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Lee S, Chih H, Affandi J, Waters S, Irish A, Price P. Markers of terminally differentiated T-cells as predictors of vascular health in renal transplant recipients and healthy adults. Clin Immunol 2023; 255:109760. [PMID: 37678718 DOI: 10.1016/j.clim.2023.109760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/27/2023] [Accepted: 09/02/2023] [Indexed: 09/09/2023]
Abstract
Meta-analyses confirm a link between persistent human cytomegalovirus (HCMV) infections and cardiovascular disease, but the mechanisms are unclear. We assess whether proportions of T-cell populations are reliable predictors of subclinical atherosclerosis and/or reflect the burden of HCMV in healthy adults and renal transplant recipients (RTR). Samples were collected from healthy adults and RTR at baseline (T0) and after 32 (24-40) months (T1). Left carotid intima media thickness (cIMT) and proportions of T-cells expressing CD57, LIR-1 or the TEMRA phenotype increased in healthy adults and RTR. The T-cell populations correlated with levels of HCMV-reactive antibodies. Proportions of CD57+, LIR-1+ and TEMRA CD8+ T-cells correlated with left and right cIMT in healthy adults. Proportions of CD57+ and LIR-1+ CD8+ T-cells at T0 predicted left cIMT at T1 among healthy adults, but these associations disappeared after adjustment for covariates. We link LIR-1+ and CD57+CD8+ T-cells with the progression of cIMT in healthy adults.
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Affiliation(s)
- Silvia Lee
- School of Medicine, Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia; Department of Microbiology, Pathwest Laboratory Medicine, Western Australia, Australia.
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Bentley, Perth, Australia
| | - Jacquita Affandi
- Curtin School of Population Health, Curtin University, Bentley, Perth, Australia
| | - Shelley Waters
- School of Medicine, Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Ashley Irish
- Renal Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Patricia Price
- School of Medicine, Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
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Wanjalla CN, Simmons J, Oakes J, Zhang X, Nochowicz C, Priest S, Bailin SS, Warren CM, Mashayekhi M, Beasley HK, Wang J, Meenderink L, Sheng Q, Stolze J, Gangula R, Chopra A, Gabriel CL, Temu T, Pakala S, Wilfong EM, Gianella S, Phillips EJ, Harrison DG, Hinton A, Kalams SA, Mallal SA, Koethe JR. Distinct CD3 + CD14 + T Cell-Monocytes are dynamic complexes that harbor HIV and are increased with glucose intolerance. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.24.538020. [PMID: 37162990 PMCID: PMC10168203 DOI: 10.1101/2023.04.24.538020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Persistent systemic inflammation in persons with HIV (PWH) is accompanied by an increased risk of metabolic disease. Yet, changes in the innate and adaptive immune system in PWH who develop metabolic disease remain poorly defined. Using unbiased approaches, we show that PWH with prediabetes/diabetes have a significantly higher proportion of circulating CD14 + monocytes complexed to T cells. The complexed CD3 + T cells and CD14 + monocytes demonstrate functional immune synapses, increased expression of proinflammatory cytokines, and greater glucose utilization. Furthermore, these complexes harbor more latent HIV DNA compared to CD14 + monocytes or CD4 + T cells. Our results demonstrate that circulating CD3 + CD14 + T cell-monocyte pairs represent functional dynamic cellular interactions that likely contribute to inflammation and, in light of their increased proportion, may have a role in metabolic disease pathogenesis. These findings provide an incentive for future studies to investigate T cell-monocyte immune complexes as mechanistic in HIV cure and diseases of aging. Highlights Persons with HIV and diabetes have increased circulating CD3 + CD14 + T cell-monocyte complexes. CD3 + CD14 + T cell-monocytes are a heterogenous group of functional and dynamic complexes. We can detect HIV in T cell-monocyte complexes. The proportion of CD3 + CD14 + T cell-monocyte complexes is positively associated with blood glucose levels and negatively with plasma IL-10 and CD4 + T regulatory cells.
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Kaluba L, Chikopela T, Goma F, Malambo M, Mutale W, Heimburger DC, Koethe JR. Vascular dysfunction and body mass index in African adults with HIV. BMC Cardiovasc Disord 2023; 23:64. [PMID: 36737679 PMCID: PMC9896806 DOI: 10.1186/s12872-023-03093-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Impaired vascular compliance is common among persons with HIV (PWH) and a risk factor for cardiovascular disease (CVD), though many studies documenting this are from regions with a high prevalence of overweight and obesity. The prevalence and characteristics of impaired vascular compliance among PWH with low body mass index (BMI) is not well described, particularly in sub-Saharan Africa (SSA) where the majority of PWH live, a low BMI is more common, and the burden of CVD is rising. AIM To assess non-invasive vascular compliance measurements, including augmentation index (AIX), pulse wave velocity (PWV) and pulse waveforms, in underweight, normal weight, and overweight PWH on long-term antiretroviral therapy (ART) in SSA. METHODS A cross-sectional study among PWH on ART at the University Teaching Hospital in Lusaka, Zambia. All participants had been on a regimen of efavirenz, emtricitabine, and tenofovir disoproxil fumarate for five or more years. Carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and the corresponding augmentation indexes (cfAIX and crAIX), were measured in all participants, in addition to aortic pressure waveforms, classified as type A, B, C and D according to reflected wave timings and amplitude. Multiple linear regression assessed relationships between demographic and clinical factors with vascular measurement endpoints. RESULTS Ninety one PWH on long-term ART were enrolled; 38 (42%) were underweight (BMI < 18.5 kg/m2), 43 (47%) were normal weight (18.5-24.9 kg/m2) and 10 (11%) were overweight (> 25 kg/m2). Median age was 41, 40 and 40 years, among the three groups, respectively, and the proportion of women increased with BMI level. Overweight participants had a 39% higher cfAIX compared to normal-weight participants, while being underweight was associated with 27% lower cfAIX, after adjusting for age, sex and blood pressure (P = 0.02 and P = 0.01, respectively), but measurements of cfPWV, crPWV and crAIX did not differ. CONCLUSION Underweight PWH in SSA had lower cfAIX measurements compared to normal weight individuals, indicating less arterial stiffness. However, similar cfPWV, crPWV and crAIX values among the underweight and overweight PWH suggest a low BMI may not confer substantial protection against impaired vascular compliance as a contributor to CVD risk among individuals on ART.
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Affiliation(s)
- Longa Kaluba
- School of Medicine, Cavendish University Zambia, Lusaka, Zambia.
| | - Theresa Chikopela
- Department of Human Physiology, Faculty of Medicine, Lusaka Apex University, Lusaka, Zambia
| | - Fastone Goma
- grid.12984.360000 0000 8914 5257Department of Physiological Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mordecai Malambo
- grid.468776.c0000 0004 5346 0270School of Medicine, Cavendish University Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- grid.12984.360000 0000 8914 5257Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Douglas C. Heimburger
- grid.412807.80000 0004 1936 9916Vanderbilt Institute for Global Health and Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN USA ,grid.12984.360000 0000 8914 5257Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
| | - John R. Koethe
- grid.412807.80000 0004 1936 9916Vanderbilt Institute for Global Health and Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN USA
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Wanjalla CN, Temu TM, Mashayekhi M, Warren CM, Shepherd BE, Gangula R, Fuseini H, Bailin S, Gabriel CL, Gangula P, Madhur MS, Kalams S, Mallal SA, Harrison DG, Beckman JA, Koethe JR. Interleukin-17A is associated with flow-mediated dilation and interleukin-4 with carotid plaque in persons with HIV. AIDS 2022; 36:963-973. [PMID: 35165215 PMCID: PMC9167243 DOI: 10.1097/qad.0000000000003196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Chronic inflammation contributes to the high burden of cardiovascular disease (CVD) in persons with HIV (PWH). HIV has broad effects on innate and adaptive immune cells, including innate lymphoid cells (ILCs) and CD4+ T-helper cells. At present, the relationship between CVD and plasma cytokines reflecting ILC/T-helper responses in PWH is not well defined. We investigated relationships between plasma cytokines and subclinical atherosclerosis. DESIGN A cross-sectional study. METHODS We recruited 70 PWH on a single antiretroviral regimen (efavirenz, teno- fovir, and emtricitabine) with at least 12 months of suppressed viremia and 30 HIVnegative controls. We quantified plasma cytokines and chemokines, including inter- feron-g, interleukin (IL)-4, IL-13, and IL-17A, markers of macrophage activation, and markers of endothelial activation using multiplex assays and ELISA. Cytokines were grouped using Ward's hierarchical clustering. Brachial artery flow-mediated dilation (FMD) and carotid plaque burden were determined using ultrasound. Multivariable linear regression and negative binomial regression analyses were used to assess the relationships of plasma biomarkers and endpoints adjusted for CVD risk factors. RESULTS We identified three distinct clusters in PWH, one containing Th1/Th2/ILC1/ ILC2 type cytokines, one with Th17/ILC3/macrophage-related cytokines, and a less specific third cluster. Lower FMD was associated with higher plasma IL-17A and macrophage inflammatory protein-1 a. In contrast, IL-4, a Th2/ILC2 type cytokine, was associated with carotid plaque. When HIV-negative controls were added to the models clustering was more diffuse, and these associations were attenuated or absent. CONCLUSION Th17/ILC3 and Th2/ILC2-mediated immune mechanisms may have distinct roles in endothelial dysfunction and atherosclerotic plaque formation, respectively, in PWH.
