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Dye CK, Wu H, Jackson GL, Kidane A, Nkambule R, Lukhele NG, Malinga BP, Chekenyere R, El-Sadr WM, Baccarelli AA, Harris TG. Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging. Clin Epigenetics 2024; 16:32. [PMID: 38403593 PMCID: PMC10895753 DOI: 10.1186/s13148-024-01629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND People living with HIV (PLHIV) on effective antiretroviral therapy are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases. In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether epigenetic aging (i.e., the residual between regressing epigenetic age on chronological age) was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated epigenetic aging focusing on the Horvath, Hannum, PhenoAge and GrimAge epigenetic clocks, and a pace of biological aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini. RESULTS Age at HIV diagnosis was associated with Hannum epigenetic age acceleration (EAA) (β-coefficient [95% Confidence Interval]; 0.53 [0.05, 1.00], p = 0.03) and longer duration since HIV diagnosis was associated with slower Hannum EAA (- 0.53 [- 1.00, - 0.05], p = 0.03). The average daily dietary intake of fruits and vegetables was associated with DunedinPACE (0.12 [0.03, 0.22], p = 0.01). The associations of Hannum EAA with the age at HIV diagnosis and duration of time since HIV diagnosis were attenuated when the average daily intake of fruits and vegetables or physical activity were included in our models. Diet and self-perceived quality of life measures modified the relationship between CD4+ T cell counts at participant enrollment and Hannum EAA. CONCLUSIONS Epigenetic age is more advanced in OPLHIV in Eswatini in those diagnosed with HIV at an older age and slowed in those who have lived for a longer time with diagnosed HIV. Lifestyle and quality of life factors may differentially affect epigenetic aging in OPLHIV. To our knowledge, this is the first study to assess epigenetic aging in OPLHIV in Eswatini and one of the few in sub-Saharan Africa.
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Affiliation(s)
- Christian K Dye
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 630 West 168th St. Room 16-416, New York, NY, 10032, USA.
| | - Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 630 West 168th St. Room 16-416, New York, NY, 10032, USA
| | - Gabriela L Jackson
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 630 West 168th St. Room 16-416, New York, NY, 10032, USA
| | - Altaye Kidane
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 630 West 168th St. Room 16-416, New York, NY, 10032, USA
| | - Tiffany G Harris
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Höft MA, Burgers WA, Riou C. The immune response to SARS-CoV-2 in people with HIV. Cell Mol Immunol 2024; 21:184-196. [PMID: 37821620 PMCID: PMC10806256 DOI: 10.1038/s41423-023-01087-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
This review examines the intersection of the HIV and SARS-CoV-2 pandemics. People with HIV (PWH) are a heterogeneous group that differ in their degree of immune suppression, immune reconstitution, and viral control. While COVID-19 in those with well-controlled HIV infection poses no greater risk than that for HIV-uninfected individuals, people with advanced HIV disease are more vulnerable to poor COVID-19 outcomes. COVID-19 vaccines are effective and well tolerated in the majority of PWH, though reduced vaccine efficacy, breakthrough infections and faster waning of vaccine effectiveness have been demonstrated in PWH. This is likely a result of suboptimal humoral and cellular immune responses after vaccination. People with advanced HIV may also experience prolonged infection that may give rise to new epidemiologically significant variants, but initiation or resumption of antiretroviral therapy (ART) can effectively clear persistent infection. COVID-19 vaccine guidelines reflect these increased risks and recommend prioritization for vaccination and additional booster doses for PWH who are moderately to severely immunocompromised. We recommend continued research and monitoring of PWH with SARS-CoV-2 infection, especially in areas with a high HIV burden.
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Affiliation(s)
- Maxine A Höft
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Wendy A Burgers
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa.
| | - Catherine Riou
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa.
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Neelamegam M, Nawi N, Bashah NSA, Hwei YS, Zulhaimi NS, Kamarulzaman A, Kamaruzzaman SB, Ramli N, Rajasuriar R. Significant loss of retinal nerve fibre layer and contrast sensitivity in people with well controlled HIV disease: implications for aging with HIV. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1251126. [PMID: 38983023 PMCID: PMC11182154 DOI: 10.3389/fopht.2023.1251126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/27/2023] [Indexed: 07/11/2024]
Abstract
Objective Antiretroviral therapy has decreased the prevalence of retinal opportunistic infections in people living with HIV (PLWH). However, abnormalities in visual function are evident and may be associated with an early onset of aging in PLWH. In this study, we examined the Retinal Nerve Fibre Layer (RNFL) thickness and visual function in PLWH and HIV non-infected controls in Malaysia. Design Cross-sectional study. Methods Two hundred and two (202) PLWH without retinal opportunistic infection and 182 age-matched, HIV seronegative individuals were enrolled. PLWH were recruited from the Infectious Disease clinic at the University Malaya Medical Centre. Controls were recruited among the hospital staff and community volunteers. RNFL thickness was measured with spectral domain optical coherence tomography (SDOCT). Visual functions include visual acuity using LogMAR chart and contrast sensitivity using Pelli- Robson Chart. Results All PLWH (mean age 46.1 years ± 9.9 years) in the study were on ART and 61.2% had a CD4+ T-cell count more than 500 cell/μl. The mean visual acuity was similar between the two groups (LogMAR 0.05 vs. 0.07, p = 0.115). Contrast sensitivity was lower in PLWH compared to HIV seronegative individuals (1.90 vs 1.93, p = 0.032). RNFL thickness was significantly thinner in the temporal quadrant for PLWH compared to controls (68.89 μm vs 74.08 μm, p = 0.001). Conclusion Changes in RNFL thickness and contrast sensitivity were seen in PLWH despite their relatively young age and well controlled HIV disease. The changes reflect structural and functional deficits, and could have long-term implications on their health trajectory.
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Affiliation(s)
- Malinee Neelamegam
- Department of Medicine and Centre for Excellence for Research in Acquired Immunodeficiency Syndrome (AIDS), University Malaya, Kuala Lumpur, Malaysia
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Nilani Nawi
- University Malaya Eye Research Centre, Department of Ophthalmology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Syuhada Ahmad Bashah
- Department of Medicine and Centre for Excellence for Research in Acquired Immunodeficiency Syndrome (AIDS), University Malaya, Kuala Lumpur, Malaysia
| | - Yap Siew Hwei
- Department of Medicine and Centre for Excellence for Research in Acquired Immunodeficiency Syndrome (AIDS), University Malaya, Kuala Lumpur, Malaysia
| | - Nurul Syuhada Zulhaimi
- Department of Medicine and Centre for Excellence for Research in Acquired Immunodeficiency Syndrome (AIDS), University Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Department of Medicine and Centre for Excellence for Research in Acquired Immunodeficiency Syndrome (AIDS), University Malaya, Kuala Lumpur, Malaysia
| | | | - Norlina Ramli
- University Malaya Eye Research Centre, Department of Ophthalmology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Medicine and Centre for Excellence for Research in Acquired Immunodeficiency Syndrome (AIDS), University Malaya, Kuala Lumpur, Malaysia
- The Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
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Plaza-Jennings A, Akbarian S. Genomic Exploration of the Brain in People Infected with HIV-Recent Progress and the Road Ahead. Curr HIV/AIDS Rep 2023; 20:357-367. [PMID: 37947981 PMCID: PMC10719125 DOI: 10.1007/s11904-023-00675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE OF REVIEW The adult human brain harbors billions of microglia and other myeloid and lymphoid cells highly susceptible to HIV infection and retroviral insertion into the nuclear DNA. HIV infection of the brain is important because the brain is a potentially large reservoir site that may be a barrier to HIV cure strategies and because infection can lead to the development of HIV-associated neurocognitive disorder. To better understand both the central nervous system (CNS) reservoir and how it can cause neurologic dysfunction, novel genomic, epigenomic, transcriptomic, and proteomic approaches need to be employed. Several characteristics of the reservoir are important to learn, including where the virus integrates, whether integrated proviruses are intact or defective, whether integrated proviruses can be reactivated from a latent state to seed ongoing infection, and how this all impacts brain function. RECENT FINDINGS Here, we discuss similarities and differences of viral integration sites between brain and blood and discuss evidence for and against the hypothesis that in the absence of susceptible T-lymphocytes in the periphery, the virus housing in the infected brain is not able to sustain a systemic infection. Moreover, microglia from HIV + brains across a wide range of disease severity appear to share one type of common alteration, which is defined by downregulated expression, and repressive chromosomal compartmentalization, for microglial genes regulating synaptic connectivity. Therefore, viral infection of the brain, including in immunocompetent cases with near-normal levels of CD4 blood lymphocytes, could be associated with an early disruption in microglia-dependent neuronal support functions, contributing to cognitive and neurological deficits in people living with HIV.
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Affiliation(s)
- Amara Plaza-Jennings
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Nash Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Nash Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Dye CK, Wu H, Jackson GL, Kidane A, Nkambule R, Lukhele NG, Malinga BP, Chekenyere R, El-Sadr WM, Baccarelli AA, Harris TG. Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging. RESEARCH SQUARE 2023:rs.3.rs-3389208. [PMID: 37886587 PMCID: PMC10602087 DOI: 10.21203/rs.3.rs-3389208/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background People living with HIV (PLHIV) on effective antiretroviral therapy (ART) are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases (NCD). In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether biological aging (i.e., the difference between epigenetic age and chronological age, termed 'epigenetic age acceleration [EAA]') was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated EAA focusing on the second-generation epigenetic clocks, PhenoAge and GrimAge, and a pace of aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini. Results Among participants, the PhenoAge clock showed older epigenetic age (68 years old [63, 77]) but a younger GrimAge epigenetic age (median=56 years old [interquartile range=50, 61]) compared to the chronological age (59 years old [54, 66]). Participants diagnosed with HIV at an older age showed slower DunedinPACE (β-coefficient [95% Confidence Interval]; -0.02 [-0.04, -0.01], p=0.002) and longer duration since HIV diagnosis was associated with faster DunedinPACE (0.02 [0.01, 0.04], p=0.002). The average daily dietary intake of fruits and vegetables was associated with faster DunedinPACE (0.12 [0.03, 0.22], p=0.01) and modified the relationship between HIV status variables (number of years living with HIV since diagnosis, age at HIV diagnosis, CD4+ T cell counts) and PhenoAge EAA, and DunedinPACE. Conclusions Biological age is accelerated in OPLHIV in Eswatini, with those living with HIV for a longer duration at risk for faster biological aging. Lifestyle factors, especially healthier diets, may attenuate biological aging in OPLHIV. To our knowledge, this is the first study to assess biological aging in Eswatini and one of the few in sub-Saharan Africa.
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Affiliation(s)
| | - Haotian Wu
- Columbia University Mailman School of Public Health
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Jumare J, Dakum P, Sam-Agudu N, Memiah P, Nowak R, Bada F, Oguama U, Odonye G, Adebiyi R, Cairo C, Kwaghe V, Adebamowo C, Abimiku A, Charurat M. Prevalence and characteristics of metabolic syndrome and its components among adults living with and without HIV in Nigeria: a single-center study. BMC Endocr Disord 2023; 23:160. [PMID: 37507703 PMCID: PMC10375691 DOI: 10.1186/s12902-023-01419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLHIV) now live longer due to effective combination antiretroviral therapy. However, emerging evidence indicates that they may be at increased risk for some cardiometabolic disorders. We compared the prevalence of metabolic syndrome (MetS) and its component disorders between persons living with and without HIV in Nigeria. METHODS This was a cross-sectional analysis of baseline data from a prospective cohort study of non-communicable diseases among PLHIV along with age- and sex-matched persons without HIV (PWoH) at the University of Abuja Teaching Hospital Nigeria. We collected sociodemographic and clinical data, including anthropometric measures and results of relevant laboratory tests. MetS was defined using a modification of the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) criteria. RESULTS Of the 440 PLHIV and 232 PWoH, women constituted 50.5% and 51.3% respectively. The median age of the PLHIV was 45 years while that of the PWoH was 40 years. The prevalence of MetS was 30.7% (95% CI: 26.4%, 35.2%) and 22.8% (95% CI: 17.6%, 28.8%) among the PLHIV and PWoH respectively (P = 0.026). Independent associations were found for older age (P < 0.001), female sex (P < 0.001), family history of diabetes (P < 0.001), family history of hypertension (P = 0.013) and alcohol use (P = 0.015). The prevalence of component disorders for PLHIV versus PWoH were as follows: high blood pressure (22.3% vs 20.3%), prediabetes (33.8% vs 21.1%), diabetes (20.5% vs 8.2%), high triglycerides (24.5% vs 17.2%), low HDL-Cholesterol (51.1% vs 41.4%), and abdominal obesity (38.4% vs 37.1%). Adjusting for age and sex, prediabetes, diabetes, and low HDL-Cholesterol were significantly associated with HIV status. Duration on antiretroviral therapy, protease inhibitor-based regimen, CD4 count, and viral load were associated with some of the disorders mostly in unadjusted analyses. CONCLUSION We found a high burden of MetS and its component disorders, with significantly higher prevalence of dysglycemia and dyslipidemia among PLHIV as compared to PWoH. Integration of strategies for the prevention and management of MetS disorders is needed in HIV treatment settings.
