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Sreejithkumar V, Ghods K, Bandara T, Martcheva M, Tuncer N. Modeling the interplay between albumin-globulin metabolism and HIV infection. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:19527-19552. [PMID: 38052613 DOI: 10.3934/mbe.2023865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Human immunodeficiency virus (HIV) infection is a major public health concern with 1.2 million people living with HIV in the United States. The role of nutrition in general, and albumin/globulin in particular in HIV progression has long been recognized. However, no mathematical models exist to describe the interplay between HIV and albumin/globulin. In this paper, we present a family of models of HIV and the two protein components albumin and globulin. We use albumin, globulin, viral load and target cell data from simian immunodeficiency virus (SIV)-infected monkeys to perform model selection on the family of models. We discover that the simplest model accurately and uniquely describes the data. The selection of the simplest model leads to the observation that albumin and globulin do not impact the infection rate of target cells by the virus and the clearance of the infected target cells by the immune system. Moreover, the recruitment of target cells and immune cells are modeled independently of globulin in the selected model. Mathematical analysis of the selected model reveals that the model has an infection-free equilibrium and a unique infected equilibrium when the immunological reproduction number is above one. The infection-free equilibrium is locally stable when the immunological reproduction number is below one, and unstable when the immunological reproduction number is greater than one. The infection equilibrium is locally stable whenever it exists. To determine the parameters of the best fitted model we perform structural and practical identifiability analysis. The structural identifiability analysis reveals that the model is identifiable when the immune cell infection rate is fixed at a value obtained from the literature. Practical identifiability reveals that only seven of the sixteen parameters are practically identifiable with the given data. Practical identifiability of parameters performed with synthetic data sampled a lot more frequently reveals that only two parameters are practically unidentifiable. We conclude that experiments that will improve the quality of the data can help improve the parameter estimates and lead to better understanding of the interplay of HIV and albumin-globulin metabolism.
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Affiliation(s)
- Vivek Sreejithkumar
- Florida Atlantic University, Department of Mathematical Sciences, Boca Raton, FL 33431, USA
| | - Kia Ghods
- Florida Atlantic University, Department of Mathematical Sciences, Boca Raton, FL 33431, USA
| | - Tharusha Bandara
- University of Florida, Department of Mathematics, Gainesville, FL 32611, USA
| | - Maia Martcheva
- University of Florida, Department of Mathematics, Gainesville, FL 32611, USA
| | - Necibe Tuncer
- Florida Atlantic University, Department of Mathematical Sciences, Boca Raton, FL 33431, USA
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Grant‐McAuley W, Piwowar‐Manning E, Clarke W, Breaud A, Zewdie KB, Moore A, Ayles HM, Kosloff B, Shanaube K, Bock P, Meehan S, Maarman G, Fidler S, Hayes R, Donnell D, Eshleman SH. Population-level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART). J Int AIDS Soc 2023; 26:e26179. [PMID: 37886843 PMCID: PMC10603557 DOI: 10.1002/jia2.26179] [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: 01/10/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community-randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013-2018). METHODS VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non-controllers if they had a VL ≥2000 copies/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs <2000 with no ARV drugs detected at both visits. Non-controllers who had ARV drugs detected at either visit were excluded from the analysis to minimize potential confounders associated with ARV drug access and uptake. RESULTS The final cohort included 126 viraemic controllers and 766 non-controllers who had no ARV drugs detected. The prevalence of controllers among the 4072 persons assessed was 3.1% (95% confidence interval [CI]: 2.6%, 3.6%). This should be considered a minimum estimate, since high rates of ARV drug use in the parent study limited the ability to identify controllers. Among the 892 participants in the final cohort, controller status was associated with biological sex (female > male, p = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV-2) status at study enrolment. CONCLUSIONS To our knowledge, this report presents the first large-scale, population-level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self-reported data). This study identified a large cohort of HIV controllers and non-controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control.
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Affiliation(s)
- Wendy Grant‐McAuley
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | - William Clarke
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Autumn Breaud
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | | | - Helen Mary Ayles
- ZambartUniversity of Zambia School of Public HealthLusakaZambia
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Barry Kosloff
- ZambartUniversity of Zambia School of Public HealthLusakaZambia
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Kwame Shanaube
- ZambartUniversity of Zambia School of Public HealthLusakaZambia
| | - Peter Bock
- Desmond Tutu TB CenterDepartment of Paediatrics and Child HealthStellenbosch UniversityWestern CapeSouth Africa
| | - Sue‐Ann Meehan
- Desmond Tutu TB CenterDepartment of Paediatrics and Child HealthStellenbosch UniversityWestern CapeSouth Africa
| | - Gerald Maarman
- Centre for Cardio‐Metabolic Research in AfricaDivision of Medical PhysiologyFaculty of Medicine and Health SciencesStellenbosch UniversityWestern CapeSouth Africa
| | - Sarah Fidler
- Department of Infectious DiseaseImperial College LondonLondonUK
| | - Richard Hayes
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Susan H. Eshleman
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Nosik M, Berezhnya E, Bystritskaya E, Kiseleva I, Lobach O, Kireev D, Svitich O. Female Sex Hormones Upregulate the Replication Activity of HIV-1 Sub-Subtype A6 and CRF02_AG but Not HIV-1 Subtype B. Pathogens 2023; 12:880. [PMID: 37513727 PMCID: PMC10383583 DOI: 10.3390/pathogens12070880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
More than 50% of all people living with HIV worldwide are women. Globally, HIV/AIDS is the leading cause of death among women aged 15 to 44. The safe and effective methods of hormonal contraception are an essential component of preventive medical care in order to reduce maternal and infant mortality. However, there is limited knowledge regarding the effect of hormones on the rate of viral replication in HIV infection, especially non-B subtypes. The goal of the present work was to study in vitro how the female hormones β-estradiol and progesterone affect the replication of the HIV-1 subtypes A6, CRF02_AG, and B. The findings show that high doses of hormones enhanced the replication of HIV-1 sub-subtype A6 by an average of 1.75 times and the recombinant variant CRF02_AG by 1.4 times but did not affect the replication of HIV-1 subtype B. No difference was detected in the expression of CCR5 and CXCR4 co-receptors on the cell surface, either in the presence or absence of hormones. However, one of the reasons for the increased viral replication could be the modulated TLRs secretion, as it was found that high doses of estradiol and progesterone upregulated, to varying degrees, the expression of TLR2 and TLR9 genes in the PBMCs of female donors infected with HIV-1 sub-subtype A6.
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Affiliation(s)
- Marina Nosik
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia
| | - Elena Berezhnya
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia
| | | | - Irina Kiseleva
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia
| | - Olga Lobach
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia
| | - Dmitry Kireev
- Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Oxana Svitich
- I.I. Mechnikov Institute of Vaccines and Sera, 105064 Moscow, Russia
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Madlala P, Mkhize Z, Naicker S, Khathi SP, Maikoo S, Gopee K, Dong KL, Ndung'u T. Genetic variation of the HIV-1 subtype C transmitted/founder viruses long terminal repeat elements and the impact on transcription activation potential and clinical disease outcomes. PLoS Pathog 2023; 19:e1011194. [PMID: 37307292 DOI: 10.1371/journal.ppat.1011194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
A genetic bottleneck is a hallmark of HIV-1 transmission such that only very few viral strains, termed transmitted/founder (T/F) variants establish infection in a newly infected host. Phenotypic characteristics of these variants may determine the subsequent course of disease. The HIV-1 5' long terminal repeat (LTR) promoter drives viral gene transcription and is genetically identical to the 3' LTR. We hypothesized that HIV-1 subtype C (HIV-1C) T/F virus LTR genetic variation is a determinant of transcriptional activation potential and clinical disease outcome. The 3'LTR was amplified from plasma samples of 41 study participants acutely infected with HIV-1C (Fiebig stages I and V/VI). Paired longitudinal samples were also available at one year post-infection for 31 of the 41 participants. 3' LTR amplicons were cloned into a pGL3-basic luciferase expression vector, and transfected alone or together with Transactivator of transcription (tat) into Jurkat cells in the absence or presence of cell activators (TNF-α, PMA, Prostratin and SAHA). Inter-patient T/F LTR sequence diversity was 5.7% (Renge: 2-12) with subsequent intrahost viral evolution observed in 48.4% of the participants analyzed at 12 months post-infection. T/F LTR variants exhibited differential basal transcriptional activity, with significantly higher Tat-mediated transcriptional activity compared to basal (p<0.001). Basal and Tat-mediated T/F LTR transcriptional activity showed significant positive correlation with contemporaneous viral loads and negative correlation with CD4 T cell counts (p<0.05) during acute infection respectively. Furthermore, Tat-mediated T/F LTR transcriptional activity significanly correlated positively with viral load set point and viral load; and negatively with CD4 T cell counts at one year post infection (all p<0.05). Lastly, PMA, Prostratin, TNF-α and SAHA cell stimulation resulted in enhanced yet heterologous transcriptional activation of different T/F LTR variants. Our data suggest that T/F LTR variants may influence viral transcriptional activity, disease outcomes and sensitivity to cell activation, with potential implications for therapeutic interventions.
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Affiliation(s)
- Paradise Madlala
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Zakithi Mkhize
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shamara Naicker
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Samukelisiwe P Khathi
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shreyal Maikoo
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kasmira Gopee
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Krista L Dong
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
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Bouman JA, Venner CM, Walker C, Arts EJ, Regoes RR. Per-pathogen virulence of HIV-1 subtypes A, C and D. Proc Biol Sci 2023; 290:20222572. [PMID: 37161335 PMCID: PMC10170192 DOI: 10.1098/rspb.2022.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
HIV-1 subtypes differ in their clinical manifestations and the speed in which they spread. In particular, the frequency of subtype C is increasing relative to subtypes A and D. We investigate whether HIV-1 subtypes A, C and D differ in their per-pathogen virulence and to what extend this explains the difference in spread between these subtypes. We use data from the hormonal contraception and HIV-1 genital shedding and disease progression among women with primary HIV infection study. For each study participant, we determine the set-point viral load value, CD4+ T cell level after primary infection and CD4+ T cell decline. Based on both the CD4+ T cell count after primary infection and CD4+ T cell decline, we estimate the time until AIDS. We then obtain our newly introduced measure of virulence as the inverse of the estimated time until AIDS. After fitting a model to the measured virulence and set-point viral load values, we tested if this relation varies per subtype. We found that subtype C has a significantly higher per-pathogen virulence than subtype A. Based on an evolutionary model, we then hypothesize that differences in the primary length of infection period cause the observed variation in the speed of spread of the subtypes.
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Affiliation(s)
- Judith A Bouman
- Institute of Integrative Biology, ETH Zurich, 8092 Zurich, Switzerland
| | - Colin M Venner
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 3K7, Canada
| | - Courtney Walker
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 3K7, Canada
| | - Eric J Arts
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 3K7, Canada
| | - Roland R Regoes
- Institute of Integrative Biology, ETH Zurich, 8092 Zurich, Switzerland
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Parker E, Judge MA, Pastor L, Fuente-Soro L, Jairoce C, Carter KW, Anderson D, Mandomando I, Clifford HD, Naniche D, Le Souëf PN. Gene dysregulation in acute HIV-1 infection – early transcriptomic analysis reveals the crucial biological functions affected. Front Cell Infect Microbiol 2023; 13:1074847. [PMID: 37077524 PMCID: PMC10106835 DOI: 10.3389/fcimb.2023.1074847] [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: 10/20/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionTranscriptomic analyses from early human immunodeficiency virus (HIV) infection have the potential to reveal how HIV causes widespread and lasting damage to biological functions, especially in the immune system. Previous studies have been limited by difficulties in obtaining early specimens.MethodsA hospital symptom-based screening approach was applied in a rural Mozambican setting to enrol patients with suspected acute HIV infection (Fiebig stage I-IV). Blood samples were collected from all those recruited, so that acute cases and contemporaneously recruited, uninfected controls were included. PBMC were isolated and sequenced using RNA-seq. Sample cellular composition was estimated from gene expression data. Differential gene expression analysis was completed, and correlations were determined between viral load and differential gene expression. Biological implications were examined using Cytoscape, gene set enrichment analysis, and enrichment mapping.ResultsTwenty-nine HIV infected subjects one month from presentation and 46 uninfected controls were included in this study. Subjects with acute HIV infection demonstrated profound gene dysregulation, with 6131 (almost 13% of the genome mapped in this study) significantly differentially expressed. Viral load was correlated with 1.6% of dysregulated genes, in particular, highly upregulated genes involved in key cell cycle functions, were correlated with viremia. The most profoundly upregulated biological functions related to cell cycle regulation, in particular, CDCA7 may drive aberrant cell division, promoted by overexpressed E2F family proteins. Also upregulated were DNA repair and replication, microtubule and spindle organization, and immune activation and response. The interferome of acute HIV was characterized by broad activation of interferon-stimulated genes with antiviral functions, most notably IFI27 and OTOF. BCL2 downregulation alongside upregulation of several apoptotic trigger genes and downstream effectors may contribute to cycle arrest and apoptosis. Transmembrane protein 155 (TMEM155) was consistently highly overexpressed during acute infection, with roles hitherto unknown.DiscussionOur study contributes to a better understanding of the mechanisms of early HIV-induced immune damage. These findings have the potential to lead to new earlier interventions that improve outcomes.
