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Clark US, Herrington OD, Hegde RR. Effects of Early-Life Adversities on Neuropsychiatric and Executive Functions in HIV-Positive Adults. J Int Neuropsychol Soc 2023; 29:68-79. [PMID: 35105402 PMCID: PMC10552908 DOI: 10.1017/s1355617721001466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) contribute to elevations in neuropsychiatric and neurocognitive symptoms in HIV+ adults. Emerging data suggest that exposures to threat-related and deprivation-related ACEs may have differential impacts on function, with threat exposure contributing to neuropsychiatric symptoms, and deprivation contributing to executive dysfunction. Yet, it remains unclear how specific types of ACEs impact neuropsychiatric and neurocognitive symptoms in HIV+ adults. Hence, the current study examined whether these two dimensions of adversity contribute differentially to neuropsychiatric symptoms and executive dysfunction in HIV+ adults. METHODS We included a sample of demographically matched HIV+ (N = 72) and HIV-negative (N = 85) adults. Standardized self-report measures assessed threat-related (interpersonal violence) and deprivation-related (poverty/neglect) ACEs, as well as neuropsychiatric symptoms (depression, anxiety, apathy). A brief battery of neuropsychological tests assessed executive functions. RESULTS Compared to HIV-negative participants, HIV+ participants reported significantly higher rates of threat exposure (51% vs. 67%, p = .04), while rates of deprivation did not differ significantly (8% vs. 13%, p = .38). In the HIV+ sample, threat exposure was associated with neuropsychiatric symptoms (p < .01) but not executive dysfunction (p = .75). By contrast, deprivation was associated with executive dysfunction, at a trend level (p = .09), but not with neuropsychiatric symptoms (p = .70). CONCLUSIONS Our data suggest that, relative to HIV-negative samples, HIV+ samples experience higher rates of threat-related ACEs, which contribute to neuropsychiatric symptom elevations. Moreover, our preliminary findings suggest that different types of ACEs could be associated with different profiles of neuropsychiatric and neurocognitive difficulty in HIV+ adults, highlighting the importance of considering dimensions of adversity in future studies.
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Affiliation(s)
- Uraina S. Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Olivia D. Herrington
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Rachal R. Hegde
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bronshteyn M, Yang FN, Shattuck KF, Dawson M, Kumar P, Moore DJ, Ellis RJ, Jiang X. Depression is associated with hippocampal volume loss in adults with HIV. Hum Brain Mapp 2021; 42:3750-3759. [PMID: 34089276 PMCID: PMC8288081 DOI: 10.1002/hbm.25451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
Depressive symptoms are more prevalent in persons with HIV (PWH) than HIV-uninfected individuals. In HIV-uninfected individuals, depression has been associated with atrophy in the hippocampus and other brain regions. In the present study, we investigated the impact of depression on brain structure in PWH. One hundred PWH participated in a cross-sectional study (56.6 ± 6.4 yrs, range 41-70 yrs, 24 females, 63 African Americans). The Beck's Depression Inventory-II (BDI-II) was used to assess depressive symptoms. Structural MRI images were collected. Both the voxel-based morphometry (VBM) technique and a region of interest (ROI) based approach were used to examine the relationship between hippocampal gray matter volume (GMv) and depressive symptoms. The impact of HIV CD4 nadir and antidepressants was also investigated. Both VBM and ROI approaches revealed that higher BDI-II scores (implicating more severe depressive symptoms) were associated with loss of hippocampal GMv, especially in the right hippocampus and the right entorhinal cortex. Low CD4 nadir predicted additional hippocampal volume loss independent of depressive symptoms. Taking antidepressants did not have a detectable effect on hippocampal volume. In summary, having more depressive symptoms is associated with smaller hippocampal volume in PWH, and a history of severe immunosuppression (i.e., low CD4 nadir) correlates with additional hippocampal volume reduction. However, the impact of depression on hippocampal volume may be independent of HIV-disease severity such as low CD4 nadir.
