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Obare LM, Temu T, Mallal SA, Wanjalla CN. Inflammation in HIV and Its Impact on Atherosclerotic Cardiovascular Disease. Circ Res 2024; 134:1515-1545. [PMID: 38781301 PMCID: PMC11122788 DOI: 10.1161/circresaha.124.323891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
People living with HIV have a 1.5- to 2-fold increased risk of developing cardiovascular disease. Despite treatment with highly effective antiretroviral therapy, people living with HIV have chronic inflammation that makes them susceptible to multiple comorbidities. Several factors, including the HIV reservoir, coinfections, clonal hematopoiesis of indeterminate potential (CHIP), microbial translocation, and antiretroviral therapy, may contribute to the chronic state of inflammation. Within the innate immune system, macrophages harbor latent HIV and are among the prominent immune cells present in atheroma during the progression of atherosclerosis. They secrete inflammatory cytokines such as IL (interleukin)-6 and tumor necrosis-α that stimulate the expression of adhesion molecules on the endothelium. This leads to the recruitment of other immune cells, including cluster of differentiation (CD)8+ and CD4+ T cells, also present in early and late atheroma. As such, cells of the innate and adaptive immune systems contribute to both systemic inflammation and vascular inflammation. On a molecular level, HIV-1 primes the NLRP3 (NLR family pyrin domain containing 3) inflammasome, leading to an increased expression of IL-1β, which is important for cardiovascular outcomes. Moreover, activation of TLRs (toll-like receptors) by HIV, gut microbes, and substance abuse further activates the NLRP3 inflammasome pathway. Finally, HIV proteins such as Nef (negative regulatory factor) can inhibit cholesterol efflux in monocytes and macrophages through direct action on the cholesterol transporter ABCA1 (ATP-binding cassette transporter A1), which promotes the formation of foam cells and the progression of atherosclerotic plaque. Here, we summarize the stages of atherosclerosis in the context of HIV, highlighting the effects of HIV, coinfections, and antiretroviral therapy on cells of the innate and adaptive immune system and describe current and future interventions to reduce residual inflammation and improve cardiovascular outcomes among people living with HIV.
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Affiliation(s)
- Laventa M. Obare
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN (L.M.O., S.A.M., C.N.W.)
| | - Tecla Temu
- Department of Pathology, Harvard Medical School, Boston, MA (T.T.)
| | - Simon A. Mallal
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN (L.M.O., S.A.M., C.N.W.)
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN (S.A.M.)
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (S.A.M.)
- Institute for Immunology and Infectious Diseases, Murdoch University, WA, Western Australia (S.A.M.)
| | - Celestine N. Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN (L.M.O., S.A.M., C.N.W.)
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2
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Rambaran S, Maseko TG, Lewis L, Hassan-Moosa R, Archary D, Ngcapu S, Garrett N, McKinnon LR, Padayatchi N, Naidoo K, Sivro A. Blood monocyte and dendritic cell profiles among people living with HIV with Mycobacterium tuberculosis co-infection. BMC Immunol 2023; 24:21. [PMID: 37480005 PMCID: PMC10362598 DOI: 10.1186/s12865-023-00558-z] [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: 12/22/2022] [Accepted: 07/14/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Understanding the complex interactions of the immune response mediated by Mycobacterium tuberculosis and HIV co-infection is fundamental to disease biomarker discovery, vaccine, and drug development. Using flow cytometry, we characterized the frequencies and phenotypic differences in monocytes and dendritic cell populations using peripheral blood mononuclear cells from individuals with recurrent, active pulmonary tuberculosis with and without coexisting HIV infection (CAPRISA 011, Clinicaltrials.gov, NCT02114684, 29/01/2014) and compared them to samples from HIV positive individuals and healthy controls. Additionally, we assessed the associations between the frequency of monocyte and dendritic cell subsets and time to culture conversion and cavitary disease in patients with active TB using a cox proportional hazards and logistic regression models. RESULTS Compared to healthy controls, the frequency of total monocytes (HLA-DR + CD14 +) was significantly higher in the TB/HIV and TB groups and the frequency of dendritic cells (HLA-DR + CD14-) was significantly higher in TB/HIV and HIV groups. We observed significant variation in the expression of CCR2, CD40, CD11b, CD86, CD163, CX3CR1 across different cell subsets in the four study groups. Increase in CCR2, CD11b and CD40 was associated with active TB infection, while decrease in CX3CR1 and increase in CD163 was associated with HIV infection. Expression of CX3CR1 (aHR 0.98, 95% CI 0.963 - 0.997, p = 0.019) on non-classical monocytes associated with longer time to TB culture conversion in the multivariable model correcting for randomization arm, age, sex, HIV status, lung cavitation, alcohol use, smoking and BMI. Higher surface expression of CD86 (aOR 1.017, 95% CI 1.001 - 1.032, p = 0.033) on intermediate monocytes associated with the presence of lung cavitation, while higher expression of transitional monocytes (aOR 0.944, 95% CI 0.892 - 0.999, p = 0.047) associated with the absence of lung cavitation in the multivariable model. CONCLUSION These data provide valuable insight into the heterogenous role of monocyte and dendritic cells in TB and HIV infections.
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Affiliation(s)
- Santhuri Rambaran
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Thando Glory Maseko
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
- South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa.
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa.
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.
- JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
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Plasma CD16 + Extracellular Vesicles Associate with Carotid Artery Intima-Media Thickness in HIV + Adults on Combination Antiretroviral Therapy. mBio 2022; 13:e0300521. [PMID: 35435733 PMCID: PMC9239192 DOI: 10.1128/mbio.03005-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
HIV-infected individuals have increased risk for cardiovascular disease (CVD) despite suppressive antiretroviral therapy (ART). This is likely a result of persistent immune activation and systemic inflammation. Extracellular vesicles (EVs) have emerged as critical mediators of intercellular communication and may drive inflammation contributing to CVD. EVs were characterized in plasma from 74 HIV-infected individuals on combination antiretroviral therapy (cART) and 64 HIV-uninfected controls with paired carotid intima-media thickness (cIMT) assessment. EVs were profiled with markers reflecting lymphoid, myeloid, and endothelial origin. Seventeen plasma inflammatory biomarkers were also assessed. Human umbilical vein endothelial cell (HUVEC) apoptosis was quantified after EV exposure. A significant correlation was observed in HIV-infected participants between cIMT and EVs expressing CD16, and the monocyte-related markers CD4, CD14, and CX3CR1 showed a similar but nonsignificant association with cIMT. No significant correlation between cIMT measurements from HIV-uninfected individuals and EVs was observed. Levels of serum amyloid A, C-reactive protein, and myeloperoxidase significantly correlated with CD14+, CD16+, and CX3CR1+ EVs. No correlation was noted between cIMT and soluble inflammatory markers. HUVECs showed increased necrosis after exposure to the EV-containing fraction of plasma derived from HIV-infected individuals compared to uninfected controls. Our study reveals that EVs expressing monocyte markers correlated with cIMT in HIV-infected individuals on cART. Moreover, EV fractions derived from HIV-infected individuals lead to greater endothelial cell death via necrotic pathways. Collectively, EVs have potential as biomarkers of and therapeutic targets in the pathogenesis of CVD in the setting of treated HIV disease. IMPORTANCE HIV-infected individuals have a 2-fold-increased risk of cardiovascular disease compared with the general population, yet the mechanisms underlying this comorbidity are unclear. Extracellular vesicles have emerged as important mediators in cell-cell communication and, given what we know of their biology, may drive inflammation contributing to cardiovascular disease in this vulnerable population.