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Affiliation(s)
- Erica Parker
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Melinda A. Judge
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- *Correspondence: Melinda A. Judge,
| | - Lucia Pastor
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
- AIDS Research Institute-IrsiCaixa, Institut Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Laura Fuente-Soro
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | | | | | - Inácio Mandomando
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | | | - Denise Naniche
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Peter Neils Le Souëf
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
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Kuriakose Gift S, Wieczorek L, Sanders-Buell E, Zemil M, Molnar S, Donofrio G, Townsley S, Chenine AL, Bose M, Trinh HV, Barrows BM, Sriplienchan S, Kitsiripornchai S, Nitayapan S, Eller LA, Rao M, Ferrari G, Michael NL, Ake JA, Krebs SJ, Robb ML, Tovanabutra S, Polonis VR. Evolution of Antibody Responses in HIV-1 CRF01_AE Acute Infection: Founder Envelope V1V2 Impacts the Timing and Magnitude of Autologous Neutralizing Antibodies. J Virol 2023; 97:e0163522. [PMID: 36749076 PMCID: PMC9973046 DOI: 10.1128/jvi.01635-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
Understanding the dynamics of early immune responses to HIV-1 infection, including the evolution of initial neutralizing and antibody-dependent cellular cytotoxicity (ADCC)-mediating antibodies, will inform HIV vaccine design. In this study, we assess the development of autologous neutralizing antibodies (ANAbs) against founder envelopes (Envs) from 18 participants with HIV-1 CRF01_AE acute infection. The timing of ANAb development directly associated with the magnitude of the longitudinal ANAb response. Participants that developed ANAbs within 6 months of infection had significantly higher ANAb responses at 1 year (50% inhibitory concentration [IC50] geometric mean titer [GMT] = 2,010 versus 184; P = 0.001) and 2 years (GMT = 3,479 versus 340; P = 0.015), compared to participants that developed ANAb responses after 6 months. Participants with later development of ANAb tended to develop an earlier, potent heterologous tier 1 (92TH023) neutralizing antibody (NAb) response (P = 0.049). CRF01_AE founder Env V1V2 loop lengths correlated indirectly with the timing (P = 0.002, r = -0.675) and directly with magnitude (P = 0.005, r = 0.635) of ANAb responses; Envs with longer V1V2 loop lengths elicited earlier and more potent ANAb responses. While ANAb responses did not associate with viral load, the viral load set point correlated directly with neutralization of the heterologous 92TH023 strain (P = 0.007, r = 0.638). In contrast, a striking inverse correlation was observed between viral load set point and peak ADCC against heterologous 92TH023 Env strain (P = 0.0005, r = -0.738). These data indicate that specific antibody functions can be differentially related to viral load set point and may affect HIV-1 pathogenesis. Exploiting Env properties, such as V1V2 length, could facilitate development of subtype-specific vaccines that elicit more effective immune responses and improved protection. IMPORTANCE Development of an effective HIV-1 vaccine will be facilitated by better understanding the dynamics between the founder virus and the early humoral responses. Variations between subtypes may influence the evolution of immune responses and should be considered as we strive to understand these dynamics. In this study, autologous founder envelope neutralization and heterologous functional humoral responses were evaluated after acute infection by HIV-1 CRF01_AE, a subtype that has not been thoroughly characterized. The evolution of these humoral responses was assessed in relation to envelope characteristics, magnitude of elicited immune responses, and viral load. Understanding immune parameters in natural infection will improve our understanding of protective responses and aid in the development of immunogens that elicit protective functional antibodies. Advancing our knowledge of correlates of positive clinical outcomes should lead to the design of more efficacious vaccines.
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Affiliation(s)
- Syna Kuriakose Gift
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Lindsay Wieczorek
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Eric Sanders-Buell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Michelle Zemil
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Sebastian Molnar
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Gina Donofrio
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Samantha Townsley
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Agnes L. Chenine
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Meera Bose
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Hung V. Trinh
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Brittani M. Barrows
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Somchai Sriplienchan
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Suchai Kitsiripornchai
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sorachai Nitayapan
- Royal Thai Army, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Leigh-Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Mangala Rao
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Guido Ferrari
- Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nelson L. Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Shelly J. Krebs
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Victoria R. Polonis
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Smith SA, Murray PM, Amancha PK, Ackerley CG, Tharp GK, Bosinger SE, Amara RR, Kelley CF. T-cell activation and B-cell interaction signatures in rectal tissues are associated with HIV replication in ex-vivo model of infection. AIDS 2022; 36:2101-2106. [PMID: 35969202 PMCID: PMC10228710 DOI: 10.1097/qad.0000000000003356] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The rectal mucosa is a critical site of HIV vulnerability. We sought to identify transcriptomic features of rectal mucosal tissue prior to exposure associated with support or restriction of HIV replication. DESIGN Rectal tissue from HIV-negative cis gender men ( n = 57) underwent concurrent RNAseq transcriptomic analyses (two biopsies/participant) and challenge with HIV in the ex-vivo explant model of infection (three biopsies challenged/participant) as part of a larger cohort study to understand the rectal mucosal immune environment among MSM. METHODS P24 was quantified in the explant supernatants over a culture period of 18 days via ELISA. Participant median p24 log area under the curve was correlated with bulk transcriptomic data (Illumina HiSeq3000) to identify associations between gene expression and p24 production. Significant differentially expressed genes (DEGs) were identified via DESeq2 analysis and analyzed with Reactome to identify pathways of interest. RESULTS In total, 183 DEG (181 upregulated, two downregulated) were associated with higher p24 accumulation in the ex-vivo challenge model, including T-cell activation, B-cell function, and chemokine DEG. Reactome analysis of the upregulated genes identified 'Adaptive Immune System', 'Cytokine Signaling in Immune System', and 'Innate Immune System' as significantly upregulated pathways. CONCLUSION For the first time, we identified rectal tissue transcriptomic signatures associated with increased p24 production utilizing an ex-vivo model. Our findings are highly relevant to HIV transmission and the early establishment of HIV reservoirs in humans, and future studies should examine the identified pathways as targets for new or improved biomedical prevention or treatment interventions.
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Affiliation(s)
- S. Abigail Smith
- Division of Infectious Disease, The Hope Clinic of the Emory Vaccine Center, Decatur, GA, USA
| | - Phillip M. Murray
- Division of Infectious Disease, The Hope Clinic of the Emory Vaccine Center, Decatur, GA, USA
| | - Praveen K. Amancha
- Division of Infectious Disease, The Hope Clinic of the Emory Vaccine Center, Decatur, GA, USA
| | - Cassie G. Ackerley
- Division of Infectious Disease, The Hope Clinic of the Emory Vaccine Center, Decatur, GA, USA
| | - Gregory K. Tharp
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Steven E. Bosinger
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Rama R. Amara
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Colleen F. Kelley
- Division of Infectious Disease, The Hope Clinic of the Emory Vaccine Center, Decatur, GA, USA
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9
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Alrubayyi A, Rowland-Jones S, Peppa D. Natural killer cells during acute HIV-1 infection: clues for HIV-1 prevention and therapy. AIDS 2022; 36:1903-1915. [PMID: 35851334 PMCID: PMC9612724 DOI: 10.1097/qad.0000000000003319] [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: 04/29/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
Despite progress in preexposure prophylaxis, the number of newly diagnosed cases with HIV-1 remains high, highlighting the urgent need for preventive and therapeutic strategies to reduce HIV-1 acquisition and limit disease progression. Early immunological events, occurring during acute infection, are key determinants of the outcome and course of disease. Understanding early immune responses occurring before viral set-point is established, is critical to identify potential targets for prophylactic and therapeutic approaches. Natural killer (NK) cells represent a key cellular component of innate immunity and contribute to the early host defence against HIV-1 infection, modulating the pathogenesis of acute HIV-1 infection (AHI). Emerging studies have identified tools for harnessing NK cell responses and expanding specialized NK subpopulations with adaptive/memory features, paving the way for development of novel HIV-1 therapeutics. This review highlights the knowns and unknowns regarding the role of NK cell subsets in the containment of acute HIV-1 infection, and summarizes recent advances in selectively augmenting NK cell functions through prophylactic and therapeutic interventions.
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Affiliation(s)
- Aljawharah Alrubayyi
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford
- Division of Infection and Immunity, University College London
| | | | - Dimitra Peppa
- Division of Infection and Immunity, University College London
- Mortimer Market Centre, Department of HIV, CNWL NHS Trust, London, UK
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10
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Ramalingam VV, Fletcher GJ, Kasirajan A, Demosthenes JP, Rupali P, Varghese GM, Pulimood SA, Rebekah G, Kannangai R. Can In-house HIV-2 Viral Load Assay be a Reliable Alternative to Commercial Assays for Clinical and Therapeutic Monitoring? Curr HIV Res 2022; 20:274-286. [PMID: 35692165 DOI: 10.2174/1570162x20666220609155237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Currently, there is a global contemplation to end the AIDS epidemic by 2030. HIV-2 poses unique challenges to this end. The burden of HIV-2 is higher in resource-limited countries, and it is intrinsically resistant to NNRTI drugs. In addition, there is no FDA-approved plasma viral load assay to monitor disease progression and therapeutic efficacy. To overcome these challenges, we have developed and evaluated an in-house quantitative HIV-2 viral load assay. METHODS Blood samples were collected from 28 HIV-2 treatment-naïve monoinfected individuals and tested using an in-house qPCR HIV-2 viral load assay. The extracted RNA was amplified using Quantifast pathogen + IC kit. RESULTS The in-house qPCR has a limit of detection of 695 copies/ml. The intra- and inter-assay variation (% CV) of the assay was 0.61 and 0.95, respectively. The in-house assay quantified HIV-2 NIBSC accurately (1000 IU) with a mean of 1952 copies/mL. Among the 28 samples tested by in-house qPCR assay, 11 (39.2%) samples were quantified, whereas 17 (60.7%) samples were not detected. In comparison with Altona RealStar HIV-2 RT PCR and Exavir Load RT assay, the results were 96.4% and 69.6% concordant, respectively. No significant (p = 0.99 and p = 0.13) difference in quantifying viral load between the three assays. Based on clinical and immunological (CD4) staging, the performance characteristics were comparable. CONCLUSION To the best of our knowledge, this is the first in-house qPCR developed in India. The performance characteristics of the in-house assay are comparable to the commercial assays, and they can be used assertively to monitor HIV-2 patients.
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Affiliation(s)
| | | | - Anand Kasirajan
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - John Paul Demosthenes
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - George Mannil Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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11
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Kleinman AJ, Pandrea I, Apetrei C. So Pathogenic or So What?-A Brief Overview of SIV Pathogenesis with an Emphasis on Cure Research. Viruses 2022; 14:135. [PMID: 35062339 PMCID: PMC8781889 DOI: 10.3390/v14010135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/10/2021] [Accepted: 12/25/2021] [Indexed: 02/07/2023] Open
Abstract
HIV infection requires lifelong antiretroviral therapy (ART) to control disease progression. Although ART has greatly extended the life expectancy of persons living with HIV (PWH), PWH nonetheless suffer from an increase in AIDS-related and non-AIDS related comorbidities resulting from HIV pathogenesis. Thus, an HIV cure is imperative to improve the quality of life of PWH. In this review, we discuss the origins of various SIV strains utilized in cure and comorbidity research as well as their respective animal species used. We briefly detail the life cycle of HIV and describe the pathogenesis of HIV/SIV and the integral role of chronic immune activation and inflammation on disease progression and comorbidities, with comparisons between pathogenic infections and nonpathogenic infections that occur in natural hosts of SIVs. We further discuss the various HIV cure strategies being explored with an emphasis on immunological therapies and "shock and kill".
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Affiliation(s)
- Adam J. Kleinman
- Division of Infectious Diseases, DOM, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Ivona Pandrea
- Department of Infectious Diseases and Immunology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Cristian Apetrei
- Division of Infectious Diseases, DOM, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
- Department of Infectious Diseases and Immunology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
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12
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Bangalee A, Bhoora S, Punchoo R. Evaluation of serological assays for the diagnosis of HIV infection in adults. S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 34797096 PMCID: PMC8603111 DOI: 10.4102/safp.v63i1.5316] [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: 04/09/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
Serological tests based on the enzyme immunoassay (EIA) are the primary tool for the diagnosis of human immunodeficiency virus (HIV) in adults and have rapidly evolved to quicker, affordable and more accurate test formats to detect early HIV infection. Second- and third-generation HIV rapid tests detect the immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to the HIV and are used at the point of care and in HIV self-testing. The tests are affordable and accessible in state and private diagnostic laboratories. The present-day fourth- and fifth-generation EIAs can detect both p24 antigen and IgG and IgM HIV antibodies and thereby diagnose early HIV infection at approximately 2 weeks. The fourth- and fifth-generation EIAs also report sensitivity and specificity of more than 99%. The correct interpretation of HIV diagnosis of false-positive and false-negative EIA test results requires collaborative scrutiny of patient factors and laboratory test methodologies.
