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Chen M, Liu C, Xie J, Tang X, Zhang Y, Pan D, Zhong H, Du P, Li Q, Li L, Gu J, Cai W. Effectiveness of integrase strand transfer inhibitors among treatment-naive people living with HIV/AIDS in Guangdong, China: A real-world, retrospective cohort study. Medicine (Baltimore) 2024; 103:e38497. [PMID: 38847660 PMCID: PMC11155602 DOI: 10.1097/md.0000000000038497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
Integrase strand transfer inhibitors (INSTIs) in anti-retroviral therapy (ART) have been recommended by the World Health Organization for their higher efficacy, favorable safety and tolerability. However, the clinical evidence supporting switching to INSTI-containing regimens in low-and-middle-income countries (LMICs) is limited, as few patients have access to these regimens. We aimed to assess the effectiveness of INSTI-containing regimens in real-world settings in China compared to government-provided free ART. We compared the short-term (first 4 mo following ART initiation) and long-term (1 year after ART initiation) effectiveness between INSTI-containing regimens and free ART drugs provided by the Chinese government in 4 dimensions: viral suppression status, immune response, liver and kidney function, and AIDS-related diseases. We obtained data from electronic medical records in the National Infectious Disease Surveillance System. To control baseline confounders, we used propensity score matching (PSM), calculated using logistic regression including socio-demographic and baseline factors. Among 12,836 patients from 2012 to 2019, 673 (5.2%) used INSTI-containing regimens. Patients with INSTI-containing regimens were matched to those with free drugs (644 vs 644). For short-term effectiveness, patients initiating INSTI-containing regimens were more likely to achieve viral suppression (81.4% vs 52.0%; P < .001). The differences in immune response, liver and kidney function and AIDS-related diseases were not significant between the 2 groups. For long-term effectiveness, viral suppression rates were similar (87.96% vs 84.59%; P = .135), with no significant differences in immune response, liver and kidney function, or AIDS-related diseases. Our study suggests that patients initiating ART with INSTI-containing regimens have worse physical status at baseline than patients starting with free ART drugs. Furthermore, we found better virological performances of INSTI-containing regimens in the short-term but not in the long-term due to a high rate of drug changes. Our findings have clinical implications and provide new evidence regarding the effectiveness of INSTI-containing regimens in LMICs.
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Affiliation(s)
- Mingyu Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Cong Liu
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jinzhao Xie
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoping Tang
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yao Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Deng Pan
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Haidan Zhong
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Peishan Du
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Quanmin Li
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Weiping Cai
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Chen X, Ma B, Yang Y, Zhang M, Xu F. Predicting the potentially exacerbation of severe viral pneumonia in hospital by MuLBSTA score joint CD4 + and CD8 +T cell counts: construction and verification of risk warning model. BMC Pulm Med 2024; 24:261. [PMID: 38811907 PMCID: PMC11137986 DOI: 10.1186/s12890-024-03073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE This study mainly focuses on the immune function and introduces CD4+, CD8+ T cells and their ratios based on the MuLBSTA score, a previous viral pneumonia mortality risk warning model, to construct an early warning model of severe viral pneumonia risk. METHODS A retrospective single-center observational study was operated from January 2021 to December 2022 at the People's Hospital of Liangjiang New Area, Chongqing, China. A total of 138 patients who met the criteria for viral pneumonia in hospital were selected and their data, including demographic data, comorbidities, laboratory results, CT scans, immunologic and pathogenic tests, treatment regimens, and clinical outcomes, were collected and statistically analyzed. RESULTS Forty-one patients (29.7%) developed severe or critical illness. A viral pneumonia severe risk warning model was successfully constructed, including eight parameters: age, bacterial coinfection, CD4+, CD4+/CD8+, multiple lung lobe infiltrations, smoking, hypertension, and hospital admission days. The risk score for severe illness in patients was set at 600 points. The model had good predictive performance (AUROC = 0.94397), better than the original MuLBSTA score (AUROC = 0.8241). CONCLUSION A warning system constructed based on immune function has a good warning effect on the risk of severe conversion in patients with viral pneumonia.
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Affiliation(s)
- Xi Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
- Department of Critical Care Medicine, People's Hospital of Chongqing Liangjiang New Area, Chongqing, 401120, China
| | - Bei Ma
- Department of Critical Care Medicine, People's Hospital of Chongqing Liangjiang New Area, Chongqing, 401120, China
| | - Yu Yang
- Department of Critical Care Medicine, People's Hospital of Chongqing Liangjiang New Area, Chongqing, 401120, China
| | - Mu Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Fang Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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van Santen DK, Stewart A, Doyle JS, Stoové MA, Asselin J, Klein MB, Young J, Berenguer J, Jarrin I, Lacombe K, Wittkop L, Leleux O, Salmon D, Bonnet F, Rauch A, Mugglin C, Matthews G, Prins M, Smit C, Boyd A, van der Valk M, Sacks-Davis R, Hellard ME. Cohort Profile: International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Int J Epidemiol 2024; 53:dyad154. [PMID: 38066671 PMCID: PMC10859136 DOI: 10.1093/ije/dyad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, Alfred and Monash University, Melbourne, VIC, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Inmaculada Jarrin
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Karine Lacombe
- Sorbonne Université, Inserm, IPLESP, Paris, France
- St Antoine Hospital, APHP, Paris, France
| | - Linda Wittkop
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Service d’information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
- INRIA SISTM team, Talence, France
| | - Olivier Leleux
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Fabrice Bonnet
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Service d’information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Hôpital Saint-André, Service de Médecine Interne et Maladies Infectieuses, F-33000 Bordeaux, France
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Catrina Mugglin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gail Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Marc van der Valk
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Infectious Diseases, Amsterdam, The Netherlands
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Department of Infectious Diseases, Alfred and Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
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Borjabad B, Inciarte A, Chivite I, Gonzalez-Cordon A, Mosquera M, Hurtado C, Rovira C, Gonzalez T, Sempere A, Torres B, Calvo J, De La Mora L, Martinez-Rebollar M, Laguno M, Foncillas A, Ambrosioni J, Blanch J, Rodriguez A, Solbes E, Llobet R, Berrocal L, Mallolas J, Miro JM, Alcami J, Blanco JL, Sanchez-Palomino S, De Lazzari E, Martinez E. Efficacy and safety of raltegravir plus lamivudine maintenance therapy. J Antimicrob Chemother 2024; 79:255-261. [PMID: 38039097 DOI: 10.1093/jac/dkad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Decreasing medication burden with raltegravir plus lamivudine in virologically suppressed persons with HIV (PWH) maintained efficacy and was well tolerated at 24 weeks, but more comprehensive data over longer follow-up are required. METHODS Prospective 48 week extension phase of the raltegravir plus lamivudine arm from a previous 24 week pilot randomized clinical trial in which virologically suppressed PWH were randomized 2:1 to switch to fixed-dose combination 150 mg lamivudine/300 mg raltegravir twice daily or to continue therapy. In this 48 week extension phase, raltegravir was dosed at 1200 mg/day and lamivudine 300 mg/day. Primary outcome was the proportion of PWH with treatment failure at Week 48. Secondary outcomes were changes in ultrasensitive plasma HIV RNA, HIV DNA in CD4 cells, serum IL-6, ultrasensitive C-reactive protein and sCD14, body composition, sleep quality, quality of life and adverse effects. RESULTS Between May 2018 and June 2019, 33 PWH were enrolled. One participant experienced virological failure without resistance mutations and re-achieved sustained virological suppression without therapy discontinuation, and two others discontinued therapy due to adverse effects. Treatment failure was 9% (95% CI 2%-24%) and 3% (95% CI 0%-17%) in the ITT and on-treatment populations. There were significant changes between baseline and Week 48 in serum cytokines but not in other secondary outcomes. CONCLUSIONS Switching to raltegravir and lamivudine in PWH with virological suppression maintains efficacy and is well tolerated. This maintenance regimen might be a cost-effective option for PWH at risk of drug-drug interactions or needing to avoid specific toxicities of certain antiretroviral drugs or their negative impact on comorbidities.
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Affiliation(s)
- Beatriz Borjabad
- Internal Medicine Service, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Ivan Chivite
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Ana Gonzalez-Cordon
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Mosquera
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Hurtado
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Cristina Rovira
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Tania Gonzalez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Abiu Sempere
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Calvo
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Lorena De La Mora
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Martinez-Rebollar
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Foncillas
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Blanch
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari de Santa Maria, Lleida, Spain
- CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Rodriguez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Roger Llobet
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Leire Berrocal
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M Miro
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Alcami
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Acquired Immunodeficiency Syndrome (AIDS) Immunopathology Unit, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Spain
| | - Jose L Blanco
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonsoles Sanchez-Palomino
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa De Lazzari
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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5
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Rohani R, Malakismail J, Njoku E. Pharmacological and Behavioral Interventions to Mitigate Premature Aging in Patients with HIV. Curr HIV/AIDS Rep 2023; 20:394-404. [PMID: 37917387 DOI: 10.1007/s11904-023-00677-7] [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] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE OF REVIEW We sought to review pharmacological and behavioral interventions that have been publicly presented, published, or are currently ongoing to prevent or mitigate the effect of premature HIV-associated comorbidities. RECENT FINDINGS Multiple studies have been conducted in hopes of finding an effective intervention. While the choice of antiretroviral regimen influences recovery of immune function, several drugs used as adjunct treatments have proven effective to mitigate premature aging. Additionally, few behavioral interventions have exhibited some efficacy. Statins, angiotensin-receptor blockers, and anti-hyperglycemic agents as well as optimal adherence, exercise, and intermittent fasting among others have had beneficial impact on markers of immune activation and levels of inflammatory biomarkers. However, several investigations had inconclusive outcomes so further studies with larger sample sizes are warranted.
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Affiliation(s)
- Roxane Rohani
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road BSB 3.266, North Chicago, IL, USA.
- Department of Pharmacy, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA.
| | - Jacob Malakismail
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Emmanuel Njoku
- Section of Infectious Disease, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA
- Discipline of Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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6
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Suanzes P, Navarro J, Rando-Segura A, Álvarez-López P, García J, Descalzo V, Monforte A, Arando M, Rodríguez L, Planas B, Burgos J, Curran A, Buzón MJ, Falcó V. Impact of very early antiretroviral therapy during acute HIV infection on long-term immunovirological outcomes. Int J Infect Dis 2023; 136:100-106. [PMID: 37726066 DOI: 10.1016/j.ijid.2023.09.009] [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: 06/06/2023] [Revised: 08/26/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES We aimed to determine if starting antiretroviral therapy (ART) in the first 30 days after acquiring HIV infection has an impact on immunovirological response. METHODS Observational, ambispective study including 147 patients with confirmed acute HIV infection (January/1995-August/2022). ART was defined as very early (≤30 days after the estimated date of infection), early (31-180 days), and late (>180 days). We compared time to viral suppression (viral load [VL] <50 copies/ml) and immune recovery (IR) (CD4+/CD8+ ratio ≥1) according to the timing and type of ART using survival analysis. RESULTS ART was started in 140 (95.2%) patients. ART was very early in 24 (17.1%), early in 77 (55.0%), and late in 39 (27.9%) cases. Integrase strand transfer inhibitor (INSTI)-based regimens were the most used in both the overall population (65%) and the very early ART group (23/24, 95.8%). Median HIV VL and CD4+/CD8+ ratio pre-ART were higher in the very early ART group (P <0.05). Patients in the very early and early ART groups and treated with INSTI-based regimens achieved IR earlier (P <0.05). Factors associated with faster IR were the CD4+/CD8+ ratio pre-ART (hazard ratio: 9.3, 95% CI: 3.1-27.8, P <0.001) and INSTI-based regimens (hazard ratio: 2.4, 95% CI: 1.3-4.2, P = 0.003). CONCLUSIONS The strongest predictors of IR in patients who start ART during AHI are the CD4+/CD8+ ratio pre-ART and INSTI-based ART regimens.