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Affiliation(s)
- Celestine N. Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tecla M. Temu
- Departments of Global Health, University of Washington, Seattle, WA USA
| | - Mona Mashayekhi
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian M. Warren
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rama Gangula
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hubaida Fuseini
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel Bailin
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Curtis L. Gabriel
- Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pandu Gangula
- Department of Medicine & Dentistry, Meharry Medical College, TN, USA
| | - Meena S. Madhur
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spyros Kalams
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon A. Mallal
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David G. Harrison
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua A. Beckman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
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Kausalya B, Saravanan S, Pallikkuth S, Pahwa R, Saini SR, Iqbal S, Solomon S, Murugavel KG, Poongulali S, Kumarasamy N, Pahwa S. Immune correlates of cardiovascular co-morbidity in HIV infected participants from South India. BMC Immunol 2022; 23:24. [PMID: 35581554 PMCID: PMC9115939 DOI: 10.1186/s12865-022-00498-0] [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: 08/09/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the immune correlates of cardiovascular disease (CVD) risk in HIV infection is an important area of investigation in the current era of aging with HIV infection. Less is known about CVD risk and HIV infection in developing nations where additional risk factors may be playing a role in the CVD development. In this study, we assessed the effects of systemic inflammation, microbial translocation (MT), T cell immune activation (IA), and nadir CD4 counts on cardiac function and arterial stiffness as markers of subclinical atherosclerosis in HIV-infected individuals. METHODS People with HIV (PWH) who were ART naïve (n = 102) or virally suppressed on ART (n = 172) were stratified on nadir CD4 counts and compared to HIV-uninfected controls (n = 64). Determination was made of cardiac function via radial pulse wave and carotid intima thickness (C-IMT) measurements. Plasma biomarkers of inflammation and MT by ELISA or multiplex assays, and immune activation (IA) of T cells based HLA-DR and CD38 expression were investigated by flow cytometry. T-test, Mann-Whitney U test, and Spearman correlation were used to analyze study parameters. RESULTS Reduction in cardiac function with lower cardiac ejection time (p < 0.001), stroke volume (p < 0.001), cardiac output (p = 0.007), higher arterial stiffness (p < 0.05) were identified in ART-naïve participants, compared to PWH on ART (p < 0.05). No significant difference in C-IMT values were noted. Higher inflammatory and MT markers were found in the ART-naïve group compared to treated group who were comparable to uninfected participants, except for having higher TNF-α (p < 0.001) and sCD14 (p < 0.001). Immune activation of CD4 and CD8 T-cells was greater in ART-naïve participants compared to ART-treated and uninfected controls (p < 0.05). Lower nadir CD4 counts, higher inflammation, and higher MT predicted poor cardiac measures in the ART-naïve with nadir CD4 < 200cells/mm3 manifesting the highest arterial stiffness, and lowest cardiac function, whereas ART-treated, even with nadir < 200 cells/mm3 were similar to uninfected in these measures. CONCLUSIONS In HIV-infected individuals, initiation of ART even at nadir of < 200 cells/mm3 may prevent or reverse cardiovascular disease outcomes that are easily measurable in low income countries.
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Affiliation(s)
| | | | - Suresh Pallikkuth
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA
| | - Rajendra Pahwa
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA
| | - Shelly Rani Saini
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA
| | - Syed Iqbal
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Sunil Solomon
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Nagalingeswaran Kumarasamy
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,VHS-Infectious Diseases Medical Centre, Chennai, India
| | - Savita Pahwa
- University of Miami Miller School of Medicine, 1580 NW 10th Avenue; BCRI 712, Miami, FL, 33136, USA.
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Rerkasem A, Tangmunkongvorakul A, Aurpibul L, Sripan P, Parklak W, Nantakool S, Srithanaviboonchai K, Rerkasem K. Association of cardio-ankle vascular index and future major adverse cardiovascular events in older adults living with HIV. AIDS Care 2022; 35:591-599. [PMID: 35499141 DOI: 10.1080/09540121.2022.2029820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACTIncreased arterial stiffness is an indicator of cardiovascular disease (CVD) and death in the general population. The cardio-ankle vascular index (CAVI) is a novel method for measuring arterial stiffness. This study investigated the utility of CAVI as a prognostic indicator of CVD and death in older adults living with HIV(OALHIV). Patients aged ≥50 taking antiretroviral treatment with no history of cardiovascular events enrolled from multiple centers in Chiang Mai, Thailand. Participants (N = 347) who underwent CAVI were followed up for five years. The primary endpoint was major adverse cardiovascular events (MACE): a composite of total deaths and hospitalizations due to myocardial infarction, coronary revascularization, stroke, and heart failure. Cox regression analysis determined between normal (<8) and high (≥8) CAVI against the incidence of MACE. Forty-five participants (13.0%) were diagnosed with MACE. The risk of MACE was more significant in high CAVI than normal CAVI (adjusted HR = 2.11, 95% confidence interval 1.06-4.20, p = 0.033). In OALHIV, CAVI was an independent prognosis of MACE, in addition to conventional CVD risk factors. CAVI-assisted to help identify high-risk patients showed the benefit of further evaluation and more intensive therapy to prevent CVD and death.
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Affiliation(s)
- Amaraporn Rerkasem
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Arunrat Tangmunkongvorakul
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Linda Aurpibul
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wason Parklak
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sothida Nantakool
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kriengkrai Srithanaviboonchai
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Mezoh G, Lutchman N, Worsley C, Gededzha M, Mayne E, Martinson N, Moore PL, Crowther NJ. Biomarkers of Endothelial Activation in Black South African HIV-Positive Subjects are Associated with Both High Viral Load and Low CD4 Counts. AIDS Res Hum Retroviruses 2022; 38:152-161. [PMID: 34969264 DOI: 10.1089/aid.2021.0052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence of cardiovascular death in the HIV-infected population is higher than in uninfected individuals. Growing evidence suggests that HIV infection itself is directly linked to endothelial activation and dysfunction. Therefore, the aim of this study was to investigate whether endothelial activation is present in African subjects with HIV infection and identify its possible determinants. Eighty HIV-infected treatment-naive cases, categorized into two groups based on CD4 count (38 subjects with CD4 count ≤350 cells/mm3 and 42 subjects with CD4 count >350 cells/mm3), were compared with 60 HIV-uninfected controls. A small subgroup of the HIV-infected participants (n = 13) were followed up for 18 months following initiation of antiretroviral therapy (ART). Anthropometric data, fasting lipid and glucose levels, viral load, and CD4 counts were measured as were serum levels of intercellular adhesion molecule-1 (ICAM-1), endothelial leukocyte adhesion molecule-1, vascular cell adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein-1, von Willebrand factor (vWF), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8). The HIV-infected low CD4 group had higher levels of ICAM-1 (p < .05), VCAM-1 (p < .0005), TNF-α (p < .005), and vWF (p < .005), compared with the controls. In the HIV-infected cohort, VCAM-1 levels were negatively associated with CD4 counts (β = -0.474; p < .0005), whereas vWF levels were positively associated with viral load (β = 0.344; p < .01). Levels of ICAM-1 and VCAM-1 were reduced by ART (p < .05 vs. baseline for both), however, levels of IL-6, IL-8, and TNF-α increased (p < .005 vs. baseline for all). Endothelial activation and inflammation are evident in African ART-naive HIV-infected patients; the former is attenuated, and the latter is increased after 18 months of ART. In HIV-infected subjects, both immunological dysregulation and viral load are associated with biomarkers of endothelial activation.