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Affiliation(s)
- Avania Bangalee
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Tshwane Academic Division, National Health Laboratory Services, Tshwane.
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13
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Mills AM, Schulman KL, Fusco JS, Wohlfeiler MB, Priest JL, Oglesby A, Brunet L, Lackey PC, Fusco GP. Virologic Outcomes Among People Living With Human Immunodeficiency Virus With High Pretherapy Viral Load Burden Initiating on Common Core Agents. Open Forum Infect Dis 2021; 8:ofab363. [PMID: 34381843 PMCID: PMC8351805 DOI: 10.1093/ofid/ofab363] [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: 02/01/2021] [Accepted: 07/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background People living with human immunodeficiency virus (PLWH) initiating antiretroviral therapy (ART) with viral loads (VLs) ≥100 000 copies/mL are less likely to achieve virologic success, but few studies have characterized real-world treatment outcomes. Methods ART-naive PLWH with VLs ≥100 000 copies/mL initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL), or darunavir (DRV) between 12 August 2013 and 31 July 2017 were identified from the OPERA database. Virologic failure was defined as (i) 2 consecutive VLs ≥200 copies/mL after 36 weeks of ART; (ii) 1 VL ≥200 copies/mL with core agent discontinuation after 36 weeks; (iii) 2 consecutive VLs ≥200 copies/mL after suppression (≤50 copies/mL) before 36 weeks; or (iv) 1 VL ≥200 copies/mL with discontinuation after suppression before 36 weeks. Cox modeling estimated the association between regimen and virologic failure. Results There were 2038 ART-naive patients with high VL who initiated DTG (36%), EVG (46%), DRV (16%), or RAL (2%). Median follow-up was 18.1 (interquartile range, 12.4–28.9) months. EVG and DTG initiators were similar at baseline, but RAL initiators were older and more likely to be female with low CD4 cell counts while DRV initiators differed notably on factors associated with treatment failure. Virologic failure was experienced by 9.2% DTG, 13.2% EVG, 18.4% RAL, and 18.8% DRV initiators. Compared to DTG, the adjusted hazard ratio (95% confidence interval) was 1.46 (1.05–2.03) for EVG, 2.24 (1.50–3.34) for DRV, and 4.13 (1.85–9.24) for RAL. Conclusions ART-naive PLWH with high VLs initiating on DTG were significantly less likely to experience virologic failure compared to EVG, RAL, and DRV initiators. Antiretroviral therapy-naïve people living with HIV (PLWH) initiating therapy with viral loads ≥100,000 copies/mL varied markedly at baseline. In adjusted models, PLWH initiating dolutegravir-based regimens were less likely to experience virologic failure as compared to elvitegravir, raltegravir and darunavir initiators.
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Affiliation(s)
| | | | | | | | - Julie L Priest
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Alan Oglesby
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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14
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Geidelberg L, Mitchell KM, Alary M, Mboup A, Béhanzin L, Guédou F, Geraldo N, Goma-Matsétsé E, Giguère K, Aza-Gnandji M, Kessou L, Diallo M, Kêkê RK, Bachabi M, Dramane K, Lafrance C, Affolabi D, Diabaté S, Gagnon MP, Zannou DM, Gangbo F, Silhol R, Cianci F, Vickerman P, Boily MC. Mathematical Model Impact Analysis of a Real-Life Pre-exposure Prophylaxis and Treatment-As-Prevention Study Among Female Sex Workers in Cotonou, Benin. J Acquir Immune Defic Syndr 2021; 86:e28-e42. [PMID: 33105397 PMCID: PMC7803451 DOI: 10.1097/qai.0000000000002535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/28/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015-2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin. SETTING Cotonou, Benin. METHODS We developed a compartmental HIV transmission model featuring PrEP and antiretroviral therapy (ART) among the high-risk (FSW and clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared with TasP. We estimated the population-level impact of the 2-year study and several 20-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage [median, 2.5th-97.5th percentile uncertainty interval (95% UI)] of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP and 49% ART) scenarios. RESULTS The 2-year study (2017 coverages: 9% PrEP and 83% ART) prevented an estimated 8% (95% UI 6-12) and 6% (3-10) infections among FSW over 2 and 20 years, respectively, compared with 7% (3-11) and 5% (2-9) overall. The PrEP and TasP arms prevented 0.4% (0.2-0.8) and 4.6% (2.2-8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP and 88% ART) prevented 21% (17-26) and 17% (10-27) infections among FSW, respectively, and 5% (3-10) and 17% (10-27) overall. Compared with TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9× and 1.2× more infections among FSW and overall, respectively. CONCLUSIONS The demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages.
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Affiliation(s)
- Lily Geidelberg
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Kate M. Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Michel Alary
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
- Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Aminata Mboup
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
| | - Luc Béhanzin
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Bénin
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Fernand Guédou
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Bénin
| | - Nassirou Geraldo
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Bénin
| | | | - Katia Giguère
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
| | | | - Léon Kessou
- Service de Consultance et Expertise Nouvelle en Afrique (SCEN AFRIK), Cotonou, Bénin
| | - Mamadou Diallo
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
| | - René K. Kêkê
- Programme Santé de Lutte Contre le Sida (PSLS), Cotonou, Bénin
| | - Moussa Bachabi
- Programme Santé de Lutte Contre le Sida (PSLS), Cotonou, Bénin
| | - Kania Dramane
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Christian Lafrance
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
| | - Dissou Affolabi
- Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Bénin
- Centre National Hospitalier Universitaire HMK de Cotonou, Cotonou, Bénin
| | - Souleymane Diabaté
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
- Université Alassane Ouattara, Bouake, Côte d'Ivoire
| | - Marie-Pierre Gagnon
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
- Faculté des Sciences Infirmières, Université Laval, Québec, Québec, Canada
| | - Djimon M. Zannou
- Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Bénin
- Centre National Hospitalier Universitaire HMK de Cotonou, Cotonou, Bénin
| | - Flore Gangbo
- Programme Santé de Lutte Contre le Sida (PSLS), Cotonou, Bénin
- Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Bénin
- Centre National Hospitalier Universitaire HMK de Cotonou, Cotonou, Bénin
| | - Romain Silhol
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Fiona Cianci
- Health Protection Surveillance Center, Dublin, Ireland; and
- Population Health Sciences, University of Bristol, Bristol, United Kindom
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kindom
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec–Université Laval, Québec, Quebec, Canada
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15
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Chiappini E, Larotonda F, Lisi C, Giacomet V, Erba P, Bernardi S, Zangari P, Di Biagio A, Taramasso L, Giaquinto C, Rampon O, Gabiano C, Garazzino S, Tagliabue C, Esposito S, Bruzzese E, Badolato R, Zanaboni D, Cellini M, Dedoni M, Mazza A, Pession A, Giannini AM, Salvini F, Dodi I, Carloni I, Cazzato S, Tovo PA, de Martino M, Galli L. Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018. Front Pediatr 2021; 9:665764. [PMID: 34336735 PMCID: PMC8322739 DOI: 10.3389/fped.2021.665764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001-2006 to 0.27/100 person-years in 2007-2012 and 0.07/100 person-years in 2013-2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013-2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.
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Affiliation(s)
- Elena Chiappini
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Francesca Larotonda
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Catiuscia Lisi
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Vania Giacomet
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Paola Erba
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefania Bernardi
- Unit of Immune and Infectious Diseases, Stefania Bernardi Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Paola Zangari
- Research Unit of Clinical Immunology and Vaccinology, Paola Zangari Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padua, Italy
| | - Osvalda Rampon
- Department of Women and Child Health, University of Padova, Padua, Italy
| | - Clara Gabiano
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Claudia Tagliabue
- Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico Foundation, University of Milan, Milan, Italy
| | - Susanna Esposito
- Paediatric Department, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Eugenia Bruzzese
- Paediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Domenico Zanaboni
- Department on Internal Medicine and Therapeutics, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Monica Cellini
- Paediatric Hemato-Oncology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Dedoni
- Department of Paediatrics, Ospedale Microcitemico, Cagliari, Italy
| | - Antonio Mazza
- Department of Paediatrics, "S. Chiara" Hospital, Trento, Italy
| | - Andrea Pession
- Paediatric Unit, IRCCS Scientific Institute for Research and Healthcare, Sant'Orsola Hospital, Bologna, Italy
| | - Anna Maria Giannini
- Paediatric Infectious Diseases Unit, University Hospital Policlinico Giovanni XXIII, Bari, Italy
| | - Filippo Salvini
- Department of Paediatrics, Niguarda Hospital, University of Milan, Milan, Italy
| | - Icilio Dodi
- Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Pier Angelo Tovo
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Maurizio de Martino
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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16
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Mochache V, Richardson BA, Masese LN, Graham SM, Mandaliya K, Kinuthia J, Jaoko W, Overbaugh J, McClelland RS. Older age at infection and nulliparity are associated with long-term non-progression in female sex workers infected with non-subtype B HIV-1. Int J STD AIDS 2020; 31:510-516. [PMID: 32295475 DOI: 10.1177/0956462419898324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies have reported on HIV-infected, antiretroviral therapy (ART)-naïve individuals who show minimal disease progression despite prolonged infection. The characteristics of these long-term non-progressors (LTNPs) are not well-characterized in populations predominantly infected with non-subtype B HIV-1. Female sex workers in Mombasa, Kenya who acquired HIV-1 were studied to ascertain immunologic disease progression. Long-term non-progression was defined as an ART-naïve duration of infection ≥7 years and a majority of CD4+ cell counts ≥600 cells/µl with a non-declining CD4+ trend. Correlates of long-term non-progression were determined using multivariable logistic regression. Between February 1993 and March 2014, 332 women acquired HIV-1. Of these, 77 (23%) had ≥7 years of follow-up and 13 (17%) were categorized as LTNPs. Factors associated with long-term non-progression included age >30 years at infection (aOR = 9.41, 95% CI: 1.48–59.86, P = 0.005) and nulliparity (aOR = 20.19, 95% CI: 1.36–299.90, P = 0.03). Each log10 copies/ml increase in viral load (VL) set point was associated with a lower likelihood of being a LTNP (aOR = 0.31, 95% CI: 0.12–0.79, P = 0.01). These findings suggest that age and parity may influence the likelihood of long-term non-progression through mechanisms that are not mediated by the effects of these variables on VL. Future studies should seek to determine whether the associations presented are reproducible.
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Affiliation(s)
- Vernon Mochache
- University of Maryland, Center for International Health, Education and Biosecurity, Nairobi, Kenya
| | - Barbra A Richardson
- University of Maryland, Center for International Health, Education and Biosecurity, Nairobi, Kenya
| | - Linnet N Masese
- University of Maryland, Center for International Health, Education and Biosecurity, Nairobi, Kenya
| | - Susan M Graham
- University of Maryland, Center for International Health, Education and Biosecurity, Nairobi, Kenya
| | - Kishorchandra Mandaliya
- University of Maryland, Center for International Health, Education and Biosecurity, Nairobi, Kenya
| | - John Kinuthia
- Kenyatta National Hospital, Department of Research, Nairobi, Kenya.,University of Nairobi, Faculty of Medicine, Nairobi, Kenya
| | - Walter Jaoko
- University of Nairobi, Faculty of Medicine, Nairobi, Kenya
| | - Julie Overbaugh
- Fred Hutchison Cancer Research Center, Seattle, Washington, USA
| | - R Scott McClelland
- University of Washington, Department of Epidemiology, Seattle, Washington, USA
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17
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Waters R, Ndengane M, Abrahams MR, Diedrich CR, Wilkinson RJ, Coussens AK. The Mtb-HIV syndemic interaction: why treating M. tuberculosis infection may be crucial for HIV-1 eradication. Future Virol 2020; 15:101-125. [PMID: 32273900 PMCID: PMC7132588 DOI: 10.2217/fvl-2019-0069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Accelerated tuberculosis and AIDS progression seen in HIV-1 and Mycobacterium tuberculosis (Mtb)-coinfected individuals indicates the important interaction between these syndemic pathogens. The immunological interaction between HIV-1 and Mtb has been largely defined by how the virus exacerbates tuberculosis disease pathogenesis. Understanding of the mechanisms by which pre-existing or subsequent Mtb infection may favor the replication, persistence and progression of HIV, is less characterized. We present a rationale for the critical consideration of ‘latent’ Mtb infection in HIV-1 prevention and cure strategies. In support of this position, we review evidence of the effect of Mtb infection on HIV-1 acquisition, replication and persistence. We propose that ‘latent’ Mtb infection may have considerable impact on HIV-1 pathogenesis and the continuing HIV-1 epidemic in sub-Saharan Africa.
