hague
- Department of Radiology and Diagnostic Imaging, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jonathon A. Leipsic
- Department of Radiology and Diagnostic Imaging, St. Paul's Hospital, Vancouver, BC, Canada
| | - Don D. Sin
- UBC James Hogg Research Centre, Vancouver, BC, Canada
- UBC Department of Medicine and Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Julio S. Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - S.F. Paul Man
- UBC James Hogg Research Centre, Vancouver, BC, Canada
- UBC Department of Medicine and Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada
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Gingo MR, Balasubramani GK, Rice TB, Kingsley L, Kleerup EC, Detels R, Seaberg EC, Greenblatt RM, Holman S, Huang L, Sutton SH, Bertolet M, Morris A. Pulmonary symptoms and diagnoses are associated with HIV in the MACS and WIHS cohorts. BMC Pulm Med 2014; 14:75. [PMID: 24884738 PMCID: PMC4021087 DOI: 10.1186/1471-2466-14-75] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/17/2014] [Indexed: 12/21/2022] Open
Abstract
Background Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment. Methods A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled. Results Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia. Conclusions In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher prevalence of chronic respiratory symptoms, testing for non-infectious respiratory diseases may be underutilized in the HIV-infected population.
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Affiliation(s)
- Matthew R Gingo
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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246
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Maguire JJ, Jones KL, Kuc RE, Clarke MC, Bennett MR, Davenport AP. The CCR5 chemokine receptor mediates vasoconstriction and stimulates intimal hyperplasia in human vessels in vitro. Cardiovasc Res 2014; 101:513-21. [PMID: 24323316 PMCID: PMC3928001 DOI: 10.1093/cvr/cvt333] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 11/22/2022] Open
Abstract
AIMS The chemokine receptor CCR5 and its inflammatory ligands have been linked to atherosclerosis, an accelerated form of which occurs in saphenous vein graft disease. We investigated the function of vascular smooth muscle CCR5 in human coronary artery and saphenous vein, vascular tissues susceptible to atherosclerosis, and vasospasm. METHODS AND RESULTS CCR5 ligands were vasoconstrictors in saphenous vein and coronary artery. In vein, constrictor responses to CCL4 were completely blocked by CCR5 antagonists, including maraviroc. CCR5 antagonists prevented the development of a neointima after 14 days in cultured saphenous vein. CCR5 and its ligands were expressed in normal and diseased coronary artery and saphenous vein and localized to medial and intimal smooth muscle, endothelial, and inflammatory cells. [(125)I]-CCL4 bound to venous smooth muscle with KD = 1.15 ± 0.26 nmol/L and density of 22 ± 9 fmol mg(-1) protein. CONCLUSIONS Our data support a potential role for CCR5 in vasoconstriction and neointimal formation in vitro and imply that CCR5 chemokines may contribute to vascular remodelling and augmented vascular tone in human coronary artery and vein graft disease. The repurposing of maraviroc for the treatment of cardiovascular disease warrants further investigation.
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Affiliation(s)
- Janet J. Maguire
- Clinical Pharmacology Unit, Level 6 ACCI, Box 110 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Katie L. Jones
- Clinical Pharmacology Unit, Level 6 ACCI, Box 110 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Rhoda E. Kuc
- Clinical Pharmacology Unit, Level 6 ACCI, Box 110 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Murray C.H. Clarke
- Division of Cardiovascular Medicine, Level 6 ACCI, Box 110 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Martin R. Bennett
- Division of Cardiovascular Medicine, Level 6 ACCI, Box 110 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Anthony P. Davenport
- Clinical Pharmacology Unit, Level 6 ACCI, Box 110 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Abstract
Community-acquired pneumonia continues to be an important complication of HIV infection. Rates of pneumonia decrease with the use of antiretroviral therapy but continue to be higher than in HIV uninfected individuals. Risk factors for pneumonia include low blood CD4+ count, unsuppressed plasma HIV load, smoking, injection drug use and renal impairment. Immunization against Streptococcus pneumoniae and smoking cessation can reduce this risk. It is unclear whether newly reported viral respiratory pathogens (such as the Middle East respiratory syndrome coronavirus, will be more of a problem in HIV-infected individuals than the general population.