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Affiliation(s)
- Genevieve Mezoh
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nereshni Lutchman
- Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa
| | - Catherine Worsley
- Department of Hematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Immunology, University of Pretoria, Johannesburg, South Africa
| | - Maemu Gededzha
- Department of Hematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth Mayne
- Department of Hematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Penny L. Moore
- Center for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa
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Mikuła T, Suchacz M, Sapuła M, Wiercińska-Drapało A. Significance of Vascular Cell Adhesion Molecule-1 and Tumor Necrosis Factor-Alpha in HIV-Infected Patients. J Clin Med 2022; 11:jcm11030514. [PMID: 35159966 PMCID: PMC8836431 DOI: 10.3390/jcm11030514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/02/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background. The aim of this study was the evaluation of the correlation between VCAM-1 and TNF-alpha serum concentrations and various clinical and laboratory parameters in HIV-infected patients. Methods. All included subjects were patients of the Department of Infectious and Tropical Diseases and Hepatology of the Medical University of Warsaw in Poland in the years 2014–2016. The inclusion criteria were: confirmed HIV infection, Caucasian origin, and age > 18 years old. PCT, CRP, serum HIV-1 RNA, CD4/CD8 T cell count, PCR HCV RNA, HBsAg, VCAM-1, and TNF-alpha were measured. The VCAM-1 and TNF-alpha serum levels were evaluated by ELISA. Results. Seventy-two HIV-infected patients were included (16 women and 56 men: mean age 38.7 years, 66.6% cigarette smokers, 34.7% HCV co-infected HCV, and 27.8% ART-naïve). VCAM-1 concentrations were significantly higher in HIV/HCV co-infected patients than in HIV mono-infected patients (125.6 ± 85.4 vs. 78.4 ± 58.6 ng/mL, p = 0.011) and ART-naïve in comparison to patients on cART (121.9 ± 76.5 vs. 69.4 ± 57.1 ng/mL, p = 0.003). The significant positive correlation between HCV-infection and VCAM-1 and negative correlation between cART use and VCAM-1 was confirmed in multivariate analyses. The only variable associated significantly with TNF-alpha concentration was lymphocytes T CD8+ cell count (p = 0.026, estimate = 0.033). Conclusions. Successful cART and HCV eradication seemed to play an important role in the reduction of endothelial dysfunction and persistent inflammation in HIV-infected patients. CD8 T cell count seemed to be one of the markers of the pro-inflammatory state in HIV-infection patients.
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Affiliation(s)
- Tomasz Mikuła
- Department of Infectious and Tropical Diseases and Hepatology, The Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (M.S.); (A.W.-D.)
- Warsaw’s Hospital for Infectious Diseases, 01-201 Warsaw, Poland
- Correspondence: ; Tel.: +48-(22)-33-55-222 (ext. 294)
| | - Magdalena Suchacz
- Department of Infectious and Tropical Diseases and Hepatology, The Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (M.S.); (A.W.-D.)
- Warsaw’s Hospital for Infectious Diseases, 01-201 Warsaw, Poland
| | - Mariusz Sapuła
- Department of Infectious and Tropical Diseases and Hepatology, The Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (M.S.); (A.W.-D.)
- Warsaw’s Hospital for Infectious Diseases, 01-201 Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, The Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (M.S.); (A.W.-D.)
- Warsaw’s Hospital for Infectious Diseases, 01-201 Warsaw, Poland
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Fuseini H, Smith R, Nochowicz CH, Simmons JD, Hannah L, Wanjalla CN, Gabriel CL, Mashayekhi M, Bailin SS, Castilho JL, Hasty AH, Koethe JR, Kalams SA. Leptin Promotes Greater Ki67 Expression in CD4 + T Cells From Obese Compared to Lean Persons Living With HIV. Front Immunol 2022; 12:796898. [PMID: 35111163 PMCID: PMC8801429 DOI: 10.3389/fimmu.2021.796898] [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: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
While antiretroviral therapy (ART) has proven effective in suppressing viremia and disease progression among people living with human immunodeficiency virus (HIV; PLWH), suboptimal CD4+ T cell reconstitution remains a major obstacle in nearly 30% of ART-treated individuals. Epidemiological studies demonstrate that obesity, or a body mass index (BMI) ≥ 30 kg/m2, is positively correlated with greater CD4+ T cell recovery in PLWH on ART. Leptin is a known immunomodulator that is produced in proportion to fat mass and is increased in obese individuals, including PLWH. We hypothesized that CD4+ T cells from obese PLWH have increased cell proliferation and cytokine production compared to cells from lean PLWH, potentially modulated by differential effects of leptin signaling. To test this hypothesis, peripheral blood mononuclear cells from obese and lean PLWH with long-term virologic suppression on the same ART regimen were pretreated with recombinant leptin and then stimulated with anti-CD3/CD28 or PMA/ionomycin to measure Ki67 expression, leptin receptor (LepR) surface expression and cytokine production. In the absence of leptin, Ki67 expression and IL-17A production were significantly higher in CD4+ T cells from obese compared to lean PLWH. However, LepR expression was significantly lower on CD4+ T cells from obese compared to lean PLWH. After leptin treatment, Ki67 expression was significantly increased in CD4+ T cells from obese PLWH compared to the lean participants. Leptin also increased IL-17A production in CD4+ T cells from obese healthy controls. In contrast, leptin decreased IL-17A production in CD4+ T cells from both obese and lean PLWH. Combined, these results demonstrate that obesity is associated with greater CD4+ T cell proliferation among PLWH, and that higher circulating leptin levels in obesity may contribute to improved CD4+ T reconstitution in PLWH initiating ART.
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Affiliation(s)
- Hubaida Fuseini
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Rita Smith
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Cindy H. Nochowicz
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Joshua D. Simmons
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - LaToya Hannah
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Celestine N. Wanjalla
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Curtis L. Gabriel
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mona Mashayekhi
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel S. Bailin
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jessica L. Castilho
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alyssa H. Hasty
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States
- The Veterans Affairs Tennessee Healthcare System, Nashville, TN, United States
| | - John R. Koethe
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
- The Veterans Affairs Tennessee Healthcare System, Nashville, TN, United States
| | - Spyros A. Kalams
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
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10
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Affi R, Gabillard D, Kouame GM, Ntakpe JB, Moh R, Badje A, Danel C, Inwoley A, Eholié SP, Anglaret X, Weiss L. Plasma sVCAM-1, antiretroviral therapy and mortality in HIV-1-infected West African adults. HIV Med 2022; 23:717-726. [PMID: 35023284 DOI: 10.1111/hiv.13230] [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: 06/18/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We report the association between pre-antiretroviral therapy (pre-ART) soluble vascular cell adhesion molecule-1 (sVCAM-1) levels and long-term mortality in HIV-infected West African adults participating in a trial of early ART in West Africa (Temprano ANRS 12136 trial). METHODS The ART-naïve HIV-infected adults were randomly assigned to start ART immediately or defer ART until the WHO criteria were met. Participants who completed the trial follow-up were invited to participate in a post-trial phase (PTP). The PTP end-point was all-cause death. We used multivariable Cox proportional models to analyse the association between baseline sVCAM-1 and all-cause death, adjusting for ART strategy, sex, CD4 count, plasma HIV-1 RNA and peripheral blood mononuclear cell HIV-1 DNA levels. RESULTS In all, 954 adults (77% women, median CD4 count of 387 cells/μL) were randomly assigned to start ART immediately (n = 477) or to defer initiation of ART (n = 477). They were followed for a median of 5.8 years [interquartile range (IQR): 5.2-6.3]. In multivariable analysis, the risk of death was significantly associated with baseline sVCAM-1 [≥1458 vs. < 1458 ng/mL; adjusted hazard ratio = 2.86, 95% confidence interval (CI): 1.60-5.11]. The 6-year probability of death rates were 14.4% (95%CI: 9.1-22.6) and 9.4% (5.4-16.1) in patients with baseline sVCAM-1 ≥ 1458 ng/mL randomized to deferred and immediate ART, respectively, and 3.8% (2.2-6.5) and 3.5% (1.9-6.3) in patients with baseline sVCAM-1 < 1458 ng/mL randomized to deferred and immediate ART. The median difference between pre-ART and 12-month sVCAM-1 levels in patients randomized to immediate ART was -252 (IQR: -587 to -61). CONCLUSIONS Pre-ART sVCAM-1 levels were significantly associated with mortality, independently of whether ART was started immediately or deferred, but they significantly decreased after 12 months of ART.