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Affiliation(s)
- Margarita Bronshteyn
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Fan Nils Yang
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Kyle F. Shattuck
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Matthew Dawson
- Department of PsychiatryUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Princy Kumar
- Department of MedicineGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - David J. Moore
- Department of PsychiatryUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Ronald J. Ellis
- Department of PsychiatryUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
- Department of NeurosciencesUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Xiong Jiang
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
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3
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Yang FN, Bronshteyn M, Flowers SA, Dawson M, Kumar P, Rebeck GW, Turner RS, Moore DJ, Ellis RJ, Jiang X. Low CD4+ cell count nadir exacerbates the impacts of APOE ε4 on functional connectivity and memory in adults with HIV. AIDS 2021; 35:727-736. [PMID: 33587445 PMCID: PMC8318747 DOI: 10.1097/qad.0000000000002840] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Nearly half of individuals living with HIV in the USA are now 50 or older. This rapidly ageing populace may be at an increasingly greater risk of Alzheimer's disease. However, the potential interaction between HIV-disease and Alzheimer's disease pathogenesis (i.e. Alzheimer's disease genetic risk factors) on brain function remains an open question. The present study aimed to investigate the impact of APOE ε4 on brain function in middle-aged to older people with HIV (PWH), as well as the putative interaction between ε4 and HIV disease severity. METHODS Ninety-nine PWH participated in a cross-sectional study (56.3 ± 6.5 years, range 41-70 years, 27 women, 26 ε4 carriers and 73 noncarriers). Structural MRI and resting-state functional MRI were collected to assess alterations in brain structure and functional connectivity, respectively. RESULTS APOE ε4 was associated with worse memory performance and reduced functional connectivity in the memory network. The functional connectivity reduction was centred at the caudate nucleus rather than hippocampus and correlated with worse memory performance. In ε4 carriers, low CD4+ cell count nadir was associated with reduced functional connectivity in the memory network, but this association was absent in noncarriers. Furthermore, there was an indirect detrimental impact of ε4 on memory performance through memory network functional connectivity. However, this indirect effect was contingent on CD4+ cell count nadir, that is the indirect effect of ε4 on memory was only significant when CD4+ cell count nadir was low. INTERPRETATION APOE ε4 is associated with reduced memory and reduced functional connectivity within the memory network, and low CD4+ cell count nadir -- indicating a history of severe immunosuppression -- may exacerbate the effects of ε4.
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Affiliation(s)
- Fan Nils Yang
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Margarita Bronshteyn
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Sarah A. Flowers
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Matthew Dawson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - Princy Kumar
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20057, USA
| | - G. William Rebeck
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA
| | - R. Scott Turner
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Xiong Jiang
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA
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Hassanzadeh-Behbahani S, Shattuck KF, Bronshteyn M, Dawson M, Diaz M, Kumar P, Moore DJ, Ellis RJ, Jiang X. Low CD4 nadir linked to widespread cortical thinning in adults living with HIV. NEUROIMAGE-CLINICAL 2019; 25:102155. [PMID: 31901790 PMCID: PMC6948363 DOI: 10.1016/j.nicl.2019.102155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The history of immune suppression, especially CD4 nadir, has been shown to be a strong predictor of HIV-associated neurocognitive disorders (HAND). However, the potential mechanism of this association is not well understood. METHODS High resolution structural MRI images and neuropsychological data were obtained from fifty-nine HIV+ adults (mean age, 56.5 ± 5.8) to investigate the correlation between CD4 nadir and cortical thickness. RESULTS Low CD4 nadir was associated with widespread cortical thinning, especially in the frontal and temporal regions, and global mean cortical thickness correlated with CD4 nadir. In addition, worse global neurocognitive function was associated with bilateral frontal cortical thinning, and the association largely persisted (especially in the left frontal cortex) in the subset of participants who did not meet HAND criteria. CONCLUSIONS These results suggest that low CD4 nadir may be associated with widespread neural injury in the brain, especially in the frontal and temporal regions. The diffuse neural injury might contribute to the prevalence and the phenotypes of HAND, as well as the difficulty treating HAND due to a broad network of brain regions affected. Low CD4 nadir related neural injury to the frontal cortex might contribute to subtle neurocognitive impairment/decline, even in the absence of HAND diagnosis.
