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Abadi T, Teklu T, Wondmagegn T, Alem M, Desalegn G. CD4 + T cell count and HIV-1 viral load dynamics positively impacted by H. pylori infection in HIV-positive patients regardless of ART status in a high-burden setting. Eur J Med Res 2024; 29:178. [PMID: 38494500 PMCID: PMC10946129 DOI: 10.1186/s40001-024-01750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND There is a widespread co-infection of HIV and Helicobacter pylori (H. pylori) globally, particularly in developing countries, and it has been suggested that this co-infection may affect the course of HIV disease. However, the interplay between H. pylori infection and HIV disease progression is not fully elucidated. In this study, we investigated the effect of H. pylori co-infection on CD4+ T cell count and HIV viral load dynamics in HIV-positive individuals in a high co-endemic setting. METHODS A comparative cross-sectional study was conducted among 288 HIV-positive and 175 HIV-negative individuals, both with and without H. pylori infection. Among HIV-positive participants, 195 were on antiretroviral therapy (ART) and 93 were ART-naïve. CD4+ T cell count and HIV-1 viral load were measured and compared between H. pylori-infected and -uninfected individuals, taking into account different HIV and ART status. RESULT Our study demonstrated that individuals infected with H. pylori had a significantly higher CD4+ T cell count compared to uninfected controls among both HIV-negative and HIV-positive participants, regardless of ART therapy. Conversely, HIV/H. pylori co-infected participants had lower HIV-1 viral load than those without H. pylori infection. Linear regression analysis further confirmed a positive association between H. pylori infection, along with other clinical factors such as BMI, ART, and duration of therapy, with CD4+ T cell count while indicating an inverse relationship with HIV-1 viral load in HIV-positive patients. Additionally, factors such as khat chewing, age and WHO clinical stage of HIV were associated with reduced CD4+ T cell count and increased HIV-1 viral load. CONCLUSION Our study demonstrates that H. pylori co-infection was associated with higher CD4+ T cell count and lower HIV-1 viral load in HIV-positive patients, regardless of ART status. These findings show a positive effect of H. pylori co-infection on the dynamics of HIV-related immunological and virological parameters. Further studies are needed to elucidate the underlying mechanisms of the observed effects.
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Affiliation(s)
- Tesfay Abadi
- Department of Medical Laboratory Science, Adigrat University, Adigrat, Ethiopia
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Takele Teklu
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia.
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia.
| | - Tadelo Wondmagegn
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Meseret Alem
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Girmay Desalegn
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Dickey BL, Putney RM, Suneja G, Kresovich JK, Spivak AM, Patel AB, Teng M, Extermann M, Giuliano AR, Gillis N, Berglund A, Coghill AE. Differences in epigenetic age by HIV status among patients with a non-AIDS defining cancer. AIDS 2023; 37:2049-2057. [PMID: 37467055 PMCID: PMC10538418 DOI: 10.1097/qad.0000000000003661] [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] [Indexed: 07/21/2023]
Abstract
OBJECTIVE People with HIV (PWH) are living longer and experiencing higher numbers of non-AIDS-defining cancers (NADC). Epigenetic aging biomarkers have been linked to cancer risk, and cancer is now a leading cause of death in PWH, but these biomarkers have not been investigated in PWH and cancer. DESIGN In order to compare epigenetic age by HIV status, HIV-uninfected participants were matched to PWH by reported age, tumor site, tumor sequence number, and cancer treatment status. METHODS DNA from blood was assayed using Illumina MethylationEPIC BeadChip, and we estimated immune cell composition and aging from three epigenetic clocks: Horvath, GrimAge, and epiTOC2. Age acceleration by clock was computed as the residual from the expected value, calculated using linear regression, for each study participant. Comparisons across HIV status used the Wilcoxon rank sum test. Hazard ratios and 95% confidence intervals for the association between age acceleration and survival in PWH were estimated with Cox regression. RESULTS Among 65 NADC participants with HIV and 64 without, biological age from epiTOC2 ( P < 0.0001) and GrimAge ( P = 0.017) was significantly higher in PWH. Biological age acceleration was significantly higher in PWH using epiTOC2 ( P < 0.01) and GrimAge ( P < 0.0001), with the difference in GrimAge remaining statistically significant after adjustment for immune cell composition. Among PWH, GrimAge acceleration was significantly associated with increased risk of death (hazard ratio 1.11; 95% confidence interval (CI) 1.04-1.18). CONCLUSION We observed a higher epigenetic age in PWH with a NADC diagnosis compared with their HIV-uninfected counterparts, as well as a significant association between this accelerated biological aging and survival for patients diagnosed with a NADC.
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Affiliation(s)
| | - Ryan M Putney
- Biostatistics/Bioinformatics Division, Moffitt Cancer Center
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah
| | - Jacob K Kresovich
- Department of Cancer Epidemiology
- Department of Breast Oncology, Moffitt Cancer Center
| | - Adam M Spivak
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine
| | - Ami B Patel
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah
| | - Mingxiang Teng
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center & Research Institute
| | | | - Anna R Giuliano
- Department of Cancer Epidemiology
- Center for Immunization and Infection Research in Cancer
| | | | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center & Research Institute
| | - Anna E Coghill
- Department of Cancer Epidemiology
- Center for Immunization and Infection Research in Cancer
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Hernanz I, Alvear-Torres A, Serrano Del Castillo C, Sánchez-Pernaute O, Recuero S, Romero-Bueno F, Muñoz N, Carreño E. Non-infectious Uveitis as a Manifestation of the Immune Reconstitution Inflammatory Syndrome in Patients Infected by HIV. Ocul Immunol Inflamm 2022; 30:1599-1603. [PMID: 33908843 DOI: 10.1080/09273948.2021.1919310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe a retrospective review of HIV patients with noninfectious uveitis. Data collected included: demographics, anatomic classification and phenotypic diagnosis of the uveitis, systemic immune-mediated disorders (IMD), time from HIV diagnosis to uveitis, CD4 count, viral load, treatment and complications of treatment and time of follow-up. RESULTS Twenty patients (18 males) were included. The time lag between HIV diagnosis and the onset of uveitis was 9 ± 8.5 years. Mean CD4 count was 670 ± 294 cells/ml. Viral load was undetectable in 14 out of 18 cases. In 6 patients IMD was diagnosed prior to or concurring with the uveitis diagnosis. The use of immunosuppressive therapies was necessary in 6 patients (including biologics in 4 cases). The mean follow-up was 42.2 months. CONCLUSIONS noninfectious uveitis could be the first manifestation of IMD in patients with well-controlled HIV infection. Immunosuppression appeared to be a safe therapeutic option in our cohort of patients.
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Affiliation(s)
- Ines Hernanz
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Andrea Alvear-Torres
- Rheumatology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Sheila Recuero
- Rheumatology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | - Nelida Muñoz
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Ester Carreño
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
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4
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Segrelles-Calvo G, de S Araújo GR, Llopis-Pastor E, Carrillo J, Hernández-Hernández M, Rey L, Melean NR, Escribano I, Antón E, Zamarro C, García-Salmones M, Frases S. Candida spp. co-infection in COVID-19 patients with severe pneumonia: Prevalence study and associated risk factors. Respir Med 2021; 188:106619. [PMID: 34555702 PMCID: PMC8445759 DOI: 10.1016/j.rmed.2021.106619] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022]
Abstract
Background Invasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet. Objectives We aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis. Patients/methods We designed a study including patients with a confirmed diagnosis of COVID-19. Results The prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1β and Lopinavir-Ritonavir. Conclusions Results suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.