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Affiliation(s)
- Paula Suanzes
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Navarro
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Ariadna Rando-Segura
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Patricia Álvarez-López
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jorge García
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Vicente Descalzo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Arnau Monforte
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maider Arando
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lucía Rodríguez
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bibiana Planas
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joaquín Burgos
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María José Buzón
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Taramasso L, Andreoni M, Antinori A, Bandera A, Bonfanti P, Bonora S, Borderi M, Castagna A, Cattelan AM, Celesia BM, Cicalini S, Cingolani A, Cossarizza A, D'Arminio Monforte A, D'Ettorre G, Di Biagio A, Di Giambenedetto S, Di Perri G, Esposito V, Focà E, Gervasoni C, Gori A, Gianotti N, Guaraldi G, Gulminetti R, Lo Caputo S, Madeddu G, Maggi P, Marandola G, Marchetti GC, Mastroianni CM, Mussini C, Perno CF, Rizzardini G, Rusconi S, Santoro M, Sarmati L, Zazzi M, Maggiolo F. Pillars of long-term antiretroviral therapy success. Pharmacol Res 2023; 196:106898. [PMID: 37648103 DOI: 10.1016/j.phrs.2023.106898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies. METHODS With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care. RESULTS Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people's satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed. CONCLUSIONS Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.
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Affiliation(s)
- Lucia Taramasso
- IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy.
| | | | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Bonfanti
- Università degli Studi di Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori - Monza, Monza, Italy
| | - Stefano Bonora
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Marco Borderi
- Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefania Cicalini
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | | | | | | | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases AOU Policlinico Umberto I Sapienza, Rome, Italy
| | - Antonio Di Biagio
- Department of Health Sciences, Clinic of Infectious Diseases, University of Genoa, Genoa, Italy
| | | | - Giovanni Di Perri
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Vincenzo Esposito
- UOC di Malattie infettive e Medicina di Genere P.O. Cotugno-A.O. dei Colli, Napoli, Italy
| | - Emanuele Focà
- Università degli Studi di Brescia e ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Gori
- Università degli Studi di Milano, Milano, Italy; ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milano, Italy
| | | | - Giovanni Guaraldi
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Maggi
- Università degli Studi della Campania Luigi Vanvitelli, AORN S. Anna e S. Sebastiano Caserta, Caserta, Italy
| | | | - Giulia Carla Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Cristina Mussini
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Stefano Rusconi
- Ospedale Civile di Legnano ASST Ovest Milanese - Università degli Studi di Milano, Legnano, Italy
| | - Maria Santoro
- Università degli Studi di Roma "Tor Vergata", Roma, Italy
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Wang X, Xiao J, Zhang L, Liu Y, Chen N, Deng M, Song C, Liu T, Zhang Y, Zhao H. Longitudinal analysis of immune reconstitution and metabolic changes in women living with HIV: A real-world observational study. Chin Med J (Engl) 2023; 136:2168-2177. [PMID: 37580056 PMCID: PMC10508409 DOI: 10.1097/cm9.0000000000002756] [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: 12/08/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Women comprise more than half of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) worldwide and incomplete immune recovery and metabolic abnormalities affect them deeply. Studies of HIV antiretroviral therapy (ART) have a low female representation in China. We aimed to investigate immune reconstitution and metabolic changes of female HIV-positive cohort in China longitudinally. METHODS HIV-positive women who initiated ART from January 2005 to June 2021 and were followed up regularly at least once a year were included in this study. Immunological indicators (cluster of differentiation 4 [CD4] counts and CD8 counts), viral load (VL), and metabolic indicators were collected at follow-up. All data were collected from the China Disease Prevention and Control Information System (CDPCIS). VL was tested half a year, 1 year after receiving ART, and every other year subsequently according to local policy. CD4/CD8 ratio normalization was considered as the primary outcome and defined as a value ≥1. Incidence rate and probability of CD4/CD8 ratio normalization were estimated through per 100 person-years follow-up (PYFU) and Kaplan-Meier curve, respectively. Multivariate Cox regression was used to identify independent risk factors associated with CD4/CD8 ratio normalization. We further studied the rate of dyslipidemia, hyperuricemia, diabetes, liver injury, and renal injury after ART initiation with the chi-squared tests or Fisher's exact probability tests, and a generalized estimating equation model was used to analyze factors of dyslipidemia and hyperuricemia. RESULTS A total of 494 female patients with HIV/AIDS started ART within 16 years from January 2005 to June 2021, out of which 301 women were enrolled with a median duration of ART for 4.1 years (interquartile range, 2.3-7.0 years). The overall incidence rate of CD4/CD8 ratio normalization was 8.9 (95% confidence interval [CI], 7.4-10.6) per 100 PYFU, and probabilities of CD4/CD8 normalization after initiating ART at 1 year, 2 years, 5 years, and 10 years follow-up were 11.7%, 23.2%, 44.0%, and 59.0%, respectively. Independent risk factors associated with CD4/CD8 normalization were baseline CD4 cell counts <200 cells/μL, CD8 counts >1000 cells/μL, and more than 6 months from the start of combined ART (cART) to first virological suppression. Longitudinally, the rate of hypercholesterolemia (total cholesterol [TC]) and high triglyceride (TG) showed an increasing trend, while the rate of low high-density lipoprotein cholesterol (HDL) showed a decreasing trend. The rate of hyperuricemia presented a downtrend at follow-up. Although liver and renal injury and diabetes persisted during ART, the rate was not statistically significant. Older age and protease inhibitors were independent risk factors for increase of TC and TG, and ART duration was an independent factor for elevation of TC and recovery of HDL-C. CONCLUSIONS This study showed that women were more likely to normalize CD4/CD8 ratio in comparison with findings reported in the literature even though immune reconstruction was incomplete.
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Affiliation(s)
- Xiaolei Wang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Leidan Zhang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing 100015, China
| | - Ying Liu
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Na Chen
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing 100015, China
| | - Meiju Deng
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Chuan Song
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Tingting Liu
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yuanyuan Zhang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hongxin Zhao
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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Martínez-Sanz J, Díaz-Álvarez J, Rosas M, Ron R, Iribarren JA, Bernal E, Gutiérrez F, Ruiz Sancho A, Cabello N, Olalla J, Moreno S, Serrano-Villar S. Expanding HIV clinical monitoring: the role of CD4, CD8, and CD4/CD8 ratio in predicting non-AIDS events. EBioMedicine 2023; 95:104773. [PMID: 37639938 PMCID: PMC10474064 DOI: 10.1016/j.ebiom.2023.104773] [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: 04/25/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear. METHODS We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events. FINDINGS The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio <0.3 predicted an increased risk of SNAEs during the next five years (OR 1.63, 95% CI 1.03-2.58). The effect was stronger at a CD4/CD8 ratio cut-off of <0.2 (OR 3.09, 95% CI 1.57-6.07). Additionally, low CD4 count at cut-offs of <500 cells/μL predicted an increased risk of clinical events. Among participants with a CD4 count ≥500 cells/μL, a CD8 count ≥1500 cells/μL or a CD4/CD8 ratio <0.4 predicted increased SNAE risk. INTERPRETATION Our results support the use of the CD4/CD8 ratio and CD8 count as predictors of clinical progression. Patients with CD4/CD8 ratio <0.3 or CD8 count ≥1500/μL, regardless of their CD4 count, may benefit from closer monitoring and targeted preventive interventions. FUNDING This work was supported by CIBER (CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU; by the Spanish AIDS Research Network (RIS) RD16/0025/0001 project as part of the Plan Nacional R + D + I, and cofinanced by Instituto de Salud Carlos III (ISCIII)- Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER), ISCIII projects PI18/00154, PI21/00141, and ERDF, "A way to make Europe", ICI20/00058.
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Affiliation(s)
- Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jorge Díaz-Álvarez
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Rosas
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Iribarren
- Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Félix Gutiérrez
- Hospital General Universitario de Elche & Universidad Miguel Hernández, Alicante, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Noemi Cabello
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; University of Alcalá, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Sangaré MN, Baril JG, de Pokomandy A, Klein M, Thomas R, Tremblay C, Pexos C, Durand M, Chawla S, Laporte L, Trottier H. CD4/CD8 Ratio Outcome According to the Class of the Third Active Drug in Antiretroviral Therapy Regimens: Results From the Quebec Human Immunodeficiency Virus Cohort Study. Clin Infect Dis 2023; 76:1879-1888. [PMID: 36722329 DOI: 10.1093/cid/ciad056] [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: 08/23/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The impact of different therapeutic classes of drugs in antiretroviral therapy (ART) regimens on the CD4/CD8 ratio is not well documented in people treated for HIV. The objective of this study was to analyze the long-term effect of exposure to integrase strand transfer inhibitor (INSTI) on CD4/CD8 ratio compared with nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) among ART-treated persons with HIV (PWH). METHODS Data from the Quebec HIV Cohort collected from 31 August 2017 were used. Our analysis included all patients in the cohort who received a first or subsequent ART regimen composed of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and a third active drug of a different class (NNRTI, PI, or INSTI) for at least 16 weeks. Marginal structural Cox models were constructed to estimate the effect of different therapeutic classes on the CD4/CD8 ratio outcome. RESULTS Among the 3907 eligible patients, 972 (24.9%), 1996 (51.1%), and 939 (24.0%) were exposed to an ART regimen whose third active agent was an NNRTI, PI, or INSTI, respectively. The total follow-up time was 13 640.24 person-years. The weighted hazard ratio for the association between the third active class and CD4/CD8 ratio ≥1 was .56 (95% confidence interval [CI]: .48-.65) for patients exposed to NNRTI + 2 NRTIs and .41 (95% CI: .35-.47) for those exposed to PI + 2 NRTIs, compared with those exposed INSTI + 2 NRTIs. CONCLUSIONS For people treated for HIV, INSTI-based ART appears to be associated with a higher CD4/CD8 ratio than NNRTI and PI-based ART.