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Affiliation(s)
- Roseline Affi
- CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.,PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Delphine Gabillard
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,INSERM U1219, University of Bordeaux, IRD, Bordeaux, France
| | - Gérard Menan Kouame
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,INSERM U1219, University of Bordeaux, IRD, Bordeaux, France
| | - Jean Baptiste Ntakpe
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,INSERM U1219, University of Bordeaux, IRD, Bordeaux, France
| | - Raoul Moh
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Anani Badje
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Christine Danel
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,INSERM U1219, University of Bordeaux, IRD, Bordeaux, France
| | - André Inwoley
- CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.,PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Serge P Eholié
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Xavier Anglaret
- PACCI/ANRS Research site in Côte d'Ivoire, Abidjan, Côte d'Ivoire.,INSERM U1219, University of Bordeaux, IRD, Bordeaux, France
| | - Laurence Weiss
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,Service d'Immunologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM U976, Paris, France
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11
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Abstract
PURPOSE OF REVIEW To summarize the state of chronic, treated HIV infection and its contribution to accelerated aging, and to evaluate recent research relevant to the study and treatment of aging and senescence. RECENT FINDINGS Chronic treated HIV-1 infection is associated with significant risk of end-organ impairment, non-AIDS-associated malignancies, and accelerated physiologic aging. Coupled with the chronologic aging of the HIV-1-positive population, the development of therapies that target these processes is of great clinical importance. Age-related diseases are partly the result of cellular senescence. Both immune and nonimmune cell subsets are thought to mediate this senescent phenotype, a state of stable cell cycle arrest characterized by sustained release of pro-inflammatory mediators. Recent research in the field of aging has identified a number of 'senotherapeutics' to combat aging-related diseases, pharmacologic agents that act either by selectively promoting the death of senescent cells ('senolytics') or modifying senescent phenotype ('senomorphics'). SUMMARY Senescence is a hallmark of aging-related diseases that is characterized by stable cell cycle arrest and chronic inflammation. Chronic HIV-1 infection predisposes patients to aging-related illnesses and is similarly marked by a senescence-like phenotype. A better understanding of the role of HIV-1 in aging will inform the development of therapeutics aimed at eliminating senescent cells that drive accelerated physiologic aging.
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12
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Antiretroviral therapy-treated HIV-infected adults with coronary artery disease are characterized by a distinctive regulatory T-cell signature. AIDS 2021; 35:1003-1014. [PMID: 33587446 DOI: 10.1097/qad.0000000000002842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the success of antiretroviral therapy (ART) to control viral replication, people living with HIV (PWH) have high levels of chronic systemic inflammation and immune dysregulation which drives accelerated co-morbidities including coronary artery disease (CAD). Regulatory T cells (Tregs) and ectonucleotidases CD39/CD73 are known to be athero-protective via their immunosuppressive and anti-inflammatory functions. DESIGN We assessed the dynamics of Treg subsets in ART-treated PWH with or without CAD vs. HIV-uninfected individuals. METHODS Blood specimens were obtained from 142 participants including ART-treated HIV-infected adults with (n = 43) or without CAD (n = 41), as well as HIV-uninfected controls with (n = 31) or without CAD (n = 27). CAD was determined by the presence of atherosclerotic features on computed tomography angiography of the coronary arteries performed on all study participants. Treg subsets frequencies were assessed by flow cytometry. RESULTS Regardless of statin treatment or ART regimen, HIV+CAD+ individuals had the highest total Treg frequencies and increased thymic generation and output of Tregs (Helios/CD31 expression), while athero-protective CD39+/CD73+ Tregs were significantly depleted in this group. Tregs from PWH had higher expression of CCR6/CXCR3 than uninfected individuals regardless of CAD, while in HIV+CAD+ individuals Tregs expressed the highest levels of CCR4, which limits their maintenance. The lowest levels of CD4+ and CD8+ T-cell immune activation has been observed in HIV+CAD+ within study groups. CONCLUSION ART-treated PWH with diagnosed CAD are characterized by profound alterations in populations of anti-inflammatory and athero-protective Treg subsets. These changes may contribute to atherosclerotic plaque formation and progression during chronic HIV infection in the ART era.
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13
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Kaluba L, Goma F, Guure C, Munsaka S, Mutale W, Heimburger DC, Chikopela T, Koethe JR. Immune activation and arterial stiffness in lean adults with HIV on antiretroviral therapy. South Afr J HIV Med 2021; 22:1190. [PMID: 33824734 PMCID: PMC8008040 DOI: 10.4102/sajhivmed.v22i1.1190] [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] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022] Open
Abstract
Background Greater T-cell activation was associated with reduced vascular compliance amongst persons living with HIV (PLWH) especially among overweight and obese individuals. There is a paucity of data regarding immune activation and arterial stiffness amongst PLWH in sub-Saharan Africa (SSA). Objective To determine the association between immune activation and arterial stiffness in lean PLWH in SSA. Method Forty-eight human immunodeficiency virus positive (HIV+) adults on antiretroviral therapy (ART) >5 years and 26 HIV-negative adults, all with BMI < 25 kg/m2 and no history of CVD, were enrolled. The relationship of vascular compliance with circulating CD4+ and CD8+ naïve, memory, activated and senescent T cells, and serum 8-isoprostane was assessed by HIV status. Results Increased immune activation was observed in the CD4+ and CD8+ T cells of PLWH, 16.7% vs. 8.9% and 22.0% vs. 12.4% respectively; p < 0.001 (both). Furthermore, a higher proportion of senescent CD4+ T cells were associated with a lower carotid-femoral pulse wave velocity (cfPWV; p = 0.01), whilst a higher proportion of activated CD8+ T cells were associated with a lower carotid-radial pulse wave velocity (crPWV; p = 0.04), after adjustment for BMI and age. However, PLWH also had a higher median carotid-femoral augmentation index (cfAiX) (21.1% vs. 6.0%; p < 0.05) in comparison to their HIV controls. Conclusion Our population of lean PLWH had increased immune activation and higher cfAiX, a marker of arterial stiffness, compared to HIV-negative persons. The negative association between immune activation and arterial stiffness as measured by crPWV in PLHW on long-term treatment needs further elucidation.
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Affiliation(s)
- Longa Kaluba
- School of Medicine, Cavendish University Zambia, Lusaka, Zambia
| | - Fastone Goma
- Eden University, Lusaka, Zambia.,Department of Physiological Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Douglas C Heimburger
- Vanderbilt Institute for Global Health and Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN, United States of America
| | - Theresa Chikopela
- Department of Human Physiology, Faculty of Medicine, Lusaka Apex University, Lusaka, Zambia
| | - John R Koethe
- Vanderbilt Institute for Global Health and Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN, United States of America
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14
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Wanjalla CN, Mashayekhi M, Bailin S, Gabriel CL, Meenderink LM, Temu T, Fuller DT, Guo L, Kawai K, Virmani R, Jenkins C, Abana CO, Warren CM, Gangula R, Smith R, Madhur MS, Finn AV, Gelbard AH, Su YR, Tyska MJ, Kalams SA, Harrison DG, Mallal SA, Absi TS, Beckman JA, Koethe JR. Anticytomegalovirus CD4 + T Cells Are Associated With Subclinical Atherosclerosis in Persons With HIV. Arterioscler Thromb Vasc Biol 2021; 41:1459-1473. [PMID: 33567869 DOI: 10.1161/atvbaha.120.315786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Celestine N Wanjalla
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Tennessee Center for AIDS Research (C.N.W., C.L.G., C.M.W., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville
| | - Mona Mashayekhi
- Division of Diabetes, Endocrinology and Metabolism (M.M.), Vanderbilt University Medical Center, Nashville
| | - Samuel Bailin
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville
| | - Curtis L Gabriel
- Tennessee Center for AIDS Research (C.N.W., C.L.G., C.M.W., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Division of Gastroenterology (C.L.G., ), Vanderbilt University Medical Center, Nashville
| | - Leslie M Meenderink
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN (L.M.M.).,Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN (L.M.M., J.R.K.)