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Affiliation(s)
- Robyn Waters
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Observatory 7925, WC, South Africa.,Department of Medicine, University of Cape Town, Observatory 7925, WC, South Africa
| | - Mthawelanga Ndengane
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Observatory 7925, WC, South Africa.,Department of Pathology, University of Cape Town, Observatory 7925, WC, South Africa
| | - Melissa-Rose Abrahams
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Observatory 7925, WC, South Africa.,Department of Pathology, University of Cape Town, Observatory 7925, WC, South Africa
| | - Collin R Diedrich
- Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Observatory 7925, WC, South Africa.,Department of Medicine, University of Cape Town, Observatory 7925, WC, South Africa.,Department of Infectious Diseases, Imperial College London, London W2 1PG, United Kingdom.,The Francis Crick Institute, London NW1 1AT, United Kingdom
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Observatory 7925, WC, South Africa.,Department of Pathology, University of Cape Town, Observatory 7925, WC, South Africa.,Infectious Diseases and Immune Defence Division, The Walter & Eliza Hall Institute of Medical Research, Parkville 3279, VIC, Australia.,Division of Medical Biology, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville 3279, VIC, Australia
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18
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Bochner AF, Secor WE, Baeten JM, van Dam GJ, Szpiro AA, Njenga SM, Corstjens PLAM, Mackelprang RD, Mugo NR, Overbaugh J, Celum C, Mujugira A, McClelland RS, Barnabas RV. Schistosomiasis was not associated with higher HIV-1 plasma or genital set point viral loads among HIV seroconverters from four cohort studies. PLoS Negl Trop Dis 2019; 13:e0007886. [PMID: 31747411 PMCID: PMC6867600 DOI: 10.1371/journal.pntd.0007886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023] Open
Abstract
Background Many regions of sub-Saharan Africa experience a high prevalence of both schistosomiasis and HIV-1, leading to frequent coinfection. Higher plasma HIV-1 viral loads are associated with faster disease progression and genital HIV-1 loads are a primary determinant of HIV-1 transmission risk. We hypothesized that schistosome infection would be associated with higher HIV-1 viral loads in plasma and genital samples. Methods/Principal findings We utilized data from individuals who HIV-1 seroconverted while enrolled in one of four prospective cohort studies. Plasma and genital viral loads collected 4–24 months after the estimated date of HIV-1 acquisition, but prior to antiretroviral therapy initiation, were included. Detection of circulating anodic antigen in archived blood samples, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species causing infection. Our analysis included 370 HIV-1 seroconverters with plasma viral load results, of whom 82 (22%) had schistosomiasis. We did not find a statistically significant association between schistosomiasis and higher HIV-1 set point plasma viral loads (-0.17 log10 copies/ml, 95% CI -0.38 to 0.03); S. mansoni infection was associated with a lower set point (-0.34 log10 copies/ml, 95% CI -0.58 to -0.09). We found no association between schistosomiasis and cervical (+0.07 log10 copies/swab, 95% CI -0.20 to 0.34) or vaginal (+0.11 log10 copies/swab, 95% CI -0.17 to 0.39) set point viral loads; S. haematobium infection was associated with lower cervical viral loads (-0.59 log10 copies/swab, 95% CI -1.11 to -0.06). Conclusions/Significance These results do not support the hypotheses that schistosome coinfection increases plasma or genital HIV-1 viral loads. Schistosomiasis is a parasitic disease that is common in many parts of sub-Saharan Africa most affected by the HIV-1 epidemic. Schistosomiasis causes genital damage when schistosome ova become lodged in the female genital tract, inducing inflammation that may elevate HIV-1 genital viral loads and increase the risk of HIV-1 transmission. Schistosomiasis may also promote viral replication by facilitating cell-to-cell transmission of HIV-1, elevating HIV-1 plasma viral load levels. Using data from 370 individuals residing in Kenya or Uganda who acquired HIV-1 while participating in one of four prospective cohort studies, we tested the hypotheses that schistosomiasis increases plasma and genital viral load levels. We found no evidence that individuals with schistosomiasis had higher set point plasma viral load levels, a measure of viral replication obtained during the set point period 4–24 months after HIV-1 acquisition when viral load levels remain relatively stable. Additionally, we found no evidence that schistosomiasis was associated with higher female set point genital viral loads measured from vaginal or cervical swabs. Unexpectedly, we found that S. mansoni infection was associated with a decline in plasma viral load levels while S. haematobium infection was associated with a decline in cervical viral load levels. Thus, our results do not support the hypotheses that schistosomiasis increases plasma and genital HIV-1 viral loads.
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Affiliation(s)
- Aaron F. Bochner
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jared M. Baeten
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | | | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Romel D. Mackelprang
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Julie Overbaugh
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
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19
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Crowell TA, Colby DJ, Pinyakorn S, Fletcher JLK, Kroon E, Schuetz A, Krebs SJ, Slike BM, Leyre L, Chomont N, Jagodzinski LL, Sereti I, Utay NS, Dewar R, Rerknimitr R, Chomchey N, Trichavaroj R, Valcour VG, Spudich S, Michael NL, Robb ML, Phanuphak N, Ananworanich J. Acute Retroviral Syndrome Is Associated With High Viral Burden, CD4 Depletion, and Immune Activation in Systemic and Tissue Compartments. Clin Infect Dis 2019; 66:1540-1549. [PMID: 29228130 DOI: 10.1093/cid/cix1063] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/04/2017] [Indexed: 01/21/2023] Open
Abstract
Background Many individuals with acute human immunodeficiency virus infection (AHI) experience acute retroviral syndrome (ARS), which is associated with adverse long-term clinical outcomes. Methods Participants presenting for voluntary human immunodeficiency virus (HIV) testing were enrolled during AHI in Bangkok, Thailand. ARS was defined by ≥3 qualifying signs/symptoms. HIV burden, immunophenotypes, and biomarkers were stratified by ARS diagnosis at enrollment and after up to 96 weeks of antiretroviral therapy (ART). Results From 212382 samples screened, 430 participants were enrolled during AHI, including 335 (78%) with ARS. Median age was 26 years and 416 (97%) were men. Sixty (14%) underwent sigmoid biopsy and 105 (24%) underwent lumbar puncture during AHI. Common symptoms included fever (93%), fatigue (79%), pharyngitis (67%), and headache (64%). Compared to those without ARS, participants with ARS were in later Fiebig stages with higher HIV RNA in blood, colon, and cerebrospinal fluid; higher total HIV DNA in blood; CD4 depletion in blood and colon; and elevated plasma tumor necrosis factor alpha (TNF-α), C-reactive protein, and D-dimer (all P < .05). Subgroup analyses of Fiebig I/II participants (95 with ARS, 69 without) demonstrated similar findings. After 96 weeks of ART, TNF-α and interleukin 6 were elevated in the ARS group (P < .05) but other biomarkers equilibrated. Conclusions ARS was associated with high viral burden, CD4 depletion, and immune activation across multiple body compartments during AHI and prior to ART. Persistent inflammation despite suppressive ART could contribute to increased morbidity in individuals who experience ARS.
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Affiliation(s)
- Trevor A Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Donn J Colby
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Suteeraporn Pinyakorn
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Eugène Kroon
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Alexandra Schuetz
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Shelly J Krebs
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Bonnie M Slike
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Louise Leyre
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Quebec, Canada
| | - Nicolas Chomont
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Quebec, Canada
| | - Linda L Jagodzinski
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Irini Sereti
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Netanya S Utay
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Maryland
| | - Robin Dewar
- Virus Isolation and Serological Laboratory, National Cancer Institute at Frederick, Maryland
| | - Rungsun Rerknimitr
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nitiya Chomchey
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Rapee Trichavaroj
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco School of Medicine, New Haven, Connecticut
| | - Serena Spudich
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Nelson L Michael
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Merlin L Robb
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Global Health, University of Amsterdam, The Netherlands
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20
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Different pattern of stool and plasma gastrointestinal damage biomarkers during primary and chronic HIV infection. PLoS One 2019; 14:e0218000. [PMID: 31185037 PMCID: PMC6559643 DOI: 10.1371/journal.pone.0218000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Primary HIV infection (PHI) is the initial phase after HIV acquisition characterized by high viral replication, massive inflammatory response and irreversible immune-damage, particularly at the gastrointestinal level. In this study we aimed to characterize the dynamics of gastrointestinal damage biomarkers during the different phases of HIV infection and assess their association with HIV-disease markers and their accuracy to differentiate PHI from chronic HIV infection (CHI). Methods PHI-individuals (n = 57) were identified as HIV-seronegative/HIV-RNA positive and were followed up for one year at the Manhiça District Hospital in Mozambique. Ten plasma and 12 stool biomarkers were quantified by Luminex or ELISA and levels were compared to CHI-naive (n = 26), CHI on antiretroviral-treatment (ART; n = 30) and HIV-uninfected individuals (n = 58). Regression models adjusted by time point were used to estimate the association of the biomarkers with HIV-disease markers. Receiver operating curves were compared for the best accuracy to distinguish PHI from CHI. Results Soluble (s)CD14 was significantly associated with the CD4/CD8 ratio (P < 0.05) and viremia levels (P < 0.0001) during PHI. Plasma zonulin and stool lactoferrin were significantly higher in PHI as compared to CHI-individuals (P < 0.05). Plasma zonulin demonstrated the best accuracy to identify PHI among HIV-infected individuals (AUC = 0.85 [95% CI 0.75–0.94]). Using a cutoff value of plasma zonulin ≥ 8.75 ng/mL the model identified PHI with 87.7% sensitivity (95% CI 76.3–94.9) and 69.2% specificity (95% CI 48.2–85.7). An adjusted multivariate model including age, plasma zonulin and sCD14 further increased the classification performance (AUC = 0.92 [95% CI 0.86–0.99]). Conclusions While the stool biomarkers did not provide any predictive ability to distinguish PHI from CHI-individuals, plasma sCD14 and zonulin were significantly associated with HIV-disease markers and PHI identification, respectively. These inflammatory biomarkers may be useful to monitor changes in gastrointestinal integrity during HIV infection.
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21
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Du L, Lin Y, Wang M, Yan L, Bai L, Feng P, Tang H. Mortality-related risks in treatment-naive hospitalized AIDS patients with opportunistic infections in Southwest China. Future Virol 2019. [DOI: 10.2217/fvl-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: We aimed to profile the characteristics and analyze the risk factors related to mortality in treatment-naive hospitalized AIDS patients with opportunistic infections (OIs) in Southwest China. Materials & methods: Two hundred and four treatment-naive patients diagnosed with AIDS-related OIs that were hospitalized in our hospital were enrolled. Their demographics, medical data and prognosis were described and analyzed. Result: Most patients were middle-aged married or cohabiting males. The infections in the respiratory system were the major OIs and leading cause of mortality. High CRP and IL-6 were identified as independent risk factors predicting mortality. Conclusion: Middle-aged treatment-naive males were the major victims of AIDS-related OIs. Respiratory infection should be monitored, and early intervention should be applied to improve prognosis if there is high CRP or IL-6 found.
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Affiliation(s)
- Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Yixiao Lin
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR China
| | - Ming Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Libo Yan
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Ping Feng
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
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22
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Hepatitis B virus coinfection is associated with high early mortality in HIV-infected Tanzanians on antiretroviral therapy. AIDS 2019; 33:465-473. [PMID: 30702515 DOI: 10.1097/qad.0000000000002073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is limited data on the effect of antiviral therapies on clinical outcomes in HIV and hepatitis B virus (HBV)-infected individuals in sub-Saharan Africa. DESIGN Single center, prospective longitudinal cohort study at Management and Development for Health supported HIV Care and Treatment clinics in Dar es Salaam, Tanzania. METHODS Between April 2014 and December 2015, HIV-infected, HBV-infected and HIV/HBV-coinfected, treatment naïve, Tanzanian adults more than 18 years of age were eligible for enrollment and followed for 10-18 months after initiating antivirals. All HIV-infected and HIV/HBV-coinfected participants received tenofovir, lamivudine and efavirenz; HBV-infected participants received lamivudine. Multivariate regression models were constructed to identify factors associated with mortality in HIV-infected and HIV/HBV-coinfected participants. RESULTS A total of 265 HIV-infected, 165 HBV-infected and 64 HIV/HBV-coinfected participants were analyzed. At baseline, HBV-infected participants were younger and had a higher BMI than HIV-infected and HIV/HBV-coinfected participants. After a median of 371 (interquartile range 50) days on treatment, there were 40 deaths. Mortality was significantly higher among HIV/HBV-coinfected participants compared with HIV and HBV-infected participants [HIV/HBV-coinfected 12 of 64 (19%) vs. HIV-infected 26 of 265 (10%) and HBV-infected two of 265 (1%), P < 0.01]. High baseline HIV RNA and low hemoglobin levels, but not HBV coinfection were independently associated with early mortality in multivariate analyses of HIV-infected participants. CONCLUSION High rates of early mortality were observed after treatment initiation in HIV/HBV-coinfected individuals compared with participants with HIV or HBV alone, despite robust aspartate aminotransferase to platelet ratio index declines and high rates of virologic suppression. HIV rather than HBV-related factors are more important contributors to mortality in these individuals.