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Affiliation(s)
- Jibreel Jumare
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria.
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Nadia Sam-Agudu
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Peter Memiah
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Rebecca Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Florence Bada
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Uzoamaka Oguama
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - George Odonye
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Ruxton Adebiyi
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Cristiana Cairo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Vivian Kwaghe
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, and Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Alash'le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Guo S, Zhang J, Yang X, Weissman S, Olatosi B, Patel RC, Li X. Impact of HIV on COVID-19 Outcomes: A Propensity Score Matching Analysis with Varying Age Differences. AIDS Behav 2023:10.1007/s10461-023-04088-y. [PMID: 37289345 PMCID: PMC10249542 DOI: 10.1007/s10461-023-04088-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
To exploratorily test (1) the impact of HIV and aging process among PLWH on COVID-19 outcomes; and (2) whether the effects of HIV on COVID-19 outcomes differed by immunity level. The data used in this study was retrieved from the COVID-19 positive cohort in National COVID Cohort Collaborative (N3C). Multivariable logistic regression models were conducted on populations that were matched using either exact matching or propensity score matching (PSM) with varying age difference between PLWH and non-PLWH to examine the impact of HIV and aging process on all-cause mortality and hospitalization among COVID-19 patients. Subgroup analyses by CD4 counts and viral load (VL) levels were conducted using similar approaches. Among the 2,422,864 adults with a COVID-19 diagnosis, 15,188 were PLWH. PLWH had a significantly higher odds of death compared to non-PLWH until age difference reached 6 years or more, while PLWH were still at an elevated risk of hospitalization across all matched cohorts. The odds of both severe outcomes were persistently higher among PLWH with CD4 < 200 cells/mm3. VL ≥ 200 copies/ml was only associated with higher hospitalization, regardless of the predefined age differences. Age advancement in HIV might significantly contribute to the higher risk of COVID-19 mortality and HIV infection may still impact COVID-19 hospitalization independent of the age advancement in HIV.
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Affiliation(s)
- Siyuan Guo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rena C Patel
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Guerville F, Vialemaringe M, Cognet C, Duffau P, Lazaro E, Cazanave C, Bonnet F, Leleux O, Rossignol R, Pinson B, Tumiotto C, Gabriel F, Appay V, Déchanet-Merville J, Wittkop L, Faustin B, Pellegrin I. Mechanisms of systemic low-grade inflammation in HIV patients on long-term suppressive antiretroviral therapy: the inflammasome hypothesis. AIDS 2023; 37:1035-1046. [PMID: 36928274 DOI: 10.1097/qad.0000000000003546] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE We aimed to determine the contribution of inflammasome activation in chronic low-grade systemic inflammation observed in patients with HIV (PWH) on long-term suppressive antiretroviral therapy (ART) and to explore mechanisms of such activation. DESIGN Forty-two PWH on long-term suppressive ART (HIV-RNA < 40 copies/ml) were compared with 10 HIV-negative healthy controls (HC). METHODS Inflammasome activation was measured by dosing mature interleukin (IL)-1β and IL-18 cytokines in patient serum. We explored inflammasome pathways through ex vivo stimulation of PWH primary monocytes with inflammasome activators; expression of inflammasome components by transcriptomic analysis; and metabolomics analysis of patient sera. RESULTS Median (Q1; Q3) age, ART and viral suppression duration in PWH were 54 (48; 60), 15 (9; 20) and 7.5 (5; 12) years, respectively. Higher serum IL-18 was measured in PWH than in HC (61 (42; 77) vs. 36 (27-48 pg/ml), P = 0.009); IL-1β was detected in 10/42 PWH (0.5 (0.34; 0.80) pg/ml) but not in HC. Monocytes from PWH did not produce more inflammatory cytokines in vitro , but secretion of IL-1β in response to NOD like receptor family, pyrin domain containing 3 (NLRP3) inflammasome stimulation was higher than in HC. This was not explained at the transcriptional level. We found an oxidative stress molecular profile in PWH sera. CONCLUSION HIV infection with long-term effective ART is associated with a serum inflammatory signature, including markers of inflammasome activation, and an increased activation of monocytes upon inflammasome stimulation. Other cells should be investigated as sources of inflammatory cytokines in PWH. Oxidative stress might contribute to this chronic low-grade inflammation.
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Affiliation(s)
| | | | - Celine Cognet
- CHU Bordeaux, Laboratory of Immunology and Immunogenetics
| | - Pierre Duffau
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, INSERM ERL 1303
- CHU Bordeaux, Service de Médecine Interne et Immunologie Clinique
| | - Estibaliz Lazaro
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, INSERM ERL 1303
- CHU Bordeaux, Service de Médecine Interne
| | | | - Fabrice Bonnet
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401
- CHU Bordeaux, Hôpital Saint-André, Service de Médecine Interne et Maladies Infectieuses
| | - Olivier Leleux
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401
| | - Rodrigue Rossignol
- INSERM U1211, 33000 Bordeaux, France; Bordeaux University; CELLOMET, Functional Genomics Center (CGFB), 146 rue Léo Saignat
| | - Benoît Pinson
- Service Analyses Métaboliques TBMcore CNRS UAR 3427 INSERM US005 Université de Bordeaux, 1 rue Camille Saint-Saëns
| | | | | | - Victor Appay
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, INSERM ERL 1303
| | | | - Linda Wittkop
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401
- INRIA SISTM team, Talence
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
| | - Benjamin Faustin
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, INSERM ERL 1303
- Immunology Discovery, Janssen Research & Development, San Diego, California, USA
| | - Isabelle Pellegrin
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, INSERM ERL 1303
- CHU Bordeaux, Laboratory of Immunology and Immunogenetics
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Baribeau V, Kim CJ, Lorgeoux RP, Brisebois J, Tossonian H, Lachaine J. Healthcare resource utilization and costs associated with renal, bone and cardiovascular comorbidities among persons living with HIV compared to the general population in Quebec, Canada. PLoS One 2022; 17:e0262645. [PMID: 35816474 PMCID: PMC9273062 DOI: 10.1371/journal.pone.0262645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
There is limited understanding on healthcare utilization and costs of age-related comorbidities such as cardiovascular, bone and renal disease/disorder in people living with human immunodeficiency virus, so we compared comorbidity prevalence and associated healthcare utilization and costs. Through the Quebec health insurance database, people living with human immunodeficiency virus on antiretroviral therapy for ≥6 months from January 2006 to June 2012 were categorized by their comorbidity status using International Classification of Diseases (ICD)-9 codes, and controls without human immunodeficiency virus diagnosis or antiretroviral therapy use were age and gender matched. We compared healthcare utilization and costs. A total of 3,905 people living with human immunodeficiency virus and 11,715 control individuals were included. The mean age of people living with human immunodeficiency virus was 45.3 years and 77.3% were men. Prevalence of comorbidities was higher and occurred earlier in people living with human immunodeficiency virus and increased with older age regardless of human immunodeficiency virus status. Interestingly, bone comorbidity was high (37%) and 5-fold greater in people living with human immunodeficiency virus <20 years than the controls. Polypharmacy and comorbidity scores were greater in people living with human immunodeficiency virus than controls (p<0.01), as were cardiovascular, bone and renal comorbidities (40.3%, 26.0% and 5.5%, respectively; p<0.01). People living with human immunodeficiency virus had higher healthcare utilization and costs than controls largely due to longer hospital stays and prescriptions. Mean total healthcare cost/person/year for people living with human immunodeficiency virus was CAD$6,248 and was highest for those with renal disease (CAD$19,617). Comorbidities in people living with human immunodeficiency virus are more prevalent, occur earlier and incur a higher burden on the healthcare system; earlier screening and improved preventative and management strategies may reduce the burden to people living with human immunodeficiency virus and to the healthcare system.
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Affiliation(s)
| | - Connie J. Kim
- Gilead Sciences Canada, Inc, Mississauga, Ontario, Canada
| | | | | | | | - Jean Lachaine
- PeriPharm Inc, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
- * E-mail:
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10
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Li L, Li XW, Ma CJ, Wang LH, Yu FT, Yang SY, Song SJ, Tang YX. Accelerated Aging of T-cell Subsets among ART-Naïve HIV-Infected Chinese Men who Have Sex with Men: A Case-control Study. Curr HIV Res 2022; 20:129-136. [PMID: 35170409 DOI: 10.2174/1570162x20666220216103504] [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: 10/06/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evidence of lymphopoiesis, exhaustion, and premature aging in Chinese patients with human immunodeficiency virus (HIV) is very limited. OBJECTIVE To assess biological aging and immune senescence in Chinese healthy controls (HC) and ART-naïve HIV-infected men who have sex with men (MSM). METHODS This case-control study was conducted in Beijing Ditan Hospital from March 2018 to June 2019. The percentages of naïve (TN), central memory (TCM), effector memory (TEM), and terminally differentiated memory (TemRA) subsets of CD4 and CD8 T cells were studied, along with markers of senescence (CD28-CD57+) and activation (HLA-DR+). Telomere length of naïve (CD45RA+) and memory (CD45RO+) CD8 T cells was quantified by real-time PCR. RESULTS A total of 26 HIV-infected and 20 age-matched HC MSM were included. Compared to HC group, CD4/CD8 ratio of HIV-infected group was significantly reduced (0.30 vs. 1.70, P<0.001); significant differences emerged among all CD8 but not CD4 T cell subsets (all P<0.05). In HIV-infected group, the percentages of senescent cells (CD28-CD57+) in TN, TCM, TEM, and TemRA subsets of CD8 T cells were higher (all P<0.05); while a significant difference was only found in naïve CD4 T cells (P<0.05). HLA-DR expression was increased significantly in all CD4 and CD8 T cell subsets. Both naïve (CD45RA+) and memory (CD45RO+) CD8 T cells in this population had significantly shorter telomere length (P<0.01) compared to HC group. CONCLUSION HIV-infected MSM exhibit signs of accelerated immune senescence and biological aging, which particularly affects the CD8 T-cell subsets.
