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Trunfio M, Tang B, Okwuegbuna O, Iudicello JE, Bharti A, Moore DJ, Gelman BB, Morgello S, Patel PB, Rubin LH, Ances BM, Gianella S, Heaton RK, Ellis RJ, Letendre SL. Longitudinal analysis of CSF HIV RNA in untreated people with HIV: Identification of CSF controllers. J Med Virol 2024; 96:e29550. [PMID: 38511593 PMCID: PMC11139255 DOI: 10.1002/jmv.29550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
Interindividual variation of human immunodeficiency virus (HIV) RNA setpoint in cerebrospinal fluid (CSF) and its determinants are poorly understood, but relevant for HIV neuropathology, brain reservoirs, viral escape, and reseeding after antiretroviral interruptions. Longitudinal multicentric study on demographic, clinical, and laboratory correlates of CSF HIV RNA in 2000 follow-up visits from 597 people with HIV (PWH) off antiretroviral therapy (ART) and with plasma HIV RNA > the lower limit of quantification (LLQ). Factors associated with CSF control (CSFC; CSF HIV RNA < LLQ while plasma HIV RNA > LLQ) and with CSF/plasma discordance (CSF > plasma HIV RNA > LLQ) were also assessed through mixed-effects models. Posthoc and sensitivity analyses were performed for persistent CSFC and ART-naïve participants, respectively. Over a median follow-up of 2.1 years, CSF HIV RNA was associated with CD4+ and CD8+ T cells, CSF leukocytes, blood-brain barrier (BBB) integrity, biomarkers of iron and lipid metabolism, serum globulins, past exposure to lamivudine, and plasma HIV RNA (model p < 0.0001). CSFC (persistent in 7.7% over 3 years) and CSF/plasma discordance (persistent in <0.01% over 1 year) were variably associated with the same parameters (model p < 0.001). Sensitivity analyses confirmed most of the previous associations in participants never exposed to ART. Persistent CSFC was associated with higher CD4+ T-cell count nadir (p < 0.001), lower serum globulins (p = 0.003), and lower CSF leukocytes (p < 0.001). Without ART, one in 13 PWH had persistently undetectable CSF HIV RNA, while persistent CSF/plasma discordance was extremely rare over years. Immune responses, inflammation, BBB permeability, and iron and lipid metabolism were all associated with HIV replication in CSF.
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Affiliation(s)
- Mattia Trunfio
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Bin Tang
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Oluwakemi Okwuegbuna
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jennifer E. Iudicello
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Ajay Bharti
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Payal B. Patel
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Leah H. Rubin
- Department of Neurology, Psychiatry and Behavioral Sciences, Molecular and Cellular Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Beau M. Ances
- Department of Neurology, Washington University, St Louis, Missouri, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, California, USA
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Ronald J. Ellis
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
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Anaemia and Nutritional Status during HIV and Helminth Coinfection among Adults in South Africa. Nutrients 2022; 14:nu14234970. [PMID: 36501001 PMCID: PMC9739090 DOI: 10.3390/nu14234970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Sub-Saharan Africa is burdened with helminthiasis and HIV/AIDS, and there is a significant overlap between these infections. However, little is known about the extent of anaemia and malnutrition in HIV/AIDS and helminth coinfected adults. The study investigated the anaemia profiles and nutritional status of HIV and helminth coinfected adult South Africans. Stool samples were collected from participants (N = 414) for parasite detection using the Kato−Katz and Mini Parasep® SF techniques. Blood was collected to determine participants’ HIV status, micro- and macronutrients, haematological parameters, and Ascaris lumbricoides-specific IgE and IgG4 levels. Thereafter, participants were stratified into single infection (HIV or helminths), coinfection, and uninfected controls (no HIV and helminth) groups. The majority (74.9%) of participants had CD4 counts of >500 cells/μL, indicating no significant immunosupression. The coinfected group had an overall anaemia prevalence of 16.9%, which was lower than that of the HIV-infected group (44.6%) and higher than helminth infected group (15.4%). Overall helminth prevalence was 33%, with Ascaris lumbricoides being the most prevalent. The coinfected group also had lower vitamin A (p = 0.0107), calcium (p = 0.0002), and albumin (p < 0.0001) levels compared to HIV/helminth uninfected controls. Unexpectedly, the coinfected group had the highest serum iron levels, followed by the helminth-infected and control groups, both of which had similar iron levels, and finally, the HIV-infected group, which had the lowest iron levels (p = 0.04). Coinfected adults may be prone to micronutrient deficiency and anaemia. Further research and intervention programmes are required in this neglected field.