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Affiliation(s)
- Gonzalo Segrelles-Calvo
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Biomédica, Fundación Jiménez Díaz, Madrid, Spain
| | - Glauber R de S Araújo
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidad Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Javier Carrillo
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Servicio de Neumología, Hospital Universitario Infanta Elena, Madrid, Spain
| | | | - Laura Rey
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | | | - Inés Escribano
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Biomédica, Fundación Jiménez Díaz, Madrid, Spain
| | - Esther Antón
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Celia Zamarro
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Mercedes García-Salmones
- Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Madrid, Spain; Servicio de Neumología, Hospital Universitario Infanta Elena, Madrid, Spain
| | - Susana Frases
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidad Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Goovaerts O, Massinga-Loembé M, Ondoa P, Ceulemans A, Worodria W, Mayanja-Kizza H, Colebunders R, Kestens L. Lack of elevated pre-ART elastase-ANCA levels in patients developing TB-IRIS. PLoS One 2020; 15:e0244800. [PMID: 33382831 PMCID: PMC7775098 DOI: 10.1371/journal.pone.0244800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in HIV-TB co-infected patients receiving antiretroviral therapy (ART) has been linked to neutrophil activation. Anti-neutrophil cytoplasmic antibodies (ANCAs) are also associated with neutrophil activation. Since ANCAs are reportedly skewed in TB and HIV infections, we investigated plasma levels of 7 ANCAs in TB-IRIS patients. Methods We retrospectively compared 17 HIV-TB patients who developed TB-IRIS with controls of similar CD4 count, age and gender who did not (HIV+TB+ n = 17), HIV-infected patients without TB (HIV+TB-, n = 17) and 10 HIV-negative (HIV-TB-) controls. Frozen plasma was collected before ART, at 3 and 9 months of ART, and examined by ELISA for levels of 7 ANCAs directed against; Proteinase 3 (PR3), Myeloperoxidase (MPO), Permeability-increasing protein (BPI), Elastase, Cathepsin, Lysozyme, and Lactoferrin. Results Compared to HIV+TB+ controls, pre-ART anti-elastase levels were lower in TB-IRIS patients (p = 0.026) and HIV-TB- controls (p = 0.044), whereas other ANCAs did not show significant differences between groups at any time point. A significant decrease over time could be observed in TB-IRIS patients during ART for anti -PR3 (p = 0.027), -lysozyme (p = 0.011), and -lactoferrin (p = 0.019). Conversely, HIV+TB+ controls showed a significant decrease over time for anti -MPO (p = 0.002), -lyzosyme (p = 0.002) and -elastase (p < 0.001). Conclusion The lack of elevated anti-elastase levels in TB-IRIS patients as opposed to HIV+TB+ controls correspond to previous findings of lowered immune capacity in patients that will develop TB-IRIS. This may suggest a specific role for anti-elastase, elastase or even matrix-metalloproteinases in TB-IRIS. The precise dynamics of neutrophil activation in HIV-TB merits further investigation and could provide more insight in the early mechanisms leading up to TB-IRIS.
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Affiliation(s)
- Odin Goovaerts
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Marguerite Massinga-Loembé
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambarene, Gabon
- Institut für Tropenmedizin,Universität Tübingen, Tübingen, Germany
| | - Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
- Amsterdam Institute of Global Health and Development, Academic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Ann Ceulemans
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - William Worodria
- Department of Medicine, Mulago Hospital, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Network for Treatment and Research in Africa (INTERACT), Kampala, Uganda
| | - Harriet Mayanja-Kizza
- Department of Medicine, Mulago Hospital, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Luc Kestens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Abstract
Immune reconstitution inflammatory syndrome (IRIS) describes a syndrome of aberrant reconstituted immunity, often in association with HIV infection, beginning with a normalization of CD4+ T-cell counts resulting in a dysregulated immune response against an infecting opportunistic pathogen and the host. In this chapter, we discuss the unique nature of IRIS when present in the central nervous system (CNS IRIS) and the changes experienced with each host pathogen and its unique influence on the immune system. Consensus on the mechanism of action of the immune system in IRIS pathology is less clear and multiple theories have been proposed. Here we explore the early history of the term IRIS, proposed mechanisms and animal models, as well as common CNS pathogens associated with IRIS, and management strategies.
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Affiliation(s)
- Lauren Bowen
- Section of Infections of the Nervous System, National Institute for Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute for Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
| | - Bryan Smith
- Section of Infections of the Nervous System, National Institute for Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
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7
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Bell L, Peyper JM, Garnett S, Tadokera R, Wilkinson R, Meintjes G, Blackburn JM. TB-IRIS: Proteomic analysis of in vitro PBMC responses to Mycobacterium tuberculosis and response modulation by dexamethasone. Exp Mol Pathol 2017; 102:237-246. [PMID: 28209523 PMCID: PMC5446321 DOI: 10.1016/j.yexmp.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/11/2017] [Indexed: 12/02/2022]
Abstract
Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) occurs in 8-54% of South African patients undergoing treatment for tuberculosis/human immunodeficiency virus co-infection. Improved TB-IRIS molecular pathogenesis understanding would enhance risk stratification, diagnosis, prognostication, and treatment. We assessed how TB-IRIS status and dexamethasone influence leukocyte proteomic responses to Mycobacterium tuberculosis (Mtb). Patient blood was obtained three weeks post-anti-retroviral therapy initiation. Isolated mononuclear cells were stimulated ex vivo with heat-killed Mtb in the presence/absence of dexamethasone. Mass spectrometry-based proteomic comparison of TB-IRIS and non-IRIS patient-derived cells facilitated generation of hypotheses regarding pathogenesis. Few represented TB-IRIS-group immune-related pathways achieved significant activation, with relative under-utilisation of "inter-cellular interaction" and "Fcγ receptor-mediated phagocytosis" (but a tendency towards apoptosis-related) pathways. Dexamethasone facilitated significant activation of innate-related pathways. Differentially-expressed non-IRIS-group proteins suggest focused and co-ordinated immunological pathways, regardless of dexamethasone status. Findings suggest a relative deficit in TB-IRIS-group responses to and clearance of Mtb antigens, ameliorated by dexamethasone.
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Affiliation(s)
- Liam Bell
- Department of Integrative Biomedical Sciences & Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa; Centre for Proteomic and Genomic Research (CPGR), Observatory, 7925 Cape Town, South Africa
| | - Janique M Peyper
- Department of Integrative Biomedical Sciences & Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
| | - Shaun Garnett
- Department of Integrative Biomedical Sciences & Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
| | - Rabecca Tadokera
- Department of Integrative Biomedical Sciences & Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa; Clinical Infectious Diseases Research Initiative, IDM, University of Cape Town, Observatory, 7925 South Africa; HIV/AIDS, STIs and TB Programme, Human Sciences Research Council, Arcadia, 0002 Pretoria, South Africa
| | - Robert Wilkinson
- Department of Medicine, Imperial College, London W2 1PG, UK; Clinical Infectious Diseases Research Initiative, IDM, University of Cape Town, Observatory, 7925 South Africa; Department of Medicine, University of Cape Town, Observatory, 7925 South Africa; Francis Crick Institute, Mill Hill Laboratory, London NW7 1AA, UK
| | - Graeme Meintjes
- Clinical Infectious Diseases Research Initiative, IDM, University of Cape Town, Observatory, 7925 South Africa; Department of Medicine, University of Cape Town, Observatory, 7925 South Africa
| | - Jonathan M Blackburn
- Department of Integrative Biomedical Sciences & Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa.