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Affiliation(s)
- Li Li
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Xing-Wang Li
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Cheng-Jie Ma
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ling-Hang Wang
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Feng-Ting Yu
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Si-Yuan Yang
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shu-Jing Song
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yun-Xia Tang
- Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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11
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Guaraldi G, Milic J, Barbieri S, Marchiò T, Caselgrandi A, Volpi S, Aprile E, Belli M, Venuta M, Mussini C. Resilience and Frailty in People Living With HIV During the COVID Era: Two Complementary Constructs Associated With Health-Related Quality of Life. J Acquir Immune Defic Syndr 2022; 89:S65-S72. [PMID: 35015747 PMCID: PMC8751290 DOI: 10.1097/qai.0000000000002865] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resilience is defined as an individual's positive adaptation to stressors. The COVID-19 pandemic represents a generalized stressor which may affect differently people living with HIV (PLWH). The objective of this study was to characterize resilience in PLWH with particular regarding the identification of frailty-resilience phenotypes, which may differently affect health-related quality of life (HR-QoL). METHODS This was an observational study of PLWH attending Modena HIV Metabolic Clinic. Frailty was assessed in 2019, before the onset of the COVID-19 pandemic by using 37-Item frailty index ranging from 0 to 1. The frailty index score was categorized as fit (<0.25) or frail (>0.25). In January 2021, PLWH were offered to complete a set of electronic questionnaires including the CD-RISC-25 for resilience and EQ-5D5L and SF-36 for HR-QoL. Resilience was defined as CD-RISC-25 score >75.7 (ranging from 0 to 100). RESULTS Of 800 PLWH reached by mail, 575 (72%) completed the questionnaires. The median age and HIV duration were 54.5 and 24.3 years, respectively. Impaired resilience was associated with loneliness [odds ratio (OR = 2.39; 1.20 to 4.76, P < 0.001)]. Predictors for EQ-5D5L <89.7% were the phenotypes "frail/nonresilient" [OR = 5.21, 95% confidence interval (CI): 2.62 to 10.33] and "fit/nonresilient" (OR = 5.48, 95% CI: 2.8 to 10.74). Predictors for SF-36 <64.40 were the phenotypes "frail/nonresilient" (OR = 7.43, 95% CI: 2.57 to 21.22) and "fit/nonresilient" (OR = 6.27, 95% CI: 2.17 to 18.16). Both models were corrected for age, sex, HIV duration, and nadir CD4. CONCLUSIONS Resilience characterizes the well-being of PLWH during the COVID-19 crisis. This construct is complementary to frailty in the identification of clinical phenotypes with different impacts on HR-QoL.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy;
- Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy;
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy; and
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy;
- Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy;
| | - Sara Barbieri
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy;
| | | | | | - Sara Volpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy; and
| | - Emanuele Aprile
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy; and
| | - Michela Belli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy; and
| | - Maria Venuta
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy; and
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy;
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy; and
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12
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Salahuddin MF, Qrareya AN, Mahdi F, Moss E, Akins NS, Li J, Le HV, Paris JJ. Allopregnanolone and neuroHIV: Potential benefits of neuroendocrine modulation in the era of antiretroviral therapy. J Neuroendocrinol 2022; 34:e13047. [PMID: 34651359 PMCID: PMC8866218 DOI: 10.1111/jne.13047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
Forty years into the HIV pandemic, approximately 50% of infected individuals still suffer from a constellation of neurological disorders collectively known as 'neuroHIV.' Although combination antiretroviral therapy (cART) has been a tremendous success, in its present form, it cannot eradicate HIV. Reservoirs of virus reside within the central nervous system, serving as sources of HIV virotoxins that damage mitochondria and promote neurotoxicity. Although understudied, there is evidence that HIV or the HIV regulatory protein, trans-activator of transcription (Tat), can dysregulate neurosteroid formation potentially contributing to endocrine dysfunction. People living with HIV commonly suffer from endocrine disorders, including hypercortisolemia accompanied by paradoxical adrenal insufficiency upon stress. Age-related comorbidities often onset sooner and with greater magnitude among people living with HIV and are commonly accompanied by hypogonadism. In the post-cART era, these derangements of the hypothalamic-pituitary-adrenal and -gonadal axes are secondary (i.e., relegated to the brain) and indicative of neuroendocrine dysfunction. We review the clinical and preclinical evidence for neuroendocrine dysfunction in HIV, the capacity for hormone therapeutics to play an ameliorative role and the future steroid-based therapeutics that may have efficacy as novel adjunctives to cART.
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Affiliation(s)
- Mohammed F. Salahuddin
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Alaa N. Qrareya
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Fakhri Mahdi
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Emaya Moss
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Nicholas S. Akins
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Jing Li
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
- Research Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Hoang V. Le
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
- Research Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
| | - Jason J. Paris
- Department of BioMolecular SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
- Research Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMSUSA
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13
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Yang X, Zhang J, Chen S, Weissman S, Olatosi B, Li X. Utilizing electronic health record data to understand comorbidity burden among people living with HIV: a machine learning approach. AIDS 2021; 35:S39-S51. [PMID: 33867488 PMCID: PMC8058944 DOI: 10.1097/qad.0000000000002736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES An understanding of the predictors of comorbidity among people living with HIV (PLWH) is critical for effective HIV care management. In this study, we identified predictors of comorbidity burden among PLWH based on machine learning models with electronic health record (EHR) data. METHODS The study population are individuals with a HIV diagnosis between January 2005 and December 2016 in South Carolina (SC). The change of comorbidity burden, represented by the Charlson Comorbidity Index (CCI) score, was measured by the score difference between pre- and post-HIV diagnosis, and dichotomized into a binary outcome variable. Thirty-five risk predictors from multiple domains were used to predict the increase in comorbidity burden based on the logistic least absolute shrinkage and selection operator (Lasso) regression analysis using 80% data for model development and 20% data for validation. RESULTS Of 8253 PLWH, the mean value of the CCI score difference was 0.8 ± 1.9 (range from 0 to 21) with 2328 (28.2%) patients showing an increase in CCI score after HIV diagnosis. Top predictors for an increase in CCI score using the LASSO model included older age at HIV diagnosis, positive family history of chronic conditions, tobacco use, longer duration with retention in care, having PEBA insurance, having low recent CD4+ cell count and duration of viral suppression. CONCLUSION The application of machine learning methods to EHR data could identify important predictors of increased comorbidity burden among PLWH with high accuracy. Results may enhance the understanding of comorbidities and provide the evidence based data for integrated HIV and comorbidity care management of PLWH.
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Affiliation(s)
- Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Jiajia Zhang
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie Chen
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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14
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Walker EM, Slisarenko N, Gerrets GL, Grasperge BF, Mattison JA, Kissinger PJ, Welsh DA, Veazey RS, Jazwinski SM, Rout N. Dysregulation of IL-17/IL-22 Effector Functions in Blood and Gut Mucosal Gamma Delta T Cells Correlates With Increase in Circulating Leaky Gut and Inflammatory Markers During cART-Treated Chronic SIV Infection in Macaques. Front Immunol 2021; 12:647398. [PMID: 33717202 PMCID: PMC7946846 DOI: 10.3389/fimmu.2021.647398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
HIV-associated inflammation has been implicated in the premature aging and increased risk of age-associated comorbidities in cART-treated individuals. However, the immune mechanisms underlying the chronic inflammatory state of cART-suppressed HIV infection remain unclear. Here, we investigated the role of γδT cells, a group of innate IL-17 producing T lymphocytes, in the development of systemic inflammation and leaky gut phenotype during cART-suppressed SIV infection of macaques. Plasma levels of inflammatory mediators, intestinal epithelial barrier disruption (IEBD) and microbial translocation (MT) biomarkers, and Th1/Th17-type cytokine functions were longitudinally assessed in blood and gut mucosa of SIV-infected, cART-suppressed macaques. Among the various gut mucosal IL-17/IL-22-producing T lymphocyte subsets including Th17, γδT, CD161+ CD8+ T, and MAIT cells, a specific decline in the Vδ2 subset of γδT cells and impaired IL-17/IL-22 production in γδT cells significantly correlated with the subsequent increase in plasma IEBD/MT markers (IFABP, LPS-binding protein, and sCD14) and pro-inflammatory cytokines (IL-6, IL-1β, IP10, etc.) despite continued viral suppression during long-term cART. Further, the plasma inflammatory cytokine signature during long-term cART was distinct from acute SIV infection and resembled the inflammatory cytokine profile of uninfected aging (inflammaging) macaques. Overall, our data suggest that during cART-suppressed chronic SIV infection, dysregulation of IL-17/IL-22 cytokine effector functions and decline of Vδ2 γδT cell subsets may contribute to gut epithelial barrier disruption and development of a distinct plasma inflammatory signature characteristic of inflammaging. Our results advance the current understanding of the impact of chronic HIV/SIV infection on γδT cell functions and demonstrate that in the setting of long-term cART, the loss of epithelial barrier-protective functions of Vδ2 T cells and ensuing IEBD/MT occurs before the hallmark expansion of Vδ1 subsets and skewed Vδ2/Vδ1 ratio. Thus, our work suggests that novel therapeutic approaches toward restoring IL-17/IL-22 cytokine functions of intestinal Vδ2 T cells may be beneficial in preserving gut epithelial barrier function and reducing chronic inflammation in HIV-infected individuals.
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Affiliation(s)
- Edith M. Walker
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
| | - Nadia Slisarenko
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
| | - Giovanni L. Gerrets
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
| | - Brooke F. Grasperge
- Veterinary Medicine, Tulane National Primate Research Center, Covington, LA, United States
| | - Julie A. Mattison
- Translational Gerontology Branch, National Institute on Aging, NIH, Poolesville, MD, United States
| | - Patricia J. Kissinger
- School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - David A. Welsh
- Department of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine, New Orleans, LA, United States
| | - Ronald S. Veazey
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, United States
| | - S. Michal Jazwinski
- Tulane Center for Aging, Tulane University School of Medicine, New Orleans, LA, United States
| | - Namita Rout
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
- Tulane Center for Aging, Tulane University School of Medicine, New Orleans, LA, United States
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15
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Mondi A, Cimini E, Colavita F, Cicalini S, Pinnetti C, Matusali G, Casetti R, Maeurer M, Vergori A, Mazzotta V, Gagliardini R, De Zottis F, Schininà V, Girardi E, Puro V, Ippolito G, Vaia F, Capobianchi MR, Castilletti C, Agrati C, Antinori A. COVID-19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS-CoV-2. J Med Virol 2020; 93:1796-1804. [PMID: 32975842 PMCID: PMC7537181 DOI: 10.1002/jmv.26556] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/24/2023]
Abstract
Little evidence on coronavirus disease 2019 (COVID‐19) in people living with HIV (PLWH) is currently available. We reported clinical and viroimmunological data of all HIV‐positive patients admitted to our center with COVID‐19 from March 1 to May 12, 2020. Overall, five patients were included: all were virologically‐suppressed on antiretroviral therapy and CD4+ count was greater than 350 cell/mm3 in all but two patients. Although all patients had evidence of pneumonia on admission, only one developed respiratory failure. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA was never detected from nasopharyngeal swabs in two patients, whereas in the others, viral clearance occurred within a maximum of 43 days. Immunoglobulin G production was elicited in all patients and neutralizing antibodies in all but one patient. Specific‐T‐cell response developed in all patients but was stronger in those with the more severe presentations. Similarly, the highest level of proinflammatory cytokines was found in the only patient experiencing respiratory failure. Despite a mild presentation, patients with more pronounced immunosuppression showed high degrees of both cytokines production and immune activation. Our study did not find an increased risk and severity of COVID‐19 in PLWH. Adaptative cellular immune response to SARS‐CoV‐2 appeared to correlate to disease severity. The mild clinical picture showed in advanced HIV patients, despite a significant T‐cell activation and inflammatory profile, suggests a potential role of HIV‐driven immunological dysregulation in avoiding immune‐pathogenetic processes. However, other possible explanations, as a protective role of certain antiretroviral drugs, should be considered. Further larger studies are needed to better clarify the impact of HIV infection on COVID‐19. The clinical course of COVID‐19 and the dynamics of the immune response to SARS‐CoV‐2 infection in people living with HIV have not yet been fully elucidated Indeed, although worse outcomes might be expected in HIV‐positive patients compared to the general population, it has been supposed that the HIV‐related immune dysregulation could paradoxically mitigate the hyperinflammation syndrome responsible for the most severe complications of SARS‐CoV‐2 infection. In this case series we did not find an increased risk of both acquiring and having a severe course of COVID‐19 in people living with HIV compared to how reported in the general population. We observed that patients with more severe HIV‐related immunosuppression, despite the development of a specific immune response and the presence of a strong cellular immune‐activation and a moderate inflammatory profile, experienced a mild/moderate disease. These findings might suggest that the lower and impaired immune reactivity of advanced HIV infection could contribute to avoid immune‐pathogenetic processes. However, other possible explanations, as a potential protective role of certain antiretroviral regimens, should be considered.
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Affiliation(s)
- Annalisa Mondi
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Cimini
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Casetti
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Markus Maeurer
- Immunotherapy Programme, Champalimaud Centre for the Unknown, Lisbon, Portugal.,I Medical Clinical, University of Mainz, Mainz, Germany
| | - Alessandra Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico De Zottis
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Schininà
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Vincenzo Puro
- AIDS Reference Centre-National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Francesco Vaia
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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Catalan J, Ridge D, Cheshire A, Hedge B, Rosenfeld D. The Changing Narratives of Death, Dying, and HIV in the United Kingdom. QUALITATIVE HEALTH RESEARCH 2020; 30:1561-1571. [PMID: 32507074 PMCID: PMC7411528 DOI: 10.1177/1049732320922510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Death and infection were closely linked from the start of the HIV epidemic, until successful treatments became available. The initial impact of mostly young, gay men dying from HIV was powerful in shaping UK responses. Neoliberal discourses developed at the same time, particularly focusing on how citizens (rather than the state) should take responsibility to improve health. Subsequently "successful ageing" became an allied discourse, further marginalising death discussions. Our study reflected on a broad range of meanings around death within the historical UK epidemic, to examine how dying narratives shape contemporary HIV experiences. Fifty-one participants including people living with HIV, professionals, and activists were recruited for semistructured interviews. Assuming a symbolic interactionist framework, analysis highlighted how HIV deaths were initially experienced as not only traumatic but also energizing, leading to creativity. With effective antiretrovirals, dying changed shape (e.g., loss of death literacy), and better integration of palliative care was recommended.
