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Bouba Y, Armenia D, Forbici F, Bertoli A, Borghi V, Gagliardini R, Vergori A, Cicalini S, Mazzotta V, Malagnino V, Lichtner M, Latini A, Mussini C, Andreoni M, Antinori A, Perno CF, Ceccherini-Silberstein F, Santoro MM. Genotypic HIV-1 tropism determination might help to identify people with exhausted treatment options and advanced disease. J Antimicrob Chemother 2021; 76:3272-3279. [PMID: 34529797 DOI: 10.1093/jac/dkab322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate HIV-1 tropism in 1382 combined antiretroviral therapy (cART)-experienced patients failing therapy to characterize those with exhausted therapeutic options. METHODS HIV-1 genotypic tropism was inferred through Geno2Pheno by estimating the false-positive-rate (FPR) values. Cumulative resistance and drug activity were evaluated by Stanford algorithm. RESULTS Overall, median (IQR) CD4 count (cells/mm3) nadir and at last genotypic resistance test (GRT) available were 98 (33-211) and 312 (155-517), respectively. Considering HIV-1 tropism, 30.5% had X4/dual-mixed strains (FPR ≤5%: 22.2%; FPR 5%-10%: 8.3%). By stratifying according to tropism, by decreasing FPR, a significant decrease of CD4 nadir and at last GRT was observed. The proportion of individuals with CD4 count <200 cells/mm3, who were perinatally infected and with a long treatment history significantly increased as FPR levels decreased. Regarding resistance, 933 (67.5%) individuals accumulated at least one class resistance, with 52.7%, 48.2%, 23.5% and 13.2% of individuals showing resistance to NRTIs, NNRTIs, PIs and INIs; while 23.2%, 27.2%, 14.3% and 2.8% harboured resistance to 1, 2, 3 and 4 classes, respectively. Individuals with FPR ≤5% showed a significantly higher level of resistance to PIs, NRTIs and INIs compared with others. The proportion of individuals harbouring strains susceptible to ≤2 active drugs was only about 2%; nonetheless, this proportion doubled (4.6%) in patients infected with FPR ≤5%. CONCLUSIONS Our findings showed that a small proportion of cART failing individuals have limited therapeutic options. However, tropism determination might help to identify people who have accumulated a high level of resistance and have a greater risk of advanced disease.
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Affiliation(s)
- Yagai Bouba
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.,Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Daniele Armenia
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy.,Saint Camillus International, University of Health Sciences, Rome, Italy
| | - Federica Forbici
- Laboratory of Virology, INMI 'Lazzaro Spallanzani'-IRCCS, Rome, Italy
| | - Ada Bertoli
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy.,Laboratory of Virology, University Hospital 'Tor Vergata', Rome, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | - Vincenzo Malagnino
- Clinical Infectious Diseases, University Hospital, 'Tor Vergata', Rome, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, 'Sapienza' University, Polo Pontino, Latina, Italy
| | - Alessandra Latini
- Unit of Dermatology and Sexually Transmitted Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, University Hospital, 'Tor Vergata', Rome, Italy
| | - Andrea Antinori
- Clinical Department, INMI 'Lazzaro Spallanzani'-IRCCS, Rome, Italy
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Changes in cerebral function parameters with maraviroc-intensified antiretroviral therapy in treatment naive HIV-positive individuals. AIDS 2018; 32:1007-1015. [PMID: 29438199 DOI: 10.1097/qad.0000000000001786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Maraviroc-intensified antiretroviral therapy (ART) may be associated with cognitive benefits. METHODS Therapy-naive, cognitively asymptomatic, HIV-positive individuals were randomly allocated on a 1 : 1 basis to standard ART (Arm1: tenofovir-emtricitabine and atazanavir/ritonavir) or maraviroc intensified ART (Arm2: abacavir-lamivudine and darunavir/ritonavir/maraviroc). Over 48 weeks, detailed assessments of cognitive function tests were undertaken and cerebral metabolites measured using proton magnetic resonance spectroscopy. Our primary endpoint was mean change in cognitive function across treatment arms with factors associated with cognitive function changes also assessed. RESULTS Of 60 individuals randomized (30 Arm1 and 30 Arm2), 58 were men and 44 of white ethnicity. Treatment groups had similar disease characteristics including overall mean (SD) baseline CD4 cell count 428 (209) and 414 (229) cells/μl, Arms1 and 2, respectively. At week 48, plasma HIV RNA was less than 50 copies/ml in 55 of 56 of those completing study procedures. Cognitive function improved over 48 weeks [mean change z-score (SD) 0.16 (0.09) Arm1 and 0.25 (0.08) Arm2, P = 0.96 for differences between study arms]. A greater increase in frontal grey matter N-acetyl aspartate/creatine ratio was observed in Arm1 [ratio change of 0.071 (SD 0.16)] versus Arm2 [change -0.097 (SD 0.18), P = 0.009], although this was not associated with changes in cognitive function (P = 0.17). CONCLUSION Maraviroc-intensified ART had no demonstrable benefit on cognitive function in individuals initiating ART. Greater improvement in neuronal metabolites (N-acetyl aspartate/creatine) was observed with standard ART. Future work should focus on maraviroc-intensified ART in individuals with cognitive impairment.