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Uddhao Z, Aditi C, Chitra N, Swagata T. A rare occurrence of epidermolysis bullosa acquisita in a patient with retroviral disease. Int J STD AIDS 2017. [PMID: 28632473 DOI: 10.1177/0956462417696433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidermolysis bullosa acquisita is a chronic subepidermal blistering disease associated with autoimmunity to type-VII collagen within anchoring fibrils located at the dermo-epidermal junction. This entity is rarely reported from India. It can have a variety of presentations. Its occurrence with retroviral disease has rarely been reported. Here, we present a case of epidermolysis bullosa acquisita in a patient with HIV infection.
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Affiliation(s)
- Zambare Uddhao
- Department of Dermatology, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Chhonkar Aditi
- Department of Dermatology, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Nayak Chitra
- Department of Dermatology, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Tambe Swagata
- Department of Dermatology, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
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HIV-1 Evolutionary Patterns Associated with Metastatic Kaposi's Sarcoma during AIDS. Sarcoma 2016; 2016:4510483. [PMID: 27651732 PMCID: PMC5019946 DOI: 10.1155/2016/4510483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/07/2016] [Indexed: 12/19/2022] Open
Abstract
Kaposi's sarcoma (KS) in HIV-infected individuals can have a wide range of clinical outcomes, from indolent skin tumors to a life-threatening visceral cancer. KS tumors contain endothelial-related cells and inflammatory cells that may be HIV-infected. In this study we tested if HIV evolutionary patterns distinguish KS tumor relatedness and progression. Multisite autopsies from participants who died from HIV-AIDS with KS prior to the availability of antiretroviral therapy were identified at the AIDS and Cancer Specimen Resource (ACSR). Two patients (KS1 and KS2) died predominantly from non-KS-associated disease and KS3 died due to aggressive and metastatic KS within one month of diagnosis. Skin and visceral tumor and nontumor autopsy tissues were obtained (n = 12). Single genome sequencing was used to amplify HIV RNA and DNA, which was present in all tumors. Independent HIV tumor clades in phylogenies differentiated KS1 and KS2 from KS3, whose sequences were interrelated by both phylogeny and selection. HIV compartmentalization was confirmed in KS1 and KS2 tumors; however, in KS3, no compartmentalization was observed among sampled tissues. While the sample size is small, the HIV evolutionary patterns observed in all patients suggest an interplay between tumor cells and HIV-infected cells which provides a selective advantage and could promote KS progression.
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10
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Meys R, Purdie KJ, de Koning MNC, Quint KD, Little AM, Baker F, Francis N, Asboe D, Hawkins D, Marsh SGE, Harwood CA, Gotch FM, Bunker CB. HLA Immunogenotype Determines Persistent Human Papillomavirus Virus Infection in HIV-Infected Patients Receiving Antiretroviral Treatment. J Infect Dis 2016; 213:1717-24. [PMID: 26908737 DOI: 10.1093/infdis/jiw038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Abstract
A proportion of human immunodeficiency virus (HIV)-infected patients develop persistent, stigmatizing human papillomavirus (HPV)-related cutaneous and genital warts and anogenital (pre)cancer. This is the first study to investigate immunogenetic variations that might account for HPV susceptibility and the largest to date to categorize the HPV types associated with cutaneous warts in HIV-positive patients. The HLA class I and II allele distribution was analyzed in 49 antiretroviral (ART)-treated HIV-positive patients with persistent warts, 42 noninfected controls, and 46 HIV-positive controls. The allele HLA-B*44 was more frequently identified in HIV-positive patients with warts (P = .004); a susceptible haplotype (HLA-B*44, HLA-C*05; P = .001) and protective genes (HLA-DQB1*06; P = .03) may also contribute. Cutaneous wart biopsy specimens from HIV-positive patients harbored common wart types HPV27/57, the unusual wart type HPV7, and an excess of Betapapillomavirus types (P = .002), compared with wart specimens from noninfected controls. These findings suggest that HLA testing might assist in stratifying those patients in whom vaccination should be recommended.
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Affiliation(s)
| | - Karin J Purdie
- Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | | | - Koen D Quint
- DDL Diagnostic Laboratory, Rijswijk Department of Dermatology, Leiden University Medical Centre, The Netherlands
| | - Ann-Margaret Little
- Anthony Nolan Research Institute, Royal Free Hospital Cancer Institute, University College London, United Kingdom
| | | | - Nick Francis
- Department of Histopathology, Charing Cross Hospital, Imperial College London
| | - David Asboe
- Department of HIV Medicine and Sexual Health, Chelsea and Westminster Hospital
| | - David Hawkins
- Department of HIV Medicine and Sexual Health, Chelsea and Westminster Hospital
| | - Steven G E Marsh
- Anthony Nolan Research Institute, Royal Free Hospital Cancer Institute, University College London, United Kingdom
| | - Catherine A Harwood
- Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London
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11
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Manzardo C, Guardo AC, Letang E, Plana M, Gatell JM, Miro JM. Opportunistic infections and immune reconstitution inflammatory syndrome in HIV-1-infected adults in the combined antiretroviral therapy era: a comprehensive review. Expert Rev Anti Infect Ther 2015; 13:751-67. [PMID: 25860288 DOI: 10.1586/14787210.2015.1029917] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the availability of effective combined antiretroviral treatment, many patients still present with advanced HIV infection, often accompanied by an AIDS-defining disease. A subgroup of patients starting antiretroviral treatment under these clinical conditions may experience paradoxical worsening of their disease as a result of an exaggerated immune response towards an active (but also subclinical) infectious agent, despite an appropriate virological and immunological response to the treatment. This clinical condition, known as immune reconstitution inflammatory syndrome, may cause significant morbidity and even mortality if it is not promptly recognized and treated. This review updates current knowledge about the incidence, diagnostic criteria, risk factors, clinical manifestations, and management of opportunistic infections and immune reconstitution inflammatory syndrome in the combined antiretroviral treatment era.
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Affiliation(s)
- Christian Manzardo
- Infectious Diseases Service and HIV Research Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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12
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Vishnu P, Dorer RP, Aboulafia DM. Immune reconstitution inflammatory syndrome-associated Burkitt lymphoma after combination antiretroviral therapy in HIV-infected patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:e23-9. [PMID: 25458079 DOI: 10.1016/j.clml.2014.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/25/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Prakash Vishnu
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA.
| | - Russell P Dorer
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA
| | - David M Aboulafia
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA; Division of Hematology, University of Washington, Seattle, WA
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13
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Carvalho LGD, Teixeira PDFDS, Panico ALBG, Cohen MV, Pinheiro MFMC, Barroso PF, Vaisman M. Evaluation of thyroid function and autoimmunity in HIV-infected women. ACTA ACUST UNITED AC 2014; 57:450-6. [PMID: 24030185 DOI: 10.1590/s0004-27302013000600007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/06/2013] [Indexed: 11/22/2022]
Abstract
Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active anti-retroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4+ lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIV-infected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4+ T cell counts.