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Affiliation(s)
- Jose Catalan
- South Kensington and Chelsea
Mental Health Centre, London, United Kingdom
| | - Damien Ridge
- University of Westminster, London,
United Kingdom
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17
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Munsamy AJ, Moodley AA, Brautaset RL. Recognising the threat of vision loss in people living with HIV on antiretroviral therapy without retinitis. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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18
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Chikomba CE, Padoa CJ, Tanyanyiwa D. Evaluation of the impact of delayed centrifugation on the diagnostic performance of serum creatinine as a baseline measure of renal function before antiretroviral treatment. South Afr J HIV Med 2020; 21:1056. [PMID: 32832109 PMCID: PMC7433244 DOI: 10.4102/sajhivmed.v21i1.1056] [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: 12/12/2019] [Accepted: 04/11/2020] [Indexed: 01/01/2023] Open
Abstract
Background The measurement of serum creatinine is a standard requirement of the medical management of people living with HIV. Renal dysfunction is common, both as a complication of HIV-infection and as a result of its treatment. The detection of abnormal renal function before the start of antiretroviral therapy will impact patient management and the outcome of treatment. Objectives This study aimed to determine if a time delay in the centrifugation of serum samples affected the creatinine level and the estimated glomerular filtration rate as recorded on the analytical platforms used in the laboratory. Methods Twenty-two (n = 22) HIV-positive, newly diagnosed and treatment-naïve patients were randomly recruited from Alexandra Health Clinic, Johannesburg, South Africa. Serum samples were centrifuged at six time intervals following receipt of the sample viz. < 4 h (baseline), 6 h, 24 h, 48 h, 72 h and 96 h. Creatinine concentrations were measured on the Roche platform utilising the enzymatic and kinetic Jaffe methods. Whole blood samples were also analysed with the Abbott i-STAT point-of-care instrument. The estimated glomerular filtration rate was calculated using the Cockcroft Gault, CKD-Epidemiology Collaboration and Modified Diet and Renal Disease v3/4 equations. Results At baseline (< 4 h) there was good agreement between the enzymatic and kinetic Jaffe methods: bias 1.7 µmol/l. The enzymatic and i-STAT creatinine concentrations were stable over 96 h viz. changes of 1.8% and 5.7%. However, from 24 h onwards agreement between the enzymatic and kinetic Jaffe methods was poor with the latter measuring 43.7 µmol/l higher than the enzymatic method at 96 h. Creatinine concentrations measured with the kinetic Jaffe method increased significantly in samples centrifuged after 6 h (p < 0.001, 61.7% change), and resulted in a 95% decline in eGFR at 96 h as determined with the CKD-Epidemiology Collaboration equation. Conclusion The analysis of serum creatinine using the isotope dilution mass spectrometry traceable kinetic Jaffe method is unreliable if performed on samples centrifuged ≥ 6 h after collection. The raised creatinine concentration can affect clinical decisions such as renal functional assessment, choice of antiretroviral drug or regimen, and the dose and frequency of medication.
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Affiliation(s)
- Chemedzai E Chikomba
- Department of Chemical Pathology, National Health Laboratory Services, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Carolyn J Padoa
- Department of Chemical Pathology, National Health Laboratory Services, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Donald Tanyanyiwa
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Science, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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19
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Associations of antiretroviral therapy and comorbidities with neurocognitive outcomes in HIV-1-infected patients. AIDS 2020; 34:893-902. [PMID: 32028325 DOI: 10.1097/qad.0000000000002491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate associations of antiretroviral therapy (ART) and comorbidities with neurocognitive impairments (NCIs) in ART-naive HIV-1-infected patients in clinical practice. DESIGN A retrospective study was conducted in ART-naive patients with HIV-1 diagnosis between January 2009 and December 2013 in the United States. METHODS The primary outcome was any NCI that included HIV-associated neurocognitive disorders (HAND), Alzheimer's disease, Parkinson's disease, multiple sclerosis, and other dementias. RESULTS A total of 47 862 patients met eligibility criteria (30 828 antiretroviral-treated and 17 034 antiretroviral-untreated). The median age was 45 years [interquartile range (IQR) 35--52] with 31% of patients aged at least 50 years. Seventy-five percent were men. Overall, ART was associated with reduced risks of any NCI (hazard ratio 0.41, 95% CI: 0.37--0.45), HAND (hazard ratio 0.57, 95% CI: 0.48--0.69), Alzheimer's disease (hazard ratio 0.36, 95% CI: 0.24--0.54), Parkinson's disease (hazard ratio 0.36, 95% CI: 0.25--0.51), multiple sclerosis (hazard ratio 0.26, 95% CI: 0.18--0.37), and other dementias (hazard ratio 0.50, 95% CI: 0.45--0.55). Meanwhile, the risk of any NCI was significantly increased in patients with various comorbidities including cardiac arrhythmia, paralysis, other neurological disorders, complicated diabetes, hypothyroidism, renal failure, lymphoma, rheumatoid arthritis, weight loss, and depression as compared with patients without those comorbidities. CONCLUSION ART may reduce the risk of NCIs in HIV-infected patients in general. Further research to investigate NCIs on specific antiretroviral regimens and comorbidities may provide insights regarding the long-term clinical care of these patients.
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Abstract
Objective: The Rotterdam Healthy Aging Score (HAS) is a validated multidimensional index constructed from five health domains. We describe the HAS distribution in a cohort of HIV-positive adults and correlate it with health outcomes. Design: A cross-sectional pilot study of 101 adults aged at least 40 years, on suppressive antiretroviral therapy attending a tertiary HIV clinic in Toronto, Canada. Methods: Participants completed questionnaires to calculate their HAS (range 0–14). Demographics, HAS and sub-scores were compared by age and sex. The HAS was compared with results of the Fried Frailty Score, Short Performance Physical Battery score (SPPB) and measures of health utilization. Kruskal--Wallis Rank-Sum and Fisher's exact tests were used for all comparisons. Results: Median (IQR) age was 56 (50--62), 81 (80%) men and 50 (50%) born in Canada. Median (IQR) CD4+ cell count was 574 (417--794) cells/μl. Median (IQR) HAS was 12 (10--13) with 39 (39%) achieving a score more than 12 (considered healthy aging). Younger participants experienced more depression, whereas women had greater pain. The HAS score correlated with the Fried Frailty Score (P = 0.008) and trended with the SPPB Score (P = 0.077). Those with the poorest HAS scores were more likely to have been hospitalized in the preceding 6 months (P = 0.034). Conclusion: The HAS ranged from 5 to 14 in this cohort of older HIV adults with 39% attaining scores in the ‘healthy’ range. The HAS correlated with measures of physical performance and health utilization. Further validation of an objective outcome in HIV-positive patients will facilitate evaluation of interventional studies to improve healthy aging.
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21
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Oliveira VHF, Borsari AL, Webel AR, Erlandson KM, Deminice R. Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis. Eur J Clin Nutr 2020; 74:1009-1021. [PMID: 32341489 DOI: 10.1038/s41430-020-0637-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/05/2023]
Abstract
People living with HIV (PLHIV) experience greater loss of muscle mass and function than people without HIV. However, HIV is not routinely recognized as a sarcopenia risk factor outside of HIV literature. The purposes of this study were to establish the prevalence and predictors of sarcopenia among PLHIV, and to compare the prevalence of sarcopenia among PLHIV and people without HIV. A systematic literature search of the PubMed, Embase, Cinahl, and Scielo databases was performed following PRISMA and MOOSE guidelines. Identified articles were included if they evaluated sarcopenia among PLHIV using either the presence of low muscle mass only or low muscle mass in association with low muscle function. The pooled prevalence of sarcopenia among PLHIV and the odds ratio for sarcopenia in PLHIV compared with controls were calculated. From 13 studies and 2267 participants, the prevalence of sarcopenia among PLHIV was 24.1% (95% CI = 17.8-31.0%). PLHIV presented 6.1 greater odds (95% CI = 1.1-33.5) of sarcopenia compared with people without HIV, matched by age, sex, BMI, and ethnicity. Longer exposure to specific HIV drugs, tobacco and alcohol, lower education and employment rates, and greater HIV duration were associated with sarcopenia. In conclusion, PLHIV had a high prevalence of sarcopenia, related to both HIV and non-HIV risk factors. HIV should be considered a risk factor for sarcopenia in the general population. CRD42019131449.
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Affiliation(s)
- Vitor H F Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil.
| | - Ana L Borsari
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
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22
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Lu J, Ma SS, Zhang WY, Duan JP. Changes in peripheral blood inflammatory factors (TNF-α and IL-6) and intestinal flora in AIDS and HIV-positive individuals. J Zhejiang Univ Sci B 2020; 20:793-802. [PMID: 31489799 DOI: 10.1631/jzus.b1900075] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE In this study, we investigated the changes in peripheral blood inflammatory factors and intestinal flora in acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-positive individuals (AIDS/HIV patients), and explored the relationships among intestinal flora, peripheral blood inflammatory factors, and CD4+ T lymphocytes. METHODS Thirty blood and stool samples from an AIDS group and a control group were collected. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA), and the number of CD4+ T lymphocytes by a FACSCount automated instrument. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the messenger RNA (mRNA) levels of Bifidobacterium, Lactobacillus, Escherichia coli, Enterococcus faecalis, and Enterococcus faecium. Correlations among intestinal flora, inflammatory factor levels, and CD4+ T lymphocyte values were evaluated using the Spearman correlation coefficient. RESULTS The levels of TNF-α and IL-6 in the AIDS group were higher than those in the control group, while the number of CD4+ T lymphocytes was lower. The amounts of Bifidobacterium and Lactobacillus in the AIDS group were significantly lower than those in control group, while the amounts of E. coli, E. faecalis, and E. faecium were much higher. The amounts of Bifidobacterium and Lactobacillus were negatively correlated with the content of TNF-α and IL-6 and the CD4+ T lymphocyte count, while those correlations were reversed for E. coli, E. faecalis, and E. faecium. CONCLUSIONS The intestinal microbiota of AIDS/HIV patients were disordered, and there was a correlation between the amount of intestinal flora and the number of CD4+ T lymphocytes and the levels of TNF-α and IL-6.
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Affiliation(s)
- Jing Lu
- Department of Infectious Disease, Qingdao Sixth People's Hospital, Qingdao 266033, China
| | - Sai-Sai Ma
- Department of Infectious Disease, Qingdao Sixth People's Hospital, Qingdao 266033, China
| | - Wei-Ying Zhang
- Department of Infectious Disease, Qingdao Sixth People's Hospital, Qingdao 266033, China
| | - Jian-Ping Duan
- Department of Infectious Disease, Qingdao Sixth People's Hospital, Qingdao 266033, China
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Fuster D. Cocaine Use: A Threat for the HIV-Infected Liver. J Womens Health (Larchmt) 2020; 29:1141-1142. [PMID: 32027220 DOI: 10.1089/jwh.2019.8284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniel Fuster
- Addiction Unit, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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24
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Tao X, Lu Y, Zhou Y, Zhang L, Chen Y. Efficacy and safety of the regimens containing tenofovir alafenamide versus tenofovir disoproxil fumarate in fixed-dose single-tablet regimens for initial treatment of HIV-1 infection: A meta-analysis of randomized controlled trials. Int J Infect Dis 2020; 93:108-117. [PMID: 31988012 DOI: 10.1016/j.ijid.2020.01.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) can cause renal and bone toxicity, which is associated with high plasma tenofovir concentrations in antiretroviral treatment of HIV-1 infected patients. Tenofovir alafenamide (TAF) is a novel tenofovir prodrug with a 90% reduction in plasma tenofovir concentrations. We aimed to assess the non-inferiority of a TAF-containing combination regimen versus a TDF-containing fixed-dose single-tablet regimen in the antiretroviral-treatment-naive, HIV-1-infected patients. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Trial Registry, from January 2001 to July 2019, using relevant keywords. Available data were extracted from eligible randomized trials (RCTs) and pooled as risk ratios (RRs) or standardized mean differences (SMDs) in a meta-analysis model using Stata/SE. RESULTS We included seven eligible randomized controlled trials (RCTs) with a total of 6269 participants. Patients who were antiretroviral-naive adults with HIV-1 on both the TAF-containing regimens and the TDF-containing regimens had similar virologic suppression effects (RR, 1.02; 95% CI, 1.00-1.04; p > 0.05) at week 24 (93.99% vs. 94.20%), week 48 (90.71% vs. 89.54%), and week 96 (86.16% vs. 84.80%). Both groups had no significant improvements in CD4 cell count for the naive patients during 48 weeks of therapy (SMD, 0.09; 95% CI, 0.01 to 0.16; p < 0.05). Both treatments were safe and well-tolerated, and most adverse events were similar as mild to moderate in severity. Moreover, compared with the TDF-containing regimens, the TAF-containing regimens in patients had significantly smaller reductions in both hip (RR, 0.33; 95CI, 0.29-0.39; p < 0.05) and spine (RR, 0.58; 95CI, 0.51-0.65; p < 0.05). Additionally, the TAF-containing regimens in patients had significantly fewer increases for renal events than those of the TDF-containing regimens through 48 weeks (0.31; 95% CI, 0.18-0.55; p < 0.05). CONCLUSIONS Our meta-analysis indicated that efficacy, safety, and tolerability of TAF-containing regimens were non-inferior in fixed-dose single-tablet regimens for initial treatment of HIV-1 infection. Furthermore, compared with those receiving the TDF-containing regimens, patients on the TAF-containing regimens had significant advantages in renal function, bone parameters, and lipid profile for the naive patients.