| | - Tecla Temu
- Department of Global Health, University of Washington, Seattle (T.T.)
| | | | - Liang Guo
- CVPath Institute, Gaithersburg, MD (D.T.F., L.G., K.K., R.V.)
| | - Kenji Kawai
- CVPath Institute, Gaithersburg, MD (D.T.F., L.G., K.K., R.V.)
| | - Renu Virmani
- CVPath Institute, Gaithersburg, MD (D.T.F., L.G., K.K., R.V.)
| | - Cathy Jenkins
- Department of Biostatistics (C.J.), Vanderbilt University Medical Center, Nashville
| | - Chike O Abana
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston (C.O.A.)
| | - Christian M Warren
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Tennessee Center for AIDS Research (C.N.W., C.L.G., C.M.W., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville
| | - Rama Gangula
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville
| | - Rita Smith
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville
| | - Meena S Madhur
- Division of Clinical Pharmacology (M.S.M., D.G.H.), Vanderbilt University Medical Center, Nashville
| | | | - Alexander H Gelbard
- Department of Otolaryngology (A.H.G., S.A.M.), Vanderbilt University Medical Center, Nashville
| | - Yan Ru Su
- Division of Cardiovascular Medicine (Y.R.S., J.A.B.), Vanderbilt University Medical Center, Nashville
| | | | - Spyros A Kalams
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Tennessee Center for AIDS Research (C.N.W., C.L.G., C.M.W., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Department of Otolaryngology (A.H.G., S.A.M.), Vanderbilt University Medical Center, Nashville.,Vanderbilt Technologies for Advanced Genomics (VANTAGE) (S.A.M.), Vanderbilt University Medical Center, Nashville
| | - David G Harrison
- Division of Clinical Pharmacology (M.S.M., D.G.H.), Vanderbilt University Medical Center, Nashville
| | - Simon A Mallal
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Tennessee Center for AIDS Research (C.N.W., C.L.G., C.M.W., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville
| | - Tarek S Absi
- Department of Cardiac Surgery (T.S.A.), Vanderbilt University Medical Center, Nashville
| | - Joshua A Beckman
- Division of Cardiovascular Medicine (Y.R.S., J.A.B.), Vanderbilt University Medical Center, Nashville
| | - John R Koethe
- Division of Infectious Diseases (C.N.W., S.B., L.M.M., C.M.W., R.G., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Tennessee Center for AIDS Research (C.N.W., C.L.G., C.M.W., R.S., S.A.K., S.A.M., J.R.K.), Vanderbilt University Medical Center, Nashville.,Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN (L.M.M., J.R.K.)
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15
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McMullen K, Bateman K, Stanley A, Combrinck M, Engelbrecht S, Bryer A. Viral protein R polymorphisms in the pathogenesis of HIV-associated acute ischaemic stroke: a case-control study. J Neurovirol 2021; 27:137-144. [PMID: 33462790 DOI: 10.1007/s13365-020-00936-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
HIV-1 viral proteins have been implicated in endothelial dysfunction, which is a major determinant of ischaemic stroke risk in HIV-infected individuals. Polymorphisms in HIV-1 viral protein R (Vpr) may alter its potential to promote endothelial dysfunction, by modifying its effects on viral replication, reactivation of latent cells, upregulation of pro-inflammatory cytokines and infection of macrophages. We analysed Vpr polymorphisms and their association with acute ischaemic stroke by comparing Vpr signature amino acids between 54 HIV-infected individuals with acute ischaemic stroke, and 80 age-matched HIV-infected non-stroke controls. Isoleucine at position 22 and serine at position 41 were associated with ischaemic stroke in HIV. Individuals with stroke had lower CD4 counts and CD4 nadirs than controls. These polymorphisms are unique to individuals with stroke compared to South African subtype C and the control group consensus sequences. Signature Vpr polymorphisms are associated with acute ischaemic stroke in HIV. These may increase stroke risk by promoting endothelial dysfunction and susceptibility to opportunistic infections. Therapeutic targeting of HIV-1 viral proteins may present an additional mechanism of decreasing stroke risk in HIV-infected individuals.
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Affiliation(s)
- Kate McMullen
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Kathleen Bateman
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alan Stanley
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Marc Combrinck
- Division of Geriatric Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Services, Cape Town, South Africa
| | - Alan Bryer
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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16
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HIV-positive demonstrate more salt sensitivity and nocturnal non-dipping blood pressure than HIV-negative individuals. Clin Hypertens 2021; 27:2. [PMID: 33446278 PMCID: PMC7809779 DOI: 10.1186/s40885-020-00160-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background High dietary salt and a lack of reduced blood pressure (BP) at night (non-dipping) are risk factors for the development of hypertension which may result in end-organ damage and death. The effect of high dietary salt on BP in black people of sub-Saharan Africa living with HIV is not well established. The goal of this study was to explore the associations between salt sensitivity and nocturnal blood pressure dipping according to HIV and hypertension status in a cohort of adult Zambian population. Methods We conducted an interventional study among 43 HIV-positive and 42 HIV-negative adults matched for age and sex. Study participants were instructed to consume a low (4 g) dietary salt intake for a week followed by high (9 g) dietary salt intake for a week. Salt resistance and salt sensitivity were defined by a mean arterial pressure difference of ≤5 mmHg and ≥ 8 mmHg, respectively, between the last day of low and high dietary salt intervention. Nocturnal dipping was defined as a 10–15% decrease in night-time blood pressure measured with an ambulatory blood pressure monitor. Results The median age was 40 years for both the HIV-positive and the HIV-negative group with 1:1 male to female ratio. HIV positive individuals with hypertension exhibited a higher BP sensitivity to salt (95%) and non-dipping BP (86%) prevalence compared with the HIV negative hypertensive (71 and 67%), HIV positive (10 and 24%) and HIV-negative normotensive (29 and 52%) groups, respectively (p < 0.05). Salt sensitivity was associated with non-dipping BP and hypertension in both the HIV-positive and HIV-negative groups even after adjustment in multivariate logistic regression (< 0.001). Conclusions The results of the present study suggest that high dietary salt intake raises blood pressure and worsens nocturnal BP dipping to a greater extent in hypertensive than normotensive individuals and that hypertensive individuals have higher dietary salt intake than their normotensive counterparts. Regarding HIV status, BP of HIV-positive hypertensive patients may be more sensitive to salt intake and demonstrate more non-dipping pattern compared to HIV-negative hypertensive group. However, further studies with a larger sample size are required to validate this. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-020-00160-0.
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17
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Temu TM, Polyak SJ, Zifodya JS, Wanjalla CN, Koethe JR, Masyuko S, Nyabiage J, Kinuthia J, Gervassi AL, Oyugi J, Page S, Farquhar C. Endothelial Dysfunction Is Related to Monocyte Activation in Antiretroviral-Treated People With HIV and HIV-Negative Adults in Kenya. Open Forum Infect Dis 2020; 7:ofaa425. [PMID: 33094120 PMCID: PMC7568437 DOI: 10.1093/ofid/ofaa425] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Residual monocyte activation may contribute to increased risk for endothelial dysfunction and subsequent atherosclerotic cardiovascular diseases (CVDs) among people with HIV (PWH) on antiretroviral therapy (ART). We examined the relationship between monocyte activation and endothelial activation in PWH in Kenya. METHODS Serum levels of markers of endothelial activation (soluble/circulating intercellular [sICAM-1] and vascular [sVCAM-1] cell adhesion molecule-1), intestinal barrier dysfunction (intestinal fatty acid binding protein [I-FABP]), and monocyte activation (soluble CD14 [sCD14]) were measured in 275 PWH on ART and 266 HIV-negative persons. Linear regression was used to evaluate associations, adjusting for demographic and traditional CVD risk factors. RESULTS Among 541 participants, the median age was 43 years, 50% were female, and most PWH were virally suppressed (97%). sICAM-1 and sVCAM-1 levels were significantly higher in PWH than in HIV-negative participants (P < .001 for both). After further adjustment for traditional CVD risk factors, HIV infection remained associated with 49% (95% CI, 33% to 67%) greater sICAM-1 and 30% (95% CI, 14% to 48%) greater sVCAM-1 relative to uninfected controls. Adjustment for sCD14 substantially attenuated the difference between PWH and HIV-negative individuals. In a stratified analysis of PWH, both sICAM-1 and sVCAM-1 were positively associated with sCD14 (P < .001). CONCLUSIONS Despite viral suppression, African PWH have evidence of enhanced endothelial activation associated with sCD14, suggesting that monocyte activation plays a role in atherosclerotic plaque development. Future studies are needed to determine mechanistic pathways leading to monocyte activation in this population.