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Miro J, Agüero F, Duclos-Vallée JC, Mueller N, Grossi P, Moreno A. Infections in solid organ transplant HIV-infected patients. Clin Microbiol Infect 2014; 20 Suppl 7:119-30. [DOI: 10.1111/1469-0691.12754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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16
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Ogola GO, Ouma C, Jura WGZO, Muok EO, Colebunders R, Mwinzi PN. A non-synonymous polymorphism in IL-23R Gene (rs1884444) is associated with reduced risk to schistosomiasis-associated Immune Reconstitution Inflammatory Syndrome in a Kenyan population. BMC Infect Dis 2014; 14:316. [PMID: 24912586 PMCID: PMC4057813 DOI: 10.1186/1471-2334-14-316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Human Immunodeficiency Virus (HIV) and Schistosomiasis co-infection is common among residents at the shores of Lake Victoria in Kenya. About 36% of this population initiating antiretroviral therapy (ART) experience Immune Reconstitution Inflammatory Syndrome (IRIS) that complicates recovery. Several IL-23R alleles have been associated with susceptibility to both autoimmune and inflammatory diseases through T-helper type 17 (TH17) cells. However, whether or not variants within the IL-23R increase susceptibility to IRIS in western Kenya is unknown. The objective of the current study was to determine the association between IL-23R gene polymorphisms, CD4+ cell counts and HIV RNA levels and IRIS in HIV and Schistosoma mansoni co-infected patients undergoing highly active anti-retroviral therapy (HAART). Methods A three-month case–control study was conducted on antiretroviral naïve schistosomiasis/HIV co-infected fishermen starting HAART in Uyoma Rarieda, Siaya County, Kenya. Seventy one patients were sampled at baseline and followed up for three months, to establish if they developed Schistosoma-related IRIS. In addition, the CD4+ cell counts and HIV RNA levels were determined in pre- and post-administration of HAART. Variations at five polymorphic sites of IL-23R (rs1884444, rs11465754, rs6682925, rs7530511 and rs7539625) based on >10% minor allele frequency in Yoruban reference population was determined using Allelic Discrimination Assay. The association between the five variants and susceptibility to IRIS was determined using logistic regression while controlling for potential confounders. In addition, the functional differences between the baseline CD4 + Cell counts and viral loads were determined using medians while across IL-23R genotypes were determined using Kruskal-Wallis tests. Results Overall, 26 (36.6%) patients developed schistosomiasis-associated IRIS at a median age of 35.5 years. Carriage of the TT genotype at the non-synonymous rs1884444 T > G relative to GG, was associated with a decreased risk of schistosomiasis-associated IRIS (OR, 0.25, 95% CI, 0.07-0.96, P = 0.043) while both baseline CD4+ cell counts and viral loads had no association with IRIS. Conclusion These findings indicate that the non-synonymous variant rs1884444 T > G of IL-23R is associated with a decreased risk to schistosomiasis-associated IRIS. However, additional studies in a larger cohort and with an all inclusive polymorphic variants in the synonymous and non-synonymous regions need to be evaluated.
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Tadokera R, Meintjes GA, Wilkinson KA, Skolimowska KH, Walker N, Friedland JS, Maartens G, Elkington PTG, Wilkinson RJ. Matrix metalloproteinases and tissue damage in HIV-tuberculosis immune reconstitution inflammatory syndrome. Eur J Immunol 2014; 44:127-36. [PMID: 24136296 PMCID: PMC3992843 DOI: 10.1002/eji.201343593] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/29/2013] [Accepted: 09/25/2013] [Indexed: 12/18/2022]
Abstract
The HIV-TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) can complicate combined treatments for HIV-1 and TB. Little is known about tissue damage in TB-IRIS. Matrix metalloproteinases (MMPs) degrade components of the extracellular matrix and consequently may play a role in such immunopathology. Here we investigated the involvement of MMPs in TB-IRIS. We determined MMP transcript abundance and secreted protein in Mycobacterium tuberculosis stimulated PBMCs from 22 TB-IRIS patients and 22 non-IRIS controls. We also measured MMP protein levels in corresponding serum and the effect of prednisone--which reduces the duration of symptoms in IRIS patients--or placebo treatment on MMP transcript and circulating MMP protein levels. PBMCs from TB-IRIS had increased MMP-1, -3, -7, and -10 transcript levels when compared with those of controls at either 6 or 24 h. Similarly, MMP-1, -3, -7, and -10 protein secretion in stimulated cultures was higher in TB-IRIS than in controls. Serum MMP-7 concentration was elevated in TB-IRIS and 2 weeks of corticosteroid therapy decreased this level, although not significantly. TB-IRIS is associated with a distinct pattern of MMP gene and protein activation. Modulation of dysregulated MMP activity may represent a novel therapeutic approach to alleviate TB-IRIS in HIV-TB patients undergoing treatment.
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Affiliation(s)
- Rebecca Tadokera
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| | - Graeme A Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Infectious Diseases Unit, GF Jooste HospitalManenberg, South Africa
- Department of Medicine, Imperial College LondonLondon, UK
| | - Katalin A Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- MRC National Institute for Medical ResearchLondon, UK
| | - Keira H Skolimowska
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Department of Medicine, Imperial College LondonLondon, UK
| | - Naomi Walker
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Department of Medicine, Imperial College LondonLondon, UK
| | | | - Gary Maartens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape TownCape Town, South Africa
| | - Paul T G Elkington
- Department of Medicine, Imperial College LondonLondon, UK
- Faculty of Medicine, University of Southampton, Southampton General HospitalSouthampton, UK
| | - Robert J Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Infectious Diseases Unit, GF Jooste HospitalManenberg, South Africa
- Department of Medicine, Imperial College LondonLondon, UK
- MRC National Institute for Medical ResearchLondon, UK
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Almeida Ferreira M, Carvalho AC, Silva SV, França M, Borges F. Two endocrine diseases in one case of immune reconstitution inflammatory syndrome. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Barber DL, Andrade BB, McBerry C, Sereti I, Sher A. Role of IL-6 in Mycobacterium avium--associated immune reconstitution inflammatory syndrome. THE JOURNAL OF IMMUNOLOGY 2013; 192:676-82. [PMID: 24337386 DOI: 10.4049/jimmunol.1301004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a major adverse event of antiretroviral therapy in HIV infection, and paradoxically occurs as HIV viremia is suppressed and CD4 T cell numbers recover. IRIS reflects pathogenic immune responses against opportunistic infections acquired during the period of immunodeficiency, but little is understood about the mechanisms of inflammatory pathology. In this study, we show that IL-6 and C-reactive protein levels transiently rise at the time of the IRIS event in HIV-infected patients, unmasking Mycobacterium avium complex infection after starting antiretroviral therapy. To directly test the role of IL-6 in IRIS pathology, we used a model of experimentally inducible IRIS in which M. avium-infected T cell-deficient mice undergo a fatal inflammatory disease after reconstitution with CD4 T cells. We find that IL-6 neutralization reduces C-reactive protein levels, alleviates wasting disease, and extends host survival during experimental IRIS. Moreover, we show that combined blockade of IL-6 and IFN-γ further reduces IRIS pathology, even after the onset of wasting disease. The combination of these clinical and experimental-model data show that the IL-6 pathway is not only a biomarker of mycobacterial IRIS but also a major mediator of pathology distinct from IFN-γ and may be a useful target for therapeutic intervention.