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Li Y, Mateu E. Interaction of Type 1 Porcine Reproductive and Respiratory Syndrome Virus With In Vitro Derived Conventional Dendritic Cells. Front Immunol 2021; 12:674185. [PMID: 34177915 PMCID: PMC8221110 DOI: 10.3389/fimmu.2021.674185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Abstract
The present study delineates the interaction of a typical PRRSV1.1 isolate 3267 (moderate virulence) with in vitro derived pig conventional dendritic cells, cDC1, cDC2, and a CD14+ population (designated as CD14+ DCs). cDC1 and cDC2 were not susceptible to 3267 infection, but a fraction of CD14+ DCs were infected. After exposure to the virus, all three DC types remained immature as determined by no increase of maturation molecules (MHC-I, MHC-II, CD80/86, CCR7), no release of cytokines, no modification of antigen presentation abilities, and no alteration of endocytic/phagocytic capabilities. However, when infected MARC-145 cells were used as a source of viral antigens, cDC2 and CD14+ DCs showed a significant increase in the expression of maturation molecules and substantial release of cytokines, notably IL-12/IL-23p40 (by both DC types) and IL-10 (by CD14+ DCs). To address the impact of PRRSV1 3267 on TLR3- and TLR7-mediated activation, cDC1, cDC2, and CD14+ DCs were inoculated by the virus (live or UV-inactivated) for 6 h prior to or simultaneously with the addition of poly I:C (TLR3 ligand) or gardiquimod (TLR7 ligand; not used for cDC1). Compared with using TLR ligand alone, combination with the virus did not result in any alteration to the maturation markers on all DC types but changed the cytokine response to either TLR3 or TLR7 ligand. Pre-exposure of cDC2 or CD14+ DCs to the live virus resulted in an increased production of IFN-α upon poly I:C stimulation, while pre-exposure to UV-inactivated virus tended to enhance the release of IL-10 upon gardiquimod stimulation. Simultaneous addition of the live virus and the TLR ligand either had no effect (mainly in cDC2) or impaired most of the cytokine release after gardiquimod stimulation (in CD14+ DCs). When used as antigen presenting cells, cDC2 pre-inoculated by the live virus before addition of gardiquimod impaired the proliferation of CD4–CD8– T cells. In the case of CD14+ DCs, pre-exposure to the live virus or simultaneously added with TLR3 or TLR7 ligand largely decreased the proliferation of CD4–CD8+ and CD4–CD8+ T-cell subsets. For cDC1, no significant changes were observed in cytokine responses or T-cell proliferation after poly I:C stimulation. Of note, cDC1 had a short life during in vitro culturing, for which the results obtained might be biased. Overall, exposure to PRRSV1 did not induce maturation of cDC1, cDC2, or CD14+ DCs, but modified TLR3 and TLR7-associated responses (except for cDC1), which may affect the development of adaptive immunity during PRRSV1 infection. Moreover, the sensing of infected cells was different from that of the free virus.
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Affiliation(s)
- Yanli Li
- Departament de Sanitat i Anatomia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Enric Mateu
- Departament de Sanitat i Anatomia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Bellaterra, Spain
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5
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Chow FC, Ma Y, Manion M, Rupert A, Lambert-Messerlian G, Bushnell CD, Cedars MI, Sereti I, Sorond FA, Hsue PY, Tien PC. Factors associated with worse cerebrovascular function in aging women with and at risk for HIV. AIDS 2021; 35:257-266. [PMID: 33229895 PMCID: PMC7789911 DOI: 10.1097/qad.0000000000002755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women may be disproportionately impacted by the negative effect of HIV on cerebrovascular risk. We examined the association of HIV, sex, menopause, and immune activation with cerebrovascular function among women with HIV (WWH) and at risk for HIV from the Women's Interagency HIV Study and men with HIV. DESIGN Cross-sectional. METHODS Participants were aged at least 40 years with coronary heart disease or at least one cardiometabolic risk factor. All persons with HIV were on antiretroviral therapy with undetectable viral load. Cerebral vasoreactivity was assessed by the transcranial Doppler breath-holding test, with lower vasoreactivity corresponding to worse cerebrovascular function. Menopausal status was determined by anti-Müllerian hormone level. We used mixed effects linear regression to identify factors associated with cerebral vasoreactivity. RESULTS Mean cerebral vasoreactivity was similar in WWH (n = 33) and women at risk for HIV (n = 16). A trend toward higher cerebral vasoreactivity in WWH compared with men with HIV (n = 37) was no longer present after excluding women on estrogen replacement therapy (n = 3). In women, menopausal status was not significantly associated with cerebral vasoreactivity. WWH with higher cardiovascular risk (-0.14 for each additional cardiometabolic risk factor, P = 0.038), sCD163 (-0.20 per doubling, P = 0.033), and proportion of CD4+CX3CR1+ T cells (-0.14 per doubling, P = 0.028) had lower cerebral vasoreactivity. CONCLUSION Among older women at high cardiovascular risk, women with virologically suppressed HIV and women at risk for HIV had similar cerebrovascular function. Our findings, which must be interpreted in the context of the small sample, highlight the contribution of traditional cardiometabolic risk factors and immune activation to cerebrovascular risk in WWH.
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Affiliation(s)
- Felicia C. Chow
- Weill Institute for Neurosciences, Department of Neurology, and Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Maura Manion
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Adam Rupert
- AIDS Monitoring Laboratory, Frederick National Laboratory for Cancer Research
| | - Geralyn Lambert-Messerlian
- Departments of Pathology and Laboratory Medicine and Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA
| | - Phyllis C. Tien
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
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Murray KD, Singh MV, Zhuang Y, Uddin MN, Qiu X, Weber MT, Tivarus ME, Wang HZ, Sahin B, Zhong J, Maggirwar SB, Schifitto G. Pathomechanisms of HIV-Associated Cerebral Small Vessel Disease: A Comprehensive Clinical and Neuroimaging Protocol and Analysis Pipeline. Front Neurol 2020; 11:595463. [PMID: 33384655 PMCID: PMC7769815 DOI: 10.3389/fneur.2020.595463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
Rationale: We provide an in-depth description of a comprehensive clinical, immunological, and neuroimaging study that includes a full image processing pipeline. This approach, although implemented in HIV infected individuals, can be used in the general population to assess cerebrovascular health. Aims: In this longitudinal study, we seek to determine the effects of neuroinflammation due to HIV-1 infection on the pathomechanisms of cerebral small vessel disease (CSVD). The study focuses on the interaction of activated platelets, pro-inflammatory monocytes and endothelial cells and their impact on the neurovascular unit. The effects on the neurovascular unit are evaluated by a novel combination of imaging biomarkers. Sample Size: We will enroll 110 HIV-infected individuals on stable combination anti-retroviral therapy for at least three months and an equal number of age-matched controls. We anticipate a drop-out rate of 20%. Methods and Design: Subjects are followed for three years and evaluated by flow cytometric analysis of whole blood (to measure platelet activation, platelet monocyte complexes, and markers of monocyte activation), neuropsychological testing, and brain MRI at the baseline, 18- and 36-month time points. MRI imaging follows the recommended clinical small vessel imaging standards and adds several advanced sequences to obtain quantitative assessments of brain tissues including white matter microstructure, tissue susceptibility, and blood perfusion. Discussion: The study provides further understanding of the underlying mechanisms of CSVD in chronic inflammatory disorders such as HIV infection. The longitudinal study design and comprehensive approach allows the investigation of quantitative changes in imaging metrics and their impact on cognitive performance.