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A comparison of mean corpuscular volume (MCV) between thalassemia-carrier and non-thalassemia-carrier pregnant women receiving highly active antiretroviral therapy (HAART). Taiwan J Obstet Gynecol 2018; 56:736-739. [PMID: 29241911 DOI: 10.1016/j.tjog.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE HIV-infected treatment with antiretroviral drugs is one of the common causes of macrocytosis. In patients receiving highly active antiretroviral therapy (HAART), the mean corpuscular volume (MCV) can be shifted from microcytic to normocytic or macrocytic after treatment and significantly affected the thalassemia screening. This study aimed to compare MCV between thalassemia-carrier and non-thalassemia-carrier antiretroviral drug-naïve, HIV-infected, pregnant women receiving HAART. The results will support the couples at risk identification in prenatal control of severe thalassemia disease. MATERIALS AND METHODS A retrospective cohort study was conducted in antiretroviral drug-naïve, HIV-infected, pregnant women who received HAART between January 2008 and December 2015 in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. Changes in MCV were compared between the thalassemia and non-thalassemia carriers. RESULTS Of 74 pregnant women who were exposed to HAART for at least 4 weeks, increased MCV levels were significantly greater in the non-thalassemia carriers group (n = 58) than in the thalassemia-carrier group (n = 16) (16.60 ± 12.55 fL and 15.61 ± 9.67 fL, respectively; p < 0.001). Pre-HAART exposure, sensitivity of MCV was 83.3% for thalassemia carriers screening using MCV <80 fL. Post-HAART exposure, sensitivity of MCV was 33.3%, and the false negative rate was 66.7%. CONCLUSION Post-HAART exposure, MCV increased substantially in both the thalassemia and non-thalassemia carriers. Using MCV <80 fL as the cutoff for diagnosing thalassemia, false negative results were observed in two thirds of the thalassemia carriers who were exposed to HAART for at least 4 weeks; therefore, the screening test should be interpreted with caution.
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Kallianpur AR, Wang Q, Jia P, Hulgan T, Zhao Z, Letendre SL, Ellis RJ, Heaton RK, Franklin DR, Barnholtz-Sloan J, Collier AC, Marra CM, Clifford DB, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Grant I. Anemia and Red Blood Cell Indices Predict HIV-Associated Neurocognitive Impairment in the Highly Active Antiretroviral Therapy Era. J Infect Dis 2015; 213:1065-73. [PMID: 26690344 DOI: 10.1093/infdis/jiv754] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/14/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anemia has been linked to adverse human immunodeficiency virus (HIV) outcomes, including dementia, in the era before highly active antiretroviral therapy (HAART). Milder forms of HIV-associated neurocognitive disorder (HAND) remain common in HIV-infected persons, despite HAART, but whether anemia predicts HAND in the HAART era is unknown. METHODS We evaluated time-dependent associations of anemia and cross-sectional associations of red blood cell indices with neurocognitive impairment in a multicenter, HAART-era HIV cohort study (N = 1261), adjusting for potential confounders, including age, nadir CD4(+) T-cell count, zidovudine use, and comorbid conditions. Subjects underwent comprehensive neuropsychiatric and neuromedical assessments. RESULTS HAND, defined according to standardized criteria, occurred in 595 subjects (47%) at entry. Mean corpuscular volume and mean corpuscular hemoglobin were positively associated with the global deficit score, a continuous measure of neurocognitive impairment (both P < .01), as well as with all HAND, milder forms of HAND, and HIV-associated dementia in multivariable analyses (all P < .05). Anemia independently predicted development of HAND during a median follow-up of 72 months (adjusted hazard ratio, 1.55; P < .01). CONCLUSIONS Anemia and red blood cell indices predict HAND in the HAART era and may contribute to risk assessment. Future studies should address whether treating anemia may help to prevent HAND or improve cognitive function in HIV-infected persons.
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Affiliation(s)
- Asha R Kallianpur
- Department of Genomic Medicine/Lerner Research Institute and Medicine Institute, Cleveland Clinic Foundation, Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Quan Wang
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Peilin Jia
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zhongming Zhao
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego
| | | | - Jill Barnholtz-Sloan
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle
| | | | - David B Clifford
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin C McArthur
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine of Mount Sinai, New York, New York
| | - David M Simpson
- Department of Neurology, Icahn School of Medicine of Mount Sinai, New York, New York
| | - J A McCutchan
- Department of Medicine, University of California, San Diego
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego
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