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Affiliation(s)
- Xingbao Tao
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing, 400036, China; Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yanqiu Lu
- Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yihong Zhou
- Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Lvlang Zhang
- Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yaokai Chen
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing, 400036, China; Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China.
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25
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McNeil T, Rowe E. 'Looking after the survivors': the health of a cohort of long-term human immunodeficiency virus patients 25 years on. Intern Med J 2020; 49:592-597. [PMID: 30426651 DOI: 10.1111/imj.14165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/06/2018] [Accepted: 10/31/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with human immunodeficiency virus (HIV) infection have higher rates of cardiovascular disease, metabolic disorders and malignancy than their uninfected peers. AIM To survey the health of a South Australian cohort of long-term HIV patients, who had been diagnosed with HIV prior to the availability of combination antiretroviral therapy. METHODS Data from 88 patients were collected retrospectively across four domains: demographics, HIV history, antiretroviral medication and medical comorbidity. RESULTS There were high rates of cardiovascular risk factors, in particular active smoking, dyslipidaemia and diabetes mellitus, which translated into a high rate of ischaemic heart disease and cerebrovascular accidents. A large proportion of the patients suffered depression and cognitive impairment. Approximately one-fifth of the cohort had been diagnosed with a malignancy, with anal cancer being the most prevalent. Many patients had experienced permanent toxicity from antiretroviral therapy. CONCLUSION The present study showed high rates of 'non-HIV morbidity' in a group of long-term HIV patients in South Australia. Clinicians should aggressively modify cardiovascular risk factors, ensure appropriate immunisations, monitor mental health and consider targeted malignancy screening in these patients. A robust clinical infrastructure and multidisciplinary team is required to facilitate the complex care needs of long-term HIV patients.
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Affiliation(s)
- Thomas McNeil
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Emily Rowe
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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26
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Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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27
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García-Calvo X, Bolao F, Sanvisens A, Zuluaga P, Tor J, Muga R, Fuster D. Significance of Markers of Monocyte Activation (CD163 and sCD14) and Inflammation (IL-6) in Patients Admitted for Alcohol Use Disorder Treatment. Alcohol Clin Exp Res 2019; 44:152-158. [PMID: 31797394 DOI: 10.1111/acer.14228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Monocyte activation and inflammation are prominent features of alcohol-related liver disease; however, they have not been thoroughly assessed in patients with alcohol use disorder (AUD) without overt liver disease. This study aimed to analyze associations among clinical and laboratory variables and markers of monocyte activation (CD163 and sCD14), and inflammation (interleukin [IL]-6) among AUD patients. METHODS We analyzed the aforementioned associations in the highest quartile in 289 patients (77.5% male; median age, 50 years) consecutively admitted for alcohol detoxification in 2 tertiary hospitals in the Barcelona metropolitan area, Spain. RESULTS Median alcohol intake was 142 g/d; median glucose, albumin, creatinine, and bilirubin levels (mg/dl), 92, 40, 0.78, and 0.69, respectively; median AST, 41 U/l; median hemoglobin, median corpuscular volume, and platelet count, 14.1 g/dl, 94.8 fL, and 189 × 109 /l, respectively; median cholesterol, triglyceride, fibrinogen, and ferritin levels, 187 mg/dl, 109.3 mg/dl, 341 mg/dl, and 177 ng/ml, respectively. In addition, 36.7% patients had an erythrocyte sedimentation rate >20 mm, 32.5% had a C-reactive protein (CRP) level of >5 mg/l, and 10.9% were hepatitis C virus (HCV)-positive. Median CD163, sCD14, and IL-6 levels were 759, 1.68 × 106 , and 4.37 pg/ml, respectively. On logistic regression analyses, glucose, AST, bilirubin, hemoglobin levels, and HCV infection (adjusted odds ratio [aORs]: 1.01, 1.02, 3.04, and 9.73, respectively) were associated with CD163. Glucose, AST, triglyceride, and CRP >5 mg/l (aORs: 1.02, 1.01, 1.00, and 3.49, respectively) were associated with sCD14. Alcohol consumption upon admission, MCV, total cholesterol levels, and CRP >5 mg/l (aORs: 0.99, 1.05, 0.99, and 2.56, respectively) were associated with IL-6. CONCLUSIONS Monocyte activation and systemic inflammation are associated with higher glucose, liver enzyme, and lipid levels, HCV infections, and CRP of >5 mg/l, thus potentially identifying patients with AUD at high risk of midterm poor outcomes.
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Affiliation(s)
- Xavier García-Calvo
- Department of Internal Medicine, Addiction Unit, Hospital Universitari Germans Trias i Pujol. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ferran Bolao
- Department of Internal Medicine, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantza Sanvisens
- Department of Internal Medicine, Addiction Unit, Hospital Universitari Germans Trias i Pujol. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Zuluaga
- Department of Internal Medicine, Addiction Unit, Hospital Universitari Germans Trias i Pujol. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Tor
- Department of Internal Medicine, Addiction Unit, Hospital Universitari Germans Trias i Pujol. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Robert Muga
- Department of Internal Medicine, Addiction Unit, Hospital Universitari Germans Trias i Pujol. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Fuster
- Department of Internal Medicine, Addiction Unit, Hospital Universitari Germans Trias i Pujol. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Tao X, Lu Y, Zhou Y, Huang Y, Chen Y. Virologically suppressed HIV-infected patients on TDF-containing regimens significantly benefit from switching to TAF-containing regimens: A meta-analysis of randomized controlled trials. Int J Infect Dis 2019; 87:43-53. [PMID: 31330323 DOI: 10.1016/j.ijid.2019.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate whether TDF-containing regimens significantly benefited efficacy, safety, and tolerability in TAF-containing regimens in virologically suppressed HIV-infected patients. METHODS PubMed, Embase, Web of Science, and the Cochrane Trial Registry were systematically searched for eligible studies. We extracted and evaluated the pooled data from available randomized controlled trials (RCTs). RESULTS Eight eligible RCTs were included. In the intention-to-treat (ITT) analysis, patients who switched to TAF-containing regimens had significantly better viral suppression than those continuing TDF-containing regimens at weeks 48 and 96 (RR, 1.02; 95CI, 1.00-1.03; p<0.05), but no significant difference in the per-protocol (PP) analysis (RR, 1.00; 95CI, 0.99-1.01; p>0.05). Compared with those receiving the TDF-containing regimens, virologically suppressed HIV-infected patients on the TAF-containing regimens had significant increases in CD4 cell counts (SMD, 0.12; 95CI, 0.08 to 0.17; p<0.05), renal and bone parameters at the hip (RR, 2.86; 95CI, 2.24-3.64; p<0.05) and the spine (RR, 2.43; 95 CI, 2.03-2.90; p<0.05) between weeks 48 and 96. CONCLUSIONS Virologically suppressed HIV-infected patients on TDF-containing regimens significantly benefit from switching to TAF-containing regimens, resulting in better viral suppression, better immune reconstruction, and less bone and renal problems.
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Affiliation(s)
- Xingbao Tao
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yanqiu Lu
- Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yihong Zhou
- Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yinqiu Huang
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yaokai Chen
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing 400036, China; Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China.
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Influence of Hepatitis C virus coinfection on immune reconstitution in HIV subjects. Med Microbiol Immunol 2019; 208:747-756. [PMID: 31147782 DOI: 10.1007/s00430-019-00619-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
Despite successful HIV suppression by antiretroviral treatment (ART), immune activation may persist in HIV patients, contributing to an impaired immunological reconstitution and disease progression. Information regarding Hepatitis C virus (HCV) coinfection as a factor that accounts for immune activation in HIV subjects remains unclear. Furthermore, most studies have been carried out considering HIV/HCV patients as a whole, without taking into account the presence or absence of liver damage. Therefore, it is unknown if HCV and/or its liver-related disease could act as two independent factors contributing to the immune activation. In this study, we investigated the presence of immune activation in a cohort of 50 HIV/HCV patients by measuring cytokine levels, CD4+ T-cell counts and CD4/CD8 ratios. Six patient groups were defined according to HIV viral load, HCV status, and liver disease to assess the impact of each of these factors on immune activation and reconstitution in HIV/HCV patients. Only subjects with controlled HIV infection and cleared HCV displayed immunological parameters within normal ranges. The mere presence of HCV contributes to immune activation leading to an inappropriate immunological reconstitution. This state exacerbates in the presence of HCV-associated liver disease. Our results suggest that ART is not enough to suppress immune activation in the context of HIV/HCV coinfection, since both HCV and its liver-related disease would contribute to the immune activation. Given that immune activation worsens immunological reconstitution and clinical status, these results support the priority of HCV treatment in HIV/HCV patients and suggest the monitoring of their liver status.
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Domingo P, Suarez-Lozano I, Gutierrez F, Estrada V, Knobel H, Palacios R, Antela A, Blanco JR, Fulladosa X. Predictive factors of renal impairment in HIV-infected patients on antiretroviral therapy: Results from the VACH longitudinal cohort study. Nefrologia 2019; 39:497-505. [PMID: 31027896 DOI: 10.1016/j.nefro.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 11/23/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of combination antiretroviral therapy has led to dramatic improvements in the life expectancy of HIV-infected persons. As result, the HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as chronic kidney disease (CKD). METHODS A retrospective longitudinal study was conducted using data from years 2010 and 2014 in all HIV-infected persons enrolled at the Spanish VACH cohort. We analyzed the prevalence and the predictive factors for developing CKD (estimated glomerular filtration rate, eGFR<60mL/min/1.73m2). RESULTS The CKD prevalence at baseline was 456/8968, 5.1% [4.6-5.6%]. Of 8512 HIV-positive individuals examined without CKD at baseline (73.7% male, median age 44 years-old), 2.15% developed CKD (eGFR<60mL/min/1.73m2). The odds ratios [95%CI] for the independent predictive factors identified were gender (male) 0.54 [0.39-0.75], age (per year) 1.08 [1.07-1.10], AIDS diagnosis 1.40 [1.03-1.91], protease inhibitor-based regimens 1.49 [1.10-2.02], hypertension 1.37 [0.94-1.99], diabetes 1.84 [1.33-2.55] and history of cardiovascular events 1.66 [0.96-2.86]. CONCLUSION The prevalence and risk factors for CKD and its progression are high in the VACH cohort. Thus, preventive measures such as control of hypertension, diabetes and obesity, as well as efforts for avoiding exposure to nephrotoxic drugs, including some antiretrovirals, are warranted in this aging HIV population.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Félix Gutierrez
- Infectious Diseases Unit, Hospital Universitario de Elche, Alicante, Spain
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Hernando Knobel
- Infectious Diseases Unit, Hospital del Mar, Barcelona, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Xavier Fulladosa
- Nephrology Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
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Moayedi Y, Walmsley SL. Heart Failure With Preserved Ejection Fraction in Women Living With HIV: Another Inflammatory Comorbidity? J Infect Dis 2019; 221:1219-1222. [DOI: 10.1093/infdis/jiz185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 01/14/2023] Open
Affiliation(s)
- Yasbanoo Moayedi
- Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, University of Toronto
- Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support Group, Division of Cardiovascular Medicine, Department of Medicine, Stanford University, California
| | - Sharon L Walmsley
- Division of Infectious Diseases, Department of Medicine, Toronto, Canada, University Health Network, University of Toronto, Canada
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Belkina AC, Starchenko A, Drake KA, Proctor EA, Pihl RMF, Olson A, Lauffenburger DA, Lin N, Snyder-Cappione JE. Multivariate Computational Analysis of Gamma Delta T Cell Inhibitory Receptor Signatures Reveals the Divergence of Healthy and ART-Suppressed HIV+ Aging. Front Immunol 2018; 9:2783. [PMID: 30568654 PMCID: PMC6290897 DOI: 10.3389/fimmu.2018.02783] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022] Open
Abstract
Even with effective viral control, HIV-infected individuals are at a higher risk for morbidities associated with older age than the general population, and these serious non-AIDS events (SNAEs) track with plasma inflammatory and coagulation markers. The cell subsets driving inflammation in aviremic HIV infection are not yet elucidated. Also, whether ART-suppressed HIV infection causes premature induction of the inflammatory events found in uninfected elderly or if a novel inflammatory network ensues when HIV and older age co-exist is unclear. In this study we measured combinational expression of five inhibitory receptors (IRs) on seven immune cell subsets and 16 plasma markers from peripheral blood mononuclear cells (PBMC) and plasma samples, respectively, from a HIV and Aging cohort comprised of ART-suppressed HIV-infected and uninfected controls stratified by age (≤35 or ≥50 years old). For data analysis, multiple multivariate computational algorithms [cluster identification, characterization, and regression (CITRUS), partial least squares regression (PLSR), and partial least squares-discriminant analysis (PLS-DA)] were used to determine if immune parameter disparities can distinguish the subject groups and to investigate if there is a cross-impact of aviremic HIV and age on immune signatures. IR expression on gamma delta (γδ) T cells exclusively separated HIV+ subjects from controls in CITRUS analyses and secretion of inflammatory cytokines and cytotoxic mediators from γδ T cells tracked with TIGIT expression among HIV+ subjects. Also, plasma markers predicted the percentages of TIGIT+ γδ T cells in subjects with and without HIV in PSLR models, and a PLS-DA model of γδ T cell IR signatures and plasma markers significantly stratified all four of the subject groups (uninfected younger, uninfected older, HIV+ younger, and HIV+ older). These data implicate γδ T cells as an inflammatory driver in ART-suppressed HIV infection and provide evidence of distinct “inflamm-aging” processes with and without ART-suppressed HIV infection.