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Affiliation(s)
- Kyle D Murray
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States
| | - Meera V Singh
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States
| | - Yuchuan Zhuang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Md Nasir Uddin
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Xing Qiu
- Department of Biostatistics, University of Rochester, Rochester, NY, United States
| | - Miriam T Weber
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States.,Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
| | - Bogachan Sahin
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Jianhui Zhong
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States.,Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States.,Department of Biostatistics, University of Rochester, Rochester, NY, United States
| | - Sanjay B Maggirwar
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC, United States
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester, Rochester, NY, United States.,Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
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Teague HL, Aksentijevich M, Stansky E, Silverman JI, Varghese NJ, Dey AK, Elnabawi Y, Goyal A, Dagur PK, Chen MY, McCoy JP, Playford MP, Hourigan C, Gelfand JM, Mehta NN. Cells of Myeloid Origin Partly Mediate the Association between Psoriasis Severity and Coronary Plaque. J Invest Dermatol 2019; 140:912-915.e1. [PMID: 31539534 DOI: 10.1016/j.jid.2019.07.724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Heather L Teague
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Milena Aksentijevich
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Elena Stansky
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joanna I Silverman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nevin J Varghese
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit K Dey
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Youssef Elnabawi
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya Goyal
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Pradeep K Dagur
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - J Philip McCoy
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Martin P Playford
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher Hourigan
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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8
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Mosepele M, Mohammed T, Mupfumi L, Moyo S, Bennett K, Lockman S, Hemphill LC, Triant VA. HIV disease is associated with increased biomarkers of endothelial dysfunction despite viral suppression on long-term antiretroviral therapy in Botswana. Cardiovasc J Afr 2018; 29:155-161. [PMID: 29771268 PMCID: PMC6107727 DOI: 10.5830/cvja-2018-003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background Untreated HIV infection is associated with increased biomarkers of endothelial dysfunction. However, the predictors and degree of endothelial dysfunction among virally suppressed HIV–infected adults on long–term antiretroviral therapy (ART) have not been well studied in sub– Saharan Africa (SSA). Methods We enrolled 112 HIV–infected adults with virological suppression on long–term ART and 84 HIV–uninfected controls in Botswana. We measured plasma levels of markers of endothelial injury [soluble vascular adhesion molecule 1 (VCAM–1), intercellular adhesion molecule 1 (ICAM–1) and E–selectin] and plasma levels of biomarkers of inflammation [interleukin 6 (IL–6)] and monocyte activation (sCD163). Baseline traditional cardiovascular disease (CVD) risk factors and bilateral common carotid intima–media thickness (cIMT) were also available for all participants. We assessed whether HIV status (despite virological suppression on ART) was associated with biomarkers of endothelial dysfunction after controlling for traditional CVD risk factors in linear regression models. We additionally assessed the association between IL–6, sCD163 and cIMT with endothelial dysfunction in separate multivariate linear regression models, controlling for cIMT, among virally suppressed HIV–infected participants only. Results In multivariate analysis, HIV infection was significantly associated with increased VCAM–1 (p < 0.01) and ICAM–1 (p = 0.03) but not E–selectin (p = 0.74) levels. Within the HIV–positive group, higher sCD163 levels were associated with decreased ICAM–1 and E–selectin (p < 0.01 and p = 0.01, respectively) but not VCAM–1 (p = 0.13) levels. IL–6 was not associated with any of the biomarkers of endothelial dysfunction. Conclusion HIV disease was associated with biomarkers of endothelial dysfunction among virally suppressed adults in Botswana on long–term ART after controlling for traditional CVD risk factors. Future work should explore the clinical impact of persistent endothelial dysfunction following longterm HIV viral suppression on the risk of CVD clinical endpoints among HIV–infected patients in this setting.
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Affiliation(s)
- Mosepele Mosepele
- Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | | | - Lucy Mupfumi
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kara Bennett
- Bennett Statistical Consulting Inc, Ballston Lake, New York, USA
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Linda C Hemphill
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Virginia A Triant
- Division of General Internal Medicine and Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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9
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Janjua SA, Staziaki PV, Szilveszter B, Takx RAP, Mayrhofer T, Hennessy O, Emami HA, Park J, Ivanov A, Hallett TR, Lu MT, Romero JM, Grinspoon SK, Hoffmann U, Zanni MV, Neilan TG. Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005777. [PMID: 29021257 DOI: 10.1161/circimaging.116.005777] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 08/21/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Data from broad populations have established associations between incidental carotid plaque and vascular events. Among people living with HIV (PLWHIV), the risk of vascular events is increased; however, whether incidental carotid plaque is increased and there is an association between incidental carotid plaque, plaque characteristics, and vascular events among PLWHIV is unclear. METHODS AND RESULTS Data from the multi-institutional Research Patient Data Registry were used. Presence and characteristics (high-risk plaque, including spotty calcification and low attenuation) of carotid plaque by computerized tomography among PLWHIV without known vascular disease were described. Data were compared with uninfected controls similar in age, sex, and cardiovascular risk factors, including diabetes mellitus, hyperlipidemia, and cigarette smoking to cases. Primary outcome was an atherosclerotic cardiovascular disease event, and secondary outcome was ischemic stroke. Cohort consisted of 209 PLWHIV (45±10 years, 72% male) and 168 controls. Using computerized tomography, PLWHIV without vascular disease had higher rates of any carotid plaque (34% versus 25%; P=0.04), noncalcified (18% versus 5%; P<0.001) and high-risk plaque (25% versus 16%; P=0.03). Over a follow-up of 3 years, 19 atherosclerotic cardiovascular disease events (9 strokes) occurred. Carotid plaque was independently associated with a 3-fold increase in atherosclerotic cardiovascular disease events among PLWHIV (hazard ratio, 2.91; confidence interval, 1.10-7.7, P=0.03) and a 4-fold increased risk of stroke (hazard ratio, 4.43; confidence interval, 1.17-16.70; P=0.02); high-risk plaque was associated with a 3-fold increased risk of atherosclerotic cardiovascular disease events and a 4-fold increased risk of stroke. CONCLUSIONS There is an increase in incidental carotid plaque, noncalcified plaque, and high-risk plaque among PLWHIV, and the presence and characteristics of carotid plaque are associated with subsequent vascular events.
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Affiliation(s)
- Sumbal A Janjua
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Pedro V Staziaki
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Balint Szilveszter
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Richard A P Takx
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Thomas Mayrhofer
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Orla Hennessy
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Hamed A Emami
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jakob Park
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Alexander Ivanov
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Travis R Hallett
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Michael T Lu
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Javier M Romero
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Steven K Grinspoon
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Udo Hoffmann
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Markella V Zanni
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Tomas G Neilan
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston.
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10
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Abstract
Cardiovascular disease, including atherosclerosis and atherosclerosis-associated complications, is an increasing cause of morbidity and mortality in human immunodeficiency virus (HIV) patients in the post-antiretroviral therapy era. HIV alone accelerates atherosclerosis. Antiretroviral therapy; HIV-associated comorbidities, such as dyslipidemia, drug abuse, and opportunistic infections; and lifestyle are risk factors for HIV-associated atherosclerosis. However, our current understanding of HIV-associated atherogenesis is very limited and has largely been obtained from clinical observation. There is a pressing need to experimentally unravel the missing link between HIV and atherosclerosis. Understanding these mechanisms will help to better develop and design novel therapeutic interventions for the treatment of HIV-associated cardiovascular disease. HIV mainly infects T cells and macrophages resulting in the induction of oxidative and endoplasmic reticulum stress, the formation of the inflammasome, and the dysregulation of autophagy. These mechanisms may contribute to HIV-associated atherogenesis. In this review, we will summarize our current understanding and propose potential mechanisms of HIV-associated atherosclerosis.
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Affiliation(s)
- Alison Kearns
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jennifer Gordon
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Tricia H Burdo
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
| | - Xuebin Qin
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
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11
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Abstract
BACKGROUND Nitric oxide helps maintain vascular function and is generated through the oxidation of arginine. Whether altered arginine metabolism may lead to elevated levels of inflammation in HIV is unclear. METHODS We performed a cross-sectional analysis of HIV-infected adults on stable antiretroviral therapy with HIV-1 RNA less than 50 copies/ml and HIV-uninfected controls. We measured biomarkers in the arginine pathway, markers of systemic inflammation, and monocyte activation. T-tests, χ tests, and propensity score matching analyses were used to compare markers by HIV status, and multiple linear regressions were used to assess associations of arginine metabolites with markers of inflammation. RESULTS Overall, 131 participants were enrolled (93 HIV-infected and 38 HIV-uninfected controls); 70% were men; 58% African-Americans; median age was 51 years, median absolute CD4 was 735 cell/mm. Lysine, arginine, citrulline, global arginine bioavailability ratio, and symmetrical dimethylarginine were different between HIV-infected and HIV-uninfected adults (P = ≤0.02), but asymmetric dimethylarginine was not (P ≥ 0.13). Arginine biomarkers in HIV-infected, but not in HIV-uninfected controls, were associated with all measured markers of inflammation, endothelial activation, and coagulation (P ≤ 0.05). CONCLUSION HIV-infected participants on antiretroviral therapy with virologic suppression have altered plasma levels of biomarkers in the arginine pathway compared with controls. These biomarkers are independently associated with markers of inflammation and monocyte activation in HIV.