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Affiliation(s)
| | - Kyle F Shattuck
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, United States
| | - Margarita Bronshteyn
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, United States
| | - Matthew Dawson
- Department of Psychiatry, University of California, La Jolla, San Diego, CA 92093, United States
| | - Monica Diaz
- Department of Neurosciences, University of California, La Jolla, San Diego, CA 92093, United States
| | - Princy Kumar
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, United States
| | - David J Moore
- Department of Psychiatry, University of California, La Jolla, San Diego, CA 92093, United States
| | - Ronald J Ellis
- Department of Psychiatry, University of California, La Jolla, San Diego, CA 92093, United States; Department of Neurosciences, University of California, La Jolla, San Diego, CA 92093, United States
| | - Xiong Jiang
- Departments of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, United States.
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Cho H, Jiang Y, Li X, Deming M. The relationship between self-reported viral load suppression and quality of life among people living with HIV in South Carolina. AIDS Care 2019; 32:1198-1205. [PMID: 31814429 DOI: 10.1080/09540121.2019.1698706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ensuring the wellbeing of people living with HIV (PLWH) has become a significant public health concern in the era of highly active antiretroviral therapy. This study was to assess the quality of life (QoL) among PLWH in South Carolina (SC) and to examine the relationship between self-reported viral load (VL) suppression and their perceived QoL. In 2018, a cross-sectional survey was conducted among 402 PLWH from a large immunology clinic in SC. The WHOQoL brief version (WHOQoL-HIV-BREF) instrument with six domains (physical health, psychological health, social relations, independence, environmental health, and spirituality) and two specific questions (overall rate of QoL and satisfaction with health) were used. On a five-point scale, the participants rated their overall rating of QoL as good (mean = 4.07). The participants reported their psychological health as the highest (mean = 3.88) followed by environmental health (mean = 3.82), social relations (mean = 3.69), and independence (mean = 3.47). 71% reported an undetected VL. In multivariable analyses, self-awareness of undetected VL was significantly associated with satisfaction with health, psychological health, social relations, environmental health, but negatively associated with spirituality. These findings suggest that self-awareness of undetected VL had a significant impact on their perceived QoL beyond sociodemographic factors among PLWH who were linked to care in SC.
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Affiliation(s)
- Hyunsan Cho
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Yanping Jiang
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michelle Deming
- Department of Sociology: History, Culture and Society, Baker University, Baldwin City, KS, USA
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Gutiérrez C, Lopez-Abente J, Pérez-Fernández V, Prieto-Sánchez A, Correa-Rocha R, Moreno-Guillen S, Muñoz-Fernández MÁ, Pion M. Analysis of the dysregulation between regulatory B and T cells (Breg and Treg) in human immunodeficiency virus (HIV)-infected patients. PLoS One 2019; 14:e0213744. [PMID: 30917149 PMCID: PMC6436717 DOI: 10.1371/journal.pone.0213744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/27/2019] [Indexed: 12/21/2022] Open
Abstract
This study examines the relationship between regulatory B (Breg) and T (Treg) compartments, which play crucial roles in the maintenance of immune homeostasis in the context of HIV. Using flow cytometry, the phenotypes of different Breg and Treg subsets from HIV-infected and healthy individuals were analyzed, along with the suppressive capacity of Breg. Peripheral blood samples of thirteen HIV+ treatment-naïve individuals, fourteen treated-HIV+ individuals with undetectable viral load and twelve healthy individuals were analyzed. The absolute counts of Breg and Treg subsets were decreased in HIV+ treatment-naïve individuals in comparison to treated-HIV+ and healthy individuals. Interestingly, correlations between Breg subsets (CD24hiCD27+ and PD-L1+ B cells) and IL-10-producing Breg observed in healthy individuals were lost in HIV+ treatment-naïve individuals. However, a correlation between frequencies of CD24hiCD38hi or TIM-1+-Breg subsets and Treg was observed in HIV+ treatment-naïve individuals and not in healthy individuals. Therefore, we hypothesized that various Breg subsets might have different functions during B and T-cell homeostasis during HIV-1 infection. In parallel, stimulated Breg from HIV-infected treatment-naïve individuals presented a decreased ability to suppress CD4+ T-cell proliferation in comparison to the stimulated Breg from treated-HIV+ or healthy individuals. We demonstrate a dysregulation between Breg and Treg subsets in HIV-infected individuals, which might participate in the hyper-activation and exhaustion of the immune system that occurs in such patients.