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Affiliation(s)
- Daniel L Barber
- T Lymphocyte Biology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
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Nagy LH, Grishina I, Macal M, Hirao LA, Hu WK, Sankaran-Walters S, Gaulke CA, Pollard R, Brown J, Suni M, Baumler AJ, Ghanekar S, Marco ML, Dandekar S. Chronic HIV infection enhances the responsiveness of antigen presenting cells to commensal Lactobacillus. PLoS One 2013; 8:e72789. [PMID: 24023646 PMCID: PMC3758347 DOI: 10.1371/journal.pone.0072789] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/11/2013] [Indexed: 01/23/2023] Open
Abstract
Chronic immune activation despite long-term therapy poses an obstacle to immune recovery in HIV infection. The role of antigen presenting cells (APCs) in chronic immune activation during HIV infection remains to be fully determined. APCs, the frontline of immune defense against pathogens, are capable of distinguishing between pathogens and non-pathogenic, commensal bacteria. We hypothesized that HIV infection induces dysfunction in APC immune recognition and response to some commensal bacteria and that this may promote chronic immune activation. Therefore we examined APC inflammatory cytokine responses to commensal lactobacilli. We found that APCs from HIV-infected patients produced an enhanced inflammatory response to Lactobacillus plantarum WCFS1 as compared to APCs from healthy, HIV-negative controls. Increased APC expression of TLR2 and CD36, signaling through p38-MAPK, and decreased expression of MAP kinase phosphatase-1 (MKP-1) in HIV infection was associated with this heightened immune response. Our findings suggest that chronic HIV infection enhances the responsiveness of APCs to commensal lactobacilli, a mechanism that may partly contribute to chronic immune activation.
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Affiliation(s)
- Lauren H. Nagy
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Irina Grishina
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Monica Macal
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Lauren A. Hirao
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - William K. Hu
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Sumathi Sankaran-Walters
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Christopher A. Gaulke
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Richard Pollard
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Jennifer Brown
- Department of Internal Medicine, University of California Davis, Davis, California, United States of America
| | - Maria Suni
- Becton Dickinson Biosciences, San Jose, California, United States of America
| | - Andreas J. Baumler
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
| | - Smita Ghanekar
- Becton Dickinson Biosciences, San Jose, California, United States of America
| | - Maria L. Marco
- Food Science and Technology University of California Davis, Davis, California, USA
| | - Satya Dandekar
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
- * E-mail:
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Honda A, Kashiwazaki K, Tsunoda T, Gallant JE, Brown TT. Short communication: CD4 cell count increases during successful treatment of Graves' disease with methimazole in HIV-infected patients on antiretroviral therapy. AIDS Res Hum Retroviruses 2012; 28:1627-9. [PMID: 22632156 DOI: 10.1089/aid.2011.0309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
With the increased survival of HIV-infected patients receiving antiretroviral therapy (ART), unexpected complications due to the untoward effect of antiretroviral agents or immunologic changes have been observed. Here, we report two cases of Graves' disease (GD) presenting with classic symptoms of hyperthyroidism occurring 44 and 47 months after ART initiation. Both patients had severe immune suppression prior to ART initiation (CD4 cell count≤50 cells/μL), with an increase on CD4 cell count to 354 and 329 cells/μL, respectively, at the time of GD diagnosis. Administration of methimazole (MMI) resulted in dramatic improvements in symptoms and thyroid function. In addition, CD4 cell count unexpectedly increased to >500 cells/μL within three months on MMI. Hyperthyroidism caused by GD has been increasingly reported following the initiation of ART and may be related to immune reconstitution. The mechanisms underlying the increases in CD4 cell count after successful treatment of GD with MMI require further investigation, but may be due to improved immune recovery with the correction of hyperthyroidism or a specific effect of MMI on immune function.
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Affiliation(s)
- Arata Honda
- Department of Clinical Laboratory, Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Tokyo, Japan
| | - Koichi Kashiwazaki
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Tokyo, Japan
| | - Takafumi Tsunoda
- Department of Infectious diseases, Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Tokyo, Japan
| | - Joel E. Gallant
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Fairman P, Angel JB. The effect of human immunodeficiency virus-1 on monocyte-derived dendritic cell maturation and function. Clin Exp Immunol 2012; 170:101-13. [PMID: 22943206 PMCID: PMC3444722 DOI: 10.1111/j.1365-2249.2012.04628.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 12/24/2022] Open
Abstract
Dendritic cells (DC) are mediators of the adaptive immune response responsible for antigen presentation to naive T cells in secondary lymph organs. Human immunodeficiency virus (HIV-1) has been reported to inhibit the maturation of DC, but a clear link between maturation and function has not been elucidated. To understand further the effects of HIV-1 on DC maturation and function, we expanded upon previous investigations and assessed the effects of HIV-1 infection on the expression of surface molecules, carbohydrate endocytosis, antigen presentation and lipopolysaccharide (LPS) responsiveness over the course of maturation. In vitro infection with HIV-1 resulted in an increase in the expression of DC-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) as well as decreases in maturation-induced CCR7 and major histocompatibility complex (MHC)-II expression. Retention of endocytosis that normally occurs with DC maturation as well as inhibition of antigen presentation to CD8(+) T cells was also observed. Mitogen-activated protein kinase (MAPK) responsiveness to LPS as measured by phosphorylation of p38, c-Jun N-terminal kinase (JNK) and extracellular-regulated kinase (ERK)1/2 was not affected by HIV-1 infection. In summary, in-vitro HIV-1 impairs DC maturation, as defined by cell surface protein expression, with selective alterations in mature DC function. Understanding the mechanisms of DC dysfunction in HIV infection will provide further insight into HIV immune pathogenesis.
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Affiliation(s)
- P Fairman
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Abstract
A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating antiretroviral therapy in HIV-infected patients is defined as immune reconstitution inflammatory syndrome (IRIS). Because of wide variation in clinical presentation and the still increasing spectrum of symptoms and etiologies reported, diagnosis remains problematic. Furthermore, no test is currently available to establish an IRIS diagnosis. Until a greater understanding of the syndrome is achieved in different regions of the world, clinicians need to remain vigilant when initiating ART and individualize therapy according to known treatment options for the specific infectious agent.
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Affiliation(s)
- Sanjay S Bosamiya
- Department of Dermatology, Surat Municipal Institute of Medical Education and Research, Umarwada, Surat, Gujarat, India
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Pathogenesis of the immune reconstitution inflammatory syndrome in HIV-infected patients. Curr Opin Infect Dis 2012; 25:312-20. [PMID: 22562000 DOI: 10.1097/qco.0b013e328352b664] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The immune reconstitution inflammatory syndrome (IRIS) is an important clinical complication in HIV-infected patients initiating antiretroviral therapy. This review focuses on the latest literature pertaining to the pathogenesis of IRIS. RECENT FINDINGS The clinical manifestations of IRIS are heterogeneous due to the variety of opportunistic infections that are associated with this inflammatory syndrome. However, the disproportionate inflammation is a defining hallmark for which common mechanisms are suspected. Lymphopenia-induced proliferation in the context of systemic immune activation, presence of high antigenic exposure and a wider availability of interleukin-7 contribute to the exacerbated immune response underlying IRIS. Defect in pathogen clearance by phagocytes might favor high pathogen burden, which in turn is thought to activate both innate immune cells and pathogen-specific T cells upon correction of the CD4 T-cell lymphopenia, predisposing to IRIS. This common scenario might be further invigorated by functional impairments among regulatory T cells. SUMMARY Further insight into the cellular mechanisms driving IRIS is urgently needed. Understanding the relative contribution of distinct effector and regulatory T-cell subsets, and innate immune components to IRIS is required to inspire future therapeutic approaches.