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Affiliation(s)
| | - Jean-Guy Baril
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Marina Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | | | - Cécile Tremblay
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Canada
- Department of Microbiology and Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Costa Pexos
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Madeleine Durand
- Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Canada
| | - Seerat Chawla
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Louise Laporte
- Sainte Justine University Hospital Center, Montreal, Canada
| | - Helen Trottier
- Sainte Justine University Hospital Center, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
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Kouamou V, Gundidza P, Ndhlovu CE, Makadzange AT, Study C. Effects of Gender and Baseline CD4 Count on Post Treatment CD4 Count Recovery and Outcomes in Patients with Advanced HIV Disease: a Retrospective Cohort Study. AIDS Res Hum Retroviruses 2023. [PMID: 36924288 DOI: 10.1089/aid.2022.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Presentation to care with advanced HIV disease (AHD) is a significant problem in Sub-Saharan Africa. We evaluated factors associated with immune recovery among individuals presenting to care with AHD in Zimbabwe. We conducted a retrospective evaluation of outcomes among adult (>18 years old) individuals with AHD (CD4 count ≤ 200 cells/mm3) receiving care at 18 outpatient primary care clinics in Harare, Zimbabwe. Baseline and 12-month CD4 count data were extracted from medical records. CD4 count recovery (defined as CD4 count > 200 cells/mm3) after 12 months on NNRTI-based antiretroviral therapy (ART) regimen was determined and factors associated with CD4 count recovery were established using logistic regression. All statistical analysis was performed on SPSS v23. A total of 1338 participant records were included in the analysis. The median interquartile range (IQR) age was 37 (30-43) years and 52% were females. The baseline median (IQR) CD4 count was 50 (28-75) cells/mm3 and was significantly lower among patients with history of cryptococcal meningitis compared to those without (25(10-52) vs 52(32-77), respectively; p=0.0009). The median (IQR) CD4 count at 12 months after ART initiation increased from 50 (28-75) at baseline to 180 (92-290) cells/mm3. Immune recovery with a CD4 count > 200 cells/mm3, was observed in 181/417 (43%). Male gender and low baseline CD4 count were strong predictors of poor immunological recovery on ART. Immunological recovery following ART initiation was 43% among individuals with AHD. Male patients are most vulnerable to persistent immunological failure.
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Affiliation(s)
- Vinie Kouamou
- University of Zimbabwe Faculty of Medicine, 108329, Primary Health Care Sciences, Harare, Harare, Zimbabwe.,Charles River Medical Group, Harare, Zimbabwe;
| | | | - Chiratidzo Ellen Ndhlovu
- Charles River Medical Group, Harare, -, Zimbabwe.,University of Zimbabwe Faculty of Medicine, 108329, Harare, Harare, Zimbabwe;
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12
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Chan P, Yoon B, Colby D, Kroon E, Sacdalan C, Sriplienchan S, Pinyakorn S, Ananworanich J, Valcour V, Vasan S, Hsu D, Phanuphak N, Paul R, Spudich S. Immunological, Cognitive, and Psychiatric Outcomes After Initiating Efavirenz- and Dolutegravir-based Antiretroviral Therapy During Acute Human Immunodeficiency Virus Infection. Clin Infect Dis 2023; 76:e718-e726. [PMID: 35687498 PMCID: PMC9907536 DOI: 10.1093/cid/ciac466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Efavirenz (EFV)- and dolutegravir (DTG)-based antiretroviral therapy (ART) is the former and current recommended regimen for treatment-naive individuals with human immunodeficiency virus type 1 (HIV-1). Whether they impact the immunological and neuropsychiatric profile differentially remains unclear. METHODS This retrospective analysis included 258 participants enrolled during acute HIV-1 infection (AHI). Participants initiated 1 of 3 ART regimens during AHI: EFV-based (n = 131), DTG-based (n = 92), or DTG intensified with maraviroc (DTG/MVC, n = 35). All regimens included 2 nucleoside reverse-transcriptase inhibitors and were maintained for 96 weeks. CD4+ and CD8+ T-cell counts, mood symptoms, and composite score on a 4-test neuropsychological battery (NPZ-4) were compared. RESULTS At baseline, the median age was 26 years, 99% were male, and 36% were enrolled during Fiebig stage I-II. Plasma viral suppression at weeks 24 and 96 was similar between the groups. Compared with the EFV group, the DTG group showed greater increments of CD4+ (P < .001) and CD8+ (P = .015) T-cell counts but a similar increment of CD4/CD8 ratio at week 96. NPZ-4 improvement was similar between the 2 groups at week 24 but greater in the DTG group at week 96 (P = .005). Depressive mood and distress symptoms based on the Patient Health Questionnaire and distress thermometer were similar between the 2 groups at follow-up. Findings for the DTG/MVC group were comparable to those for the DTG group vs the EFV group. CONCLUSIONS Among individuals with AHI, 96 weeks of DTG-based ART was associated with greater increments of CD4+ and CD8+ T-cell counts and improvement in cognitive performance.
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Affiliation(s)
- Phillip Chan
- South East Asia Research Collaboration in HIV, Institute of HIV Research and Innovation, Bangkok, Thailand
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bohyung Yoon
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Donn Colby
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Eugène Kroon
- South East Asia Research Collaboration in HIV, Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Carlo Sacdalan
- South East Asia Research Collaboration in HIV, Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Somchai Sriplienchan
- South East Asia Research Collaboration in HIV, Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Suteeraporn Pinyakorn
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Jintanat Ananworanich
- Department of Global Health, Amsterdam University Medical Centers, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Victor Valcour
- Department of Neurology, Memory and Aging Center, University of California–San Francisco, San Francisco,California, USA
| | - Sandhya Vasan
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Denise Hsu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Nittaya Phanuphak
- South East Asia Research Collaboration in HIV, Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Robert Paul
- Faculty of Psychological Sciences, Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Serena Spudich
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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Han WM, Avihingsanon A, Rajasuriar R, Tanuma J, Mundhe S, Lee MP, Choi JY, Pujari S, Chan YJ, Somia A, Zhang F, Kumarasamy N, NG OT, Gani Y, Chaiwarith R, Pham TN, Do CD, Ditangco R, Kiertiburanakul S, Khol V, Ross J, Jiamsakul A. CD4/CD8 Ratio Recovery Among People Living With HIV Starting With First-Line Integrase Strand Transfer Inhibitors: A Prospective Regional Cohort Analysis. J Acquir Immune Defic Syndr 2023; 92:180-188. [PMID: 36625858 PMCID: PMC10064076 DOI: 10.1097/qai.0000000000003121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND We evaluated trends in CD4/CD8 ratio among people living with HIV (PLWH) starting antiretroviral therapy (ART) with first-line integrase strand transfer inhibitors (INSTI) compared with non-INSTI-based ART, and the incidence of CD4/CD8 ratio normalization. METHODS All PLWH enrolled in adult HIV cohorts of IeDEA Asia-Pacific who started with triple-ART with at least 1 CD4, CD8 (3-month window), and HIV-1 RNA measurement post-ART were included. CD4/CD8 ratio normalization was defined as a ratio ≥1. Longitudinal changes in CD4/CD8 ratio were analyzed by linear mixed model, the incidence of the normalization by Cox regression, and the differences in ratio recovery by group-based trajectory modeling. RESULTS A total of 5529 PLWH were included; 80% male, median age 35 years (interquartile range [IQR], 29-43). First-line regimens were comprised of 65% NNRTI, 19% PI, and 16% INSTI. The baseline CD4/CD8 ratio was 0.19 (IQR, 0.09-0.33). PLWH starting with NNRTI- (P = 0.005) or PI-based ART (P = 0.030) had lower CD4/CD8 recovery over 5 years compared with INSTI. During 24,304 person-years of follow-up, 32% had CD4/CD8 ratio normalization. After adjusting for age, sex, baseline CD4, HIV-1 RNA, HCV, and year of ART initiation, PLWH started with INSTI had higher odds of achieving CD4/CD8 ratio normalization than NNRTI- (P < 0.001) or PI-based ART (P = 0.015). In group-based trajectory modeling analysis, INSTI was associated with greater odds of being in the higher ratio trajectory. CONCLUSIONS INSTI use was associated with higher rates of CD4/CD8 ratio recovery and normalization in our cohort. These results emphasize the relative benefits of INSTI-based ART for immune restoration.
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Affiliation(s)
- Win Min Han
- The Kirby Institute, UNSW Sydney, NSW, Australia
- HIV-NAT/ Thai Red Cross AIDS Research Centre and Centre of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT/ Thai Red Cross AIDS Research Centre and Centre of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Reena Rajasuriar
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Sanjay Mundhe
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Agus Somia
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | - Oon Tek NG
- Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore
| | - Yasmin Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Romanee Chaiwarith
- Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand
| | | | | | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Vohith Khol
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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van Santen DK, Sacks-Davis R, Stewart A, Boyd A, Young J, van der Valk M, Smit C, Rauch A, Braun DL, Jarrin I, Berenguer J, Lazarus JV, Lacombe K, Requena MB, Wittkop L, Leleux O, Salmon D, Bonnet F, Matthews G, Doyle JS, Spelman T, Klein MB, Prins M, Asselin J, Stoové MA, Hellard M. Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019. EClinicalMedicine 2023; 56:101810. [PMID: 36618902 PMCID: PMC9816910 DOI: 10.1016/j.eclinm.2022.101810] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Broad direct-acting antiviral (DAA) access may reduce hepatitis C virus (HCV) incidence through a "treatment as prevention" (TasP) effect. We assessed changes in primary HCV incidence following DAA access among people living with HIV (PLHIV). METHODS We used pooled individual-level data from six cohorts from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Follow-up started from the first recorded negative HCV antibody test date and ended at last negative antibody test or estimated infection date. Follow-up was restricted to 2010-2019. We used segmented Poisson regression to model trends across pre-, limited- (i.e., restrictions on access) and broad-DAA access periods. FINDINGS Overall, 45,942 participants had at least one HCV antibody negative result and follow-up between 2010 and 2019. We observed 2042 incident HCV infections over 248,189 person-years (PY). Pooled incidence decreased from 0.91 per 100 PY in 2015 to 0.41 per 100 PY in 2019. Compared to the average pre-DAA period incidence (0.90 per 100 PY), average incidence was similar during the limited-DAA access period (Incidence rate ratio [IRR] = 0.98; 95%CI = 0.87, 1.11), and 52% lower during the broad-DAA access period (IRR = 0.48; 95%CI = 0.42, 0.52). The average annual decline in HCV incidence was 2% in the pre-DAA period; an additional 9% annual decline in incidence was observed during the limited-DAA access period (IRR = 0.91; 95%CI = 0.82, 1.00) and a further 20% decline in the broad-DAA access period (IRR = 0.80, 95%CI = 0.73, 0.89). INTERPRETATION Our findings suggest that broad DAA access has a TasP effect on primary HCV incidence among PLHIV. Based on the initial years of DAA availability, the countries in the InCHEHC collaboration are on track to meet the World Health Organization's 80% HCV incidence reduction target for PLHIV by 2030. FUNDING This study was funded by the Australian Government National Health and Medical Research Council (Grant number GNT1132902).
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Affiliation(s)
- Daniela K. van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author.