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Affiliation(s)
- Anna C Belkina
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, MA, United States.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Alina Starchenko
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | - Elizabeth A Proctor
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Riley M F Pihl
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, MA, United States
| | - Alex Olson
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Nina Lin
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Jennifer E Snyder-Cappione
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, MA, United States.,Department of Microbiology, Boston University School of Medicine, Boston, MA, United States
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Rate of cardiovascular, renal and bone disease and their major risks factors in HIV-infected individuals on antiretroviral therapy in Spain. Enferm Infecc Microbiol Clin 2018; 37:373-379. [PMID: 30389268 DOI: 10.1016/j.eimc.2018.09.015] [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: 07/28/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The life expectancy of HIV-infected individuals has dramatically improved with potent antiretroviral therapies. However, organ-specific toxicities of some antiretrovirals and persistent inflammation and immune activation due to residual virus replication account for a high burden of age-associated comorbidities in the HIV population. METHODS The prevalence of overt cardiovascular, renal and bone diseases as well as their major risk factors were cross-sectionally examined during the year 2014 in the VACH cohort, a large nationwide population of HIV-infected individuals in Spain. RESULTS A total of 10,897 HIV-infected patients were examined. Seventy-one point four percent were male and the mean age was 48 years. Mean time since HIV diagnosis was 15.8 years and mean time on antiretroviral therapy was 13.1 years. The proportion of patients with undetectable viral load was 87.1%, whereas 65.7% had CD4 counts>500 cells/mm3. Overall, cardiovascular, renal and bone disease were recorded in 4.7%, 5.9% and 2.8%, respectively. The prevalence of major risk factors was as follows: smoking 51.3%, alcohol abuse 7.8%, overweight/obesity 42.2%, diabetes 19.9%, dyslipidaemia 72.6%, hypertension 25.6%, and osteoporosis 11.1%. In the subset of patients older than 55 years-old (18%), all figures for overt disease and their major risk factors were significantly greater. CONCLUSION Major age-related medical conditions and most of their risk factors are highly prevalent in HIV-infected individuals on long-term antiretroviral therapy in Spain. Preventive actions, including careful selection of antiretroviral agents, should be prioritized in the ageing HIV population.
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Yamada H, Yonemura T, Nemoto T, Ninomiya N, Irie S. Pharmacokinetics of Tenofovir Alafenamide, Tenofovir, and Emtricitabine Following Administration of Coformulated Emtricitabine/Tenofovir Alafenamide in Healthy Japanese Subjects. Clin Pharmacol Drug Dev 2018; 8:511-520. [PMID: 30325567 DOI: 10.1002/cpdd.623] [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: 04/18/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
A fixed-dose combination of tenofovir alafenamide (TAF) and emtricitabine (FTC) is available in 2 tablet strengths in Japan (FTC/TAF 200/10 mg and FTC/TAF 200/25 mg). These are used once daily in combination with other antiretroviral agents for the treatment of human immunodeficiency virus type 1 infection. The primary objective of this study was to investigate if there is any clinically relevant pharmacokinetic difference for TAF, tenofovir (TFV), and FTC between Japanese and non-Japanese with historical data. Three treatment groups were set in the study; FTC/TAF 200/10 mg in combination with darunavir (DRV) 800 mg + ritonavir (RTV) 100 mg (treatment A) or DRV/cobicistat (COBI) 800/150 mg (treatment B) and FTC/TAF 200/25 mg alone (treatment C). Especially for treatment C, it was designated for another purpose to evaluate the pharmacokinetic boosting effects of RTV and COBI on TAF bioavailability. As a result, the mean exposure of TAF among treatment groups was 125 to 154 ng/mL for Cmax and 119 to 179 ng·h/mL for AUCinf , which were comparable with the historical data in non-Japanese. The exposures of TFV and FTC were also consistent with the historical data. Therefore, no clinically relevant pharmacokinetic differences for TAF, TFV, and FTC were observed between Japanese and non-Japanese. Boosting effects of RTV and COBI on TAF bioavailability were slightly lower than we expected, less than a 2.5-fold increase, but it was within the range of exposures associated with efficacy and safety in phase 3 studies. Therefore, it was not considered clinically relevant.
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Affiliation(s)
- Hiroyuki Yamada
- Clinical Development Department, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | | | - Takanori Nemoto
- Clinical Development Department, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | - Noriko Ninomiya
- Clinical Development Department, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | - Shin Irie
- SOUSEIKAI Sumida Hospital, Tokyo, Japan
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Cohen J, D'Agostino L, Tuzer F, Torres C. HIV antiretroviral therapy drugs induce premature senescence and altered physiology in HUVECs. Mech Ageing Dev 2018; 175:74-82. [PMID: 30055190 PMCID: PMC6133242 DOI: 10.1016/j.mad.2018.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/10/2018] [Accepted: 07/25/2018] [Indexed: 12/20/2022]
Abstract
Developments in medicine have led to a significant increase in the average human lifespan. This increase in aging is most readily apparent in the case of HIV where antiretroviral therapy has shifted infection from a terminal to a chronic but manageable disease. Despite this advance, patients suffer from co-morbidities best described as an accelerated aging phenotype. A potential contributor is cellular senescence, an aging-associated growth arrest, which has already been linked to other HIV co-morbidities such as lipodystrophies and osteoporosis in response to antiretroviral drugs. We have previously demonstrated that astrocytes senescence in response to antiretroviral drugs. As endothelial cells play a critical role regulating the blood brain barrier (BBB) and senescence could severely impact barrier permeability, we investigate the role of a commonly used combination of HIV reverse transcriptase inhibitors on the senescence program of human umbilical vein endothelial cells (HUVECs). Our studies indicate that HUVECs underwent premature senescence associated with inflammation, oxidative stress and altered eNOS activation. Treated cells had detrimental paracrine effects on astrocytes including paracrine senescence, suggesting that senescent HUVECs could influence astrocytes, which line the other side of the BBB. These results may have implications for HIV-associated neurocognitive disorders (HAND), a set of neurological deficits.
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Affiliation(s)
- Justin Cohen
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Luca D'Agostino
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ferit Tuzer
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Claudio Torres
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
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The HIV patient profile in 2013 and 2003: Results from the Greek AMACS cohort. PLoS One 2018; 13:e0203601. [PMID: 30208097 PMCID: PMC6135491 DOI: 10.1371/journal.pone.0203601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023] Open
Abstract
Combined Antiretroviral therapy (cART) has improved life-expectancy of people living with HIV (PLHIV) but as they age, prevalence of chronic non-AIDS related comorbidities may increase. We study the evolution of HIV-disease markers and comorbidities’ prevalence in PLHIV in Greece. Two cross-sectional analyses (2003 and 2013) on data from the AMACS cohort were performed. Comparisons were based on population average models and were repeated for subjects under follow-up at both 2003 and 2013. 2,403 PLHIV were identified in 2003 and 4,910 in 2013 (1,730 contributing for both cross-sections). Individuals in 2013 were on average older, diagnosed/treated for HIV for longer, more likely to be on cART, virologically suppressed, and with higher CD4 counts. Chronic kidney disease, dyslipidemia and hypertension prevalence increased over time. There was an increase in prescription of lipid-lowering treatment (3.5% in 2003 vs. 7.7% 2013, p<0.001). Among 220 and 879 individuals eligible for Framingham 10-year Event Risk calculation, the proportion of patients in the high-risk group (>20%) increased from 18.2% to 22.2% (p = 0.002). Increase in the prevalence of comorbidities was more pronounced in the subset of patients who were followed in both 2003 and 2013. The increased availability and uptake of cART led to significant improvements in the immuno-virological status of PLHIV in Greece, but they aged alongside an increase in prevalence of non-AIDS related comorbidities. These results highlight the need for appropriate monitoring, optimal cART selection and long-term management and prevention strategies for such comorbidities.
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Abstract
OBJECTIVE To review the pharmacokinetics, safety, common drug-drug interactions (DDIs), and advantages and disadvantages of new single-tablet regimens (STRs) approved since September 2016 for HIV-1 infection. DATA SOURCES A search using PubMed was conducted (2004 through May 2018) using the following keywords: single tablet regimen AND HIV. Additionally, a PubMed search was conducted for each individual STR using the generic names of the agents. For specific STRs, additional search terms were added to narrow results. Articles were evaluated for content, and additional references were identified from a review of literature citations. Conference abstracts from national and international HIV conferences were also searched. STUDY SELECTION AND DATA EXTRACTION Studies included were published randomized controlled trials and observational studies that evaluated STR approved since September 2016. Relevant conference abstracts were included if the study design was a randomized controlled trial or observational study pertaining to the STRs included. DATA SYNTHESIS Four new STRs are available, including the first dual antiretroviral therapy (ART) regimen for virologically suppressed patients. Of the STRs, only 1 is a new molecular entity, and others include new combinations of existing agents that result in distinct advantages and disadvantages. Relevance to Patient Care and Clinical Practice: The treatment of HIV-1 continues to improve with new agents developed rapidly. These agents should be analyzed in regard to efficacy, safety, DDIs, and appropriateness for specific patients on an individual basis. CONCLUSIONS STRs and agents in the pipeline continue to simplify ART regimens, increase medication adherence, and minimize toxicities.