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McLeod DSA, Woods ML, Kandiah DA. Immune reconstitution inflammatory syndrome manifesting as development of multiple autoimmune disorders and skin cancer progression. Intern Med J 2012; 41:699-703. [PMID: 21899684 DOI: 10.1111/j.1445-5994.2011.02546.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 56-year-old man with the rare autoimmune pathologies of alternating hypothyroidism and hyperthyroidism due to thyroid-stimulating hormone receptor antibodies, and rheumatoid arthritis as manifestations of a human immunodeficiency virus-related immune reconstitution inflammatory syndrome. The patient also developed overt progression of a pre-existing skin malignancy that may also be related. This case highlights immune reconstitution syndrome as an important differential diagnosis following antiretroviral therapy commencement, and that a high index of suspicion should be maintained for this rare but important cluster of conditions. Furthermore, the patient's genetic predisposition to autoimmunity provides helpful insights into the pathogenesis of these disorders.
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Affiliation(s)
- D S A McLeod
- Department of Endocrinology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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26
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Cytomegalovirus retinitis associated with HIV in resource-constrained settings: systematic screening and case detection. Int Health 2012; 4:86-94. [DOI: 10.1016/j.inhe.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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HIV-1 matrix protein p17 binds to the IL-8 receptor CXCR1 and shows IL-8–like chemokine activity on monocytes through Rho/ROCK activation. Blood 2012; 119:2274-83. [DOI: 10.1182/blood-2011-06-364083] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AbstractExogenous HIV-1 matrix protein p17 was found to deregulate biologic activities of many different immune cells that are directly or indirectly involved in AIDS pathogenesis after binding to unknown cellular receptor(s). In particular, p17 was found to induce a functional program in monocytes related to activation and inflammation. In the present study, we demonstrate that CXCR1 is the receptor molecule responsible for p17 chemokine–like activity on monocytes. After CXCR1 binding, p17 was capable of triggering rapid adhesion and chemotaxis of monocytes through a pathway that involved Rho/ROCK. Moreover, CXCR1-silenced primary monocytes lost responsiveness to p17 chemoattraction, whereas CXCR1-transfected Jurkat cells acquired responsiveness. Surface plasmon resonance studies confirmed the capacity of p17 to bind CXCR1 and showed that the p17/CXCR1 interaction occurred with a low affinity compared with that measured for IL-8, the physiologic CXCR1 ligand. In all of its activities, p17 mimicked IL-8, the natural high-affinity ligand of CXCR1. Recent studies have highlighted the role of IL-8 and CXCR1 in HIV-1 replication and AIDS pathogenesis. Our findings herein call for an exploration of the therapeutic potential of blocking the p17/IL-8/CXCR1 axis in HIV-1 infection.
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Miró JM, Blanes M, Norman F, Martín-Dávila P. Infections in solid organ transplantation in special situations: HIV-infection and immigration. Enferm Infecc Microbiol Clin 2012; 30 Suppl 2:76-85. [DOI: 10.1016/s0213-005x(12)70086-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pozniak AL, Coyne KM, Miller RF, Lipman MCI, Freedman AR, Ormerod LP, Johnson MA, Collins S, Lucas SB. British HIV Association guidelines for the treatment of TB/HIV coinfection 2011. HIV Med 2011; 12:517-24. [PMID: 21951595 DOI: 10.1111/j.1468-1293.2011.00954.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A L Pozniak
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD, UK.
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Lawn SD, Meintjes G. Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy. Expert Rev Anti Infect Ther 2011; 9:415-30. [PMID: 21504399 DOI: 10.1586/eri.11.21] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The risks of unmasking and paradoxical forms of immune reconstitution disease in HIV-infected patients starting antiretroviral therapy (ART) are fuelled by a combination of the late presentation of patients with advanced immunodeficiency, the associated high rates of opportunistic infections (OIs) and the need for rapid initiation of ART to minimize overall mortality risk. We review the risk factors and our current knowledge of the immunopathogenesis of immune reconstitution disease, leading to a discussion of strategies for prevention. Initiation of ART at higher CD4 counts, use of OI-preventive therapies prior to ART eligibility, intensified screening for OIs prior to ART initiation and optimum therapy for OIs are all needed. In addition, use of a range of pharmacological agents with immunosuppressive and immunomodulatory activity is being explored.
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Affiliation(s)
- Stephen D Lawn
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Morris A, Crothers K, Beck JM, Huang L. An official ATS workshop report: Emerging issues and current controversies in HIV-associated pulmonary diseases. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2011; 8:17-26. [PMID: 21364216 PMCID: PMC5830656 DOI: 10.1513/pats.2009-047ws] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pulmonary diseases are major causes of morbidity and death in persons with HIV infection. Millions of people with HIV/AIDS throughout the world are at risk of opportunistic pneumonias such as tuberculosis, bacterial pneumonia, and Pneumocystis pneumonia. However, the availability of combination antiretroviral therapy has turned HIV into a chronic disease, and noninfectious lung diseases such as lung cancer, chronic obstructive pulmonary disease, and pulmonary arterial hypertension are also emerging as important causes of illness. Despite the importance of these diseases and the rapidly evolving understanding of their pathogenesis and epidemiology, few avenues exist for the discussion and dissemination of new clinical and basic insights. In May of 2008, the American Thoracic Society sponsored a 1-day workshop, "Emerging Issues and Current Controversies in HIV-Associated Pulmonary Diseases," which brought together basic and clinical researchers in HIV-associated pulmonary disease. A review of the literature was performed by workshop participants, and the workshop included 18 presentations on diverse topics summarized in this article.
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MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/drug therapy
- AIDS-Related Opportunistic Infections/epidemiology
- Anti-Bacterial Agents/therapeutic use
- Anti-HIV Agents/therapeutic use
- Antitubercular Agents/therapeutic use
- Comorbidity
- Female
- Humans
- Incidence
- Male
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Pneumocystis/diagnosis
- Pneumonia, Pneumocystis/drug therapy
- Pneumonia, Pneumocystis/epidemiology
- Practice Guidelines as Topic
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Societies, Medical
- Survival Rate
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- United States/epidemiology
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Burkitt's leukemia/lymphoma as a manifestation of HIV immune reconstitution inflammatory syndrome. A review: A propos of a case. HIV & AIDS REVIEW 2011. [DOI: 10.1016/j.hivar.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sugawara Y, Tamura S, Kokudo N. Liver transplantation in HCV/HIV positive patients. World J Gastrointest Surg 2011; 3:21-8. [PMID: 21394322 PMCID: PMC3052410 DOI: 10.4240/wjgs.v3.i2.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 01/15/2011] [Accepted: 01/21/2011] [Indexed: 02/06/2023] Open
Abstract
Since the introduction of highly active antiretroviral therapy (HAART) in 1996 for human immunodeficiency virus (HIV)-infected patients, the incidence of liver diseases secondary to co-infection with hepatitis C has increased. Although data on the outcome of liver transplantation in HIV-infected recipients is limited, the overall results to date seem to be comparable to that in non-HIV-infected recipients. Liver transplant centers are now accepting HIV-infected individuals as organ recipients. Post-transplantation HIV replication is controlled by HAART. Hepatitis C re-infection of the liver graft, however, remains an important problem because cirrhotic changes of the liver graft may be more rapid in HIV-infected recipients. Interactions between the HAART components and immunosuppressive drugs influence drug metabolism and therefore meticulous monitoring of drug blood level concentrations is required. The risk of opportunistic infection in HIV-positive transplant patients seems to be similar to that in HIV-negative transplant recipients.