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12
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HSU DC, MA YF, HUR S, LI D, RUPERT A, SCHERZER R, KALAPUS S, DEEKS S, SERETI I, HSUE PY. Plasma IL-6 levels are independently associated with atherosclerosis and mortality in HIV-infected individuals on suppressive antiretroviral therapy. AIDS 2016; 30:2065-74. [PMID: 27177313 PMCID: PMC5586221 DOI: 10.1097/qad.0000000000001149] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the associations of markers of immune activation with atherosclerosis and mortality, in participants with treated and suppressed HIV infection. DESIGN Observational study of 149 HIV-infected participants with virologic suppression on antiretroviral therapy. METHODS Cryopreserved mononuclear cells and plasma were used to evaluate markers of T cell and monocyte activation, inflammation and coagulopathy. Carotid artery intima-media thickness (CIMT) was measured by high-resolution ultrasound at the common, bifurcation and internal carotid regions. Associations of immunologic markers with CIMT and all-cause mortality were assessed using multivariable linear regression and Cox proportional hazards regression. RESULTS The majority of participants were men (93%) and white (67%), median age of 48.5 years and median CD4 T-cell count of 522 cells/μl. The median baseline IMT was 1.0 mm. Over a median of 8.3-year follow-up, 12 deaths occurred. In multivariate analysis, adjusted for traditional cardiovascular risk factors, higher monocyte C-C motif chemokine receptor 5 (CCR5) expression [5.4%, P = 0.001] was associated with greater common CIMT. Higher plasma IL-6 was associated with greater bifurcation [8.0%, P = 0.007] and overall mean IMT [5.2%, P = 0.026]. Finally, higher plasma IL-6 [hazard ratio 1.9, P = 0.030], internal carotid [hazard ratio 4.1, P = 0.022] and mean IMT [hazard ratio 5.2, P = 0.026] were individually associated with all-cause mortality. CONCLUSION Higher monocyte CCR5 expression and plasma IL-6 were associated with atherosclerosis, independent of traditional cardiovascular risk factors. IL-6 and CIMT were individually associated with all-cause mortality. The impact of therapies targeting immune activation in cardiovascular disease in treated HIV infection merits additional investigation.
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Affiliation(s)
- Denise C HSU
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Yi Fei MA
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sophia HUR
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Danny LI
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Adam RUPERT
- Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Rebecca SCHERZER
- University of California and Veterans Affairs Medical Center, San Francisco, CA, USA
| | - S.C. KALAPUS
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Steven DEEKS
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Irini SERETI
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Priscilla Y HSUE
- University of California San Francisco (UCSF), San Francisco, CA, USA
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13
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Krikke M, Arends JE, Van Lelyveld S, Hoepelman A, Visseren F. Greater carotid intima media thickness at a younger age in HIV-infected patients compared with reference values for an uninfected cohort. HIV Med 2016; 18:275-283. [PMID: 27477496 DOI: 10.1111/hiv.12428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In contrast to the general population, no decline in cardiovascular disease (CVD) has been noted in HIV-infected patients over the last 10 years. We compared the carotid artery intima media thickness (CIMT) of HIV-infected patients to that of age- and gender-matched reference values and determined the relationship between CVD risk factors and CIMT. METHODS A total of 292 HIV-infected patients were enrolled in the study. Data collected included vascular screening data, data obtained using a questionnaire, data obtained from laboratory assessments and CIMT measurement. Using linear regression (adjusted for age/gender/known HIV), the association between HIV-specific and classical cardiovascular risk factors and CIMT was evaluated. RESULTS The cohort comprised for 91% of male patients, aged 49.4 ± 10.5 years, with a known duration of HIV infection of 8.8 ± 6.7 years. The mean with standard deviation (mean ± SD) CIMT was 0.77 ± 0.19 mm, compared with 0.58 ± 0.05 mm in the controls. A steeper increase of CIMT per age was seen in the HIV-infected patients. A significant relationship between CIMT and hypertension, diabetes mellitus, smoking, systolic blood pressure, HbA1c (glycated hemoglobin) and ankle brachial index was found. Of the HIV-specific variables, only a relationship between CIMT and length of cART use and between CIMT and (inversely) current cART use was seen. CONCLUSIONS A greater CIMT was found in HIV-infected patients compared with controls. In contrast to HIV-specific variables, classical CVD risk factors were associated with a greater CIMT and should therefore be the focus of preventive measures.
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Affiliation(s)
- M Krikke
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - J E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Sfl Van Lelyveld
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Department of Internal Medicine & Gastroenterology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Aim Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Flj Visseren
- Department of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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14
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Abstract
Cardiovascular disease is one of the leading causes of morbidity and mortality in people living with HIV. Several epidemiological studies have shown an increased risk of myocardial infarction and stroke compared to uninfected controls. Although traditional risk factors contribute to this increased risk of cardiovascular disease, HIV-specific mechanisms likely also play a role. Systemic inflammation has been linked to cardiovascular disease in several populations suffering from chronic inflammation, including people living with HIV. Although antiretroviral therapy reduces immune activation, levels of inflammatory markers remain elevated compared to uninfected controls. The causes of this sustained immune response are likely multifactorial and incompletely understood. In this review, we summarize the evidence describing the relationship between inflammation and cardiovascular disease and discuss potential anti-inflammatory treatment options for cardiometabolic disease in people living with HIV.
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15
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Chow DC, Kagihara JM, Zhang G, Souza SA, Hodis HN, Li Y, Mitchell BI, Nakamoto BK, Kallianpur KJ, Keating SM, Norris PJ, Kohorn LB, Ndhlovu LC, Shikuma CM. Non-classical monocytes predict progression of carotid artery bifurcation intima-media thickness in HIV-infected individuals on stable antiretroviral therapy. HIV CLINICAL TRIALS 2016; 17:114-22. [PMID: 27125366 PMCID: PMC4892178 DOI: 10.1080/15284336.2016.1162386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inflammation may contribute to cardiovascular disease (CVD) among antiretrovirally suppressed HIV-infected individuals. We assessed relationships of monocyte, CD8 T-cell activation and plasma biomarkers to changes in carotid artery intima-media thickness (CIMT). METHODS Longitudinal study of HIV-infected subjects ≥40 years and on stable antiretroviral therapy (ART) ≥3 months. Peripheral blood mononuclear cells were immunophenotyped by multiparameteric flow cytometry to quantify classical (CD14(++)CD16(-)), intermediate (CD14(++)CD16(+)), non-classical (CD14(low/+)CD16(++)) and transitional (CD14(+)CD16(-)) monocyte subsets and activated (CD38(+)HLA-DR(+)) CD8(+) T-cells at baseline. Plasma biomarkers were assessed by multiplex Luminex assay. High-resolution B-mode ultrasounds of right carotid arteries were obtained. Changes in CIMT over two years at the right common carotid artery (CIMTCCA) and right bifurcation (CIMTBIF) were outcome variables. RESULTS We studied 50 subjects: 84% male, median age 49 (Q1, Q3; 46, 56) years, median CD4 count 461 (317, 578) cells/mm(3), and with HIV RNA ≤ 50 copies/mL in 84%. Change in CIMTBIF correlated with log values of baseline absolute count of non-classical monocytes (r = 0.37, p = 0.020), and with MCP-1 (r = 0.42, p = 0.0024) and TNF-α (r = 0.30, p = 0.036) levels. In multivariable linear regression, only non-classical monocytes and MCP-1 predicted the change in CIMTBIF, independent of Framingham Risk Score and baseline CIMTBIF. No correlation was noted between CD8 T-cell activation and CIMTBIF change. Monocyte subsets, CD8 T-cell activation, and biomarker concentrations were not correlated with changes in CIMTCCA. CONCLUSIONS Our findings highlight the role of non-classical monocytes and MCP-1 in the progression of CIMTBIF in HIV-infected individuals on stable ART independent of traditional cardio-metabolic risk factors.