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Affiliation(s)
| | - Denise Kelley
- 2 University of Florida, Health Jacksonville, Jacksonville, FL, USA
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Abstract
OBJECTIVE The extent to which controlled and uncontrolled HIV interact with ageing, European region of care and calendar year of follow-up is largely unknown. METHOD EuroSIDA participants were followed after 1 January 2001 and grouped according to current HIV progression risk; high risk (CD4 cell count ≤350/μl, viral load ≥10 000 copies/ml), low risk (CD4 cell count ≥500 cells/μl, viral load <50 copies/ml) and intermediate (other combinations). Poisson regression investigated interactions between HIV progression risk, age, European region of care and year of follow-up and incidence of AIDS or non-AIDS events. RESULTS A total of 16 839 persons were included with 136 688 person-years of follow-up. In persons aged 30 years or less, those at high risk had a six-fold increased incidence of non-AIDS compared with those at low risk, compared with a two-to-three-fold increase in older persons (P = 0.0004, interaction). In Eastern Europe, those at highest risk of non-AIDS had a 12-fold increased incidence compared with a two-to-four-fold difference in all other regions (P = 0.0029, interaction). Those at high risk of non-AIDS during 2001-2004 had a two-fold increased incidence compared with those at low risk, increasing to a five-fold increase between 2013 and 2016 (P < 0.0001, interaction). Differences among high, intermediate and low risk of AIDS were similar across age groups, year of follow-up and Europe (P = 0.57, 0.060 and 0.090, respectively, interaction). CONCLUSION Factors other than optimal control of HIV become increasingly important with ageing for predicting non-AIDS, whereas differences across Europe reflect differences in patient management as well as underlying socioeconomic circumstances. The differences between those at high, intermediate and low risk of non-AIDS between 2013 and 2016 likely reflects better quality of care.
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Emlet CA, Shiu C, Kim HJ, Fredriksen-Goldsen K. Bouncing Back: Resilience and Mastery Among HIV-Positive Older Gay and Bisexual Men. THE GERONTOLOGIST 2017; 57:S40-S49. [PMID: 28087794 DOI: 10.1093/geront/gnw171] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/22/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE OF THE STUDY Adults with HIV infection are living into old age. It is critical we investigate positive constructs such as resilience and mastery to determine factors associated with psychological well-being. We examine HIV-related factors, adverse conditions, and psychosocial characteristics that are associated with resilience (the ability to bounce back) and mastery (sense of self-efficacy). DESIGN AND METHODS We analyzed 2014 data from the longitudinal study Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), focusing on a subsample of 335 gay and bisexual older men. Multivariate linear regression was used to identify factors that contributed or detracted from resilience and mastery in the sample recruited from 17 sites from across the United States. RESULTS Resilience and mastery were independently associated with psychological health-related quality of life. In multivariate analysis, adjusting for demographic characteristics, previous diagnosis of depression was negatively associated with resilience. Time since HIV diagnosis was positively associated with mastery whereas victimization was negatively associated with mastery. Social support and community engagement were positively associated with both resilience and mastery. IMPLICATIONS Individual and structural-environmental characteristics contributed to resilience and mastery. These findings can be used to develop interventions incorporating an increased understanding of factors that are associated with both resilience and mastery.
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Affiliation(s)
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Cohen J, D'Agostino L, Wilson J, Tuzer F, Torres C. Astrocyte Senescence and Metabolic Changes in Response to HIV Antiretroviral Therapy Drugs. Front Aging Neurosci 2017; 9:281. [PMID: 28900395 PMCID: PMC5581874 DOI: 10.3389/fnagi.2017.00281] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/11/2017] [Indexed: 12/03/2022] Open
Abstract
With the advent of highly active antiretroviral therapy (HAART) survival rates among patients infected by HIV have increased. However, even though survival has increased HIV-associated neurocognitive disorders (HAND) still persist, suggesting that HAART-drugs may play a role in the neurocognitive impairment observed in HIV-infected patients. Given previous data demonstrating that astrocyte senescence plays a role in neurocognitive disorders such as Alzheimer’s disease (AD), we examined the role of HAART on markers of senescence in primary cultures of human astrocytes (HAs). Our results indicate HAART treatment induces cell cycle arrest, senescence-associated beta-galactosidase, and the cell cycle inhibitor p21. Highly active antiretroviral therapy treatment is also associated with the induction of reactive oxygen species and upregulation of mitochondrial oxygen consumption. These changes in mitochondria correlate with increased glycolysis in HAART drug treated astrocytes. Taken together these results indicate that HAART drugs induce the senescence program in HAs, which is associated with oxidative and metabolic changes that could play a role in the development of HAND.
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Affiliation(s)
- Justin Cohen
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, PhiladelphiaPA, United States
| | - Luca D'Agostino
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, PhiladelphiaPA, United States
| | - Joel Wilson
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, PhiladelphiaPA, United States
| | - Ferit Tuzer
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, PhiladelphiaPA, United States
| | - Claudio Torres
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, PhiladelphiaPA, United States
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Oliveira VHF, Wiechmann SL, Narciso AMS, Deminice R. Knee extension and flexion strength asymmetry in Human Immunodeficiency Virus positive subjects: a cross-sectional study. Braz J Phys Ther 2017; 21:434-439. [PMID: 28720481 PMCID: PMC5693428 DOI: 10.1016/j.bjpt.2017.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 11/26/2022] Open
Abstract
HIV-positive subjects present higher strength indices for the dominant versus the non-dominant leg. Strength asymmetry between limbs was observed in up to 58% of subjects. Lower-limb strength asymmetry is associated with impaired balance and gait.
Background Human Immunodeficiency Virus positive subjects present impairment in muscle function, neural activation, balance, and gait. In other populations, all of these factors have been associated with muscle strength asymmetry. Objective To investigate the existence of muscle strength asymmetry between dominant and non-dominant lower limbs and to determine the hamstrings-to-quadriceps strength ratio in Human Immunodeficiency Virus positive subjects. Methods In this cross-sectional study, 48 subjects were included (22 men and 26 women; mean age 44.6 years), all of them under highly active antiretroviral therapy. They performed isokinetic strength efforts at speeds of 60°/s and 180°/s for knee extension and flexion in concentric-concentric mode. Results Peak torque was higher (p < 0.01) at 60°/s for quadriceps (193, SD = 57 vs. 173, SD = 55% body mass) and hamstrings (97, SD = 36 vs. 90, SD = 37% body mass) in dominant compared to non-dominant. Similarly, peak torque was higher at 180°/s (quadriceps 128, SD = 44 vs. 112, SD = 42; hamstrings 64, SD = 24 vs. 57, SD = 26% body mass) in dominant. Average power was also higher for all muscle groups and speeds, comparing dominant with non-dominant. The hamstrings-to-quadriceps ratio at 60°/s was 0.50 for dominant and 0.52 for non-dominant, and at 180°/s, it was 0.51 for both limbs, with no significant difference between them. The percentage of subjects with strength asymmetry ranged from 46 to 58%, depending upon muscle group and speed analyzed. Conclusion Human Immunodeficiency Virus positive subjects present muscle strength asymmetry between lower limbs, assessed through isokinetic dynamometry.
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Affiliation(s)
- Vitor H F Oliveira
- Universidade Estadual de Londrina (UEL), Departamento de Educação Física, Londrina, PR, Brazil
| | - Susana L Wiechmann
- Universidade Estadual de Londrina (UEL), Centro de Ciências da Saúde, Hospital das Clínicas, Londrina, PR, Brazil
| | - Argéria M S Narciso
- Universidade Estadual de Londrina (UEL), Centro de Ciências da Saúde, Hospital das Clínicas, Londrina, PR, Brazil
| | - Rafael Deminice
- Universidade Estadual de Londrina (UEL), Departamento de Educação Física, Londrina, PR, Brazil.
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Khoury AL, Morey MC, Wong TC, McNeil DL, Humphries B, Frankey K, Pieper CF, Hicks CB, Huffman K, McKellar MS. Diminished physical function in older HIV-infected adults in the Southeastern U.S. despite successful antiretroviral therapy. PLoS One 2017; 12:e0179874. [PMID: 28662079 PMCID: PMC5491055 DOI: 10.1371/journal.pone.0179874] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As antiretroviral therapy efficacy improves, HIV is gradually being recognized more as a chronic disease within the aging HIV-infected population. While these individuals are surviving into old age, they may, however, be experiencing "accelerated aging" with greater declines in physical function than that observed among comparably matched individuals free of HIV. This decline is not well understood and it remains unclear if physical decline correlates with the degree of immunosuppression based on CD4 lymphocyte nadir. METHODS In a cross-sectional study of accelerated aging in the older HIV-infected population on antiretroviral therapy (ART), physical performance evaluations were completed on a cohort of 107 HIV-infected subjects, age 50 years or older (with no HIV-1 RNA >200 copies/mL in the prior 12 months), and compared to reference ranges for age- and gender-matched HIV-uninfected persons. Physical performance testing consisted of four validated assessments: the 2.4-meter walk, 30-second chair stand, grip strength and 6-minute walk test. RESULTS When compared to age- and gender-matched HIV-uninfected reference controls, older HIV-infected persons had diminished physical function. No correlation was found between physical function and degree of immunosuppression as determined by pre-ART CD4 nadir. CONCLUSIONS Despite improved survival, HIV-infected adults on suppressive ART have diminished physical function compared to HIV-uninfected persons. The degree of HIV-associated immunosuppression does not correlate with the observed degree of physical function decline in older HIV-infected persons, suggesting the decline is mediated by other mechanisms.
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Affiliation(s)
- Audrey L. Khoury
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Miriam C. Morey
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, United States of America
| | - Tammy C. Wong
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Donna Lynn McNeil
- Office of Research Support, Duke Cancer Institute, Durham, North Carolina, United States of America
| | - Barlett Humphries
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Katherine Frankey
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carl F. Pieper
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States of America
| | - Charles B. Hicks
- Division of Infectious Diseases, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Kim Huffman
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mehri S. McKellar
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina, United States of America
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Wang Y, Santerre M, Tempera I, Martin K, Mukerjee R, Sawaya BE. HIV-1 Vpr disrupts mitochondria axonal transport and accelerates neuronal aging. Neuropharmacology 2017; 117:364-375. [PMID: 28212984 PMCID: PMC5397298 DOI: 10.1016/j.neuropharm.2017.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 12/24/2022]
Abstract
Disruption of mitochondria axonal transport, essential for the maintenance of synaptic and neuronal integrity and function, has been identified in neurodegenerative diseases. Whether HIV-1 viral proteins affect mitochondria axonal transport is unknown, albeit HIV-associated neurocognitive disorders occur in around half of the patients living with HIV. Therefore, we sought to examine the effect of HIV-1 viral protein R (Vpr) on mitochondria axonal transport. Using mice primary neuronal cultures, we demonstrated that 4-day Vpr treatment reduced the ratio of moving mitochondria associated with (i) less energy (ATP) supply, (ii) reduction in Miro-1 and (iii) increase of α-synuclein which led to loss of microtubule stability as demonstrated by inconsecutive distribution of acetylated α-tubulin along the axons. Interestingly, the effect of Vpr on mitochondria axonal transport was partially restored in the presence of bongkrekic acid, a compound that negatively affected the Vpr-adenine nucleotide translocator (ANT) interaction and totally restored the ATP level in neurons. This indicated Vpr impaired mitochondria axonal transport partially related to its interaction with ANT. The above effect of Vpr was similar to the data obtained from hippocampal tissues isolated from 18-month-old aging mice compared to 5-month-old mice. In accord with previous clinical findings that HIV infection prematurely ages the brain and increases the susceptibility to HAND, we found that Vpr induced aging markers in neurons. Thus, we concluded that instead of causing cell death, low concentration of HIV-1 Vpr altered neuronal function related with inhibition of mitochondria axonal transport which might contribute to the accelerated neuronal aging.
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Affiliation(s)
- Ying Wang
- Molecular Studies of Neurodegenerative Diseases Lab, United States; Department of Neurology, The Fels Institute for Cancer Research & Molecular Biology, United States.
| | - Maryline Santerre
- Molecular Studies of Neurodegenerative Diseases Lab, United States; Department of Neurology, The Fels Institute for Cancer Research & Molecular Biology, United States
| | - Italo Tempera
- Department of Neurology, The Fels Institute for Cancer Research & Molecular Biology, United States
| | - Kayla Martin
- Department of Neurology, The Fels Institute for Cancer Research & Molecular Biology, United States
| | - Ruma Mukerjee
- Molecular Studies of Neurodegenerative Diseases Lab, United States; Department of Neurology, The Fels Institute for Cancer Research & Molecular Biology, United States
| | - Bassel E Sawaya
- Molecular Studies of Neurodegenerative Diseases Lab, United States; Department of Neurology, The Fels Institute for Cancer Research & Molecular Biology, United States; Temple University School of Medicine, Philadelphia, PA 19140, United States.