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Marc van der Valk
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Colette Smit
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Inmaculada Jarrin
- Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases. Hospital General Universitario Gregorio Marañón (IsSGM), Madrid, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Karine Lacombe
- Sorbonne Université, IPLESP INSERM UMR-S1136, St Antoine Hospital, APHP, Paris, France
| | | | - Linda Wittkop
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information Médicale, INSERM, Institut Bergonié, CIC-EC 1401, F-33000, Bordeaux, France
| | - Olivier Leleux
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Fabrice Bonnet
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, F-33000, Bordeaux, France
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Marina B. Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Mark A. Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
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Fernández Soto J, Romero-Jiménez MJ, Alarcón García JC, Bonet Estruch E, Sánchez Ramos JL, Castaño López MÁ. Predictors of subclinical atherosclerosis in HIV. BMC Infect Dis 2023; 23:17. [PMID: 36627565 PMCID: PMC9832619 DOI: 10.1186/s12879-022-07976-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major cause of morbidity and mortality in people with HIV. The detection of subclinical atherosclerosis through vascular ultrasound allows us to identify patients at an increased risk of cardiovascular disease as a primary prevention strategy; this test is not routine. Our objective is to identify predictors of subclinical atherosclerosis in a population with HIV. METHODS People with HIV infection were selected for primary prevention and underwent carotid and femoral ultrasound to detect atheromatous plaques. Logistic regression analysis including vascular risk factors was performed to predict the presence of atherosclerosis. RESULTS One hundred eighty-three patients were included, 54% of whom were smokers; the mean duration of HIV infection was 9.52 years, and all patients were undergoing antiretroviral treatment. Subclinical atherosclerosis was present in 62.29% of the patients; 83.32% had plaque in the carotid territory, 57.93% in the femoral territory and 25.6% in both vascular territories. Compared to those without atherosclerosis, patients with atherosclerosis were on average 5.35 years older (53.86 vs. 48.51, p < 0.001) and had a higher prevalence of smoking (63.23% vs. 39.12%, p = 0.020) and a CD4/CD8 ratio below 0.7 (44.23% vs. 29.02%, p = 0.043). A CD4/CD8 ratio lower than 0.3 was always associated with subclinical atherosclerosis (95% confidence interval (CI): 83.9-100%). The inclusion of smoking, the CD4/CD8 ratio and age in the logistic regression analysis led to a diagnostic yield of 72% measured by the area under the receiving operator characteristic (ROC) curve (95% CI: 64-80%). CONCLUSIONS Tobacco use, age and a CD4/CD8 ratio below 0.7 allow prediction of the presence of subclinical atherosclerosis in primary prevention. A CD4/CD8 ratio below 0.3 was a diagnostic indicator of atherosclerosis in HIV patients undergoing primary prevention in our sample.
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Affiliation(s)
- Julia Fernández Soto
- Internal Medicine Service, Lipid and Vascular Risk Unit, Infanta Elena Hospital, Doctor Pedro Naranjo S/N Street, 21007 Huelva, Spain
| | - Manuel J. Romero-Jiménez
- Internal Medicine Service, Lipid and Vascular Risk Unit, Infanta Elena Hospital, Doctor Pedro Naranjo S/N Street, 21007 Huelva, Spain
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16
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Zhong M, Li M, Qi M, Su Y, Yu N, Lv R, Ye Z, Zhang X, Xu X, Cheng C, Chen C, Wei H. A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naïve patients with advanced HIV infection in Nanjing, China. Front Immunol 2023; 13:1033098. [PMID: 36700216 PMCID: PMC9868135 DOI: 10.3389/fimmu.2022.1033098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Currently, there are limited data related to the efficacy and safety of ART regimens, as well as factors influencing immune recovery in antiretroviral therapy (ART)-naïve patients with advanced HIV infection, especially in China. We designed a single-center, retrospective cohort study from March 1, 2019, to May 31, 2022, at The Second Hospital of Nanjing, China. ART-naïve adults with advanced HIV infection (CD4+ T-cell count < 200 cells/μL) who met the study criteria were included. The plasma viral load (VL), CD4+ T-cell count, CD4/CD8 ratio, treatment discontinuation, and immune reconstitution inflammatory syndrome (IRIS) events were collected to compare the efficacy and safety of the dolutegravir (DTG) and the efavirenz (EFV) regimens. Factors of immune recovery were analyzed using the Cox regression model. Study enrolled 285 ART-naïve adults with advanced HIV-1 infection, of which 95 (33.3%) started regimens including DTG and 190 (66.7%) were treated with EFV. After ART initiation, the proportion of patients with HIV-1 RNA < 50 copies/mL was higher (22.5% versus 6.5%, P < 0.001) in those on DTG-based regimens at month 1, but no significant difference at other follow-up points. Compared to the baseline, the median CD4+ T-cell count and CD4/CD8 ratio increased significantly during follow-up both in the EFV and the DTG groups. However, the CD4+ T-cell count increased greater in patients on DTG-based regimens at months 6, 12, 24, and 36 (P < 0.05). A total of 52 (18.2%) patients discontinued treatment, with no significant difference between ART regimens in treatment discontinuation rates. Only 7 patients reported IRIS, without significant difference between ART regimens (P=0.224). Overall, 34.0% (97/285) achieved a CD4+ T-cell count ≥ 350 cells/μL during follow-up. Age (P < 0.001), baseline CD4+ T-cell count (P < 0.001), baseline VL (P < 0.001) and ART regimens (P = 0.019) were associated with the CD4+ T-cell count ≥ 350 cells/μL after adjusting for potential confounders. Among ART-naïve adults with advanced HIV infection, it appeared that DTG-based regimens were better options for initial therapy compared to regimens including EFV; in addition, ART regimens, age, baseline VL and CD4+ T-cell count were associated with immune recovery.
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Affiliation(s)
- Mingli Zhong
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengqing Li
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mingxue Qi
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yifan Su
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Nawei Yu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ru Lv
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zi Ye
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiang Zhang
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinglian Xu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cong Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China,*Correspondence: Hongxia Wei, ; Chen Chen,
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China,*Correspondence: Hongxia Wei, ; Chen Chen,
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17
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Martin-Iguacel R, Reyes-Urueña J, Bruguera A, Aceitón J, Díaz Y, Moreno-Fornés S, Domingo P, Burgos-Cibrian J, Tiraboschi JM, Johansen IS, Álvarez H, Miró JM, Casabona J, Llibre JM. Determinants of long-term survival in late HIV presenters: The prospective PISCIS cohort study. EClinicalMedicine 2022; 52:101600. [PMID: 35958520 PMCID: PMC9358427 DOI: 10.1016/j.eclinm.2022.101600] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022] Open
Abstract
Background Late HIV diagnosis (i.e CD4≤350 cells/µL) is associated with poorer outcomes. However, determinants of long-term mortality and factors influencing immune recovery within the first years after antiretroviral treatment (ART) initiation are poorly defined. Methods From PISCIS cohort, we included all HIV-positive adults, two-year survivors after initiating ART between 2005-2019. The primary outcome was all-cause mortality according to the two-year CD4 count. We used Poisson regression. The secondary outcome was incomplete immune recovery (i.e., two-year CD4<500 cells/µL). We used logistic regression and propensity score matching. Findings We included 2,719 participants (16593·1 person-years): 1441 (53%) late presenters (LP) and 1278 non-LP (1145 non-LP with two-year CD4 count >500 cells/µL, reference population). Overall, 113 patients (4·2%) died. Mortality was higher among LP with two-year CD4 count 200-500 cells/µL (aMRR 1·95[95%CI:1·06-3·61]) or <200 cells/µL (aMRR 4·59[2·25-9·37]).Conversely, no differences were observed in participants with two-year CD4 counts >500 cells/µL, regardless of being initially LP or non-LP (aMRR 1·05[0·50-2·21]). Mortality rates within each two-year CD4 strata were not affected by the initial CD4 count at ART initiation (test-interaction, p = 0·48). The stronger factor influencing immune recovery was the CD4 count at ART initiation. First-line integrase-inhibitor-(INSTI)-based regimens were associated with reduced mortality compared to other regimens (aMRR 0·54[0·31-0·93]) and reduced risk of incomplete immune recovery in LP (aOR 0·70[0·52-0·95]). Interpretation Two-year immune recovery is a good early predictor of long-term mortality in LP after surviving the first high-risk 2 years. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-LP. INSTI-based regimens were associated with higher rates of successful immune recovery and better survival compared to non-INSTI regimens. Funding Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark.
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Affiliation(s)
- Raquel Martin-Iguacel
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Jordi Aceitón
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Sergio Moreno-Fornés
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquín Burgos-Cibrian
- Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Juan Manuel Tiraboschi
- Department of Internal Medicine and Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Josep M Miró
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- Fundació Institut D'investigació En Ciències De La Salut Germans Trias I Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep M Llibre
- Infectious Diseases Department and Fight Infections Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - PISCIS study group
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
- Department of Internal Medicine and Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Infectious Diseases Unit, University Hospital of Ferrol, Spain
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- Fundació Institut D'investigació En Ciències De La Salut Germans Trias I Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Department and Fight Infections Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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18
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The Predictive Value of Changes in the Absolute Counts of Peripheral Lymphocyte Subsets for Progression and Prognosis in Breast Cancer Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3444360. [PMID: 36051923 PMCID: PMC9410830 DOI: 10.1155/2022/3444360] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
Background As the number and proportion of lymphocyte subsets are an important indicator of the immune function, an in depth understanding of the immune function of patients with malignant tumor has important clinical values for the treatment, prognosis, and evaluation of the disease. This retrospective study was to evaluate the clinical value of the absolute counts of lymphocyte subsets as potential blood biomarkers for progression and prognosis in breast cancer patients. Methods A total of 237 BC patients and 55 age-matched female normal healthy donors were included in this study. Flow cytometry was used to determine the absolute counts and the percentages of CD3+, CD4+, CD8+, B, and NK cells. The receiver operating characteristic curve (ROC) was used to evaluate the accuracy of absolute count of lymphocyte subsets in the curative efficacy assessment. The clinicopathological parameters influencing the disease progression were determined by Cox proportional hazards regression. Progression-free survival (PFS) was estimated using the Kaplan–Meier method with the log-rank test. Results: Compared with the healthy donors, the absolute counts of lymphocyte subsets in patients decreased significantly. ROC analysis showed that the area under the curve of the CD4+ absolute count was 90% (95% confidence interval 0.859–0.940), and the sensitivity and specificity were 80.9% and 85.3%, respectively. The analysis of Cox regression showed that the cutoff value of the CD4+ absolute count ≥451 cells/μL might be a favorable prognostic factor. Multivariate analysis of prognostic factors of PFS showed that the CD4+ and CD8+ absolute count were independent factors for predicting PFS. Conclusions The remarkably impaired absolute counts of the CD3+, CD4+, CD8+, B, and NK cells in patients with breast cancer can be used as potential susceptible biomarkers to evaluate the patient's immune status. The higher level of CD4+ and CD8+ absolute counts probably contributed to the longer PFS and favorable outcome of BC patients.