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Fokam J, Bellocchi MC, Armenia D, Nanfack AJ, Carioti L, Continenza F, Takou D, Temgoua ES, Tangimpundu C, Torimiro JN, Koki PN, Fokunang CN, Cappelli G, Ndjolo A, Colizzi V, Ceccherini-Silberstein F, Perno CF, Santoro MM. Next-generation sequencing provides an added value in determining drug resistance and viral tropism in Cameroonian HIV-1 vertically infected children. Medicine (Baltimore) 2018; 97:e0176. [PMID: 29595649 PMCID: PMC5895385 DOI: 10.1097/md.0000000000010176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With limited and low-genetic barrier drugs used for the prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa, vertically transmitted HIV-1 drug-resistance (HIVDR) is concerning and might prompt optimal pediatric strategies.The aim of this study was to ascertain HIVDR and viral-tropism in majority and minority populations among Cameroonian vertically infected children.A comparative analysis among 18 HIV-infected children (7 from PMTCT-exposed mothers and 11 from mothers without PMTCT-exposure) was performed. HIVDR and HIV-1 co-receptor usage was evaluated by analyzing sequences obtained by both Sanger sequencing and ultra-deep 454-pyrosequencing (UDPS), set at 1% threshold.Overall, median (interquartile range) age, viremia, and CD4 count were 6 (4-10) years, 5.5 (4.9-6.0) log10 copies/mL, and 526 (282-645) cells/mm, respectively. All children had wild-type viruses through both Sanger sequencing and UDPS, except for 1 PMTCT-exposed infant harboring minority K103N (8.31%), born to a mother exposed to AZT+3TC+NVP. X4-tropic viruses were found in 5 of 15 (33.3%) children (including 2 cases detected only by UDPS). Rate of X4-tropic viruses was 0% (0/6) below 5 years (also as minority species), and became relatively high above 5 years (55.6% [5/9], P = .040. X4-tropic viruses were higher with CD4 ≤15% (4/9 [44.4%]) versus CD4 >15% (1/6 [16.7%], P = .580); similarly for CD4 ≤200 (3/4 [75%]) versus CD4 >200 (2/11 [18.2%] cells/mm, P = .077.NGS has the ability of excluding NRTI- and NNRTI-mutations as minority species in all but 1 children, thus supporting the safe use of these drug-classes in those without such mutations, henceforth sparing ritonavir-boosted protease inhibitors or integrase inhibitors for the few remaining cases. In children under five years, X4-tropic variants would be rare, suggesting vertical-transmission with CCR5-tropic viruses and possible maraviroc usage at younger ages.
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Affiliation(s)
- Joseph Fokam
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- University of Rome Tor Vergata, Rome, Italy
- University of Yaounde I
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
| | | | | | - Aubin J. Nanfack
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- New York University School of Medicine, New York, NY
| | | | - Fabio Continenza
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Desire Takou
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | - Edith S. Temgoua
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | - Charlotte Tangimpundu
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | - Judith N. Torimiro
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- University of Yaounde I
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
| | - Paul N. Koki
- University of Yaounde I
- Mother-Child Center, Chantal BIYA Foundation, Yaounde
| | | | | | - Alexis Ndjolo
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- University of Yaounde I
| | - Vittorio Colizzi
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- University of Rome Tor Vergata, Rome, Italy
- UNESCO Board of Multidisciplinary Biotechnology, Rome, Italy
| | | | - Carlo-Federico Perno
- Chantal Biya International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- University of Rome Tor Vergata, Rome, Italy
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Fraser-Taliente T, Mackie NE, Kaye S, Nyirenda M, Foster C. Off-licence use of once-daily maraviroc in children and adolescents with perinatally acquired HIV-1 infection. HIV Med 2016; 18:311-313. [PMID: 27981720 DOI: 10.1111/hiv.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - N E Mackie
- Imperial College Healthcare NHS Trust, London, W2 1NY
| | - S Kaye
- Imperial College, London, W2 1NY
| | - M Nyirenda
- Imperial College Healthcare NHS Trust, London, W2 1NY
| | - C Foster
- Imperial College Healthcare NHS Trust, London, W2 1NY
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