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Affiliation(s)
- Carolina Gutiérrez
- Molecular Immunovirology Laboratory, Department of Infectious Diseases, Ramón y Cajal Health Research Institute (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain
| | - Jacobo Lopez-Abente
- Immuno-Regulation Laboratory, University General Hospital Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Medicine and Experimental Surgery Building, Madrid, Spain
| | - Verónica Pérez-Fernández
- Immuno-Regulation Laboratory, University General Hospital Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Medicine and Experimental Surgery Building, Madrid, Spain
| | - Adrián Prieto-Sánchez
- Immuno-Regulation Laboratory, University General Hospital Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Medicine and Experimental Surgery Building, Madrid, Spain
| | - Rafael Correa-Rocha
- Immuno-Regulation Laboratory, University General Hospital Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Medicine and Experimental Surgery Building, Madrid, Spain
| | - Santiago Moreno-Guillen
- Molecular Immunovirology Laboratory, Department of Infectious Diseases, Ramón y Cajal Health Research Institute (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain
| | - María-Ángeles Muñoz-Fernández
- Molecular ImmunoBiology Laboratory, University General Hospital Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Marjorie Pion
- Immuno-Regulation Laboratory, University General Hospital Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Medicine and Experimental Surgery Building, Madrid, Spain
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Mooney AC, Campbell CK, Ratlhagana MJ, Grignon JS, Mazibuko S, Agnew E, Gilmore H, Barnhart S, Puren A, Shade SB, Liegler T, Lippman SA. Beyond Social Desirability Bias: Investigating Inconsistencies in Self-Reported HIV Testing and Treatment Behaviors Among HIV-Positive Adults in North West Province, South Africa. AIDS Behav 2018; 22:2368-2379. [PMID: 29779162 DOI: 10.1007/s10461-018-2155-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This mixed-methods study used qualitative interviews to explore discrepancies between self-reported HIV care and treatment-related behaviors and the presence of antiretroviral medications (ARVs) in a population-based survey in South Africa. ARV analytes were identified among 18% of those reporting HIV-negative status and 18% of those reporting not being on ART. Among participants reporting diagnosis over a year prior, 19% reported multiple HIV tests in the past year. Qualitative results indicated that participant misunderstandings about their care and treatment played a substantial role in reporting inaccuracies. Participants conflated the term HIV test with CD4 and viral load testing, and confusion with terminology was compounded by recall difficulties. Data entry errors likely also played a role. Frequent discrepancies between biomarkers and self-reported data were more likely due to poor understanding of care and treatment and biomedical terminology than intentional misreporting. Results indicate a need for improving patient-provider communication, in addition to incorporating objective measures of treatment and care behaviors such as ARV analytes, to reduce inaccuracies.