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Alejos B, Díez C, Galindo MJ, López JC, Moreno-García E, Estrada V, Poveda E, Omar M, Jarrín I, Berenguer J. Progress in the quality of care for newly diagnosed people with HIV in Spain (2004-2019). Antivir Ther 2022; 27:13596535221112729. [PMID: 35802475 DOI: 10.1177/13596535221112729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We monitored the quality of care for newly diagnosed people with HIV (PWH) in Spain, including linkage to care within 1 month of HIV diagnosis (LC-1Mo) and viral suppression within 3 months of HIV diagnosis (VS-3Mo). METHODS Longitudinal study based on The Cohort of the Spanish AIDS Research Network (CoRIS). We used logistic regression stratified by year of HIV diagnosis (2004-2013 and 2014-2019) to assess differences by sex, country of origin, HIV risk group, age, prior AIDS, HIV Viral Load, and CD4 cell count. RESULTS The final analysis included 13,632 PWH: males 85%, men having sex with men (MSM) 61%, median age 35 years. LC-1Mo increased from 42% (95% CI, 38%-46%) in 2004 to 80% (95% CI, 77%-83%) in 2019 (P < 0.001). Median CD4+ cell counts at ART initiation increased from <250/mm3 in 2004-2005 to >350/mm3 since 2012 (P < 0.001). The percentage of initial regimens based on integrase strand transfer inhibitors (INSTI) increased from 3% in 2004 to >70% from 2016 onwards (P < 0.001). VS-3Mo increased from 6% (95% CI, 4%-8%) in 2004 to 45% (95% CI, 41%-49%) in 2019 (P < 0.001). Worst results for LC-1Mo were found among PWH acquiring HIV by injection drug use and those born in Latin American Countries across all the study period. CONCLUSION Care indicators have improved among newly diagnosed PWH in Spain over the last 15 years. Removal of CD4 cell counts limitations, and probably the increasing use of INSTI-based regimens was decisive for the progress made.
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Affiliation(s)
- Belén Alejos
- Centro Nacional de Epidemiología, 38176Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Díez
- Infectious Diseases, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María J Galindo
- Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan C López
- Infectious Diseases, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Vicente Estrada
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.,Infectious Diseases, 16267Hospital Clínico de San Carlos, Madrid, Spain
| | - Eva Poveda
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Mohamed Omar
- Infectious Diseases, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, 38176Instituto de Salud Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Berenguer
- Infectious Diseases, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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20
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Chen J, Liu X, Qin S, Ruan G, Lu A, Zhang J, Wu Y, Xie Z, Peng J. A Novel Prognostic Score Including the CD4/CD8 for AIDS-Related Lymphoma. Front Cell Infect Microbiol 2022; 12:919446. [PMID: 35873145 PMCID: PMC9299417 DOI: 10.3389/fcimb.2022.919446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background A simple and clinically applicable prognostic scoring system for AIDS-related lymphoma (ARL) in the era of combination antiretroviral therapy (cART) is needed to better stratify patients' risks and to assist in the decision-making of therapeutic strategies. Methods We conducted a retrospective multicenter cohort study in 138 primary ARL patients over an 8-year period from 2013 to 2020. Survival curves were estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were performed to identify the association between patient-, lymphoma-, and HIV-specific variables with progression-free survival (PFS) and overall survival (OS). The incremental prognostic value of novel inflammatory biomarkers in the International Prognostic Index (IPI) was evaluated by comparing the receiver operating characteristic (ROC) curves, the concordance index (C-index), and the integrated Brier score (IBS). Results The median age was 49.14 ± 14.20 (range 18-79) years, 81.9% were men, and the median follow-up was 44.94 (95% CI = 37.05-52.84) months. The 3-year OS and PFS were 39.4% (95% CI = 16.3-21.2) and 38.7% (95% CI = 14.5-19.7), respectively. We found that age, extranodal sites, bulky mass, CD4 T-cell counts, CD4/CD8 ratio, and hypoalbuminemia were associated with OS (all P < 0.05) at both univariate and multivariate analyses. Of the new inflammatory markers, only the CD4/CD8 ratio was an independent prognostic parameter of OS and PFS. A lower CD4/CD8 ratio was strongly associated with adverse clinical factors, including older age, advanced Ann Arbor stage, more extranodal sites, elevated erythrocyte sedimentation rate, prior history of HIV, higher red cell distribution width ratio, hypoproteinemia, and emaciation. When the CD4/CD8 ratio was added to the IPI, the composite HIV-IPI score showed significantly better discrimination than IPI alone [AUC (95% CI): HIV-IPI, 0.83 (0.77-0.89) vs. IPI, 0.72 (0.70-0.85)]. The HIV-IPI model provided good predictive performance [C-index (95% CI): HIV-IPI, 0.82 (0.81-0.83) vs. IPI, 0.75 (0.73-0.77), P < 0.001] and a satisfactory calibration function. Conclusions The CD4/CD8 ratio, an inexpensive and readily available marker, is a powerful independent prognostic parameter in patients with ARL. Furthermore, when the CD4/CD8 ratio is used in combination with IPI, it increases prognostic ability. The useful prediction of expected outcomes in ARL can inform treatment decisions.
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Affiliation(s)
- Juanjuan Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuewu Liu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanfang Qin
- Guangxi AIDS Diagnosis and Treatment Quality Control Center, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Guangjing Ruan
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Aili Lu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinxin Zhang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihua Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiman Xie
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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21
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Serrano-Villar S, Moreno S. Response to Commentary: Long-term Changes of Inflammatory Biomarkers in Individuals on Suppressive Three-Drug or Two-Drug Antiretroviral Regimens. Front Immunol 2022; 13:923905. [PMID: 35720404 PMCID: PMC9203683 DOI: 10.3389/fimmu.2022.923905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of California, San Francisco (USFC), San Francisco, CA, United States
- *Correspondence: Sergio Serrano-Villar,
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain
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22
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Serrano-Villar S, Wu K, Hunt PW, Lok JJ, Ron R, Sainz T, Moreno S, Deeks SG, Bosch RJ. Predictive value of CD8+ T cell and CD4/CD8 ratio at two years of successful ART in the risk of AIDS and non-AIDS events. EBioMedicine 2022; 80:104072. [PMID: 35644125 PMCID: PMC9156990 DOI: 10.1016/j.ebiom.2022.104072] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While increased CD8 counts and low CD4/CD8 ratio during treated HIV correlate with immunosenescence, their additional predictive values to identify individuals with HIV at higher risk of clinical events remain controversial. METHODS We selected treatment-naive individuals initiating ART from ACTG studies 384, 388, A5095, A5142, A5202, and A5257 who had achieved viral suppression at year 2. We examined the effect of CD8+ T cell counts and CD4/CD8 at year 2 on the probability of AIDS and serious non-AIDS events in years 3-7. We used inverse probability weighting methods to address informative censoring, combined with multivariable logistic regression models. FINDINGS We analyzed 5133 participants with a median age of 38 years; 959 (19%) were female, pre-ART median CD4 counts were 249 (Q1-Q3 91-372) cell/µL. Compared to participants with CD8 counts between 500/µL and 1499/µL, those with >1500/µL had a higher risk of clinical events during years 3-7 (aOR 1.75; 95%CI 1.33-2.32). CD4/CD8 ratio was not predictive of greater risk of events through year 7. Additional analyses revealed consistent CD8 count effect sizes for the risk of AIDS events and noninfectious non-AIDS events, but opposite effects for the risk of severe infections, which were more frequent among individuals with CD8 counts <500/µL (aOR 1.70; 95%CI 1.09-2.65). INTERPRETATION The results of this analysis with pooled data from clinical trials support the value of the CD8 count as a predictor of clinical progression. People with very high CD8 counts during suppressive ART might benefit from closer monitoring and may be a target population for novel interventions. FUNDING This research was supported by NIH/NIAID awards UM1 AI068634, UM1 AI068636, and UM1 AI106701 and Carlos III Health Institute and FEDER funds (BA21/00017 and BA21/00022).
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; San Francisco General Hospital, San Francisco, CA, USA.
| | - Kunling Wu
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter W Hunt
- San Francisco General Hospital, San Francisco, CA, USA
| | | | - Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | - Talía Sainz
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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23
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Li B, Zhang L, Liu Y, Xiao J, Li C, Fan L, Duan Y, Xiao J, Hao Y, Han J, Kong Y, Zhao H. A novel prediction model to evaluate the probability of CD4+/CD8+ cell ratio restoration in HIV-infected individuals. AIDS 2022; 36:795-804. [PMID: 35013083 DOI: 10.1097/qad.0000000000003167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Our study aimed to develop a clinical prediction model to evaluate the possibility of CD4+/CD8+ ratio restoration in HIV-positive individuals. METHODS About 1980, HIV/AIDS patients initiated with antiretroviral treatment from 1 January 2013, to 30 December 2016, at Beijing Ditan Hospital and achieved persistent virological suppression during the 4 years follow-up were included in this study. Multivariate Cox proportional regression analysis was used to identify the independent risk factors and establish a predictive model. The model's performance was assessed using the area under the receiver operating characteristic and calibration plots. RESULTS Overall, after 4 years of treatment, a total of 455 individuals (22.98%) restored their CD4+/CD8+ ratio (≥1). The area under the receiver operating characteristic was 0.782 and 0.743 in the deriving and validation cohort, respectively. The ultimate model included five indexes: age at AIDS diagnosis, albumin, and syphilis status, and baseline CD4+ and CD8+ values. A nomogram further visualized the model, and the calibration plots indicated high agreement of predicted and observed outcomes. CONCLUSION Our prediction model might be practical and easily applied to recognize HIV/AIDS individuals most likely to benefit from modern antiretroviral therapy.