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Affiliation(s)
- Dominic C Chow
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Jamie M Kagihara
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Guangxiang Zhang
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Scott A Souza
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
- b The Queen's Medical Center , Honolulu , HI , USA
| | - Howard N Hodis
- c University of Southern California Atherosclerosis Research Unit , CA , USA
| | - Yanjie Li
- c University of Southern California Atherosclerosis Research Unit , CA , USA
| | - Brooks I Mitchell
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Beau K Nakamoto
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
- d Straub Medical Center , Honolulu , HI , USA
| | - Kalpana J Kallianpur
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Sheila M Keating
- e Blood Systems Research Institute , San Francisco , CA , USA
- f Department of Laboratory Medicine , University of California , San Francisco , CA , USA
| | - Philip J Norris
- e Blood Systems Research Institute , San Francisco , CA , USA
- f Department of Laboratory Medicine , University of California , San Francisco , CA , USA
- g Department of Medicine , University of California , San Francisco , CA , USA
| | - Lindsay B Kohorn
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Lishomwa C Ndhlovu
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Cecilia M Shikuma
- a Hawaii Center for AIDS, John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
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16
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Havlir DV, Currier JS. CROI 2016: Complications of HIV Infection and Antiretroviral Therapy. TOPICS IN ANTIVIRAL MEDICINE 2016; 24:38-46. [PMID: 27398861 PMCID: PMC6148923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/06/2016] [Indexed: 06/06/2023]
Abstract
Noncommunicable conditions such as cardiovascular disease, hypertension, renal and bone diseases, and malignancies as well as infectious complications are an ongoing concern during the course of treated HIV disease. Research in this area continues to focus on the epidemiology and risk factors for these conditions, on identifying the contributions of HIV-related immunopathology to specific and collective end-organ diseases, and on evaluating interventions to prevent or reduce the morbidity associated with these conditions. Data presented at the 2016 Conference on Retroviruses and Opportunistic Infections provided new insights into all of these areas.
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Affiliation(s)
- Diane V Havlir
- University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Judith S Currier
- Clinical AIDS Research and Education (CARE) Center at University of California Los Angeles, Los Angeles, CA, USA
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Rinchai D, Boughorbel S, Presnell S, Quinn C, Chaussabel D. A curated compendium of monocyte transcriptome datasets of relevance to human monocyte immunobiology research. F1000Res 2016; 5:291. [PMID: 27158452 PMCID: PMC4856112 DOI: 10.12688/f1000research.8182.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/19/2022] Open
Abstract
Systems-scale profiling approaches have become widely used in translational research settings. The resulting accumulation of large-scale datasets in public repositories represents a critical opportunity to promote insight and foster knowledge discovery. However, resources that can serve as an interface between biomedical researchers and such vast and heterogeneous dataset collections are needed in order to fulfill this potential. Recently, we have developed an interactive data browsing and visualization web application, the Gene Expression Browser (GXB). This tool can be used to overlay deep molecular phenotyping data with rich contextual information about analytes, samples and studies along with ancillary clinical or immunological profiling data. In this note, we describe a curated compendium of 93 public datasets generated in the context of human monocyte immunological studies, representing a total of 4,516 transcriptome profiles. Datasets were uploaded to an instance of GXB along with study description and sample annotations. Study samples were arranged in different groups. Ranked gene lists were generated based on relevant group comparisons. This resource is publicly available online at
http://monocyte.gxbsidra.org/dm3/landing.gsp.
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Affiliation(s)
- Darawan Rinchai
- Systems Biology Department, Sidra Medical and Research Center, Doha, Qatar
| | - Sabri Boughorbel
- Biomedical Informatics Division, Sidra Medical and Research Center, Doha, Qatar
| | - Scott Presnell
- Benaroya Research Institute at Virginia Mason, Seattle, USA
| | - Charlie Quinn
- Benaroya Research Institute at Virginia Mason, Seattle, USA
| | - Damien Chaussabel
- Systems Biology Department, Sidra Medical and Research Center, Doha, Qatar
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Mitchell BI, Byron MM, Ng RC, Chow DC, Ndhlovu LC, Shikuma CM. Elevation of Non-Classical (CD14+/lowCD16++) Monocytes Is Associated with Increased Albuminuria and Urine TGF-β1 in HIV-Infected Individuals on Stable Antiretroviral Therapy. PLoS One 2016; 11:e0153758. [PMID: 27097224 PMCID: PMC4838224 DOI: 10.1371/journal.pone.0153758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/04/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE High rates of albuminuria are observed among HIV-infected individuals on stable antiretroviral therapy (ART). Though pro-inflammatory and pro-fibrotic responses are described as components of albuminuria in the general population, it is unclear how these responses are associated to albuminuria in ART-treated chronic HIV. We investigated the relationship of monocyte subsets and urine inflammatory and fibrotic biomarkers to albuminuria in ART-treated HIV-infected participants. DESIGN AND METHODS Cross-sectional analyses were performed on Hawaii Aging with HIV-cardiovascular disease study cohort participants who were required at entry to be ≥40 years old and on ART ≥3 months. Monocyte subpopulations were determined in banked peripheral blood mononuclear cells (PBMC) using multi-parametric flow-cytometry. Entry random urine samples were assessed for albumin-to-creatinine ratios (UACR). Urine samples were measured for inflammatory and fibrotic biomarkers using Luminex technology. RESULTS Among 96 HIV-infected subjects with measured UACR (87% male, 59% Caucasian, and 89% undetectable HIV RNA with median CD4 of 495.5 cells/μL), 18 patients (19%) had albuminuria. Non-classical (CD14low/+CD16++) monocytes were significantly elevated in subjects with albuminuria (p = 0.034) and were correlated to UACR (r = 0.238, p = 0.019). Elevated non-classical monocyte counts were significant predictors of worsening albuminuria, independent of traditional- and ART-associated risk factors (β = 0.539, p = 0.007). Urine TGF-β1 and collagen-IV were significantly higher in albuminuric compared to non-albuminuric participants (TGF-β1; p = 0.039 and collagen-IV; p = 0.042). Urine TGF-β1 was significantly correlated with non-classical monocyte counts (r = 0.464, p = 0.017). CONCLUSION Alterations in monocyte subpopulations and urine pro-fibrotic factors may play a role in kidney dysfunction during chronic HIV infection and warrants further study.
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Affiliation(s)
- Brooks I. Mitchell
- Department of Tropical Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
- * E-mail:
| | - Mary Margaret Byron
- Department of Tropical Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Roland C. Ng
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Dominic C. Chow
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Lishomwa C. Ndhlovu
- Department of Tropical Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Cecilia M. Shikuma
- Department of Tropical Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
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Zungsontiporn N, Tello RR, Zhang G, Mitchell BI, Budoff M, Kallianpur KJ, Nakamoto BK, Keating SM, Norris PJ, Ndhlovu LC, Souza SA, Shikuma CM, Chow DC. Non-Classical Monocytes and Monocyte Chemoattractant Protein-1 (MCP-1) Correlate with Coronary Artery Calcium Progression in Chronically HIV-1 Infected Adults on Stable Antiretroviral Therapy. PLoS One 2016; 11:e0149143. [PMID: 26867220 PMCID: PMC4750941 DOI: 10.1371/journal.pone.0149143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Persistent inflammation and immune activation has been hypothesized to contribute to increased prevalence of subclinical atherosclerosis and cardiovascular disease (CVD) risk in patients with chronic HIV infection. In this study, we examined the correlation of peripheral monocyte subsets and soluble biomarkers of inflammation to coronary artery calcium (CAC) progression, as measured by cardiac computed tomography scan. METHODS We conducted a longitudinal analysis utilizing baseline data of 78 participants with HIV infection on stable antiretroviral therapy (ART) in the Hawaii Aging with HIV-Cardiovascular study who had available baseline monocyte subset analysis as well as CAC measurement at baseline and at 2-year follow up. Monocyte phenotypes were assessed from cryopreserved blood by flow cytometry and plasma was assayed for soluble biomarkers using antibody-coated beads in a high sensitivity Milliplex Luminex platform. Change in CAC over 2 years was analyzed as the primary outcome variable. RESULTS Of all monocyte subsets and biomarkers tested, higher non-classical monocyte percentage (ρ = 0.259, p = 0.022), interleukin (IL)-6 (ρ = 0.311, p = 0.012), and monocyte chemoattractant protein (MCP)-1 (ρ = 0.524, p = <0.001) were significantly correlated to higher 2-year CAC progression in unadjusted Spearman's correlation. Non-classical monocyte percentage (ρ = 0.247, p = 0.039), and MCP-1 (ρ = 0.487, p = <0.001), remained significantly correlated to 2-year CAC progression, while IL-6 was not (ρ = 0.209, p = 0.120) after adjustment for age, hypertension, diabetes mellitus, total/HDL cholesterol ratio, smoking history, and BMI. CONCLUSION The percentage of non-classical monocytes and plasma MCP-1 levels were independently associated with CAC progression and may be related to the progression of atherosclerosis and increased CVD risk associated with chronic HIV infection on stable ART.