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Affiliation(s)
- Tecla M Temu
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Stephen J Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Jerry S Zifodya
- Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - John R Koethe
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jerusha Nyabiage
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | - Ana L Gervassi
- Center for Infectious Disease Research, Seattle Biomedical Research Institute, Seattle, Washington, USA
| | - Julius Oyugi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Stephanie Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, USA
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18
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Masenga SK, Elijovich F, Hamooya BM, Nzala S, Kwenda G, Heimburger DC, Mutale W, Munsaka SM, Zhao S, Koethe JR, Kirabo A. Elevated Eosinophils as a Feature of Inflammation Associated With Hypertension in Virally Suppressed People Living With HIV. J Am Heart Assoc 2020; 9:e011450. [PMID: 32064996 PMCID: PMC7070208 DOI: 10.1161/jaha.118.011450] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background People living with HIV (PLWH) are at increased risk of cardiovascular disease, including hypertension, which persists despite effective plasma viral suppression on antiretroviral therapy. HIV infection is characterized by long‐term alterations in immune function, but the contribution of immune factors to hypertension in PLWH is not fully understood. Prior studies have found that both innate and adaptive immune cell activation contributes to hypertension. Methods and Results We hypothesized that chronic inflammation may contribute to hypertension in PLWH. To test this hypothesis, we enrolled a cohort of 70 PLWH (44% hypertensive) on a long‐term single antiretroviral therapy regimen for broad phenotyping of inflammation biomarkers. We found that hypertensive PLWH had higher levels of inflammatory cytokines, including tumor necrosis factor‐α receptor 1, interleukin‐6, interleukin‐17, interleukin‐5, intercellular adhesion molecule 1 and macrophage inflammatory protein‐1α. After adjustment for age, sex, and fat mass index, the circulating eosinophils remained significantly associated with hypertension. On the basis of these results, we assessed the relationship of eosinophils and hypertension in 2 cohorts of 50 and 81 039 similar HIV‐negative people; although eosinophil count was associated with prevalent hypertension, this relationship was abrogated by body mass index. Conclusions These findings may represent a unique linkage between immune status and cardiovascular physiological characteristics in HIV infection, which should be evaluated further.
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Affiliation(s)
- Sepiso K Masenga
- School of Medicine and Health Sciences Mulungushi University Livingstone Zambia.,Department of Biomedical Sciences School of Health Sciences University of Zambia Lusaka Zambia.,Vanderbilt Institute for Global Health Vanderbilt University Medical Center Nashville TN
| | - Fernando Elijovich
- Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN
| | - Benson M Hamooya
- School of Medicine and Health Sciences Mulungushi University Livingstone Zambia.,Department of Epidemiology and Biostatistics School of Public Health University of Zambia Lusaka Zambia
| | - Selestine Nzala
- Department of Medical Education Development University of Zambia Lusaka Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences School of Health Sciences University of Zambia Lusaka Zambia
| | - Douglas C Heimburger
- Vanderbilt Institute for Global Health Vanderbilt University Medical Center Nashville TN
| | - Wilbroad Mutale
- Department of Health Policy and Management School of Public Health University of Zambia Lusaka Zambia
| | - Sody M Munsaka
- Department of Biomedical Sciences School of Health Sciences University of Zambia Lusaka Zambia
| | - Shilin Zhao
- Department of Biostatistics Vanderbilt University Medical Center Nashville TN
| | - John R Koethe
- Division of Infectious Diseases Vanderbilt University Medical Center Nashville TN
| | - Annet Kirabo
- Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.,Department of Molecular Physiology and Biophysics Vanderbilt University Nashville TN
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19
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Affiliation(s)
- Leah Rethy
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Matthew J Feinstein
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Arjun Sinha
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Chad Achenbach
- Division of Infectious Diseases Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sanjiv J Shah
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
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20
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Brief Report: Circulating Markers of Immunologic Activity Reflect Adiposity in Persons With HIV on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2019; 79:135-140. [PMID: 29794823 DOI: 10.1097/qai.0000000000001768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity alters adipose tissue immunology, and these changes may be reflected in circulating soluble inflammatory biomarker and T-cell subset profiles measured in HIV research studies. METHODS We recruited 70 adults with HIV (50% obese) on efavirenz, tenofovir, and emtricitabine, virologic suppression for >2 years, and no rheumatologic or other known inflammatory conditions. We measured fasting plasma levels of several markers of innate immunity and major CD4 and CD8 T-cell subsets. We assessed relationships between measurements of total adiposity [body mass index (BMI), dual-energy X-ray absorptiometry-quantified fat mass index (FMI), and plasma leptin] and the immunologic parameters using covariate-adjusted Spearman's rank correlations. RESULTS The cohort was 43% women, 54% nonwhite, and median age was 45 years. Higher BMI, FMI, and plasma leptin were consistently associated with higher C-reactive protein, serum amyloid A, and interleukin-6 (P < 0.01 for all), but lower interleukin-10 (P ≤ 0.02 for all). BMI and FMI were positively associated with soluble tumor necrosis factor-α receptor 1 levels (P ≤ 0.02 for both), and a positive correlation approached significance for all 3 body composition measurements with soluble CD163 (P ≤ 0.09 for all). Higher BMI and FMI were associated with lower CD38 expression on CD4 T cells (P ≤ 0.04 for both), but higher CD69 expression (P ≤ 0.01 for BMI and FMI, P = 0.07 for leptin). CONCLUSIONS Greater adiposity is associated with alterations in a limited set of circulating immune markers, potentially reflecting changes known to occur in adipose tissue with treated HIV infection. Measuring total fat mass radiographically did not yield substantively different results compared with BMI.
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21
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Yu X, Shang H, Jiang Y. ICAM-1 in HIV infection and underlying mechanisms. Cytokine 2019; 125:154830. [PMID: 31491723 DOI: 10.1016/j.cyto.2019.154830] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/29/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
Intercellular adhesion molecule 1 (ICAM-1) is a glycoprotein that participates in inflammatory and immune responses. Both cell surface and soluble ICAM-1 are significantly increased during human immunodeficiency virus (HIV) infection, and ICAM-1 has important functions in promoting inflammatory responses and enhancing HIV infectivity; however, a comprehensive summary these roles has yet to be elaborated. In this review we describe the general biological characteristics of ICAM-1, its association with HIV disease progression and promotion of HIV production, mechanisms inducing upregulation of ICAM-1, and possible intervention strategies, representing important insights in the context of HIV treatment.
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Affiliation(s)
- Xiaowen Yu
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang 110001, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou 310003, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang 110001, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou 310003, China.
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang 110001, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou 310003, China.
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22
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Mayne ES, Louw S. Good Fences Make Good Neighbors: Human Immunodeficiency Virus and Vascular Disease. Open Forum Infect Dis 2019; 6:ofz303. [PMID: 31737735 PMCID: PMC6847507 DOI: 10.1093/ofid/ofz303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Cardiovascular disease, venous thrombosis, and microvascular disease in people with HIV (PWH) is predicted to increase in an aging HIV-infected population. Endothelial damage and dysfunction is a risk factor for cardiovascular events in PWH and is characterized by impaired vascular relaxation and decreased nitric oxide availability. Vascular disease has been attributed to direct viral effects, opportunistic infections, chronic inflammation, effects of antiretroviral therapy, and underlying comorbid conditions, like hypertension and use of tobacco. Although biomarkers have been examined to predict and prognosticate thrombotic and cardiovascular disease in this population, more comprehensive validation of risk factors is necessary to ensure patients are managed appropriately. This review examines the pathogenesis of vascular disease in PWH and summarizes the biomarkers used to predict vascular disease in this population.