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Affiliation(s)
- Bei Li
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Leidan Zhang
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing
| | - Ying Liu
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Jing Xiao
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing
| | - Cuilin Li
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing
| | - Lina Fan
- Department of Infectious Disease, The Tianjin Second People's Hospital, Tianjin
| | - Yujiao Duan
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Yu Hao
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Junyan Han
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yaxian Kong
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
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24
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Martínez-Sanz J, Ron R, Moreno E, Sánchez-Conde M, Muriel A, López Cortés LF, Blanco JR, Pineda JA, Mena Á, Calzado Isbert S, Moreno S, Serrano-Villar S. Similar CD4/CD8 Ratio Recovery After Initiation of Dolutegravir Plus Lamivudine Versus Dolutegravir or Bictegravir-Based Three-Drug Regimens in Naive Adults With HIV. Front Immunol 2022; 13:873408. [PMID: 35432298 PMCID: PMC9009371 DOI: 10.3389/fimmu.2022.873408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 12/31/2022] Open
Abstract
Background The initiation of antiretroviral treatment based on a 2-drug regimen (2DR) with dolutegravir plus lamivudine has demonstrated non-inferior efficacy than dolutegravir-based three-drug regimens (3DR). We aimed to assess whether the treatment initiation with this 2DR has a different impact on the CD4/CD8 ratio recovery than INSTI-based 3DR. Methods We emulated a target trial using observational data from the Spanish HIV Research Network cohort (CoRIS). The outcomes of interest were the normalization of the CD4/CD8 ratio at 48 weeks using three different cutoffs: 0.5, 1.0, and 1.5. We matched each participant who started 2DR with up to four participants who received 3DR. Subsequently, we fitted generalized estimating equation (GEE) models and used the Kaplan–Meier method for survival curves. Results We included 485, 805, and 924 participants for cutoffs of 0.5, 1.0, and 1.5, respectively. At 48 weeks, 45% of participants achieved a CD4/CD8 ratio >0.5, 15% achieved a ratio >1.0, and 6% achieved a ratio >1.5. GEE models yielded a similar risk of reaching a CD4/CD8 ratio >0.5 (OR 1.00, 95% CI 0.67 - 1.50), CD4/CD8 >1.0 (OR 1.03, 95% CI 0.68 - 1.58), and CD4/CD8 >1.5 (OR 0.86, 95% CI 0.48 - 1.54) between both treatment strategies. There were no differences between 2DR and 3DR in the incidence ratio of CD4/CD8 ratio normalization at 0.5, 1.0 and 1.5 cut-offs. Conclusions In this large cohort study in people with HIV, ART initiation with dolutegravir plus lamivudine vs. dolutegravir or bictegravir-based triple antiretroviral therapy showed no difference in the rates of CD4/CD8 normalization at 48 weeks.
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Affiliation(s)
- Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Matilde Sánchez-Conde
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,University of Alcalá, Madrid, Spain
| | - Luis Fernando López Cortés
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Ramón Blanco
- Hospital San Pedro, Centro de Investigación Biomédica de la Rioja (CIBIR), Logroño, Spain
| | - Juan Antonio Pineda
- Department of Infectious Diseases and Clinical Microbiology, Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain
| | - Álvaro Mena
- Infectious Diseases Unit, Internal Medicine Service, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Sonia Calzado Isbert
- Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,University of Alcalá, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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25
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Wang X, Zhang L, Du J, Wei Y, Wang D, Song C, Chen D, Li B, Jiang M, Zhang M, Zhao H, Kong Y. Decreased CD73+ Double-Negative T Cells and Elevated Level of Soluble CD73 Correlated With and Predicted Poor Immune Reconstitution in HIV-Infected Patients After Antiretroviral Therapy. Front Immunol 2022; 13:869286. [PMID: 35444646 PMCID: PMC9013806 DOI: 10.3389/fimmu.2022.869286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Although extensive use of antiretroviral therapy (ART) has made great progress in controlling HIV replication and improving CD4+ T cell recovery, the immune reconstitution remained insufficient in some patients, who were defined as poor immunological responders (PIRs). These PIRs were at a high risk of AIDS-related and non-AIDS complications, resulting in higher morbidity and mortality rate. Thus, it is a major challenge and urgently needed to distinguish PIRs early and improve their immune function in time. Immune activation is a key factor that leads to impaired immune reconstitution in people living with HIV (PLWH) who are receiving effective ART. Double negative T cells (DNT) were reported to associate with the control of immune activation during HIV infection. However, the precise mechanisms by which DNT cells exerted their suppressive capacity during HIV infection remained puzzled. CD73, both a soluble and a membrane-bound form, display immunosuppressive effects through producing adenosine (ADO). Thus, whether DNT cells expressed CD73 and mediated immune suppression through CD73-ADO pathway needs to be investigated. Here, we found a significant downregulation of CD73 expression on DNT cells in treatment-naïve PLWH (TNs) compared to healthy controls, accompanied with increased concentration of sCD73 in plasma. Both the frequency of CD73+ DNT cells and the level of plasma sCD73 recovered after ART treatment. However, PIRs showed decreased percentage of CD73+ DNT cells compared to immunological responders (IRs). The frequency of CD73+ DNT cells was positively correlated with CD4+ T cell count and CD4/CD8 ratio, and negatively correlated with immune activation in PLWH. The level of sCD73 also showed a negative correlation to CD4+ T cell count and CD4/CD8 ratio. More importantly, in the present cohort, a higher level of sCD73 at the time of initiating ART could predict poor immune reconstitution in PLWH after long-term ART. Our findings highlighted the importance of CD73+ DNT cells and sCD73 in the disease progression and immune reconstitution of PLWH, and provided evidences for sCD73 as a potential biomarker of predicting immune recovery.
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Affiliation(s)
- Xinyue Wang
- Peking University Ditan Teaching Hospital, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leidan Zhang
- Peking University Ditan Teaching Hospital, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuqing Wei
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Di Wang
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chuan Song
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Danying Chen
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bei Li
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Meiqing Jiang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengyuan Zhang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yaxian Kong, ; Hongxin Zhao,
| | - Yaxian Kong
- Peking University Ditan Teaching Hospital, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yaxian Kong, ; Hongxin Zhao,
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26
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Serrano-Villar S, López-Huertas MR, Jiménez D, Galera C, Martínez-Sanz J, Moreno E, Muriel A, Gutiérrez F, Busca C, Portilla J, Bisbal O, Iribarren JA, Tejerina F, de Los Santos I, Moreno S. Long-Term Changes of Inflammatory Biomarkers in Individuals on Suppressive Three-Drug or Two-Drug Antiretroviral Regimens. Front Immunol 2022; 13:848630. [PMID: 35359950 PMCID: PMC8964183 DOI: 10.3389/fimmu.2022.848630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Because inflammation is associated with mortality and has been linked to HIV transcription in lymphoid tissues during ART, it is necessary to address the long-term effects of switching 3-drug (3DR) to 2-drug regimens (2DR) on inflammation. Methods Nested study in the Spanish AIDS Research Network. We selected PWH ART-naive initiating 3DR who achieved viral suppression in the first 48 weeks and either remained on 3DR or switched to 2DR (3TC+bPI; 3TC+DTG; DTG+RPV). We assessed the trajectories on inflammatory markers during ART using multivariate piecewise mixed models. Results We analyzed 619 plasma samples from 148 patients (3DR, N=90; 2DR, N=58), the median follow-up was 4.6 (IQR 3.2-6.2) years. There were no significant differences in baseline characteristics between groups. After adjusting for potential confounders, patients with 3DR experienced a slow decline of IL6, hs-CRP, sCD14, sCD163, and D-dimer over time. In contrast, compared to 3DR, switching to 2DR was associated with increases in IL-6 (p=0.001), hs-CRP (p=0.003), and D-dimer (p=0.001) after year 3 from virologic suppression. 2DR was associated with a higher risk of hs-CRP quartile increase (aOR 3.3, 95%CI 1.1-10) and D-dimer quartile increase (aOR 3.7, 95%CI 1.1-13). The adjusted biomarker trajectories did not reveal a distinct pattern according to the type of 2DR used (bPI vs DTG). Conclusions In this study in virally suppressed individuals, maintaining 3DR was associated with a more favorable long-term inflammatory profile than switching to 2DR. The potential clinical implications of these findings on the development of non-AIDS events deserve further investigation.
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Daniel Jiménez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Galera
- HIV Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Gutiérrez
- CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain.,Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Carmen Busca
- CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain.,HIV Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Joaquín Portilla
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain
| | - Otilia Bisbal
- HIV Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
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Research Progress on the Relationship between the NLRP3 Inflammasome and Immune Reconstitution in HIV-Infected Patients Receiving Antiretroviral Therapy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3179200. [PMID: 35309841 PMCID: PMC8930245 DOI: 10.1155/2022/3179200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 12/17/2022]
Abstract
Human immunodeficiency virus (HIV) infection is characterized not only by severe immunodeficiency but also by persistent inflammation and immune activation. These characteristics persist in people living with HIV (PLHIV) receiving effective antiretroviral therapy (ART) and are associated with morbidity and mortality in nonacquired immunodeficiency syndrome (AIDS) events. ART can inhibit HIV replication and promote immune reconstitution, which is currently the most effective way to control AIDS. However, despite effective long-term ART and overall suppression of plasma HIV RNA level, PLHIV still shows chronic low-level inflammation. The exact mechanisms that trigger chronic inflammation are unknown. Activation of the inflammasome is essential for the host response to pathogens, and some recent studies have confirmed the role of the inflammasome in the pathogenesis of inflammatory diseases. The NLRP3 inflammasome has been widely studied, which is a pyrin domain-containing protein 3 belonging to the family of nucleotide-binding and oligomerization domain-like receptors (NLRs). Recent studies suggest that inflammasome-mediated pyroptosis is associated with CD4+ T cell loss in the absence of persistent infectious HIV replication. This article reviews the mechanism of the NLRP3 inflammasome and its correlation with immune reconstitution in PLHIV treated with ART.
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Qin F, Lv Q, Hong W, Wei D, Huang K, Lan K, Chen R, Liu J, Liang B, Liang H, Liang H, Qin S, Ye L, Jiang J. Association Between CD4/CD8 Ratio Recovery and Chronic Kidney Disease Among Human Immunodeficiency Virus-Infected Patients Receiving Antiretroviral Therapy: A 17-Year Observational Cohort Study. Front Microbiol 2022; 13:827689. [PMID: 35222339 PMCID: PMC8867036 DOI: 10.3389/fmicb.2022.827689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND CD4/CD8 ratio is considered as an emerging biomarker for human immunodeficiency virus (HIV)-related diseases. However, the relationship of CD4/CD8 ratio recovery and chronic kidney disease (CKD), and whether cumulative antiretroviral therapy (ART) is effective in the CD4/CD8 ratio recovery and in reducing CKD incidence among HIV patients remain unclear. METHODS A 17-year observational cohort study was conducted on all HIV-infected patients receiving ART in Guangxi, China. Kaplan-Meier analysis was used to investigate the cumulative CKD incidence. Cox regression and propensity score matching (PSM) were used to evaluate the association between CD4/CD8 ratio recovery and CKD incidence, and the effect of ART regimens on CD4/CD8 ratio recovery and CKD incidence. RESULTS A total of 59,268 eligible individuals contributing 285,143 person-years of follow-up, with an overall CKD incidence of 9.65%. After ART, patients who developed CKD showed higher mortality than those with normal kidney function (12.48 vs. 7.57%, p < 0.001). Patients whose CD4/CD8 ratio did not recover to 0.7 had a higher CKD incidence than the patients who recovered (aHR = 2.84, 95% CI 2.63-3.07), similar to the PSM analysis (aHR = 3.13, 95% CI 2.85-3.45). Compared with the PI-based and INSTI-based regimens, NNRTI-based regimen had a better CD4/CD8 ratio recovery rate (27.04, 16.16, and 29.66%, respectively) and a lower CKD incidence (17.43, 16.16, and 7.31%, respectively). CONCLUSION This large-scale real-world setting provide new evidence that the CD4/CD8 ratio recovery is associated with lower CKD incidence in HIV-infected patients receiving ART. NNRTI-based is a better choice for CD4/CD8 ratio recovery and reducing the risk of CKD.