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Affiliation(s)
- Nath Zungsontiporn
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Raquel R. Tello
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Guangxiang Zhang
- Department of Tropical Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Brooks I. Mitchell
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
- Department of Tropical Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, California, United States of America
| | - Kalpana J. Kallianpur
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Beau K. Nakamoto
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
- Straub Hospital, Honolulu, Hawaii, United States of America
| | - Sheila M. Keating
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Philip J. Norris
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California, San Francisco, California, United States of America
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - Lishomwa C. Ndhlovu
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
- Department of Tropical Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Scott A. Souza
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Cecilia M. Shikuma
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Dominic C. Chow
- Hawaii Center for AIDS, Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
- * E-mail:
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Pro-Inflammatory Markers in Relation to Cardiovascular Disease in HIV Infection. A Systematic Review. PLoS One 2016; 11:e0147484. [PMID: 26808540 PMCID: PMC4726827 DOI: 10.1371/journal.pone.0147484] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/05/2016] [Indexed: 01/19/2023] Open
Abstract
Background In the past years many inflammatory markers have been studied in association with clinically manifest cardiovascular disease (CVD) and carotid intima-media thickness (CIMT) in HIV-infected patients, to obtain insights in the increased cardiovascular risk observed in HIV infection. This systematic review provides an oversight of the current knowledge. Methods A search was performed in PubMed, Embase and Cochrane in July 2014, identifying all articles from 1996 onwards addressing the relation between inflammatory markers and CVD or CIMT in HIV-positive adults. Two authors, using predefined criteria, independently conducted the selection of articles, critical appraisal and extraction of the data. Analysis was focused on the immune markers that were most frequently assessed. The review protocol was registered in the PROSPERO database at 11 July 2014 (registration number CRD42014010516). This review was performed according to the PRISMA guideline. Findings Forty articles were selected; eight addressing cardiovascular disease (CVD) and thirty-two addressing CIMT. C-reactive protein (CRP), interleukin-6 (IL-6) and d-dimer were assessed most frequently in relation to the occurrence of CVD; in four out of eight studies. All three markers were positively related to CVD in three out of four studies. Studies addressing CIMT were too heterogeneous with respect to patient populations, inflammatory markers, CIMT measurement protocols and statistical methods to allow for a formal meta-analysis to obtain summary statistics. CRP, IL-6 and soluble vascular cell adhesion molecule (sVCAM-1) were the most studied markers in relation to CIMT. None of the inflammatory markers showed an association with CIMT. Interpretation This review showed a relation between some inflammatory markers and CVD, however, no consistent relation is observed for CIMT. Statistical approaches that yields effect estimates and standardized CIMT protocols should be chosen. Further research should focus on prospective studies and a selected set of inflammatory markers.
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21
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Brown TT, Moser C, Currier JS, Ribaudo HJ, Rothenberg J, Kelesidis T, Yang O, Dubé MP, Murphy RL, Stein JH, McComsey GA. Changes in Bone Mineral Density After Initiation of Antiretroviral Treatment With Tenofovir Disoproxil Fumarate/Emtricitabine Plus Atazanavir/Ritonavir, Darunavir/Ritonavir, or Raltegravir. J Infect Dis 2015; 212:1241-9. [PMID: 25948863 DOI: 10.1093/infdis/jiv194] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/16/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Specific antiretroviral therapy (ART) medications and the severity of human immunodeficiency virus (HIV) disease before treatment contribute to bone mineral density (BMD) loss after ART initiation. METHODS We compared the percentage change in BMD over 96 weeks in 328 HIV-infected, treatment-naive individuals randomized equally to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) plus atazanavir/ritonavir (ATV/r), darunavir/ritonavir (DRV/r), or raltegravir (RAL). We also determined whether baseline levels of inflammation markers and immune activation were independently associated with BMD loss. RESULTS At week 96, the mean percentage changes from baseline in spine and hip BMDs were similar in the protease inhibitor (PI) arms (spine: -4.0% in the ATV/r group vs -3.6% in the DRV/r [P = .42]; hip: -3.9% in the ATV/r group vs -3.4% in the DRV/r group [P = .36]) but were greater in the combined PI arms than in the RAL arm (spine: -3.8% vs -1.8% [P < .001]; hip: -3.7% vs -2.4% [P = .005]). In multivariable analyses, higher baseline concentrations of high-sensitivity C-reactive protein, interleukin 6, and soluble CD14 were associated with greater total hip BMD loss, whereas markers of CD4(+) T-cell senescence and exhaustion (CD4(+)CD28(-)CD57(+)PD1(+)) and CD4(+) T-cell activation (CD4(+)CD38(+)HLA-DR(+)) were associated with lumbar spine BMD loss. CONCLUSIONS BMD losses 96 weeks after ART initiation were similar in magnitude among patients receiving PIs, ATV/r, or DRV/r but lowest among those receiving RAL. Inflammation and immune activation/senescence before ART initiation independently predicted subsequent BMD loss.
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Affiliation(s)
| | - Carlee Moser
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Judith S Currier
- David Geffen School of Medicine, University of California-Los Angeles
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | | | - Otto Yang
- David Geffen School of Medicine, University of California-Los Angeles
| | - Michael P Dubé
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert L Murphy
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Grace A McComsey
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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22
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Munger AM, Chow DC, Playford MP, Parikh NI, Gangcuangco LMA, Nakamoto BK, Kallianpur KJ, Ndhlovu LC, Shikuma CM, Mehta NN. Characterization of lipid composition and high-density lipoprotein function in HIV-infected individuals on stable antiretroviral regimens. AIDS Res Hum Retroviruses 2015; 31:221-8. [PMID: 25416403 PMCID: PMC4313425 DOI: 10.1089/aid.2014.0239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
There is an increase in the cardiovascular disease (CVD) morbidity in individuals infected with HIV that may be due to inflammatory lipid modulation not captured by traditional lipid measures. The objective of this study was to perform advanced lipoprotein phenotyping inclusive of the high-density lipoprotein (HDL) cholesterol efflux capacity and lipoprotein particle concentration and size in a well-phenotyped group of 118 patients infected with HIV. We used simple and multivariable analyses to determine the associations between advanced lipoprotein parameters and known cardiometabolic risk factors. Participants were on stable antiretroviral therapy (ART) and had benign traditional lipid panels [median total cholesterol, low-density lipoprotein (LDL)-C, HDL-C, and triglycerides of 178 mg/dl, 108 mg/dl, 44 mg/dl, and 122.5 mg/dl, respectively]. However, advanced lipoprotein phenotyping demonstrated an elevation of LDL particle number (median of 1,233 nmol/liter) and a decrease in LDL size (median of 20.4 nm), along with a decrease in protective, large HDL particles (median of 3.15 μmol/liter) and reduced HDL cholesterol efflux capacity in comparison to controls of other studies. HDL cholesterol efflux capacity was associated with HDL levels (β=0.395, p<0.001), small LDL particle concentration (β=-0.198, p=0.031), insulin sensitivity by the Matsuda index (β=0.218, p=0.029), and the Framingham Risk Score (β=-0.184, p=0.046). We demonstrate an atherogenic lipoprotein profile by NMR spectroscopy and HDL efflux measurement in a group of HIV-infected patients on stable ART with normal lipid panels.