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Affiliation(s)
- Elizabeth S Mayne
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service
| | - Susan Louw
- Department of Molecular Medicine Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
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23
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Bernal E, Martinez M, Torres A, Guillamón CF, Alcaraz A, Alcaraz MJ, Muñoz A, Valero S, Botella C, Campillo JA, Cano A, Minguela A. T cell senescence predicts subclinical atherosclerosis in HIV-infected patients similarly to traditional cardiovascular risk factors. Antiviral Res 2018; 162:163-170. [PMID: 30593833 DOI: 10.1016/j.antiviral.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/05/2018] [Accepted: 12/24/2018] [Indexed: 12/15/2022]
Abstract
The main objective of this study is to evaluate the predictive capacity of T cell activation/senescence in subclinical atherosclerosis (SCA) in a group of HIV-infected patients. So, a cross-sectional analysis was performed on 91 long-term triple-ART therapy HIV-infected patients from an observational and prospective cohort. Carotid Intima Media Thickness (cIMT) was measured. Binary logistic regression was used to evaluate independent variables associated with SCA. Compared to patients without SCA, patients with SCA (60.4%) were older (41.33 ± 9.04 vs. 51.73 ± 8.44 years old, p < 0.001) and showed Framingham risk score (2.63 ± 3.127 vs. 7.66 ± 5.84, p = 0.008), as well as higher numbers of CD4+CD8+ double positive T cells (0.50 ± 0.42% vs. 0.81 ± 0.79%, p = 0.037), CD8+CD28- T cells (41.70 ± 16.96% vs. 50.22 ± 16.15%, p = 0.018), higher expression of CD28 on CD8+CD28+ T cells (1865 ± 789 vs. 2243 ± 917 MFI, P = 0.046). In contrast, they showed lower expression of CD38 on CD19+ B cells (65.38 ± 27.47% vs. 42.67 ± 30.26%, P < 0.001). Logistic multivariable analysis showed that Framingham risk score >10% (OR = 14.84, CI95% 1.63-125; p = 0.016) and numbers of CD8+CD28- T cells (OR = 1.032, CI 95% 1-1.065; p = 0.045) were independent factors associated with SCA. Patients with CD8+CD28- T cells ≥59% compared to those <59% had higher risk of SCA (OR = 4, CI95% 1.19-13.3, p = 0.024). Interestingly, 27.4% of patients with low Framingham risk score had elevated levels of CD8+CD28- T cells. In conclusion, immune senescence represented by accumulation of CD8+CD28- T cells may contribute to improve the predictive capacity of the Framingham risk score, especially when the scores are low and can explain, at least in part, the higher prevalence of SCA observed in long-term ART-treated stable HIV infected patients.
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Affiliation(s)
- Enrique Bernal
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain.
| | - Mónica Martinez
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - Ana Torres
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - Concepción F Guillamón
- Immunology Service, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Antonia Alcaraz
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - María J Alcaraz
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - Angeles Muñoz
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - Salvador Valero
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - Carmen Botella
- Immunology Service, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - José A Campillo
- Immunology Service, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Alfredo Cano
- Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia and Murcia University, Spain
| | - Alfredo Minguela
- Immunology Service, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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24
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Groenewegen H, Bierman WFW, Delli K, Dijkstra PU, Nesse W, Vissink A, Spijkervet FKL. Severe periodontitis is more common in HIV- infected patients. J Infect 2018; 78:171-177. [PMID: 30528870 DOI: 10.1016/j.jinf.2018.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis. DESIGN cross-sectional controlled study. METHODS We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires. RESULTS Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p = 0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists. CONCLUSIONS Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients.
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Affiliation(s)
- Hester Groenewegen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Wouter F W Bierman
- Department of Internal Medicine, Division of Infectious Diseases, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery and Department Rehabilitation, Center of Rehabilitation, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Willem Nesse
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, Wilhelmina Hospital Assen, Postbus 30001, 9400 RA Assen, The Netherlands.
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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Pallikkuth S, Pahwa R, Kausalya B, Saravanan S, Pan L, Vignesh R, Iqbal S, Solomon SS, Murugavel KG, Poongulali S, Kumarasamy N, Pahwa S. Cardiac morbidity in HIV infection is associated with checkpoint inhibitor LAG-3 on CD4 T cells. PLoS One 2018; 13:e0206256. [PMID: 30379878 PMCID: PMC6209232 DOI: 10.1371/journal.pone.0206256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022] Open
Abstract
Recent findings point to a role of Checkpoint Inhibitor (CPI) receptors at the tissue level in immune homeostasis. Here we investigated the role of CPI molecules on immune cells in relation to cardiac function. Participants recruited in Chennai, India consisted of HIV+ ART naive viremic (Gp1 n = 102), HIV+ on ART, virologically suppressed (Gp2, n = 172) and HIV negative healthy controls (Gp3, n = 64). A cross-sectional analysis of cardiac function, arterial resistance and immunologic assessment of CPI expressing T cells was performed. Data indicate that ART naive exhibited cardiac function impairment and greater arterial stiffness than the other groups. Frequencies of CD4+ T cells expressing LAG-3 and PD1 were higher in ART naïve while TIGIT and TIM3 were similar among the patient groups. LAG-3+, PD1+ and dual LAG-3+PD1+ CD4 T cells were inversely correlated with cardiac function and arterial elasticity and directly with arterial stiffness in ART naïve participants and with arterial elasticity in virally suppressed group on ART. We conclude that HIV induced upregulation of LAG-3 singly or in combination with PD1 in immune cells may regulate cardiac health and warrant mechanistic investigations. The implications of these findings have bearing for the potential utility of anti-LAG-3 immunotherapy for cardiac dysfunction in chronic HIV infection.
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Affiliation(s)
- Suresh Pallikkuth
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Rajendra Pahwa
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | | | | | - Li Pan
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - R. Vignesh
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Syed Iqbal
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Sunil S. Solomon
- YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | | | | | | | - Savita Pahwa
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Mosepele M, Mohammed T, Mupfumi L, Moyo S, Bennett K, Lockman S, Hemphill LC, Triant VA. HIV disease is associated with increased biomarkers of endothelial dysfunction despite viral suppression on long-term antiretroviral therapy in Botswana. Cardiovasc J Afr 2018; 29:155-161. [PMID: 29771268 PMCID: PMC6107727 DOI: 10.5830/cvja-2018-003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background Untreated HIV infection is associated with increased biomarkers of endothelial dysfunction. However, the predictors and degree of endothelial dysfunction among virally suppressed HIV–infected adults on long–term antiretroviral therapy (ART) have not been well studied in sub– Saharan Africa (SSA). Methods We enrolled 112 HIV–infected adults with virological suppression on long–term ART and 84 HIV–uninfected controls in Botswana. We measured plasma levels of markers of endothelial injury [soluble vascular adhesion molecule 1 (VCAM–1), intercellular adhesion molecule 1 (ICAM–1) and E–selectin] and plasma levels of biomarkers of inflammation [interleukin 6 (IL–6)] and monocyte activation (sCD163). Baseline traditional cardiovascular disease (CVD) risk factors and bilateral common carotid intima–media thickness (cIMT) were also available for all participants. We assessed whether HIV status (despite virological suppression on ART) was associated with biomarkers of endothelial dysfunction after controlling for traditional CVD risk factors in linear regression models. We additionally assessed the association between IL–6, sCD163 and cIMT with endothelial dysfunction in separate multivariate linear regression models, controlling for cIMT, among virally suppressed HIV–infected participants only. Results In multivariate analysis, HIV infection was significantly associated with increased VCAM–1 (p < 0.01) and ICAM–1 (p = 0.03) but not E–selectin (p = 0.74) levels. Within the HIV–positive group, higher sCD163 levels were associated with decreased ICAM–1 and E–selectin (p < 0.01 and p = 0.01, respectively) but not VCAM–1 (p = 0.13) levels. IL–6 was not associated with any of the biomarkers of endothelial dysfunction. Conclusion HIV disease was associated with biomarkers of endothelial dysfunction among virally suppressed adults in Botswana on long–term ART after controlling for traditional CVD risk factors. Future work should explore the clinical impact of persistent endothelial dysfunction following longterm HIV viral suppression on the risk of CVD clinical endpoints among HIV–infected patients in this setting.