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Affiliation(s)
- Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Qing Lv
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Wen Hong
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China
| | - Di Wei
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Kui Huang
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Ke Lan
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Rongfeng Chen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Jie Liu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China
| | - Huayue Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Shanfang Qin
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
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Chen L, Liu CH, Kang S, Du L, Ma F, Li C, Bai L, Li H, Tang H. Determinants of suboptimal immune recovery among a Chinese Yi ethnicity population with sustained HIV suppression. BMC Infect Dis 2022; 22:137. [PMID: 35135485 PMCID: PMC8827152 DOI: 10.1186/s12879-022-07113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/28/2022] [Indexed: 02/08/2023] Open
Abstract
Objectives Despite sustained viral suppression with effective antiretroviral therapy (ART), HIV-infected patients with suboptimal immune recovery are still at high risk of both non-AIDS-related and AIDS-related events. The aim of this study was to investigate determinants potentially associated with suboptimal CD4 + T cell count recovery during free ART with sustained viral suppression among an HIV-infected Yi ethnicity population in Liangshan Prefecture, an area in China with high HIV prevalence. Methods This retrospective study included HIV-infected Yi adults (≥ 18 years and baseline CD4 + T cell count less than 500 cells/μL) for whom ART supported by National Free Antiretroviral Treatment Program was initiated between January 2015 and December 2018 in Zhaojue County, Liangshan Prefecture. Virological suppression (viral load < 50 copies/mL) was achieved within 12 months after ART initiation, and sustained virological suppression was maintained. Multivariate log-binomial regression analysis was used to assess determinants of suboptimal immune recovery. Results There were 140 female and 137 male patients in this study, with a mean age of 36.57 ± 7.63 years. Most of the Yi patients were infected through IDU (48.7%) or heterosexual contact (49.8%), and the anti-HCV antibody prevalence was high (43.7%, 121/277). Of the 277 patients with a mean ART duration of 3.77 ± 1.21 years, complete immune recovery occurred in only 32.9%. The baseline CD4 + T cell count in patients with suboptimal and intermediate immune recovery was 248.64 ± 108.10 and 288.59 ± 108.86 cells/μL, respectively, which was much lower than the baseline 320.02 ± 123.65 cells/μL in patients who achieved complete immune recovery (p < 0.001). Multivariable analysis demonstrated that low pre-ART CD4 + cell count and coinfection with HCV were associated with immune recovery of the HIV patients. Conclusions Our study suggests that for HIV-infected Yi patients in Liangshan Prefecture, prompt ART initiation after diagnosis of HIV infection should be applied, and curative HCV treatment should be given to patients with HCV/HIV coinfection to improve the immunological effectiveness of ART. Trial registration None Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07113-y.
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Affiliation(s)
- Liyu Chen
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.,Center of Antiretroviral Treatment, People's Hospital of Zhaojue County, 616150, Liangshan, Yi Autonomous Prefecture, China
| | - Chang-Hai Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Shuang Kang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghua Ma
- Center of Antiretroviral Treatment, People's Hospital of Zhaojue County, 616150, Liangshan, Yi Autonomous Prefecture, China
| | - Changmin Li
- Center of Antiretroviral Treatment, People's Hospital of Zhaojue County, 616150, Liangshan, Yi Autonomous Prefecture, China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
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Chun B, Pucilowska J, Chang S, Kim I, Nikitin B, Koguchi Y, Redmond WL, Bernard B, Rajamanickam V, Polaske N, Fields PA, Conrad V, Schmidt M, Urba WJ, Conlin AK, McArthur HL, Page DB. Changes in T-cell subsets and clonal repertoire during chemoimmunotherapy with pembrolizumab and paclitaxel or capecitabine for metastatic triple-negative breast cancer. J Immunother Cancer 2022; 10:jitc-2021-004033. [PMID: 35086949 PMCID: PMC8796261 DOI: 10.1136/jitc-2021-004033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chemoimmunotherapy is a standard treatment for triple-negative breast cancer (TNBC), however, the impacts of different chemotherapies on T-cell populations, which could correlate with clinical activity, are not known. Quantifying T-cell populations with flow cytometry and T-cell receptor (TCR) immunosequencing may improve our understanding of how chemoimmunotherapy affects T-cell subsets, and to what extent clonal shifts occur during treatment. TCR immunosequencing of intratumoral T cells may facilitate the identification and monitoring of putatively tumor-reactive T-cell clones within the blood. METHODS Blood and tumor biopsies were collected from patients with metastatic TNBC enrolled in a phase Ib clinical trial of first or second-line pembrolizumab with paclitaxel or capecitabine. Using identical biospecimen processing protocols, blood samples from a cohort of patients treated for early-stage breast cancer were obtained for comparison. Treatment-related immunological changes in peripheral blood and intratumoral T cells were characterized using flow cytometry and TCR immunosequencing. Clonal proliferation rates of T cells were compared based on intratumoral enrichment. RESULTS When combined with pembrolizumab, paclitaxel and capecitabine resulted in similar time-dependent lymphodepletions across measured peripheral T-cell subsets. Their effects were more modest than that observed following curative-intent dose-dense anthracycline and cyclophosphamide (ddAC) (average fold-change in CD3+ cells, capecitabine: -0.42, paclitaxel: -0.56, ddAC: -1.21). No differences in T-cell clonality or richness were observed following capecitabine or paclitaxel-based treatments. Regression modeling identified differences in the emergence of novel T-cell clones that were not detected at baseline (odds compared with ddAC, capecitabine: 0.292, paclitaxel: 0.652). Pembrolizumab with paclitaxel or capecitabine expanded T-cell clones within tumors; however, these clones did not always expand within the blood. Proliferation rates within the blood were similar between clones that were enriched and those that were not enriched within tumors. CONCLUSION Chemoimmunotherapy for metastatic TNBC with pembrolizumab and capecitabine or paclitaxel resulted in similar peripheral T-cell subset lymphodepletion without altering T-cell clonal diversity. Regression modeling methods are applicable in immune monitoring studies, such as this to identify the odds of novel T-cell clones emerging during treatment, and proliferation rates of tumor-enriched T-cell clones.
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Affiliation(s)
- Brie Chun
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Joanna Pucilowska
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - ShuChing Chang
- Medical Data Research Center, Providence St Joseph Health, Portland, Oregon, USA
| | - Isaac Kim
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Benjamin Nikitin
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Yoshinobu Koguchi
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - William L Redmond
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Brady Bernard
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA.,Computational Immuno-Oncology and Bioinformatics Core, Earle A. Chiles Research Institute, Portland, Oregon, USA
| | - Venkatesh Rajamanickam
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA.,Computational Immuno-Oncology and Bioinformatics Core, Earle A. Chiles Research Institute, Portland, Oregon, USA
| | | | - Paul A Fields
- Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Valerie Conrad
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Mark Schmidt
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Walter J Urba
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Alison K Conlin
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Heather L McArthur
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David B Page
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
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Peng Y, Wang X, Yin S, Wang M. A new indicator: The diagnostic value of CD8+T/B lymphocyte ratio in sepsis progression. Int J Immunopathol Pharmacol 2022; 36:3946320221123164. [PMID: 36036157 PMCID: PMC9421217 DOI: 10.1177/03946320221123164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To reveal the value of single lymphocyte subpopulation and their ratios in
the progression of sepsis. Methods From January 2019 to March 2021, 39 sepsis patients, 16 septic shock
patients, and 50 healthy volunteers were recruited in the Second Xiangya
Hospital for this cross-sectional study. The absolute quantitation of CD4+T,
CD8+T, B lymphocytes, and NK cells in peripheral blood were determined by
flow cytometry. SPSS Software was used to analyze the results. Results On the whole, the numbers of lymphocytes in the sepsis group and in the
septic shock group were lower than that in the healthy control group.
Surprisingly, the percentage of CD8+T lymphocytes in the septic shock group
was slightly higher than that in the sepsis group. The percentage of B
lymphocytes in the sepsis group was higher than that in the healthy control
group. The AUC of CD8+T/B was 0.724, with the sensitivity and specificity
being 75.00% and 71.79%, respectively. Conclusion The immune expression pattern of patients with sepsis was not a simple
decrease in the number of lymphocytes. The change in the ratios of
lymphocyte subpopulation might be more meaningful along the development and
progression of sepsis. The ratio of CD8+T/B could be used to diagnose the
progression of sepsis and reduce the misdiagnosis rate to a certain
extent.
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Affiliation(s)
- Yizhi Peng
- Department of Laboratory Medicine, 70566The Second Xiangya Hospitalof Central South University, Changsha, Hunan, China
| | - Xiaofan Wang
- Department of Laboratory Medicine, 70566The Second Xiangya Hospitalof Central South University, Changsha, Hunan, China
| | - Sheng Yin
- Department of Laboratory Medicine, 70566The Second Xiangya Hospitalof Central South University, Changsha, Hunan, China
| | - Min Wang
- Department of Laboratory Medicine, 70566The Second Xiangya Hospitalof Central South University, Changsha, Hunan, China
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Bernal E, Martinez M, Campillo JA, Puche G, Baguena C, Tomás C, Jimeno A, Alcaraz MJ, Alcaraz A, Muñoz A, Oliver E, de la Torre A, Marín I, Cano A, Minguela A. Moderate to intense physical activity is associated with improved clinical, CD4/CD8 ratio and immune activation status in HIV infected patients on ART. Open Forum Infect Dis 2021; 9:ofab654. [PMID: 35146043 PMCID: PMC8826224 DOI: 10.1093/ofid/ofab654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background Physical activity has anti-inflammatory effects and reduces morbidity and mortality in the general population, but its role in the clinical, CD4/CD8 ratio, and immune activation status of HIV-infected patients has been poorly studied. Methods A cross-sectional study was carried out in a cohort of 155 HIV-infected patients on stable antiretroviral therapy (ART) to compare clinical, biochemical, CD4/CD8 ratio, and immune activation status according to their physical activity in the last 2 years (sedentary/low vs moderate/intense) assessed by the iPAQ. A binary logistic regression and mixed analysis of variance were performed to evaluate the impact of levels of physical activity on CD4/CD8 ratio. Results In our series, 77 (49.7%) out of 155 patients were sedentary, and 78 (50.3%) practiced moderate/intense physical activity. Moderate/intense physical activity was associated with better metabolic control (lower body mass index, P = .024; glucose, P = .024; and triglyceride, P = .002) and CDC HIV stage (P = .046), lower CD8+ (P = .018), CD4+CD8+ (P = .026), CD4+CD86+ (P = .045), CD4+HLA-DR+ (P = .011), CD8+HLA-DR+ (P = .048) T lymphocytes and CD16+HLA-DR+ natural killer cells (P = .026), and higher CD3+CD4+ T lymphocytes (P = .016) and CD4/CD8 ratio (P = .001). Sedentary lifestyle (odds ratio [OR], 2.12; P = .042), CD4 nadir (OR, 1.005; P < .001), and CD8+CD38+ T cells (OR, 1.27; P = .006) were independently associated with low CD4/CD8 ratio (<0.8). Earlier and more intense CD4/CD8 ratio recovery was observed in patients with higher physical activity in the 2-year follow-up with a significant interaction between these variables: F(2, 124) = 3.31; P = .049; partial η2 = 0.042. Conclusions Moderate to high physical activity is associated with beneficial health effects, improvement in metabolic profile, and reduction of chronic inflammation in patients with HIV. Although more studies and clinical trials are needed to confirm these findings, a healthy lifestyle including at least moderate physical activity should be recommended to HIV patients on stable ART.