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Affiliation(s)
- Yasuhiko Sugawara
- Yasuhiko Sugawara, Sumihito Tamura, Norihiro Kokudo, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Meys R, Macedo C, Jones R, Day S, Weir J, Gotch F, Bunker C. Cutaneous human papillomavirus-related immune reconstitution-associated disease in human immunodeficiency virus: an under-recognized phenomenon. Br J Dermatol 2011; 164:458-9. [DOI: 10.1111/j.1365-2133.2010.10109.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martin-Blondel G, Delobel P, Blancher A, Massip P, Marchou B, Liblau RS, Mars LT. Pathogenesis of the immune reconstitution inflammatory syndrome affecting the central nervous system in patients infected with HIV. Brain 2011; 134:928-46. [DOI: 10.1093/brain/awq365] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Pathai S, Gilbert C, Weiss HA, McNally M, Lawn SD. Differing spectrum of HIV-associated ophthalmic disease among patients starting antiretroviral therapy in India and South Africa. Trop Med Int Health 2011; 16:356-9. [PMID: 21371217 PMCID: PMC3128924 DOI: 10.1111/j.1365-3156.2010.02712.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Differences in the prevalence and spectrum of HIV-associated ophthalmic disease in Africa and Asia are not well documented. We studied two comparable cohorts of patients initiating antiretroviral therapy in Mumbai, India, and Cape Town, South Africa. The prevalence of HIV-associated ophthalmic disease was higher in the Indian population (17.5%) than in the South African population (12.1%). This was largely because of vitreo-retinal opportunistic infections (11.4%vs. 2.6%, respectively), notably cytomegalovirus retinitis. This difference persisted after adjusting for confounding factors (adjusted odds ratio = 11.32, 95% confidence interval: 2.67–48.13), confirming a marked geographical difference in the prevalence of HIV-associated retinal disease.
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Affiliation(s)
- Sophia Pathai
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK.
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Pericardial Large B-Cell Lymphoma as a Manifestation of HIV Immune Reconstitution Inflammatory Syndrome. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181c5f69f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stellbrink HJ, Baldus S, Behrens G, Bogner JR, Harrer T, Hoffmann C, van Lunzen J, Münch J, Racz P, Scheller C, Stoll M, Tenner-Racz K, Rockstroh J. HIV-induced immune activation: pathogenesis and clinical relevance - summary of a workshop organized by the German AIDS Society (DAIG e.v.) and the ICH Hamburg, Hamburg, Germany, November 22, 2008. Eur J Med Res 2010; 15:1-12. [PMID: 20159665 PMCID: PMC3351841 DOI: 10.1186/2047-783x-15-1-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This manuscript is communicated by the German AIDS Society (DAIG) http://www.daignet.de. It summarizes a series of presentations and discussions during a workshop on immune activation due to HIV infection. The workshop was held on November 22nd 2008 in Hamburg, Germany. It was organized by the ICH Hamburg under the auspices of the German AIDS Society (DAIG e.V.).
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Caby F, Lemercier D, Coulomb A, Grigorescu R, Paris L, Touafek F, Carcelain G, Canestri A, Pauchard M, Katlama C, Dommergues M, Tubiana R. Fetal death as a result of placental immune reconstitution inflammatory syndrome. J Infect 2010; 61:185-8. [PMID: 20361998 DOI: 10.1016/j.jinf.2010.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 03/17/2010] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
A 26-year-old woman was HIV-1 diagnosed at 11 weeks of pregnancy (CD4 = 7/mm(3), HIV-1 RNA = 108,000 copies/mL) with immunity against toxoplasmosis (Toxoplasma IgG = 1800 UI/mL). A fetal death was diagnosed 7 weeks after starting HAART (CD4 = 185/mm(3), HIV-1 RNA = 391 copies/mL) with a positive Toxoplasma PCR on fetal tissues and amniotic fluid. The absence of severe toxoplasmic foetopathy, the very exaggerated and atypical placental inflammation and the immune restoration context led to the diagnosis of placental IRIS associated with Toxoplasma gondii reactivation. This outcome remains undescribed and could represent an issue in resource-limited settings where HIV-pregnant patients are often severely immunodeficient and infected with opportunistic pathogens.
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Affiliation(s)
- F Caby
- Service des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Assistance publique des hôpitaux de Paris (AP-HP), Paris, France.
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Crothers K, Huang L. Pulmonary complications of immune reconstitution inflammatory syndromes in HIV-infected patients. Respirology 2009; 14:486-94. [PMID: 19192228 DOI: 10.1111/j.1440-1843.2008.01468.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Immune reconstitution inflammatory syndrome (IRIS) describes a paradoxical worsening of clinical status related to recovery of the immune system, as can occur after the initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients. Most commonly, IRIS results from opportunistic infections that can unmask or develop paradoxical worsening following HAART. Cancers, autoimmune conditions and sarcoidosis have also been associated with IRIS. Pulmonary complications may be frequently encountered. This article reviews the types and clinical presentation of IRIS, with a focus on the pulmonary manifestations. Management and outcome of IRIS are considered.
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Affiliation(s)
- Kristina Crothers
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Abstract
Reconstitution Graves' disease occurs in three settings. First, bone marrow transplantation from a donor with Graves' disease may cause this disease to appear in the recipient, as a result of adoptive immunity, although disordered immunoregulation secondary to graft-versus-host disease may also play a role. Second, alemtuzumab treatment for multiple sclerosis leads to the development of Graves' disease in up to a third of patients during the phase of naive T-cell expansion, which follows therapeutic lymphocyte depletion. Other reconstitution autoimmune phenomena, including immune thrombocytopaenic purpura, are also recognised after alemtuzumab administration. Finally, reconstitution Graves' disease may occur during a similar phase of CD4(+) T-cell expansion, which follows highly active antiretroviral therapy for human immunodeficiency virus infection. Again, this complication is part of a broader spectrum of immunoregulatory disturbances, which can arise after immune reconstitution. The mechanisms responsible for reconstitution Graves' disease are at present unclear, but may include a relative bias towards a Th2-mediated immune response and reduced competition for autoreactive lymphocytes to expand during the time when recovery from lymphopenia commences.
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Affiliation(s)
- Anthony Weetman
- School of Medicine, Beech Hill Road, Sheffield, S10 2RX, UK.
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Mori S, Levin P. A brief review of potential mechanisms of immune reconstitution inflammatory syndrome in HIV following antiretroviral therapy. Int J STD AIDS 2009; 20:447-52. [PMID: 19541884 DOI: 10.1258/ijsa.2009.008521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A subset of HIV-infected individuals who receive antiretroviral therapy (ART) develop a paradoxical pathological response that significantly increases morbidity and sometimes mortality. Following the induction of highly active ART, a rapid decline in the viral load results within weeks and coincides with a steep rise in the CD4(+) T-cell counts and immune hyperactivation. Although no mechanistic pathway has been elucidated for the development of immune reconstitution inflammatory syndrome (IRIS), it is thought that change in the nature of the immune response is a predominant factor in the development of reconstitution disease. In this article, we review the current state of knowledge in this field and provide a model for the development of IRIS.
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Affiliation(s)
- S Mori
- The University of Texas Health Sciences Center, Houston, Internal Medicine Program, Houston, Texas, USA.