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Affiliation(s)
- Alyssa C Mooney
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Department of Epidemiology & Biostatistics, University of California San Francisco, Mission Hall, 2nd Floor, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Chadwick K Campbell
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mary-Jane Ratlhagana
- International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa
| | - Jessica S Grignon
- International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Sipho Mazibuko
- International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa
| | - Emily Agnew
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Hailey Gilmore
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Scott Barnhart
- International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Adrian Puren
- National Institute for Communicable Diseases/NHLS, Johannesburg, Republic of South Africa
- Division of Virology, School of Pathology, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Starley B Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Teri Liegler
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
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Palar K, Wong MD, Cunningham WE. Competing subsistence needs are associated with retention in care and detectable viral load among people living with HIV. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2018; 17:163-179. [PMID: 30505245 PMCID: PMC6261356 DOI: 10.1080/15381501.2017.1407732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Competing priorities between subsistence needs and health care may interfere with HIV health. Longitudinal data from the Los Angeles-based HIV Outreach Initiative were analyzed to examine the association between competing subsistence needs and indicators of poor retention-in-care among hard-to-reach people with HIV. Sacrificing basic needs for health care in the previous six months was associated with a 1.55 times greater incidence of missed appointments (95% CI 1.17, 2.05), 2.32 times greater incidence of emergency department visits (95% CI 1.39, 3.87), 3.66 times greater incidence of not receiving ART if CD4 < 350 (95% CI 1.60, 8.37), and 1.35 times greater incidence of detectable viral load (95% CI 1.07, 1.70) (all p < 0.01). Among hard-to-reach PLHIV, sacrificing basic needs for health care delineates a population with exceptional vulnerability to poor outcomes along the HIV treatment cascade. Efforts to identify and reduce competing needs for this population are crucial to HIV health outcomes.
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Affiliation(s)
- Kartika Palar
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mitchell D. Wong
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - William E. Cunningham
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA, Los Angeles, CA, USA
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Casadellà M, Cozzi-Lepri A, Phillips A, Noguera-Julian M, Bickel M, Sedlacek D, Zilmer K, Clotet B, Lundgren JD, Paredes R. Plasma HIV-1 Tropism and the Risk of Short-Term Clinical Progression to AIDS or Death. PLoS One 2017; 12:e0166613. [PMID: 28129343 PMCID: PMC5271314 DOI: 10.1371/journal.pone.0166613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate if plasma HIV-1 tropism testing could identify subjects at higher risk for clinical progression and death in routine clinical management. DESIGN Nested case-control study within the EuroSIDA cohort. METHODS Cases were subjects with AIDS or who died from any cause, with a plasma sample with HIV-1 RNA >1000 copies/mL available for tropism testing 3 to 12 months prior to the event. At least 1 control matched for age, HIV-1 RNA and HCV status at the time of sampling were selected per each case. Conditional logistic regression was used to investigate exposures associated with clinical progression to AIDS or death. A linear mixed model with random intercept was used to compare CD4+T-cell slopes by HIV tropism over the 12 months following the date of sampling. RESULTS The study included 266 subjects, 100 cases and 166 controls; one quarter had X4 HIV; 26% were ART-naïve. Baseline factors independently associated with clinical progression or death were female gender (OR = 2.13 vs. male, 95CI = 1.04, 4.36), p = 0.038), CD4+T-cell count (OR = 0.90 (95CI = 0.80, 1.00) per 100 cells/mm3 higher, p = 0.058), being on ART (OR = 2.72 vs. being off-ART (95CI = 1.15, 6.41), p = 0.022) and calendar year of sample [OR = 0.84 (95CI = 0.77, 0.91) per more recent year, p<0.001). Baseline tropism was not associated with the risk of clinical progression or death. CD4+T-cell slopes did not differ within or between tropism groups. CONCLUSIONS The predictive role of plasma tropism determined using 454 sequencing in the context of people receiving cART with detectable VL is not helpful to identify subjects at higher risk for clinical progression to AIDS or death.
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Affiliation(s)
- Maria Casadellà
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Catalonia, Spain
| | | | | | - Marc Noguera-Julian
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Catalonia, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain
| | | | | | - Kai Zilmer
- West-Tallinn Central Hospital, Tallinn, Estonia
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Catalonia, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain
- HIV Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Catalonia, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain
- HIV Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
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