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23
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Rafferty H, Chirro O, Oduor C, Wahome E, Ngoi C, van der Elst E, Berger R, Rowland-Jones S, Graham SM, Sanders EJ. Pilot testing of an online training module about screening for acute HIV infection in adult patients seeking urgent healthcare. Int Health 2019; 11:93-100. [PMID: 30388277 PMCID: PMC6398591 DOI: 10.1093/inthealth/ihy077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/08/2018] [Accepted: 10/24/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute HIV infection (AHI) is the phase of HIV infection immediately after acquisition, during which many patients develop symptoms and often seek healthcare. However, clinicians in sub-Saharan Africa are not currently taught about AHI. METHODS This study pilot-tested a self-directed AHI training module among clinical officers (COs) in coastal Kenya and assessed knowledge gained and challenges to instituting screening. The training module included four domains: AHI definition and importance of AHI recognition; symptoms and screening algorithms; diagnostic strategies; and management. AHI knowledge was assessed before and immediately after training. Participants' ability to utilize an AHI screening algorithm was evaluated with a case-based exercise. RESULTS Self-directed training was completed by 45 COs. Pre-test scores were low (median score 35% IQR 30-45%), but improved significantly after training (median post-test score 75%, IQR 70-85%, Wilcoxon signed-rank test p<0.0001). Participants had challenges in understanding the utility and application of a screening algorithm to identify patients for whom AHI testing would be indicated. Knowledge of AHI was poor at baseline, but improved with self-directed learning. Based on these findings, we revised and improved the AHI training module and pre- and post-assessments, which are now freely available online at www.marps-africa.org. CONCLUSIONS Guidelines on AHI screening and diagnosis are urgently needed in high HIV transmission areas.
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Affiliation(s)
- Hannah Rafferty
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
| | - Oscar Chirro
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
| | - Clifford Oduor
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
| | - Elizabeth Wahome
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
| | - Caroline Ngoi
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
| | - Elise van der Elst
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
| | - René Berger
- United States Agency for International Development (USAID), Nairobi, Kenya
| | - Sarah Rowland-Jones
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, UK
| | - Susan M Graham
- University of Washington, 359909, 325 Ninth Avenue, Seattle, WA, USA
| | - Eduard J Sanders
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research—Coast, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, UK
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24
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Abuharfeil NM, Yaseen MM, Alsheyab FM. Harnessing Antibody-Dependent Cellular Cytotoxicity To Control HIV-1 Infection. ACS Infect Dis 2019; 5:158-176. [PMID: 30525453 DOI: 10.1021/acsinfecdis.8b00167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Passive administration of broadly neutralizing anti-human immunodeficiency virus type 1 (HIV-1) antibodies (bNAbs) has been recently suggested as a promising alternative therapeutic approach for HIV-1 infection. Although the success behind the studies that used this approach has been attributed to the potency and neutralization breadth of anti-HIV-1 antibodies, several lines of evidence support the idea that specific antibody-dependent effector functions, particularly antibody-dependent cellular cytotoxicity (ADCC), play a critical role in controlling HIV-1 infection. In this review, we showed that there is a direct association between the activation of ADCC and better clinical outcomes. This, in turn, suggests that ADCC could be harnessed to control HIV-1 infection. To this end, we addressed the passive administration of bNAbs capable of selectively activating ADCC responses to HIV-1 patients. Finally, we summarized the potential barriers that may impede the optimal activation of ADCC during HIV-1 infection and provided strategic solutions to overcome these barriers.
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Affiliation(s)
- Nizar Mohammad Abuharfeil
- Department of Applied Biological Sciences, College of Science and Arts, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mahmoud Mohammad Yaseen
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110. Jordan
| | - Fawzi M. Alsheyab
- Department of Applied Biological Sciences, College of Science and Arts, Jordan University of Science and Technology, Irbid 22110, Jordan
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25
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Dirks JAMC, Hoebe CJPA, van Liere GAFS, Dukers-Muijrers NHTM, Wolffs PFG. Standardisation is necessary in urogenital and extragenital Chlamydia trachomatis bacterial load determination by quantitative PCR: a review of literature and retrospective study. Sex Transm Infect 2019; 95:562-568. [PMID: 30733424 DOI: 10.1136/sextrans-2018-053522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/17/2018] [Accepted: 11/25/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Pathogen load has been linked to disease severity in patients infected with HIV, resulting in international standards to adequately and reproducibly quantify load. Chlamydia trachomatis (CT) load has been inconsistently linked to disease severity since extensive differences exist in quantification methods (14 methods in 28 articles). Differences include normalisation for human cell load due to CT's intracellular nature, despite the inability to distinguish inflammatory cells from epithelial cells with molecular techniques. We compared the human cell load in CT-positive men and women at the genital and anal site to a CT-negative control group to estimate the impact of inflammatory cells in these samples. METHODS 188 women (tested at genital and anal site) and 519 men (207 tested at the anal site and 312 tested at the urogenital site) were included from our STI-clinic in the Netherlands. Specimens were self-collected vaginal swabs, anal swabs and urine samples. Quantitative-PCR targeting the HLA-gene quantified human cell load. Mann-Whitney-U-test was used for statistical analyses. RESULTS The genital cell load had a similar range and median (6.5 log10) between CT-negative and CT-positive women . The urogenital cell load was significantly higher than the anal cell load (median 3.6 log10). The anal cell load was significantly higher in men with- than without anal CT infection (median 4.5 versus 3.9 respectively). The anal cell load is significantly higher in CT-positive men than in women. Both Neisseria gonorrhoeae-co-infections and reported anal intercourse significantly increased the human cell load in anal samples. CONCLUSION Standardisation in CT load studies is necessary as current studies show 14 different quantification methods in 28 studies . In this study we demonstrate the inappropriateness of normalising the CT load for the human cell load using molecular techniques, as the presence of inflammatory cells cannot be excluded.
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Affiliation(s)
- Jeanne A M C Dirks
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands .,Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Christian J P A Hoebe
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Geneviève A F S van Liere
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
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26
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Zhang MX, Zheng HY, Jiang J, Song JH, Chen M, Xiao Y, Lian XD, Song TZ, Tian RR, Pang W, Zheng YT. Northern pig-tailed macaques (Macaca leonina) maintain superior CD4 + T-cell homeostasis during SIVmac239 infection. Eur J Immunol 2018; 48:384-385. [PMID: 29193040 DOI: 10.1002/eji.201747284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/08/2017] [Accepted: 11/21/2017] [Indexed: 11/09/2022]
Abstract
Gradual depletion of CD4+ T cells is a typical characteristic of pathogenic SIV infection. Intriguingly, we find a spontaneous CD4+ T-cell homeostasis in northern pig-tailed macaques (Macaca leonina) during SIVmac239 infection.
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Affiliation(s)
- Ming-Xu Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Hong-Yi Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Jin Jiang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jia-Hao Song
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,Institute of Health Sciences, Anhui University, Hefei, Anhui, China
| | - Min Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yu Xiao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Xiao-Dong Lian
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Tian-Zhang Song
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ren-Rong Tian
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Wei Pang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.,Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
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27
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Samboju V, Philippi CL, Chan P, Cobigo Y, Fletcher JLK, Robb M, Hellmuth J, Benjapornpong K, Dumrongpisutikul N, Pothisri M, Paul R, Ananworanich J, Spudich S, Valcour V. Structural and functional brain imaging in acute HIV. NEUROIMAGE-CLINICAL 2018; 20:327-335. [PMID: 30101063 PMCID: PMC6082997 DOI: 10.1016/j.nicl.2018.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/30/2018] [Accepted: 07/25/2018] [Indexed: 01/03/2023]
Abstract
Background HIV RNA is identified in cerebrospinal fluid (CSF) within eight days of estimated viral exposure. Neurological findings and impaired neuropsychological testing performance are documented in a subset of individuals with acute HIV infection (AHI). The purpose of this study was to determine whether microstructural white matter and resting-state functional connectivity (rsFC) are disrupted in AHI. Methods We examined 49 AHI (100% male; mean age = 30 ± SD 9.9) and 23 HIV-uninfected Thai participants (78% male; age = 30 ± 5.5) with diffusion tensor imaging (DTI) and rsFC acquired at 3 Tesla, and four neuropsychological tests (summarized as NPZ-4). MRI for the AHI group was performed prior to combination antiretroviral treatment (ART) in 26 participants and on average two days (range:1–5) after ART in 23 participants. Fractional anisotropy (FA), mean (MD), axial (AD), and radial diffusivity (RD) were quantified for DTI. Seed-based voxelwise rsFC analyses were completed for the default mode (DMN), fronto-parietal, and salience and 6 subcortical networks. rsFC and DTI analyses were corrected for family-wise error, with voxelwise comparisons completed using t-tests. Group-specific voxelwise regressions were conducted to examine relationships between imaging indices, HIV disease variables, and treatment status. Results The AHI group had a mean (SD) CD4 count of 421(234) cells/mm3 plasma HIV RNA of 6.07(1.1) log10 copies/mL and estimated duration of infection of 20(5.5) days. Differences between AHI and CO groups did not meet statistical significance for DTI metrics. Within the AHI group, voxelwise analyses revealed associations between brief exposure to ART and higher FA and lower RD and MD bilaterally in the corpus callosum, corona radiata, and superior longitudinal fasciculus (p < 0.05). Diffusion indices were unrelated to clinical variables or NPZ-4. The AHI group had reduced rsFC between left parahippocampal cortex (PHC) of the DMN and left middle frontal gyrus compared to CO (p < 0.002). Within AHI, ART status was unrelated to rsFC. However, higher CD4 cell count associated with increased rsFC for the right lateral parietal and PHC seeds in the DMN. Direct associations were noted between NPZ-4 correspond to higher rsFC of the bilateral caudate seed (p < 0.002). Conclusions Study findings reveal minimal disruption to structural and functional brain integrity in the earliest stages of HIV. Longitudinal studies are needed to determine if treatment with ART initiated in AHI is sufficient to prevent the evolution of brain dysfunction identified in chronically infected individuals. DTI indicates no significant differences between acute HIV and uninfected controls. rsfMRI reflects limited reduced rsFC in acute HIV compared to uninfected controls. Relatively preserved brain integrity identified in acute HIV vs uninfected controls. Cognitive testing and CD4 lymphocyte counts associate with rsFC activity in acute HIV.
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Affiliation(s)
- Vishal Samboju
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Carissa L Philippi
- University of Missouri St. Louis, Department of Psychological Sciences, St. Louis, MO, USA
| | - Phillip Chan
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Merlin Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Joanna Hellmuth
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | | | - Mantana Pothisri
- Department of Radiology, Chulalongkorn University Medical Center, Bangkok, Thailand
| | - Robert Paul
- University of Missouri St. Louis, Department of Psychological Sciences, St. Louis, MO, USA
| | - Jintanat Ananworanich
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; Department of Global Health, The University of Amsterdam, Amsterdam, The Netherlands
| | - Serena Spudich
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
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28
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Lin TY, Yang CJ, Liu CE, Tang HJ, Chen TC, Chen GJ, Hung TC, Lin KY, Cheng CY, Lee YC, Lin SP, Tsai MS, Lee YL, Cheng SH, Hung CC, Wang NC. Clinical features of acute human immunodeficiency virus infection in Taiwan: A multicenter study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:700-709. [PMID: 29555411 DOI: 10.1016/j.jmii.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/PURPOSE Acute HIV infection is characterized by a high concentration of HIV RNA in the plasma and rapid depletion of the CD4 cell count. This multicenter, retrospective observational study aimed to characterize the manifestations of acuteHIV infection in Taiwan. METHODS Between 1 January 2012 and 31 December 2016, all patients aged 20 years or greater who presented with acute HIV infection were included. Demographic and clinical characteristics of the patients at diagnosis were collected. Baseline laboratory assessment included hemogram, CD4 count, plasma HIV RNA load (PVL), serologic markers of syphilis and hepatitis A, B, and C viruses, and serum biochemistry. RESULTS The proportion of acute HIV infection was 6.9% among the patients with newly diagnosed HIV infection during the study period. The most common presenting symptoms of acute HIV infection were fever, fatigue, and myalgia. The median PVL at diagnosis was 5.9 log10 copies/ml, and median CD4 count was 307 cells/mm3. A total of 68 patients (27%) had baseline CD4 count less than 200 cells/mm3. Multiple logistic regression analysis, showed that the baseline CD4 count (OR, 4.02; p = 0.013) and aspartate aminotransaminase levels (OR, 3.49; p = 0.002) were associated with high PVL (>5 log10 copies/ml); and high baseline PVL (OR, 2.64; p = 0.002) was associated with symptomatic acute HIV infection. CONCLUSIONS Manifestations of acute HIV infection are nonspecific and of wide spectrum ranging from fever to severe illness. A higher proportion of patients with initial CD4 counts of 200 cells/mm3 or less during acute HIV infection warrants early, timely diagnosis and treatment to prevent rapid disease progression.