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Reyes-Corcho A, Bouza-Jiménez Y. [Human immunodeficiency virus and AIDS-associated immune reconstitution syndrome. State of the art]. Enferm Infecc Microbiol Clin 2009; 28:110-21. [PMID: 19632745 DOI: 10.1016/j.eimc.2009.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 03/20/2009] [Accepted: 03/27/2009] [Indexed: 01/27/2023]
Abstract
Since the arrival of highly active antiretroviral therapy (HAART), immune reconstitution syndrome (IRS) has become an increasingly more frequent complication in patients with human immunodeficiency virus (HIV) infection. This article presents a review of the available evidence on this subject, indexed in MEDLINE-PUBMED, BVS-BIREME, and BioMed Central. The review covers the definition, epidemiology, classification, and diagnostic criteria related to IRS. In addition, the clinical particularities of the most frequent etiologies are described, and a proposal for a therapeutic approach is formulated. The prognosis and future implications of this syndrome in the epidemiology of some infectious illnesses in the HIV-positive population are included. Several unresolved aspects are mentioned, such as those related to the pathophysiology of the condition, use of biomarkers for the diagnosis, and the need for evidence-based therapeutic algorithms to enable standardization of treatment for these patients.
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Affiliation(s)
- Andrés Reyes-Corcho
- Servicio de Enfermedades Infecciosas, Hospital Universitario Dr. Gustavo Aldereguía Lima, Cienfuegos, Cuba
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Vos F, Pieters G, Keuter M, van der Ven A. Graves' disease during immune reconstitution in HIV-infected patients treated with HAART. ACTA ACUST UNITED AC 2009; 38:124-6. [PMID: 16449004 DOI: 10.1080/00365540500348960] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Autoimmune phenomena after immune recovery due to HAART are not frequently described. Recently we found 3 patients with Graves' disease after starting HAART, outnumbering the expected incidence; 13 patients have been reported in the literature up to the present time.A probable relation between immune restoration and development of Graves' disease might be suspected.
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Affiliation(s)
- F Vos
- Department of Endocrinology, Radboud University of Nijmen Medical Centre, The Netherlands.
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Meys R, Gotch FM, Bunker CB. Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution-associated disease? Br J Dermatol 2009; 162:6-11. [PMID: 19709102 DOI: 10.1111/j.1365-2133.2009.09365.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.
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Affiliation(s)
- R Meys
- Department of Dermatology, Chelsea and Westminster Hospital, Imperial College, 369 Fulham Rd, London SW10 9NH, UK
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Atzori L, Pinna AL, Pilloni L, Ferreli C, Pau M, Aste N. Bullous skin eruption in an HIV patient during antiretroviral drugs therapy. Dermatol Ther 2008; 21 Suppl 2:S30-4. [PMID: 18837731 DOI: 10.1111/j.1529-8019.2008.00230.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermo-epidermal blistering is an uncommon presentation of adverse drug reactions. Several drugs are associated to such eruptions, but review of current knowledge does not list antiretroviral drugs. A 37-year-old Caucasian HIV-positive woman presented with a 6-week history of diffuse annular blistering affecting the trunk and limbs. Lesions appeared both on erythematous and normal-appearing skin. The patient was in treatment with antiretroviral (lamivudine + didanosine + nelfinavir) for 2 years. A history of previous adverse reactions to betalactams, nonsteroidal anti-inflammatory drugs, and a nevirapine-induced hepatitis was also referred. Histopathology showed a dermo-epidermal blister; direct immunofluorescence was positive for IgG, C3c at the basement membrane zone; enzyme-linked immunosorbent assay was positive for BP180 antigen. Oral prednisone 1 mg/kg daily for 20 days led to poor improvement. Discontinuation of the antiretrovirals was followed by a rapid healing. Blisters reappeared at first re-introduction essay 1 month later. Awareness of iatrogenic dermo-epidermal blistering is necessary to suspect the diagnosis and avoid long-term immunosuppressant treatment. Complete spontaneous recovery after withdrawal of the responsible drug and relapse at rechallenge are the main criteria for the diagnosis. Factors related to the state of the HIV infection, and/or immunodeficiency may have contributed in precipitating the reaction in the present authors' case.
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Affiliation(s)
- Laura Atzori
- Dermatology Department, University of Cagliari, Italy.
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47
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Tan DBA, Yong YK, Tan HY, Kamarulzaman A, Tan LH, Lim A, James I, French M, Price P. Immunological profiles of immune restoration disease presenting as mycobacterial lymphadenitis and cryptococcal meningitis. HIV Med 2008; 9:307-16. [PMID: 18400078 DOI: 10.1111/j.1468-1293.2008.00565.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy in Kuala Lumpur, Malaysia. METHODS Peripheral blood mononuclear cells were collected at weeks 0, 6, 12, 24 and 48 of ART from five patients experiencing IRD [two with cryptococcal and three with Mycobacterium tuberculosis (Mtb) disease], eight non-IRD controls who had begun ART with CD4 T-cell counts of <100 cells/microL and 17 healthy controls. Leukocytes producing interferon-gamma (IFNgamma) were quantified by enzyme-linked immunospot assay after stimulation with purified protein derivative (PPD), early secretory antigenic target-6 (ESAT-6), Cryptococcus neoformans or Cytomegalovirus antigens. Plasma immunoglobulin (IgG) antibodies reactive with these antigens were assessed by enzyme-linked immunosorbent assay. Proportions of activated (HLA-DR(hi)) and regulatory (CD25 CD127(lo) and CTLA-4(+)) CD4 T-cells were quantified by flow cytometry. RESULTS Plasma HIV RNA declined and CD4 T-cell counts rose within 8-27 weeks on ART. Mtb IRD patients displayed elevated IFNgamma responses and/or plasma IgG to PPD, but none responded to ESAT-6. Cryptococcal IRD occurred in patients with low baseline CD4 T-cell counts and involved clear IFNgamma and antibody responses to cryptococcal antigen. Proportions of activated and regulatory CD4 T-cells declined on ART, but remained higher in patients than in healthy controls. At the time of IRD, proportions of activated CD4 T-cells and regulatory CD4 T-cells were generally elevated relative to other patients. CONCLUSIONS Cryptococcal and Mtb IRD generally coincide with peaks in the proportion of activated T-cells, pathogen-specific IFNgamma responses and reactive plasma IgG. IRD does not reflect a paucity of regulatory CD4 T-cells.
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Affiliation(s)
- D B A Tan
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
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Maganti RM, Reveille JD, Williams FM. Therapy Insight: the changing spectrum of rheumatic disease in HIV infection. ACTA ACUST UNITED AC 2008; 4:428-38. [DOI: 10.1038/ncprheum0836] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 04/25/2008] [Indexed: 11/10/2022]
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50
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Dhasmana DJ, Dheda K, Ravn P, Wilkinson RJ, Meintjes G. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy : pathogenesis, clinical manifestations and management. Drugs 2008; 68:191-208. [PMID: 18197725 DOI: 10.2165/00003495-200868020-00004] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The use of antiretroviral therapy (ART) to treat HIV infection, by restoring CD4+ cell count and immune function, is associated with significant reductions in morbidity and mortality. Soon after ART initiation, there is a rapid phase of restoration of pathogen-specific immunity. In certain patients, this results in inflammatory responses that may result in clinical deterioration known as 'the immune reconstitution inflammatory syndrome' (IRIS). IRIS may be targeted at viable infective antigens, dead or dying infective antigens, host antigens, tumour antigens and other antigens, giving rise to a heterogeneous range of clinical manifestations. The commonest forms of IRIS are associated with mycobacterial infections, fungi and herpes viruses. In most patients, ART should be continued and treatment for the associated condition optimized, and there is anecdotal evidence for the use of corticosteroids in patients who are severely affected. In this review, we discuss research relating to pathogenesis, the range of clinical manifestations, treatment options and prevention issues.
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Affiliation(s)
- Devesh J Dhasmana
- Department of Respiratory Medicine, Harefield Hospital, Middlesex, UK
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