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Affiliation(s)
- Alana M. Munger
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
| | - Dominic C. Chow
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
| | - Martin P. Playford
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nisha I. Parikh
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
| | | | - Beau K. Nakamoto
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
- Straub Clinic and Hospital, Honolulu, Hawaii
| | | | - Lishomwa C. Ndhlovu
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
- Department of Tropical Medicine, John A. Burns School of Medicine, Honolulu, Hawaii
| | | | - Nehal N. Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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23
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Beltrán LM, Rubio-Navarro A, Amaro-Villalobos JM, Egido J, García-Puig J, Moreno JA. Influence of immune activation and inflammatory response on cardiovascular risk associated with the human immunodeficiency virus. Vasc Health Risk Manag 2015; 11:35-48. [PMID: 25609975 PMCID: PMC4293933 DOI: 10.2147/vhrm.s65885] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients infected with the human immunodeficiency virus (HIV) have an increased cardiovascular risk. Although initially this increased risk was attributed to metabolic alterations associated with antiretroviral treatment, in recent years, the attention has been focused on the HIV disease itself. Inflammation, immune system activation, and endothelial dysfunction facilitated by HIV infection have been identified as key factors in the development and progression of atherosclerosis. In this review, we describe the epidemiology and pathogenesis of cardiovascular disease in patients with HIV infection and summarize the latest knowledge on the relationship between traditional and novel inflammatory, immune activation, and endothelial dysfunction biomarkers on the cardiovascular risk associated with HIV infection.
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Affiliation(s)
- Luis M Beltrán
- Metabolic-Vascular Unit, Fundación IdiPAZ-Hospital Universitario La Paz, Madrid, Spain
| | - Alfonso Rubio-Navarro
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain ; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain ; Fundación Renal Iñigo Alvarez de Toledo-Instituto Reina Sofía de Investigaciones Nefrológicas (FRIAT-IRSIN), Madrid, Spain
| | - Juan García-Puig
- Metabolic-Vascular Unit, Fundación IdiPAZ-Hospital Universitario La Paz, Madrid, Spain
| | - Juan Antonio Moreno
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain
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24
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O-charoen P, Ndhlovu LC, Gangcuangco LMA, Keating SM, Norris PJ, Ng RC, Mitchell BI, Shikuma CM, Chow DC. Albuminuria is associated with elevated acute phase reactants and proinflammatory markers in HIV-infected patients receiving suppressive combination antiretroviral therapy. AIDS Res Hum Retroviruses 2014; 30:1185-91. [PMID: 25205472 PMCID: PMC4250959 DOI: 10.1089/aid.2014.0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Albuminuria among HIV-infected individuals has been found to be associated with cardiovascular disease (CVD) and mortality. Inflammation has been associated with albuminuria. The pathophysiology of albuminuria in HIV-infected individuals is poorly understood. We investigated the association of albuminuria with inflammatory biomarkers among HIV-infected individuals on combination antiretroviral therapy (cART). This is a cross-sectional analysis of participants enrolled in the Hawaii Aging with HIV-Cardiovascular Cohort. Plasma inflammatory biomarkers were assessed using the Milliplex Human Cardiovascular disease multiplex assays. A random urine sample was collected for albumin measurement. Albuminuria was defined as urine albumin-to-creatinine ratio of ≥30 mg/g. Framingham risk score was calculated and divided into three classes. Simple and multivariable logistic regression analyses were utilized to assess the correlation between plasma inflammatory biomarkers and albuminuria and were adjusted for Framingham risk category. Among 111 HIV-infected patients [median (IQR) age of 52 (46-57) years, 86% male, median (IQR) CD4 count of 489 (341-638) cells/mm(3), 85% with HIV RNA <50 copies/ml], 18 subjects (16.2%) had moderately increased albuminuria (albuminuria range between 30 and 300 mg/g) and 2 subjects (1.8%) had severely increased albuminuria (albuminuria more than 300 mg/g). In multivariable logistic models, sE-selectin, sVCAM-1, CRP, SAA, and SAP remained significantly associated with albuminuria after adjustment of CVD risk factors. This study showed an association between inflammation and albuminuria independent of previously reported risk factors for albuminuria in HIV-infected subjects who were on combination antiretroviral therapy (cART). Chronic inflammation despite potent antiretroviral treatment may contribute to higher rates of albuminuria among HIV-infected patients.
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Affiliation(s)
| | - Lishomwa C. Ndhlovu
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Louie Mar A. Gangcuangco
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
- Department of Internal Medicine, Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut
| | - Sheila M. Keating
- Blood Systems Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Philip J. Norris
- Blood Systems Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Roland C.K. Ng
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
| | - Brooks I. Mitchell
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | | | - Dominic C. Chow
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii
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Abstract
Monocytes and macrophages play critical roles in HIV transmission, viral spread early in infection, and as a reservoir of virus throughout infection. There has been a recent resurgence of interest in the biology of monocyte subsets and macrophages and their role in HIV pathogenesis, partly fuelled by efforts to understand difficulties in achieving HIV eradication. This article examines the importance of monocyte subsets and tissue macrophages in HIV pathogenesis. Additionally, we will review the role of monocytes and macrophages in the development of serious non-AIDS events including cardiovascular disease and neurocognitive impairment, their significance in viral persistence, and how these cells represent an important obstacle to achieving HIV eradication.
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Treatment intensification with maraviroc (CCR5 antagonist) leads to declines in CD16-expressing monocytes in cART-suppressed chronic HIV-infected subjects and is associated with improvements in neurocognitive test performance: implications for HIV-associated neurocognitive disease (HAND). J Neurovirol 2014; 20:571-82. [PMID: 25227930 DOI: 10.1007/s13365-014-0279-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 01/21/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) continues to be prevalent (30-50%) despite plasma HIV-RNA suppression with combination antiretroviral therapy (cART). There is no proven therapy for individuals on suppressive cART with HAND. We have shown that the degree of HIV reservoir burden (HIV DNA) in monocytes appear to be linked to cognitive outcomes. HIV infection of monocytes may therefore be critical in the pathogenesis of HAND. A single arm, open-labeled trial was conducted to examine the effect of maraviroc (MVC) intensification on monocyte inflammation and neuropsychological (NP) performance in 15 HIV subjects on stable 6-month cART with undetectable plasma HIV RNA (<48 copies/ml) and detectable monocyte HIV DNA (>10 copies/10(6) cells). MVC was added to their existing cART regimen for 24 weeks. Post-intensification change in monocytes was assessed using multiparametric flow cytometry, monocyte HIV DNA content by PCR, soluble CD163 (sCD163) by an ELISA, and NP performance over 24 weeks. In 12 evaluable subjects, MVC intensification resulted in a decreased proportion of circulating intermediate (median; 3.06% (1.93, 6.45) to 1.05% (0.77, 2.26)) and nonclassical (5.2% (3.8, 7.9) to 3.2% (1.8, 4.8)) CD16-expressing monocytes, a reduction in monocyte HIV DNA content to zero log10 copies/10(6) cells and in levels of sCD163 of 43% by 24 weeks. This was associated with significant improvement in NP performance among six subjects who entered the study with evidence of mild to moderate cognitive impairment. The results of this study suggest that antiretroviral therapy with potency against monocytes may have efficacy against HAND.
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Krikke M, van Lelyveld SFL, Tesselaar K, Arends JE, Hoepelman IM, Visseren FLJ. The role of T cells in the development of cardiovascular disease in HIV-infected patients. Atherosclerosis 2014; 237:92-8. [PMID: 25238214 DOI: 10.1016/j.atherosclerosis.2014.08.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/19/2014] [Accepted: 08/25/2014] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease (CVD) is highly prevalent in HIV-infected patients. Besides the classical cardiovascular risk factors, HIV related factors play a role, such as immune activation and treatment with highly active antiretroviral therapy (HAART). The resulting T cell activation is regarded as one of the driving forces behind this accelerated atherogenesis. Interventions, such as early treatment and anti-inflammatory therapy, decreasing T cell activation might lead to a lower incidence of CVD in future HIV infected patients. This review specifically explores the role of T cells in the development of atherosclerosis in HIV-infected patients.