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Affiliation(s)
- Te-Yu Lin
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chung-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Tun-Chieh Chen
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Tung-Che Hung
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health Welfare, Taoyuan, Taiwan, ROC
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan, ROC
| | - Chien-Yu Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health Welfare, Taoyuan, Taiwan, ROC; School of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Chien Lee
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC; Department of Internal Medicine, Catholic Fu-Jen Medical College, New Taipei City, Taiwan, ROC
| | - Shih-Ping Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Mao-Song Tsai
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; Department of Internal Medicine, Catholic Fu-Jen Medical College, New Taipei City, Taiwan, ROC
| | - Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Shu-Hsing Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health Welfare, Taoyuan, Taiwan, ROC; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC; Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Ning-Chi Wang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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29
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Hapgood JP, Kaushic C, Hel Z. Hormonal Contraception and HIV-1 Acquisition: Biological Mechanisms. Endocr Rev 2018; 39:36-78. [PMID: 29309550 PMCID: PMC5807094 DOI: 10.1210/er.2017-00103] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
Abstract
Access to effective affordable contraception is critical for individual and public health. A wide range of hormonal contraceptives (HCs), which differ in composition, concentration of the progestin component, frequency of dosage, and method of administration, is currently available globally. However, the options are rather limited in settings with restricted economic resources that frequently overlap with areas of high HIV-1 prevalence. The predominant contraceptive used in sub-Saharan Africa is the progestin-only three-monthly injectable depot medroxyprogesterone acetate. Determination of whether HCs affect HIV-1 acquisition has been hampered by behavioral differences potentially confounding clinical observational data. Meta-analysis of these studies shows a significant association between depot medroxyprogesterone acetate use and increased risk of HIV-1 acquisition, raising important concerns. No association was found for combined oral contraceptives containing levonorgestrel, nor for the two-monthly injectable contraceptive norethisterone enanthate, although data for norethisterone enanthate are limited. Susceptibility to HIV-1 and other sexually transmitted infections may, however, be dependent on the type of progestin present in the formulation. Several underlying biological mechanisms that may mediate the effect of HCs on HIV-1 and other sexually transmitted infection acquisition have been identified in clinical, animal, and ex vivo studies. A substantial gap exists in the translation of basic research into clinical practice and public health policy. To bridge this gap, we review the current knowledge of underlying mechanisms and biological effects of commonly used progestins. The review sheds light on issues critical for an informed choice of progestins for the identification of safe, effective, acceptable, and affordable contraceptive methods.
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Affiliation(s)
- Janet P Hapgood
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa.,Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Charu Kaushic
- Department of Pathology and Molecular Medicine, McMaster University, Ontario, Canada.,McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Zdenek Hel
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.,Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama
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30
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Johnson LF, May MT, Dorrington RE, Cornell M, Boulle A, Egger M, Davies MA. Estimating the impact of antiretroviral treatment on adult mortality trends in South Africa: A mathematical modelling study. PLoS Med 2017; 14:e1002468. [PMID: 29232366 PMCID: PMC5726614 DOI: 10.1371/journal.pmed.1002468] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Substantial reductions in adult mortality have been observed in South Africa since the mid-2000s, but there has been no formal evaluation of how much of this decline is attributable to the scale-up of antiretroviral treatment (ART), as previous models have not been calibrated to vital registration data. We developed a deterministic mathematical model to simulate the mortality trends that would have been expected in the absence of ART, and with earlier introduction of ART. METHODS AND FINDINGS Model estimates of mortality rates in ART patients were obtained from the International Epidemiology Databases to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration. The model was calibrated to HIV prevalence data (1997-2013) and mortality data from the South African vital registration system (1997-2014), using a Bayesian approach. In the 1985-2014 period, 2.70 million adult HIV-related deaths occurred in South Africa. Adult HIV deaths peaked at 231,000 per annum in 2006 and declined to 95,000 in 2014, a reduction of 74.7% (95% CI: 73.3%-76.1%) compared to the scenario without ART. However, HIV mortality in 2014 was estimated to be 69% (95% CI: 46%-97%) higher in 2014 (161,000) if the model was calibrated only to HIV prevalence data. In the 2000-2014 period, the South African ART programme is estimated to have reduced the cumulative number of HIV deaths in adults by 1.72 million (95% CI: 1.58 million-1.84 million) and to have saved 6.15 million life years in adults (95% CI: 5.52 million-6.69 million). This compares with a potential saving of 8.80 million (95% CI: 7.90 million-9.59 million) life years that might have been achieved if South Africa had moved swiftly to implement WHO guidelines (2004-2013) and had achieved high levels of ART uptake in HIV-diagnosed individuals from 2004 onwards. The model is limited by its reliance on all-cause mortality data, given the lack of reliable cause-of-death reporting, and also does not allow for changes over time in tuberculosis control programmes and ART effectiveness. CONCLUSIONS ART has had a dramatic impact on adult mortality in South Africa, but delays in the rollout of ART, especially in the early stages of the ART programme, have contributed to substantial loss of life. This is the first study to our knowledge to calibrate a model of ART impact to population-level recorded death data in Africa; models that are not calibrated to population-level death data may overestimate HIV-related mortality.
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Affiliation(s)
- Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Rob E. Dorrington
- Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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31
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Abstract
OBJECTIVE Symptoms of acute retroviral syndrome (ARS) may be used to identify patients with acute HIV-1 infection who seek care. ARS symptoms in African adults differ by region. We assessed whether reporting of ARS was associated with HIV-1 subtype in a multicentre African cohort study representing countries with predominant HIV-1 subtypes A, C, and D. METHODS ARS symptoms were assessed in adults enrolling within 6 weeks after the estimated date of infection in an acute and early HIV-1 infection cohort study. HIV-1 subtype was determined by POL genotyping. We used log-binomial regression to compare ARS symptom prevalence among those with subtype A vs. C or D, adjusting for sex, time since enrolment, and enrolment viral load. RESULTS Among 183 volunteers ascertained within 6 weeks after estimated date of infection, 77 (42.0%) had subtype A, 83 (45.4%) subtype C, and 23 (12.6%) subtype D infection. Individuals with subtype A were 1.40 (95% confidence interval: 1.17, 1.68) times as likely as individuals with subtypes C or D to report any ARS symptoms; each individual symptom other than rash was also more prevalent in subtype A than in subtype C or D, with prevalence ratios ranging from 1.94 (1.40, 2.70) for headache to 4.92 (2.24, 10.78) for lymphadenopathy. CONCLUSION Individuals with subtype A were significantly more likely than individuals with subtypes C or D to report any ARS symptoms. HIV-1 subtypes may help explain differences in ARS that have been observed across regions in Africa, and may impact the yield of symptom-based screening strategies for acute HIV infection detection.
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32
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Ma M, Wang Z, Chen X, Tao A, He L, Fu S, Zhang Z, Fu Y, Guo C, Liu J, Han X, Xu J, Chu Z, Ding H, Shang H, Jiang Y. NKG2C +NKG2A - Natural Killer Cells are Associated with a Lower Viral Set Point and may Predict Disease Progression in Individuals with Primary HIV Infection. Front Immunol 2017; 8:1176. [PMID: 28979268 PMCID: PMC5611385 DOI: 10.3389/fimmu.2017.01176] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/06/2017] [Indexed: 12/18/2022] Open
Abstract
Natural killer (NK) cells are the first line of defense against pathogens of the immune system and also play an important role in resistance against HIV. The activating receptor NKG2C and the inhibitory receptor NKG2A co-modulate the function of NK cells by recognizing the same ligand, HLA-E. However, the role of NKG2A and NKG2C on viral set point and the prediction of HIV disease progression have been rarely reported. In this study, we determined the expression of NKG2C or NKG2A on the surface of NK cells from 22 individuals with primary HIV infection (PHI) stage and 23 HIV-negative normal control (NC) subjects. The CD4+ T cell count and plasma level of HIV RNA in the infected individuals were longitudinally followed-up for about 720 days. The proportion of NKG2C+NKG2A- NK cells was higher in subjects from the low set point group and was negatively correlated with the viral load. In addition, strong anti-HIV activities were observed in NKG2C+ NK cells from the HIV-positive donors. Furthermore, a proportion of NKG2C+NKG2A- NK cells >35.45%, and a ratio of NKG2C/NKG2A >1.7 were predictive for higher CD4+ T cell counts 720 days after infection. Collectively, the experimental results allow us to draw the conclusion that NKG2C+ NK cells might exert an antiviral effect and that the proportion of NKG2C+NKG2A- NK cells, and the ratio of NKG2C/NKG2A, are potential biomarkers for predicting HIV disease progression.
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Affiliation(s)
- Meichen Ma
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhuo Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xi Chen
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Anfu Tao
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lei He
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Shuai Fu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zining Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yajing Fu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Chenxi Guo
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Liu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaoxu Han
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhenxing Chu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Abstract
PURPOSE OF REVIEW Understanding the characteristics of transmission during acute HIV infection (AHI) may inform targets for vaccine-induced immune interdiction. Individuals treated in AHI with a small HIV reservoir size may be ideal candidates for therapeutic HIV vaccines aiming for HIV remission (i.e. viremic control after treatment interruption). RECENT FINDINGS The AHI period is brief and peak viremia predicts a viral set point that occurs 4-5 weeks following infection. Robust HIV-specific CD8 T-cell responses lower viral set points. Phylogenetic analyses of founder viruses demonstrated unique bottleneck selections and specific genetic signatures to optimize for high-fitness variants and successful transmission events. HIV clades, route of transmission and the presence of minor variants may affect vaccine protection. Antiretroviral treatment in AHI results in smaller HIV reservoir size, better CD4 T-cell recovery and fewer virus escapes. SUMMARY The knowledge of untreated and treated AHI informs the development of vaccines, in that preventive vaccines will require broad coverage for multiple clades and antigenic variants associated with unique bottleneck selections. Vaccines that help the host to control viremia could minimize onward transmission. Therapeutic HIV vaccines aimed at HIV remission should be studied in early-treated individuals who have few or no viral escape mutants and a more preserved immune system.
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Rutstein SE, Ananworanich J, Fidler S, Johnson C, Sanders EJ, Sued O, Saez-Cirion A, Pilcher CD, Fraser C, Cohen MS, Vitoria M, Doherty M, Tucker JD. Clinical and public health implications of acute and early HIV detection and treatment: a scoping review. J Int AIDS Soc 2017; 20:21579. [PMID: 28691435 PMCID: PMC5515019 DOI: 10.7448/ias.20.1.21579] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/29/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. METHODS We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. RESULTS AND DISCUSSION Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. CONCLUSIONS There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jintanat Ananworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Cheryl Johnson
- HIV Department, World Health Organization, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard J. Sanders
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Asier Saez-Cirion
- Institut Pasteur, HIV Inflammation and Persistance Unit, Paris, France
| | | | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Myron S. Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D. Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mangal TD. Joint estimation of CD4+ cell progression and survival in untreated individuals with HIV-1 infection. AIDS 2017; 31:1073-1082. [PMID: 28301424 PMCID: PMC5414573 DOI: 10.1097/qad.0000000000001437] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/26/2017] [Accepted: 02/03/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We compiled the largest dataset of seroconverter cohorts to date from 25 countries across Africa, North America, Europe, and Southeast/East (SE/E) Asia to simultaneously estimate transition rates between CD4 cell stages and death, in antiretroviral therapy (ART)-naive HIV-1-infected individuals. DESIGN A hidden Markov model incorporating a misclassification matrix was used to represent natural short-term fluctuations and measurement errors in CD4 cell counts. Covariates were included to estimate the transition rates and survival probabilities for each subgroup. RESULTS The median follow-up time for 16 373 eligible individuals was 4.1 years (interquartile range 1.7-7.1), and the mean age at seroconversion was 31.1 years (SD 8.8). A total of 14 525 individuals had recorded CD4 cell counts pre-ART, 1885 died, and 6947 initiated ART. Median (interquartile range) survival for men aged 20 years at seroconversion was 13.0 (12.4-13.4), 11.6 (10.9-12.3), and 8.3 years (7.9-8.9) in Europe/North America, Africa, and SE/E Asia, respectively. Mortality rates increase with age (hazard ratio 2.22, 95% confidence interval 1.84-2.67 for >45 years compared with <25 years) and vary by region (hazard ratio 2.68, 1.75-4.12 for Africa and 1.88, 1.50-2.35 for Asia compared with Europe/North America). CD4 cell decline was significantly faster in Asian cohorts compared with Europe/North America (hazard ratio 1.45, 1.36-1.54). CONCLUSION Mortality and CD4 cell progression rates exhibited regional and age-specific differences, with decreased survival in African and SE/E Asian cohorts compared with Europe/North America and in older age groups. This extensive dataset reveals heterogeneities between regions and ages, which should be incorporated into future HIV models.