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Affiliation(s)
- Enrique Bernal
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Monica Martinez
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - José Antonio Campillo
- Immunology Service, Virgen de la Arrrixaca University Clinical Hospital (HCUVA), Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Gabriel Puche
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Carlos Baguena
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Cristina Tomás
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Amaya Jimeno
- Internal Medicine Service, Infectious Disease Unit. Santa Lucía University Hospital, Cartagena, Spain
| | - Maria Jose Alcaraz
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Antonia Alcaraz
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Angeles Muñoz
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Eva Oliver
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Alejandro de la Torre
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Irene Marín
- Cardiology Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Alfredo Cano
- Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Alfredo Minguela
- Immunology Service, Virgen de la Arrrixaca University Clinical Hospital (HCUVA), Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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Castro-Granell V, Garin N, Jaén Á, Casado JL, Leal L, Cenoz S, Fuster-RuizdeApodaca MJ. Recreational Drug Use in People Living with HIV in Spain: Factors Associated with Drug Use and the Impact on Clinical Outcomes. AIDS Behav 2021; 25:3883-3897. [PMID: 33932187 PMCID: PMC8602223 DOI: 10.1007/s10461-021-03271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 01/28/2023]
Abstract
We analysed the impact of recreational drug use (RDU) on different outcomes in people living with HIV (PLHIV). A multicentre retrospective cohort study was performed with two cohorts of PLHIV included: people using recreational drugs (PURD) vs. people not using recreational drugs (PNURD). Overall, 275 PLHIV were included. RDU was associated with men having sex with men (OR 4.14, 95% CI [1.14, 5.19]), previous sexually transmitted infections (OR 4.00, 95% CI [1.97, 8.13]), and current smoking (OR 2.74, 95% CI [1.44, 5.19]). While the CD4/CD8 ratio increased amongst PNURD during the follow-up year, it decreased amongst PURD (p = 0.050). PURD presented lower scores of self-reported and multi-interval antiretroviral adherence (p = 0.017, and p = 0.006, respectively), emotional well-being (p < 0.0001), and regular follow-up (p = 0.059), but paid more visits to the emergency unit (p = 0.046). RDU worsens clinical, immunological, and mental health outcomes amongst PLHIV.
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Affiliation(s)
- Vanessa Castro-Granell
- Doctoral Programme in Pharmacy, Granada University, Granada, Spain
- Department of Pharmacy, Hospital Marina Baixa, Av. Alcalde En Jaume Botella Mayor, 7, 03570 Villajoyosa, Alicante Spain
| | - Noé Garin
- Department of Pharmacy, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ángeles Jaén
- Research Unit, Fundació Docència i Recerca mutua Terrassa. Universidad de Barcelona, Terrassa, Barcelona Spain
| | - José Luis Casado
- Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain
| | - Lorna Leal
- Infectious Diseases-HIV Unit, Hospital Clínic Barcelona- IDIBAPS, Barcelona, Spain
| | - Santiago Cenoz
- Medical Department, ViiV Healthcare, Tres Cantos, Madrid Spain
| | - María José Fuster-RuizdeApodaca
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Jianu C, Itu-Mureşan C, Drugan C, Filipescu I, Topan AV, Jianu ME, Morar II, Bolboacă SD. Evaluation of several serum interleukins as markers for treatment effectiveness in naïve HIV infected patients: A pilot study. PLoS One 2021; 16:e0260007. [PMID: 34784398 PMCID: PMC8594820 DOI: 10.1371/journal.pone.0260007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
In this observational pilot study, we investigated the impact of Dolutegravir, Raltegravir, Elvitegravir (Integrase Strand Transfer Inhibitors, INSTIs), or boosted Darunavir (a Protease Inhibitor, PI) in combination with two nucleoside reverstranscriptase inhibitors (Emtricitabine/Tenofovir disoproxil or Lamivudine/Tenofovir disoproxil, NRTI) on four interleukins (IL-4, IL-10, IL-13, and IL-21) as immune activation markers in naïve HIV(Human Immunodeficiency Virus)-infected patients during the first six months of combined standard-of-care antiretroviral therapy (cART). Newly diagnosed with HIV-infected subjects and without any disease that could affect the immune activation markers were evaluated. The patients’ physicians recommended the cART as standard-of-care and the ILs were measured before cART and six months of cART. The levels of CD4+ T-cells count and CD4+/CD8+ ratio significantly increased at six months (P-value<0.02) regardless of the drugs, INSTIs or PI. However, a CD4+/CD8+ >1 was observed in 25% of patients treated with Raltegravir and half of those treated with Dolutegravir. At six months of cART, viral load was detectable in only 6/31 individuals. IL-21 had an undetectable level in 30/31 patients after six months of cART. Our results suggest the potency in restoring immune markers in HIV-infected patients with all investigated drugs. Dolutegravir showed a tendency to statistically significant changes in IL-4 and IL-10. A clinical trial with random allocation of medication and an extensive follow-up is needed to replicate this research and validate the usefulness of evaluated ILs as markers of cART effectiveness.
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Affiliation(s)
- Cristian Jianu
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Immunosuppressed, Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
| | - Corina Itu-Mureşan
- Department of Immunosuppressed, Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
| | - Cristina Drugan
- Department of Biochemistry, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Irina Filipescu
- Department of Immunosuppressed, Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
| | - Adriana Violeta Topan
- Department of Immunosuppressed, Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
- Department of Infectious Diseases, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Elena Jianu
- Department of Histology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- * E-mail: (MEJ); (SDB)
| | - Ioana Iulia Morar
- Department of Pathophysiology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- * E-mail: (MEJ); (SDB)
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González-Cordón A, Assoumou L, Moyle G, Waters L, Johnson M, Domingo P, Fox J, Stellbrink HJ, Guaraldi G, Masiá M, Gompels M, De Wit S, Florence E, Esser S, Raffi F, Behrens G, Pozniak A, Gatell JM, Martínez E. Switching from boosted PIs to dolutegravir decreases soluble CD14 and adiponectin in high cardiovascular risk people living with HIV. J Antimicrob Chemother 2021; 76:2380-2393. [PMID: 34120186 DOI: 10.1093/jac/dkab158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Switching from boosted PIs to dolutegravir in people living with HIV (PLWH) with high cardiovascular risk improved plasma lipids at 48 weeks in the NEAT022 trial. Whether this strategy may have an impact on cardiovascular biomarkers is unknown. METHODS We assessed 48 week changes in biomarkers associated with inflammation, endothelial dysfunction, monocyte immune activation, oxidation, insulin resistance, hypercoagulability, heart failure, myocardial injury, and glomerular and tubular kidney injury. RESULTS Of 415 PLWH randomized in the NEAT022 study, 313 (75.4%) remained on allocated therapy and had paired samples available. Soluble CD14 (-11%, P < 0.001) and adiponectin (-11%, P < 0.001) significantly declined and high-sensitive C-reactive protein (-13%, P = 0.069) and oxidized LDL (-13%, P = 0.084) tended to decrease with dolutegravir. Switching to dolutegravir remained significantly associated with soluble CD14 and adiponectin reductions after adjustment for baseline variables. There were inverse correlations between soluble CD14 and CD4 count changes (P = 0.05), and between adiponectin and BMI changes (P < 0.001). CONCLUSIONS Switching from boosted PIs to dolutegravir in PLWH with high cardiovascular risk led to soluble CD14 and adiponectin reductions at 48 weeks. While decreasing soluble CD14 may entail favourable health effects in PLWH, adiponectin reduction may reflect less insulin sensitivity associated with weight gain.
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Affiliation(s)
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Graeme Moyle
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Laura Waters
- Mortimer Market Centre, Central & North West London NHS Foundation Trust, London, UK
| | | | | | - Julie Fox
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Mar Masiá
- Hospital General Universitario de Elche, Elche, Spain
| | | | - Stephane De Wit
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - José M Gatell
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.,ViiV Healthcare, Brentford, UK
| | - Esteban Martínez
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Zhabokritsky A, Szadkowski L, Cooper C, Loutfy M, Wong A, McClean A, Hogg RS, Walmsley SL. Increased CD4 : CD8 ratio normalization with implementation of current ART management guidelines. J Antimicrob Chemother 2021; 76:729-737. [PMID: 33249444 PMCID: PMC7879150 DOI: 10.1093/jac/dkaa484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To determine the time to CD4 : CD8 ratio normalization among Canadian adults living with HIV in the modern ART era. To identify characteristics associated with ratio normalization. PATIENTS AND METHODS Retrospective analysis of the Canadian Observational Cohort (CANOC), an interprovincial cohort of ART-naive adults living with HIV, recruited from 11 treatment centres across Canada. We studied participants initiating ART between 1 January 2011 and 31 December 2016 with baseline CD4 : CD8 ratio <1.0 and ≥2 follow-up measurements. Normalization was defined as two consecutive CD4 : CD8 ratios ≥1.0. Kaplan-Meier estimates and log-rank tests described time to normalization. Univariable and multivariable proportional hazards (PH) models identified factors associated with ratio normalization. RESULTS Among 3218 participants, 909 (28%) normalized during a median 2.6 years of follow-up. Participants with higher baseline CD4+ T-cell count were more likely to achieve normalization; the probability of normalization by 5 years was 0.68 (95% CI 0.62-0.74) for those with baseline CD4+ T-cell count >500 cells/mm3 compared with 0.16 (95% CI 0.11-0.21) for those with ≤200 cells/mm3 (P < 0.0001). In a multivariable PH model, baseline CD4+ T-cell count was associated with a higher likelihood of achieving ratio normalization (adjusted HR = 1.5, 95% CI 1.5-1.6 per 100 cells/mm3, P < 0.0001). After adjusting for baseline characteristics, time-dependent ART class was not associated with ratio normalization. CONCLUSIONS Early ART initiation, at higher baseline CD4+ T-cell counts, has the greatest impact on CD4 : CD8 ratio normalization. Our study supports current treatment guidelines recommending immediate ART start, with no difference in ratio normalization observed based on ART class used.
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Affiliation(s)
- Alice Zhabokritsky
- Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Leah Szadkowski
- Department of Medicine, University Health Network, Toronto, Canada
- Biostatistics Research Unit, University Health Network, Toronto, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Alison McClean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Sharon L Walmsley
- Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
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Katlama C, Autran B. Do integrase inhibitors affect immune restoration? Lancet HIV 2020; 7:e526-e527. [PMID: 32763212 DOI: 10.1016/s2352-3018(20)30196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Christine Katlama
- Department of infectious diseases APHP Hopital Pitié salpetriere Institut Pierre Louis Sorbonne Université Paris F-75013, France.
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