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Affiliation(s)
- M Krikke
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Heidelberglaan 100, P.O. Box 85500, F02.126, 3508 GA Utrecht, The Netherlands; Laboratory Translation Immunology University Medical Center Utrecht (UMCU), Lundlaan 6, P.O. Box 85090, KC02.085.2, 3508 AB Utrecht, The Netherlands.
| | - S F L van Lelyveld
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Heidelberglaan 100, P.O. Box 85500, F02.126, 3508 GA Utrecht, The Netherlands.
| | - K Tesselaar
- Laboratory Translation Immunology University Medical Center Utrecht (UMCU), Lundlaan 6, P.O. Box 85090, KC02.085.2, 3508 AB Utrecht, The Netherlands.
| | - J E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Heidelberglaan 100, P.O. Box 85500, F02.126, 3508 GA Utrecht, The Netherlands; Laboratory Translation Immunology University Medical Center Utrecht (UMCU), Lundlaan 6, P.O. Box 85090, KC02.085.2, 3508 AB Utrecht, The Netherlands.
| | - I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Heidelberglaan 100, P.O. Box 85500, F02.126, 3508 GA Utrecht, The Netherlands.
| | - F L J Visseren
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Heidelberglaan 100, P.O. Box 85500, F02.126, 3508 GA Utrecht, The Netherlands.
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Romero-Sánchez MC, Alvarez-Ríos AI, Bernal-Morell E, Genebat M, Vera F, Benhnia MREI, Bravo-Urbieta J, Galera-Peñaranda C, de Pablo-Bernal RS, Abad-Carrillo MA, Leal M, Ruiz-Mateos E. Maintenance of virologic efficacy and decrease in levels of β2-microglobulin, soluble CD40L and soluble CD14 after switching previously treated HIV-infected patients to an NRTI-sparing dual therapy. Antiviral Res 2014; 111:26-32. [PMID: 25173576 DOI: 10.1016/j.antiviral.2014.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/05/2014] [Accepted: 08/20/2014] [Indexed: 11/15/2022]
Abstract
Novel strategies are necessary to decrease inflammatory parameters in successfully treated HIV-infected patients. Our aim was to evaluate the maintenance of viral suppression and potential changes in inflammatory, immune-activation and coagulation biomarkers in virologically suppressed HIV-infected patients switched to a nucleoside reverse transcriptase inhibitor-sparing (NRTI) and maraviroc (MVC)-containing combined antiretroviral therapy (cART). Fifty-eight HIV-infected patients were observed after their treatment regimens were changed to MVC 150mg/once daily plus ritonavir-boosted protease inhibitor therapy. Activation-, inflammation- and coagulation-associated biomarkers and mitochondrial (mt)DNA were analyzed after a median of 24weeks of follow-up. We observed that after changing to an NRTI-sparing regimen, 96.6% of HIV-patients on viral suppressive cART maintained viral suppression and their CD4+ T cell counts did not change significantly (median of 31weeks of follow-up). This cART switch reduced soluble CD40 ligand (p=0.002), beta-2 microglobulin (p=0.025), and soluble CD14 (p=0.009) in patients with higher baseline levels of these inflammation biomarkers after a median of 24weeks of follow-up. The results of our study show that changing to NRTI-sparing dual therapy decreased the levels of inflammatory biomarkers and maintained the immune-virologic efficacy. The potential benefits of this regimen warrant further investigation to uncover the association of this therapy with the potential decrease in the morbidity and mortality of HIV-infected patients from non-AIDS-defining illnesses.
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Affiliation(s)
- M Concepción Romero-Sánchez
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Ana I Alvarez-Ríos
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), Seville 41013, Spain
| | | | - Miguel Genebat
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Francisco Vera
- Infectious Diseases Section, Santa María del Rosell-Santa Lucía Hospital, Cartagena, Spain
| | - Mohammed Rafii-El-Idrissi Benhnia
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain; Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Spain
| | - Joaquín Bravo-Urbieta
- Infectious Diseases Section, Morales Meseguer University General Hospital, Murcia, Spain
| | | | - Rebeca S de Pablo-Bernal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - María Antonia Abad-Carrillo
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Manuel Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
| | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
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29
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Shikuma CM, Chow DC, Gangcuangco LMA, Zhang G, Keating SM, Norris PJ, Seto TB, Parikh N, Kallianpur KJ, Nakamoto BK, Nagamine LS, Ndhlovu LC, Barbour JD. Monocytes expand with immune dysregulation and is associated with insulin resistance in older individuals with chronic HIV. PLoS One 2014; 9:e90330. [PMID: 24587328 PMCID: PMC3937368 DOI: 10.1371/journal.pone.0090330] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/30/2014] [Indexed: 01/22/2023] Open
Abstract
Background Rates of insulin resistance are increased in HIV-infected patients on stable antiretroviral therapy (ART). Such increase may partially be due to HIV-induced immune dysregulation involving monocytes (MO) and its subsets. Materials and Methods Cross-sectional analysis of 141 HIV-infected subjects age ≥ 40 years on stable ART. Homeostatic model assessment–insulin resistance (HOMA-IR) and rates of metabolic syndrome were calculated. Subjects were classified by fasting glucose and oral glucose tolerance test (OGTT) into clinical diabetes categories. Multi-parametric flow cytometry was used to determine MO subset percentages: [classical (CD14++CD16−), intermediate (CD14++CD16+), non-classical (CD14low/+CD16++), and a recently identified fourth (CD14low/+CD16−) ‘transitional’ MO subset] and percentage of activated (CD38+HLA-DR+) CD8 T cells. Absolute levels of cells were calculated using clinical CBC and T cell subset data. Multiple plasma soluble biomarkers were assessed by Luminex technology. Results Median age 50 years, CD4 count (percent) 505 cells/µL (29%), and 89% male. Total MO (r = −0.23, p = 0.006) and classical and non-classical MO subsets correlated negatively with CD4 percent. No correlations were seen with CD4 count as absolute values. Log-total MO and log-classical MO predicted HOMA-IR independently of HIV immuno-virologic and diabetes risk factors (β = 0.42, p = 0.02 and β = 0.35, p = 0.02, respectively) and were increased in subjects with metabolic syndrome (p = 0.03 and p = 0.05 respectively). Total and/or subset MO levels correlated with multiple soluble plasma biomarkers including CRP, IL-6, MMP-9, MPO, SAA, SAP and tPAI-1, with tPAI-1 independently predicting HOMA-IR (β = 0.74, p<0.001). Conclusions MO levels increase with worsening HIV immune dysregulation as assessed by CD4 percent. CD4 percent may provide additional information about MO and metabolic risk in this population beyond absolute values. MO, and specifically classical MO, may contribute to insulin resistance and metabolic syndrome during chronic HIV infection. Multiple soluble plasma biomarkers including tPAI-1 increase with increase in MO. Levels of tPAI-1 independently predict the development of insulin resistance.
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Affiliation(s)
- Cecilia M Shikuma
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Dominic C Chow
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | | | - Guangxiang Zhang
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Sheila M Keating
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Philip J Norris
- Blood Systems Research Institute, San Francisco, California, United States of America ; University of California San Francisco, San Francisco, California, United States of America
| | - Todd B Seto
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America ; Queen's Medical Center, Honolulu, Hawaii, United States of America
| | - Nisha Parikh
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America ; Queen's Medical Center, Honolulu, Hawaii, United States of America
| | - Kalpana J Kallianpur
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Beau K Nakamoto
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America ; Straub Clinic and Hospital, Honolulu, Hawaii, United States of America
| | - Lorna S Nagamine
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Lishomwa C Ndhlovu
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Jason D Barbour
- Hawaii Center for AIDS, University of Hawaii, Honolulu, Hawaii, United States of America
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