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Affiliation(s)
- James Brown
- Respiratory & HIV Medicine, University College London, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
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248
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Cribbs SK, Guidot DM, Martin GS, Lennox J, Brown LA. Anti-retroviral therapy is associated with decreased alveolar glutathione levels even in healthy HIV-infected individuals. PLoS One 2014; 9:e88630. [PMID: 24533122 PMCID: PMC3922940 DOI: 10.1371/journal.pone.0088630] [Citation(s) in RCA: 24] [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: 06/25/2013] [Accepted: 01/09/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Lung infections are a leading cause of death in HIV-infected individuals. Measuring redox in HIV-infected individuals may identify those with chronic oxidative stress who are at increased risk for lung infection. We sought to estimate the association between HIV infection and oxidative stress in the lung, as reflected by decreased levels of glutathione and cysteine in the epithelial lining fluid. Methods Bronchoalveolar lavage (BAL) fluid was collected from healthy HIV-infected subjects and controls. Individuals were excluded if they had evidence of major medical co-morbidities, were malnourished or smoked cigarettes. Results We enrolled 22 otherwise healthy HIV and 21 non-HIV subjects. Among the HIV-infected subjects, 72.7% were on anti-retroviral therapy (ART) with a median CD4 count of 438 (279.8–599) and viral load of 0 (0–1.0) log copies/mL. There were no significant differences in median BAL fluid glutathione and cysteine levels between HIV and HIV-uninfected subjects. However, BAL glutathione was significantly higher in HIV-infected subjects on anti-retroviral therapy (ART) compared to those not on ART [367.4 (102–965.3) nM vs. 30.8 (1.0–112.1) nM, p = 0.008]. Further, HIV infection with ART was associated with an OR of 2.02 for increased BAL glutathione when adjusted for age and body mass index, whereas HIV infection without ART was associated with an OR of 2.17 for decreased BAL glutathione. Conclusion HIV infection without ART was associated with increased oxidative stress, as reflected by decreased alveolar glutathione levels, in otherwise healthy HIV-infected individuals. Further study needs to be done identify predictors of lung health in HIV and to address the role of ART in improving lung immunity.
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Affiliation(s)
- Sushma K. Cribbs
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - David M. Guidot
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia, United States of America
| | - Greg S. Martin
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia, United States of America
| | - Jeffrey Lennox
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, United States of America
| | - Lou Ann Brown
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia, United States of America
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249
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Mayaud C, Cadranel J. Le poumon du VIH de 1982 à 2013. Rev Mal Respir 2014; 31:119-32. [DOI: 10.1016/j.rmr.2013.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
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250
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Alçada J, Taylor MN, Shaw PJ, Janes SM, Navani N, Miller RF. High prevalence of malignancy in HIV-positive patients with mediastinal lymphadenopathy: a study in the era of antiretroviral therapy. Respirology 2014; 19:339-45. [PMID: 24471994 PMCID: PMC4016741 DOI: 10.1111/resp.12241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/09/2013] [Accepted: 11/24/2013] [Indexed: 12/15/2022]
Abstract
Background and objective Mediastinal lymphadenopathy (MLN) in human immunodeficiency virus (HIV) infection has a wide spectrum of aetiologies with different prognoses and treatments. The decision to pursue a histopathological diagnosis represents a clinical challenge as patients present with non-specific symptoms. This study aimed to determine the aetiology and predictive factors of MLN in a cohort of HIV-infected patients in the combination antiretroviral therapy (cART) era. Methods Single-centre retrospective cohort study of 217 consecutive HIV-infected patients who underwent computed tomography (CT) of the chest between January 2004 and December 2009. Fifty-two patients were identified to have MLN (>10 mm in short axis). CT images were re-reviewed by an independent radiologist blinded to the clinical information. Final diagnoses of MLN were obtained from clinical records. Multivariate analysis was performed to identify predictors of aetiology of MLN. Results Seventeen patients (33%) had a diagnosis of malignancy. Consolidation on CT was associated with a reduced likelihood of malignancy odds ratio (OR) 0.03 (95% confidence interval 0.002–0.422), and larger lymph nodes were associated with an increase in the odds of malignancy (OR 2.89; 95% confidence interval 1.24–6.71). CD4 count was found not to be a predictor of aetiology of MLN. Conclusions In the era of combination cART, opportunistic infections and malignancy remain to be the frequent causes of MLN in HIV-positive patients, but the prevalence of non-HIV related malignancy has increased compared with previous studies. Although certain findings are predictors of non-malignant disease, pathological diagnosis of MLN in HIV-positive patients should be pursued whenever possible.
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Affiliation(s)
- Joana Alçada
- Department of Thoracic Medicine, University College London Hospitals, London, UK
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