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Affiliation(s)
- Tara D Mangal
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Identification of Acute HIV-1 Infection by Hologic Aptima HIV-1 RNA Qualitative Assay. J Clin Microbiol 2017; 55:2064-2073. [PMID: 28424253 PMCID: PMC5483908 DOI: 10.1128/jcm.00431-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/12/2017] [Indexed: 11/20/2022] Open
Abstract
The Hologic Aptima HIV-1 Qualitative RNA assay was used in a rigorous screening approach designed to identify individuals at the earliest stage of HIV-1 infection for enrollment into subsequent studies of cellular and viral events in early infection (RV 217/Early Capture HIV Cohort [ECHO] study). Volunteers at high risk for HIV-1 infection were recruited from study sites in Thailand, Tanzania, Uganda, and Kenya with high HIV-1 prevalence rates among the populations examined. Small-volume blood samples were collected by finger stick at twice-weekly intervals and tested with the Aptima assay. Participants with reactive Aptima test results were contacted immediately for entry into a more comprehensive follow-up schedule with frequent blood draws. Evaluation of the Aptima test prior to use in this study showed a detection sensitivity of 5.5 copies/ml (50%), with all major HIV-1 subtypes detected. A total of 54,306 specimens from 1,112 volunteers were examined during the initial study period (August 2009 to November 2010); 27 individuals were identified as converting from uninfected to infected status. A sporadic reactive Aptima signal was observed in HIV-1-infected individuals under antiretroviral therapy. Occasional false-reactive Aptima results in uninfected individuals, or nonreactive results in HIV-1-infected individuals not on therapy, were observed and used to calculate assay sensitivity and specificity. The sensitivity and specificity of the Aptima assay were 99.03% and 99.23%, respectively; positive and negative predictive values were 92.01% and 99.91%, respectively. Conversion from HIV-1-uninfected to -infected status was rapid, with no evidence of a prolonged period of intermittent low-level viremia.
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Yaseen MM, Yaseen MM, Alqudah MA. Broadly neutralizing antibodies: An approach to control HIV-1 infection. Int Rev Immunol 2016; 36:31-40. [PMID: 27739924 DOI: 10.1080/08830185.2016.1225301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although available antiretroviral therapy (ART) has changed human immunodeficiency virus (HIV)-1 infection to a non-fatal chronic disease, the economic burden of lifelong therapy, severe adverse ART effects, daily ART adherence, and emergence of ART-resistant HIV-1 mutants require prospecting for alternative therapeutic modalities. Indeed, a growing body of evidence suggests that broadly neutralizing anti-HIV-1 antibodies (BNAbs) may offer one such feasible alternative. To evaluate their therapeutic potential in established HIV-1 infection, we sought to address recent advances in pre-clinical and clinical investigations in this area of HIV-1 research. In addition, we addressed the obstacles that may impede the success of such immunotherapeutic approach, suggested strategic solutions, and briefly compared this approach with the currently used ART to open new insights for potential future passive immunotherapy for HIV-1 infection.
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Affiliation(s)
- Mahmoud Mohammad Yaseen
- a Department of Medical Laboratory Sciences , College of Applied Medical Sciences, Jordan University of Science and Technology , Irbid , Jordan
| | - Mohammad Mahmoud Yaseen
- b Department of Public Health, College of Nursing , University of Benghazi , Benghazi , Libya
| | - Mohammad Ali Alqudah
- c Department of Clinical Pharmacy , College of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
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Robb ML, Eller LA, Kibuuka H, Rono K, Maganga L, Nitayaphan S, Kroon E, Sawe FK, Sinei S, Sriplienchan S, Jagodzinski LL, Malia J, Manak M, de Souza MS, Tovanabutra S, Sanders-Buell E, Rolland M, Dorsey-Spitz J, Eller MA, Milazzo M, Li Q, Lewandowski A, Wu H, Swann E, O'Connell RJ, Peel S, Dawson P, Kim JH, Michael NL. Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand. N Engl J Med 2016; 374:2120-30. [PMID: 27192360 PMCID: PMC5111628 DOI: 10.1056/nejmoa1508952] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute human immunodeficiency virus type 1 (HIV-1) infection is a major contributor to transmission of HIV-1. An understanding of acute HIV-1 infection may be important in the development of treatment strategies to eradicate HIV-1 or achieve a functional cure. METHODS We performed twice-weekly qualitative plasma HIV-1 RNA nucleic acid testing in 2276 volunteers who were at high risk for HIV-1 infection. For participants in whom acute HIV-1 infection was detected, clinical observations, quantitative measurements of plasma HIV-1 RNA levels (to assess viremia) and HIV antibodies, and results of immunophenotyping of lymphocytes were obtained twice weekly. RESULTS Fifty of 112 volunteers with acute HIV-1 infection had two or more blood samples collected before HIV-1 antibodies were detected. The median peak viremia (6.7 log10 copies per milliliter) occurred 13 days after the first sample showed reactivity on nucleic acid testing. Reactivity on an enzyme immunoassay occurred at a median of 14 days. The nadir of viremia (4.3 log10 copies per milliliter) occurred at a median of 31 days and was nearly equivalent to the viral-load set point, the steady-state viremia that persists durably after resolution of acute viremia (median plasma HIV-1 RNA level, 4.4 log10 copies per milliliter). The peak viremia and downslope were correlated with the viral-load set point. Clinical manifestations of acute HIV-1 infection were most common just before and at the time of peak viremia. A median of one symptom of acute HIV-1 infection was recorded at a median of two study visits, and a median of one sign of acute HIV-1 infection was recorded at a median of three visits. CONCLUSIONS The viral-load set point occurred at a median of 31 days after the first detection of plasma viremia and correlated with peak viremia. Few symptoms and signs were observed during acute HIV-1 infection, and they were most common before peak viremia. (Funded by the Department of Defense and the National Institute of Allergy and Infectious Diseases.).
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Affiliation(s)
- Merlin L Robb
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Leigh A Eller
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Hannah Kibuuka
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Kathleen Rono
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Lucas Maganga
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Sorachai Nitayaphan
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Eugene Kroon
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Fred K Sawe
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Samuel Sinei
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Somchai Sriplienchan
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Linda L Jagodzinski
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Jennifer Malia
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Mark Manak
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Mark S de Souza
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Sodsai Tovanabutra
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Eric Sanders-Buell
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Morgane Rolland
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Julie Dorsey-Spitz
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Michael A Eller
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Mark Milazzo
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Qun Li
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Andrew Lewandowski
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Hao Wu
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Edith Swann
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Robert J O'Connell
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Sheila Peel
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Peter Dawson
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Jerome H Kim
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Nelson L Michael
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
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Adewumi OM, Odaibo GN, Olaleye OD. Efficacy of generic highly active antiretroviral therapy in HIV-1 infected individuals in Nigeria. J Immunoassay Immunochem 2016; 36:464-77. [PMID: 25436763 DOI: 10.1080/15321819.2014.969436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CD4 T lymphocyte and plasma HIV RNA parameters have been used to monitor disease progression, and predict clinical course in HIV infection. Initial evaluation of these parameters was conducted in the western countries where accessible ARVs, circulating HIV subtypes and mode of transmission are different from the situation in Nigeria. This study appraised these parameters, and efficacy of generic ARVs. Consenting 106 HIV infected ARV naïve patients were enrolled. CD4 T lymphocyte and plasma HIV RNA levels were determined at interval for 24 months. Ninety eight (92.5%) of the patients who completed the follow up in strict adherence to therapy guideline were included in the analysis. Baseline median CD4 T lymphocyte increased from 114 (Range: 6-330) to highest 357 (Range: 15-1036) cells/ μ L at 18 months of therapy, while baseline median plasma viral RNA declined from 4.6 (Range: 2.6-6.0) Log10 copies/mL to undetectable level within three months of therapy. Significant CD4 T-cell restoration and plasma viral RNA decline in the study population demonstrate efficacy of the generic HAART. The importance of combined use of both parameters for evaluation of immunologic and virologic responses to ART was confirmed.
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Affiliation(s)
- Olubusuyi M Adewumi
- a Department of Virology , College of Medicine, University of Ibadan , Ibadan , Oyo State , Nigeria
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Chaitaveep N, Utachee P, Chuenchitra T, Karasavvan N, Takeda N, Kameoka M. Neutralization breadth and potency of serum derived from recently human immunodeficiency virus type 1-infected Thai individuals. Microbes Infect 2016; 18:346-53. [PMID: 26774333 DOI: 10.1016/j.micinf.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/11/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022]
Abstract
Neutralizing antibody responses play important roles in controlling several viral infections including human immunodeficiency virus type 1 (HIV-1). Potent and broad neutralizing antibody responses have been reported in some HIV-1-infected individuals; therefore, elucidating the mechanisms underlying neutralizing antibody responses will provide important information for the development of anti-HIV-1 vaccines. We herein performed a comparative study on the neutralization breadth and potency of serum samples collected from Thai individuals recently and chronically infected with HIV-1. Neutralization tests using a series of envelope glycoproteins (Env)-recombinant viruses revealed that although several serum samples derived from recently infected individuals did not show any HIV-1-specific neutralizing activity, the remaining serum samples exhibited neutralizing activity not only for recombinant viruses with CRF01_AE Env, but also for viruses with subtypes B and C Env. Furthermore, some serum samples derived from recently infected individuals showed the neutralization potency. Our results may provide a deeper insight into the characteristics of neutralizing antibody responses that develop during the course of HIV-1 infection among individuals in Thailand.
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Affiliation(s)
| | - Piraporn Utachee
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections (RCC-ERI), Nonthaburi, Thailand
| | | | - Nicos Karasavvan
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Naokazu Takeda
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections (RCC-ERI), Nonthaburi, Thailand; Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Masanori Kameoka
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan; Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan.
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Changes in B-Cell Counts and Percentages during Primary HIV Infection Associated with Disease Progression in HIV-Infected Men Who Have Sex with Men: A Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:468194. [PMID: 26436092 PMCID: PMC4575999 DOI: 10.1155/2015/468194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/06/2015] [Accepted: 08/05/2015] [Indexed: 02/04/2023]
Abstract
Numerous anomalies in B-cell phenotypes and functions have been described in HIV-infected individuals. However, the actual relationship between B cells and disease progression remains unclear. In this study, we investigated B-cell counts/percentages during a 12-month infection period in HIV-infected individuals that eventually developed into typical progressors (TPs) or rapid progressors (RPs). We found, after 12 months of infection, the baseline B-cell counts/percentages correlated positively with CD4+ T-cell counts (P = 0.0006 and P = 0.026) and negatively with HIV viral set points (P = 0.014 and P = 0.002). Kaplan-Meier survival analysis showed that high baseline B-cell counts/percentages were associated with a slow CD4-cell decline. B-cell kinetics indicated the baseline B-cell counts/percentages could be factors distinguishing between TPs and RPs. The combination of the baseline B-cell counts and percentages was associated with rapid disease progression (a 80.7% predictive value as measured by the area under the curve). These results indicate that the baseline B-cell counts/percentages might be associated with HIV disease progression.
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Lemonovich TL, Watkins RR, Morrison CS, Kwok C, Chipato T, Musoke R, Arts EJ, Nankya I, Salata RA. Differences in Clinical Manifestations of Acute and Early HIV-1 Infection between HIV-1 Subtypes in African Women. J Int Assoc Provid AIDS Care 2015; 14:415-22. [PMID: 24106054 PMCID: PMC4511722 DOI: 10.1177/2325957413504827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Little is known about the differences in clinical manifestations between women with various HIV-1 subtypes during acute (AI) and early (EI) HIV infection. In a longitudinal cohort study, clinical signs and symptoms among Uganda and Zimbabwe women with AI and EI were compared with HIV-negative controls; symptoms were assessed quarterly for 15 to 24 months. Early HIV infection was defined as the first visit during which a woman tested HIV antibody positive. Women who were HIV negative serologically but DNA polymerase chain reaction positive were considered AI. In all, 26 women were classified AI and 192 EI, with 654 HIV-negative controls. Primary HIV infection (AI and EI) was associated with unexplained fever (P <.01), weight loss (P <.01), fatigue (P <.01), inguinal adenopathy (P <.01), and cervical friability (P =.01). More women with subtype C infection had unexplained fever, fatigue, and abnormal vaginal discharge compared to subtype A or D infection. Inguinal adenopathy occurred less often in women with subtype A infection than those with subtype C or D infection.