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Affiliation(s)
- Mosepele Mosepele
- Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | | | - Lucy Mupfumi
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kara Bennett
- Bennett Statistical Consulting Inc, Ballston Lake, New York, USA
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Linda C Hemphill
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Virginia A Triant
- Division of General Internal Medicine and Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
OBJECTIVE We evaluated the subclinical shedding of six different herpesviruses in antiretroviral drug-treated HIV-positive [HIV(+)] MSM, and determined how this is associated with markers of inflammation and immune activation. METHODS We obtained blood, semen, throat washing, urine, and stool from 15 antiretroviral-treated HIV-1-infected MSM with CD4 T-cell reconstitution, and 12 age-matched HIV-negative [HIV (-)] MSM from the Multicenter AIDS Cohort Study at four timepoints over 24 weeks to measure DNA levels of cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus 1 and 2, human herpesvirus 6 (HHV6), and HHV8. T-cell activation and plasma levels of soluble markers of inflammation and activation were also measured at the corresponding timepoints. RESULTS HIV(+) participants had a trend for higher total herpesvirus shedding rate. HIV(+) participants also had a significantly higher rate of shedding EBV and CMV compared with the HIV(-) group. Herpesvirus shedding was mostly seen in throat washings. In the HIV(+) group, herpesvirus shedding rate inversely correlated with plasma levels of interferon γ-induced protein 10 and soluble CD163. CMV DNA levels negatively correlated with levels of T-cell activation. There was a trend for a positive correlation between EBV shedding rate and plasma soluble CD14. HHV6 shedding rate negatively correlated with plasma levels of interleukin-6, soluble CD163, and interferon gamma-induced protein 10. Correlations were not observed among HIV(-) individuals. CONCLUSION Among treated HIV-infected MSM, there are higher subclinical shedding rates of some herpesviruses that occur in different body compartments and negatively correlate with levels of inflammation and immune activation.
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28
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Dysangco A, Liu Z, Stein JH, Dubé MP, Gupta SK. HIV infection, antiretroviral therapy, and measures of endothelial function, inflammation, metabolism, and oxidative stress. PLoS One 2017; 12:e0183511. [PMID: 28817706 PMCID: PMC5560712 DOI: 10.1371/journal.pone.0183511] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/05/2017] [Indexed: 11/19/2022] Open
Abstract
Background HIV-infected patients have an increased risk of cardiovascular disease (CVD). Impaired endothelial function is an early risk factor for CVD in the general population. It is presumed that HIV infection is associated with impaired endothelial function, but results have been inconsistent. Objectives Our objectives were to determine the relationships between HIV infection, virologic suppression with antiretroviral therapy (ART), in vivo measures of conduit artery and microvascular endothelial function, and circulating biomarkers of pathways associated with CVD. Methods We performed a cross-sectional analysis of three prospectively enrolled groups from a single center: 28 were HIV-infected and virologically-suppressed on a regimen of FTC/TDF/EFV (HIV+ART+), 44 were HIV-infected but not on ART (HIV+ART-), and 39 were HIV-uninfected healthy volunteers (HIV-) matched to the HIV+ART- group for age, sex, smoking status, and height. None had diabetes, uncontrolled hypertension, known CVD, or other pro-inflammatory condition. Flow mediated dilation (FMD), nitroglycerin-mediated dilation (NTGMD), reactive hyperemia velocity time integral (RHVTI), and FMD/RHVTI of the brachial artery were measured, as well as circulating biomarkers of systemic inflammation, metabolism, oxidative stress, and endothelial activation. Results No significant differences were found amongst the three groups in FMD (P = 0.46), NTGMD (P = 0.42), RHVTI (P = 0.17), and FMD/RHVTI (P = 0.22) in unadjusted comparisons. Adjusted ANOVA models which included brachial artery diameter, demographics, and conventional CVD risk factors did not appreciably change these findings. In pairwise comparisons, the HIV+ART- group had significantly higher soluble tumor necrosis factor receptor II, soluble CD163, β-2 microglobulin, interferon-γ- induced protein-10, tissue inhibitor of metalloproteinase-1, and vascular cell adhesion molecule-1 compared to the other two groups (all p<0.05). Correlates of endothelial function differed between study groups. Conclusion Although untreated HIV infection was associated with elevated levels of several biomarkers of inflammation and endothelial activation, we were unable to demonstrate differences in measures of conduit artery and microvascular endothelial function in this study population.
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Affiliation(s)
- Andrew Dysangco
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Ziyue Liu
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, Indiana, United States of America
| | - James H. Stein
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Michael P. Dubé
- Division of Infectious Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Samir K. Gupta
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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29
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Abstract
Cardiovascular disease, including atherosclerosis and atherosclerosis-associated complications, is an increasing cause of morbidity and mortality in human immunodeficiency virus (HIV) patients in the post-antiretroviral therapy era. HIV alone accelerates atherosclerosis. Antiretroviral therapy; HIV-associated comorbidities, such as dyslipidemia, drug abuse, and opportunistic infections; and lifestyle are risk factors for HIV-associated atherosclerosis. However, our current understanding of HIV-associated atherogenesis is very limited and has largely been obtained from clinical observation. There is a pressing need to experimentally unravel the missing link between HIV and atherosclerosis. Understanding these mechanisms will help to better develop and design novel therapeutic interventions for the treatment of HIV-associated cardiovascular disease. HIV mainly infects T cells and macrophages resulting in the induction of oxidative and endoplasmic reticulum stress, the formation of the inflammasome, and the dysregulation of autophagy. These mechanisms may contribute to HIV-associated atherogenesis. In this review, we will summarize our current understanding and propose potential mechanisms of HIV-associated atherosclerosis.
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Affiliation(s)
- Alison Kearns
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jennifer Gordon
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Tricia H Burdo
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
| | - Xuebin Qin
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
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Rodriguez-Iturbe B, Pons H, Johnson RJ. Role of the Immune System in Hypertension. Physiol Rev 2017; 97:1127-1164. [PMID: 28566539 PMCID: PMC6151499 DOI: 10.1152/physrev.00031.2016] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 02/07/2023] Open
Abstract
High blood pressure is present in more than one billion adults worldwide and is the most important modifiable risk factor of death resulting from cardiovascular disease. While many factors contribute to the pathogenesis of hypertension, a role of the immune system has been firmly established by a large number of investigations from many laboratories around the world. Immunosuppressive drugs and inhibition of individual cytokines prevent or ameliorate experimental hypertension, and studies in genetically-modified mouse strains have demonstrated that lymphocytes are necessary participants in the development of hypertension and in hypertensive organ injury. Furthermore, immune reactivity may be the driving force of hypertension in autoimmune diseases. Infiltration of immune cells, oxidative stress, and stimulation of the intrarenal angiotensin system are induced by activation of the innate and adaptive immunity. High blood pressure results from the combined effects of inflammation-induced impairment in the pressure natriuresis relationship, dysfunctional vascular relaxation, and overactivity of the sympathetic nervous system. Imbalances between proinflammatory effector responses and anti-inflammatory responses of regulatory T cells to a large extent determine the severity of inflammation. Experimental and human studies have uncovered autoantigens (isoketal-modified proteins and heat shock protein 70) of potential clinical relevance. Further investigations on the immune reactivity in hypertension may result in the identification of new strategies for the treatment of the disease.
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Affiliation(s)
- Bernardo Rodriguez-Iturbe
- Renal Service, Hospital Universitario, Universidad del Zulia, and Instituto Venezolano de Investigaciones Científicas (IVIC)-Zulia, Maracaibo, Venezuela; and Division of Renal Diseases and Hypertension, University of Colorado, Anschutz Campus, Aurora, Colorado
| | - Hector Pons
- Renal Service, Hospital Universitario, Universidad del Zulia, and Instituto Venezolano de Investigaciones Científicas (IVIC)-Zulia, Maracaibo, Venezuela; and Division of Renal Diseases and Hypertension, University of Colorado, Anschutz Campus, Aurora, Colorado
| | - Richard J Johnson
- Renal Service, Hospital Universitario, Universidad del Zulia, and Instituto Venezolano de Investigaciones Científicas (IVIC)-Zulia, Maracaibo, Venezuela; and Division of Renal Diseases and Hypertension, University of Colorado, Anschutz Campus, Aurora, Colorado
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