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Nlooto M. Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study. PLoS One 2017; 12:e0170983. [PMID: 28151951 PMCID: PMC5289501 DOI: 10.1371/journal.pone.0170983] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/13/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects. METHODS A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis. RESULTS Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained of ARVs related side-effects. Forty-five percent of those with side-effects (141/311, 45.34%) reported taking various types of medicines for treating side-effects, with 90.07% of them (127/141) using medicines prescribed by biomedically trained doctors or by pharmacy personnel as over-the -counter medicines, p <0. 001. Very few participants (14/141, 9.93%) resorted to the use of traditional medicine for treating side effects associated with antiretroviral therapy with no significant difference (p=0.293). In a multiple logistic regression, after adjusting for age, gender, race and side-effects due to antiretroviral therapy, odds for using traditional medicine were almost two times higher [odds ratio = 1.884, 95% Confidence Interval 1.317-2.695] with those participants having comorbidities and co-infections, with a significant difference p-value< 0.001. CONCLUSIONS Comorbidities, co-infections and side effects are prevalent among HIV-infected patients attending public sector healthcare facilities. Odds of using traditional medicine were almost two times higher and significantly associated with the presence of comorbidities and co-infections than for other factors. The presence of such comorbid health problems does not explain the increased use of traditional medicine among HIV-infected patients on antiretroviral therapy. Findings from this study should be interpreted cautiously as they cannot be generalized to the entire population of HIV-infected patients in KwaZulu-Natal. Studies on safety and efficacy of herbal traditional medicines are needed for beneficiation of the minority of patients who still resort to them for co-treatment with combination antiretroviral therapy.
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Affiliation(s)
- Manimbulu Nlooto
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu- Natal, Durban, South Africa
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McGowan JA, Sherr L, Rodger AJ, Fisher M, Miners A, Anderson J, Johnson MA, Elford J, Collins S, Hart G, Phillips AN, Speakman A, Lampe FC. Age, time living with diagnosed HIV infection, and self-rated health. HIV Med 2017; 18:89-103. [PMID: 27385511 PMCID: PMC5245118 DOI: 10.1111/hiv.12398] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 12/05/2022]
Abstract
OBJECTIVES An increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV. METHODS The ASTRA study is a cross-sectional questionnaire study of 3258 HIV-diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011-2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ-9 and GAD-7, respectively), and health-related functional problems (problems on at least one of three domains of the Euroqol 5D-3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity. RESULTS The age distribution of participants was: < 30 years, 5%; 30-39 years, 23%; 40-49 years, 43%; 50-59 years, 22%; and ≥ 60 years, 7%. Overall prevalences were: physical symptom distress, 56%; depression symptoms, 27%; anxiety symptoms, 22%; functional problems, 38%. No trend was found in the prevalence of physical symptom distress with age [adjusted odds ratio (OR) for trend across age groups, 0.96; 95% confidence interval (CI) 0.89, 1.04; P = 0.36]. The prevalence of depression and anxiety symptoms decreased with age [adjusted OR 0.86 (95% CI 0.79, 0.94; P = 0.001) and adjusted OR 0.85 (95% CI 0.77, 0.94; P = 0.001), respectively], while that of functional problems increased (adjusted OR 1.28; 95% CI 1.17, 1.39; P < 0.001). In contrast, a longer time with diagnosed HIV infection was strongly and independently associated with a higher prevalence of symptom distress, depression symptoms, anxiety symptoms, and functional problems (P < 0.001 for trends, adjusted analysis). CONCLUSIONS Among people living with HIV, although health-related functional problems were more common with older age, physical symptom distress was not, and mental health was more favourable. These results suggest that a longer time with diagnosed HIV infection, rather than age, is the dominating factor contributing to psychological morbidity and lower quality of life.
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Affiliation(s)
- JA McGowan
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - L Sherr
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - AJ Rodger
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - M Fisher
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - A Miners
- London School of Hygiene and Tropical MedicineLondonUK
| | - J Anderson
- Homerton University Hospital NHS Foundation TrustLondonUK
| | - MA Johnson
- Royal Free London NHS Foundation TrustLondonUK
| | - J Elford
- School of Health SciencesCity UniversityLondonUK
| | | | - G Hart
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - AN Phillips
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - A Speakman
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - FC Lampe
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
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Lascano J, Stuckelberger A. Are we missing a target group? Expanding the role of co-trimoxazole to the ageing population. Public Health 2017; 144:120-121. [PMID: 28274372 DOI: 10.1016/j.puhe.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 10/29/2016] [Accepted: 12/01/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Josefina Lascano
- Institute of Global Health, Division on Ageing, University of Geneva, Campus Biotech Chemin des Mines 9, CH-1202, Genève, Switzerland.
| | - A Stuckelberger
- Institute of Global Health, Division on Ageing, University of Geneva, Campus Biotech Chemin des Mines 9, CH-1202, Genève, Switzerland
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Wang H, Lu X, Yang X, Xu N. The efficacy and safety of tenofovir alafenamide versus tenofovir disoproxil fumarate in antiretroviral regimens for HIV-1 therapy: Meta-analysis. Medicine (Baltimore) 2016; 95:e5146. [PMID: 27741146 PMCID: PMC5072973 DOI: 10.1097/md.0000000000005146] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To date, a definite conclusion about efficiency and safety of tenofovir alafenamide for patients with HIV-1 is not available. The aim of the study was to investigate the efficacy and safety of TAF versus TDF in antiretroviral regimens for patients with HIV-1. METHODS PUBMED, MEDLINE, and EMBASE database were searched in March 2016, with no language restriction, for randomized controlled trials (RCTs). RESULTS Six RCTs (n = 5888) met entry criteria. At week 48, viral suppression rates were similar between TAF and TDF group (90.2% vs 89.5%) for the naive patients. Interestingly, the rate was higher in patients who switched to TAF regimens compared with patients who continued previous TDF regimens (96.4% vs 93.1%). Both groups were generally well tolerated with high barrier to resistance. As compared to TDF, TAF had significantly smaller reductions in eGFR-CG, smaller changes in RBP/Cr and urineβ-2 M/Cr ratio, and less reduction in spine and hip BMD for the treatment-naive patients. Moreover, the switched group had significant efficacy advantages of improving renal function and BMD, including significant decreases in urine albumin/Cr, urine protein/Cr, urine RBP/Cr, and urine β-2 M/Cr ratios, and increases in hip and spine BMD by 1.47% and 1.56%,respectively, as compared with continued TDF regimens. CONCLUSIONS TAF has a similar tolerability, safety, and effectiveness to TDF and probably less adverse events related to renal and bone density outcomes in the treatment of naive and experienced patients with HIV-1.
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Affiliation(s)
- Huilian Wang
- Department of Genetics and Molecular Biology, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education, Xi’an, Shaanxi
- Correspondence: Huilian Wang, Department of Genetics and Molecular Biology, Xi’an Jiaotong University, School of Medicine, Xi’an, Shaanxi, P.R. China (e-mail: )
| | - Xi Lu
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Xudong Yang
- Department of Genetics and Molecular Biology, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education, Xi’an, Shaanxi
| | - Nan Xu
- Department of Clinical Laboratory, 2nd Affiliated Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, P.R. China
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‘I'm happy in my life now, I'm a positive person’: approaches to successful ageing in older adults living with HIV in Ontario, Canada. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000878] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractWorldwide approximately 3.6 million people aged 50 and older are living and ageing with the human immunodeficiency virus (HIV). Few studies have explored successful ageing from the insider perspective of those living well and ageing with HIV. This study draws upon the lived experience and wisdom of older, HIV-positive adults living in Ontario, Canada in order to understand their views and strategies for successful ageing. This qualitative study involved semi-structured interviews with 30 individuals age 50 years and older who are HIV-positive. Purposive sampling techniques were used to recruit individuals who shared their experiences of successful ageing. Constructivist grounded theory coding techniques were used for analysis. Themes related to successful ageing included resilience strategies and challenges, social support and environmental context. Stigma and struggles to maintain health were identified as impediments to successful ageing. Models of successful ageing must take into account the potential for a subjective appraisal of success in populations suffering from chronic and life-threatening illnesses including HIV. Practitioners can draw upon organically existent strengths in this population in order to provide intervention development for older adults around the world who are struggling to manage their HIV.
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Lindboe JB, Langkilde A, Eugen-Olsen J, Hansen BR, Haupt TH, Petersen J, Andersen O. Low-dose growth hormone therapy reduces inflammation in HIV-infected patients: a randomized placebo-controlled study. Infect Dis (Lond) 2016; 48:829-37. [PMID: 27417288 DOI: 10.1080/23744235.2016.1201722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has drastically increased the life expectancy of HIV-infected patients. However, HIV-infected patients exhibit increased inflammation and 33-58% exhibit a characteristic fat re-distribution termed HIV-associated lipodystrophy syndrome (HALS). Recombinant human growth hormone (rhGH) has been tested as treatment of HALS. Low-dose rhGH therapy improves thymopoiesis and fat distribution in HIV-infected patients and appears to be well tolerated. However, since high-dose rhGH is associated with adverse events related to inflammation, we wanted to investigate the impact of low-dose rhGH therapy on inflammation in HIV-infected patients. METHODS Forty-six cART-treated HIV-infected men were included in the HIV-GH low-dose (HIGH/Low) study: a randomized, placebo-controlled, double-blinded trial. Subjects were randomized 3:2 to 0.7 mg/day rhGH, or placebo for 40 weeks. rhGH was self-administered between 1 pm and 3 pm. The primary outcome of this substudy was changes in inflammation measured by plasma C-reactive protein (CRP) and soluble urokinase plasminogen activator receptor (suPAR). RESULTS Both CRP (-66%, p = 0.002) and suPAR (-9.7%, p = 0.06) decreased in the rhGH group compared to placebo; however, only CRP decreased significantly. The effect of rhGH on inflammation was not mediated through rhGH-induced changes in insulin-like growth factor 1, body composition, or immune parameters. CONCLUSION Daily 0.7 mg rhGH treatment for 40 weeks, administered at nadir endogenous GH secretion, significantly reduced CRP. The effect does not appear to be mediated by other factors. Our findings suggest that low-dose rhGH treatment may minimize long-term risks associated with high-dose rhGH therapy.
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Affiliation(s)
- Johanne Bjerre Lindboe
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Anne Langkilde
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Jesper Eugen-Olsen
- b Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Birgitte R Hansen
- b Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;,c Department of Infectious Diseases , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Thomas H Haupt
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Janne Petersen
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;,d Department of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Ove Andersen
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;,c Department of Infectious Diseases , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
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50
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Kim CJ, Walmsley SL, Raboud JM, Kovacs C, Coburn B, Rousseau R, Reinhard R, Rosenes R, Kaul R. Can Probiotics Reduce Inflammation and Enhance Gut Immune Health in People Living with HIV: Study Designs for the Probiotic Visbiome for Inflammation and Translocation (PROOV IT) Pilot Trials. HIV CLINICAL TRIALS 2016; 17:147-57. [PMID: 27267710 DOI: 10.1080/15284336.2016.1184827] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Despite substantial improvements in HIV outcomes with combination antiretroviral therapy (cART), morbidity and mortality remain above population norms. The gut mucosal immune system is not completely restored by cART, and the resultant microbial translocation may contribute to chronic inflammation, inadequate CD4 T-cell recovery, and increased rates of serious non-AIDS events. Since the microbial environment surrounding a CD4 T cell may influence its development and function, we hypothesize that probiotics provided during cART might reduce inflammation and improve gut immune health in HIV-positive treatment-naïve individuals (PROOV IT I) and individuals with suboptimal CD4 recovery on cART (PROOV IT II). METHODS These prospective, double-blinded, randomized, placebo-controlled, multicenter pilot studies will assess the impact of the probiotic Visbiome at 900 billion bacteria daily. Forty HIV positive cART-naïve men will be randomized in the PROOV IT I study, coincident with antiretroviral initiation, and be followed for 24 weeks. In PROOV IT II, 36 men on cART, but with a CD4 T-cell count below 350 cells/mm(3) will be followed for 48 weeks. The primary outcome for both studies is the comparison of blood CD8 T-cell immune activation. Secondary analyses will include comparison of blood inflammatory biomarkers, microbial translocation, blood and gut immunology and HIV levels, the bacterial community composition, diet, intestinal permeability, and the safety, adherence and tolerability of the study product. DISCUSSION These studies will evaluate the ability of probiotics as a safe and tolerable therapeutic intervention to reduce systemic immune activation and to accelerate gut immune restoration in people living with HIV.
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Affiliation(s)
- Connie J Kim
- a Toronto General Research Institute , University Health Network , Toronto , Canada
| | - Sharon L Walmsley
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | - Janet M Raboud
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | | | - Bryan Coburn
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | - Rodney Rousseau
- c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | | | - Ron Rosenes
- e Community Health Advocate and Consultant , Toronto , ON , Canada
| | - Rupert Kaul
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
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