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Affiliation(s)
- Tracy L Lemonovich
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Richard R Watkins
- Division of Infectious Diseases, Akron General Medical Center, Akron, OH, USA
| | | | | | - Tsungai Chipato
- Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Harare, Zimbabwe
| | - Robert Musoke
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eric J Arts
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Immaculate Nankya
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Robert A Salata
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA
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Abstract
PURPOSE OF REVIEW Detection of early HIV infections (EHIs), including acute HIV infection (AHI), is important for individual health, prevention of HIV transmission, and measurement of HIV incidence. We describe markers of EHI, diagnostic strategies for detecting these markers, and ways to incorporate these strategies into diagnostic and HIV incidence algorithms. RECENT FINDINGS For individual diagnosis in the USA and Europe, laboratory-based diagnostic algorithms increasingly incorporate fourth-generation HIV antigen tests, allowing for earlier detection. In some sub-Saharan African settings, symptom-based screening is being explored to identify subsets of persons at high risk for AHI. Point-of-care diagnostics designed for AHI detection are in the pipeline and, if validated, represent an opportunity for real-time AHI diagnosis. At the population level, multiassay algorithms are promising new strategies for estimating HIV incidence on the basis of several assays applied to cross-sectional samples. These algorithms can be developed to optimize performance, in addition to cost and logistical considerations. SUMMARY There are important recent advances in detection of EHIs at the individual and population levels. Applying optimal combinations of tests in diagnostic and HIV incidence algorithms is urgently needed to support the multiple goals derived from enhanced detection and discrimination of EHIs.
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Watanabe D, Suzuki S, Ashida M, Shimoji Y, Hirota K, Ogawa Y, Yajima K, Kasai D, Nishida Y, Uehira T, Shirasaka T. Disease progression of HIV-1 infection in symptomatic and asymptomatic seroconverters in Osaka, Japan: a retrospective observational study. AIDS Res Ther 2015; 12:19. [PMID: 26000028 PMCID: PMC4440509 DOI: 10.1186/s12981-015-0059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 04/27/2015] [Indexed: 01/19/2023] Open
Abstract
Background Estimates of the interval from HIV-1 infection to disease progression may be affected by selection bias, and data concerning asymptomatic early seroconverters are limited. We examined the interval until disease progression in HIV-1 seroconverters in whom the timing of infection could be estimated within 1 year before diagnosis. Methods Subjects included newly diagnosed patients at Osaka National Hospital between 2003 and 2010 who had either (1) symptomatic acute HIV-1 infection with a negative or intermediate reaction on Western blotting and a positive reaction on an HIV RNA test (symptomatic acute group) or (2) a positive reaction on Western blotting at diagnosis and a <1-year interval from the last negative HIV test until the first positive test. The latter was divided into symptomatic recent or asymptomatic recent groups based on the presence or absence, respectively, of any transient fever between the last negative and first positive tests. Disease progression was defined as a fall in the CD4 count to <350 cells/microL on 2 consecutive tests, the start of anti-HIV therapy, or the onset of AIDS-indicator diseases. Information was retrospectively collected from medical records. Results Subjects included 210 patients: 91 in the symptomatic acute group, 72 in the symptomatic recent group, and 47 in the asymptomatic recent group. In the symptomatic acute (0.8 years) and symptomatic recent (2.2 years) groups, the Kaplan-Meier estimate of median interval until disease progression was significantly shorter than that in the asymptomatic recent group (2.9 years). Multivariate analysis by Cox’s proportional hazards test showed that the symptomatic acute group (vs. asymptomatic recent group: hazard ratio: 1.93; 95% confidence interval: 1.14–3.36; p = 0.0140) and a baseline CD4 count of <400 cells/microL (hazard ratio: 3.88; 95% confidence interval: 2.57–5.96; p < 0.0001) were independent prognostic factors associated with early disease progression. Conclusions Symptomatic seroconversion was associated with early disease progression. Furthermore, the estimated median interval until the CD4 count was <350 cells/microL was only 2.9 years even in patients with asymptomatic seroconversion. These results suggest the importance of early diagnosis in early seroconverters.
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Brief report: HIV-1 transmissions during asymptomatic infection: exploring the impact of changes in HIV-1 viral load due to coinfections. J Acquir Immune Defic Syndr 2015; 68:594-8. [PMID: 25585299 PMCID: PMC4387204 DOI: 10.1097/qai.0000000000000511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. High HIV-1 plasma viral loads (PVLs) in sub-Saharan Africa, partly because of high rates of coinfection, may have been one of the drivers of the “explosive” epidemics seen in that region. Using a previously published framework of infectiousness and survival, we estimate the excess onward HIV-1 transmission events (secondary infections) resulting from coinfection-induced changes in PVL during asymptomatic HIV-1 infection. For every 100 HIV-infected people, each suffering 1 episode of tuberculosis infection, there are 4.9 (2.7th–97.5th percentile: 0.2–21.5) excess onward HIV-1 transmission events attributable to this coinfection. Other estimates are malaria 0.4 (0.0–2.0), soil-transmitted helminths 3.1 (0.1–14.9), schistosomiasis 8.5 (0.2–38.6), filariasis 13.3 (0.3–89.2), syphilis 0.1 (0.0–1.6), herpes simplex virus 4.0 (0.0–24.2), and gonorrhea 2.1 (0.1–8.0) transmissions. If these higher PVLs confer a shorter life expectancy and higher infectiousness, then their impact on transmission is, in general, reduced. For most HIV-1 coinfections, the duration of a single infection is too short and/or the associated PVL elevation is too modest to contribute substantially to onward HIV-1 transmission.
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The HLA-C*04: 01/KIR2DS4 gene combination and human leukocyte antigen alleles with high population frequency drive rate of HIV disease progression. AIDS 2015; 29:507-17. [PMID: 25715101 DOI: 10.1097/qad.0000000000000574] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study is to identify human leukocyte antigen (HLA) class I and killer-cell immunoglobulin-like receptor (KIR) genotypes associated with different risks for HIV acquisition and HIV disease progression. DESIGN A cross-sectional study of a cohort of 468 high-risk individuals (246 HIV-positive and 222 HIV-negative) from outpatient clinics in Lima (Perú). METHODS The cohort was high-resolution HLA and KIR-typed and analysed for potential differences in single-allele frequencies and allele combinations between HIV-positive and HIV-negative individuals and for associations with HIV viral load and CD4 cell counts in infected individuals. RESULTS HLA class I alleles associated with a lack of viral control had a significantly higher population frequency than relatively protective alleles (P = 0.0093), in line with a rare allele advantage. HLA-A02 : 01 and HLA-C04 : 01 were both associated with high viral loads (P = 0.0313 and 0.0001, respectively) and low CD4 cell counts (P = 0.0008 and 0.0087, respectively). Importantly, the association between HLA-C04 : 01 and poor viral control was not due to its linkage disequilibrium with other HLA alleles. Rather, the coexpression of its putative KIR ligand KIR2DS4f was critically linked to elevated viral loads. CONCLUSION These results highlight the impact of population allele frequency on viral control and identify a novel association between HLA-C04 : 01 in combination with KIR2DS4f and uncontrolled HIV infection. Our data further support the importance of the interplay of markers of the adaptive and innate immune system in viral control.
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Mackelprang RD, Carrington M, Thomas KK, Hughes JP, Baeten JM, Wald A, Farquhar C, Fife K, Campbell MS, Kapiga S, Gao X, Mullins JI, Lingappa JR. Host genetic and viral determinants of HIV-1 RNA set point among HIV-1 seroconverters from sub-saharan Africa. J Virol 2015; 89:2104-11. [PMID: 25473042 PMCID: PMC4338863 DOI: 10.1128/jvi.01573-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/25/2014] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED We quantified the collective impact of source partner HIV-1 RNA levels, human leukocyte antigen (HLA) alleles, and innate responses through Toll-like receptor (TLR) alleles on the HIV-1 set point. Data came from HIV-1 seroconverters in African HIV-1 serodiscordant couple cohorts. Linear regression was used to determine associations with set point and R(2) to estimate variation explained by covariates. The strongest predictors of set point were HLA alleles (B*53:01, B*14:01, and B*27:03) and plasma HIV-1 levels of the transmitting partner, which explained 13% and 10% of variation in set point, respectively. HLA-A concordance between partners and TLR polymorphisms (TLR2 rs3804100 and TLR7 rs179012) also were associated with set point, explaining 6% and 5% of the variation, respectively. Overall, these factors and genital factors of the transmitter (i.e., male circumcision, bacterial vaginosis, and use of acyclovir) explained 46% of variation in set point. We found that both innate and adaptive immune responses, together with plasma HIV-1 levels of the transmitting partner, explain almost half of the variation in viral load set point. IMPORTANCE After HIV-1 infection, uncontrolled virus replication leads to a rapid increase in HIV-1 concentrations. Once host immune responses develop, however, HIV-1 levels reach a peak and subsequently decline until they reach a stable level that may persist for years. This stable HIV-1 set point represents an equilibrium between the virus and host responses and is predictive of later disease progression and transmission potential. Understanding how host and virus factors interact to determine HIV-1 set point may elucidate novel mechanisms or biological pathways for treating HIV-1 infection. We identified host and virus factors that predict HIV-1 set point in people who recently acquired HIV-1, finding that both innate and adaptive immune responses, along with factors that likely influence HIV-1 virulence and inoculum, explain ∼46% of the variation in HIV-1 set point.
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Affiliation(s)
- Romel D Mackelprang
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Mary Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Inc., Frederick National Laboratories for Cancer Research, Frederick, Maryland, USA Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Katherine K Thomas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna Wald
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kenneth Fife
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA Department of Microbiology and Immunology, Indiana University, Indianapolis, Indiana, USA Department of Pathology, Indiana University, Indianapolis, Indiana, USA
| | - Mary S Campbell
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Saida Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Xiaojiang Gao
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Inc., Frederick National Laboratories for Cancer Research, Frederick, Maryland, USA
| | - James I Mullins
- Department of Medicine, University of Washington, Seattle, Washington, USA Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Jairam R Lingappa
- Department of Global Health, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Hool A, Leventhal GE, Bonhoeffer S. Virus-induced target cell activation reconciles set-point viral load heritability and within-host evolution. Epidemics 2014. [DOI: 10.1016/j.epidem.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Kulkarni AG, Paranjape RS, Thakar MR. Higher Expression of Activating Receptors on Cytotoxic NK Cells is Associated with Early Control on HIV-1C Multiplication. Front Immunol 2014; 5:222. [PMID: 24904577 PMCID: PMC4032894 DOI: 10.3389/fimmu.2014.00222] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/01/2014] [Indexed: 12/02/2022] Open
Abstract
Natural killer (NK) cells may be important in modulating HIV replication in early course of HIV infection. The effector function of NK cells is finely tuned by a balance between signals delivered by activating and inhibitory receptors. However, the influence of expression of these receptors on the early course of HIV replication and subsequent disease progression is not explored in the context of HIV-1C infection. The expression pattern of activating (NKp46, NKp44, NKp30, NKG2D, and NKG2C) and inhibitory (CD158b, NKG2A, and ILT2) receptors was determined in 20 patients with recent HIV-1C infection within 3–7 months of acquiring HIV infection and was compared with the expression pattern in individuals with progressive (N = 12), non-progressive HIV-1C infection (LTNPs, N = 12) and healthy seronegative individuals (N = 20). The association of the expression of these receptors on the rate of disease progression was assessed using viral load set point of recently infected individuals as a marker of disease progression. The study showed that higher cytotoxic potency of NK cells was associated with low viral load set point in recent HIV infection (r = −0.701; p = 0.0006) and higher CD4 counts (r = 0.720; p = 0.001). The expression of activating receptors (NKp46, NKp30, and NKG2D) on cytotoxic NK cells but not on regulatory NK cells was also significantly associated with low viral set point (p < 0.01) and viral load in LTNPs and progressors (p < 0.01). The study also indicated that cytotoxic NK cells might show the ability to specifically lyse HIV infected CD4 cells. This data collectively showed that early and sustained higher expression of activating receptors on cytotoxic NK cells could be responsible for increased cytotoxicity, reduced viral burden, and thus delaying the disease progression. The study to identify the molecular mechanism of the expression of these receptors in HIV infection will be helpful in further understanding of NK cell mediated control in early HIV infection.
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Ambrosioni J, Nicolas D, Sued O, Agüero F, Manzardo C, Miro JM. Update on antiretroviral treatment during primary HIV infection. Expert Rev Anti Infect Ther 2014; 12:793-807. [PMID: 24803105 DOI: 10.1586/14787210.2014.913981] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary HIV-1 infection covers a period of around 12 weeks in which the virus disseminates from the initial site of infection into different tissues and organs. In this phase, viremia is very high and transmission of HIV is an important issue. Most guidelines recommend antiretroviral treatment in patients who are symptomatic, although the indication for treatment remains inconclusive in asymptomatic patients. In this article the authors review the main virological and immunological events during this early phase of infection, and discuss the arguments for and against antiretroviral treatment. Recommendations of different guidelines, the issue of the HIV transmission and transmission of resistance to antiretroviral drugs, as well as recently available information opening perspectives for functional cure in patients treated in very early steps of HIV infection are also discussed.
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Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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