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Grinsztejn E, Cardoso SW, Velasque L, Hoagland B, dos Santos DG, Coutinho C, Cruz Silva SDC, Nazer SC, Ferreira ACG, Castilho J, Grinsztejn B, Veloso VG. Impact of Latent M. tuberculosis Infection Treatment on Time to CD4/CD8 Recovery in Acute, Recent, and Chronic HIV Infection. J Acquir Immune Defic Syndr 2023; 94:355-363. [PMID: 37595204 PMCID: PMC10609716 DOI: 10.1097/qai.0000000000003284] [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: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION In people living with HIV, active and latent tuberculosis (TB) coinfections are associated with immune activation that correlate with HIV progression and mortality. We investigated the effect of initiating antiretroviral therapy (ART) during acute (AHI), recent (RHI), or chronic HIV infection (CHI) on CD4/CD8 ratio normalization and associated factors, the impact of latent TB infection treatment, and prior/concomitant TB diagnosis at the time of ART initiation. METHODS We included sex with men and transgender women individuals initiating ART with AHI, RHI and CHI between 2013 and 2019, from a prospective cohort in Brazil. We compared time from ART initiation to the first normal CD4/CD8 ratio (CD4/CD8 ≥1) using Kaplan-Meier curves and multivariable Cox proportional hazards models. Sociodemographic and clinical variables were explored. Variables with P -values <0.20 in univariable analyses were included in multivariable analyses. RESULTS Five hundred fifty participants were included, 11.8% classified as AHI and 6.4% as RHI, 46.7% with CHI-CD4 cell counts ≥350 cells/mm 3 and 35.1% with CHI-CD4 cell counts <350 cells/mm 3 . Time to normalization was shortest among AHI patients, followed by RHI and CHI individuals with higher baseline CD4. In the multivariable model, AHI was associated with a six-fold increased likelihood of achieving a CD4/CD8 ratio ≥1 (hazard ratio [HR]: 6.03; 95% confidence interval [CI]: 3.70 to 9.82; P < 0.001), RHI with HR: 4.47 (95% CI: 2.57 to 7.76; P < 0.001), and CHI CD4 ≥350 cells/mm 3 with HR: 1.87 (95% CI: 1.24 to 2.84; P = 0.003). Latent TB infection treatment was significantly associated with a higher likelihood of the outcome (HR: 1.79; 95% CI: 1.22 to 2.62; P = 0.003). Previous history or concomitant active TB at ART initiation was associated with a lower likelihood of the outcome (HR: 0.41; 95% CI: 0.16 to 1.02; P = 0.054). CONCLUSIONS Initiating ART early during AHI may offer an opportunity to mitigate immune damage. Efforts to implement HIV diagnosis and ART initiation during AHI are critical to amplify ART benefits.
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Affiliation(s)
- Eduarda Grinsztejn
- Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | - Luciane Velasque
- Departamento de Matemática e Estatística, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | | | - Carolina Coutinho
- Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | | | | | | | | | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Valdilea G. Veloso
- Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
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Lama JR, Ignacio RAB, Alfaro R, Rios J, Cartagena JG, Valdez R, Bain C, Barbarán KS, Villaran MV, Pilcher CD, Gonzales P, Sanchez J, Duerr A. Clinical and Immunologic Outcomes After Immediate or Deferred Antiretroviral Therapy Initiation During Primary Human Immunodeficiency Virus Infection: The Sabes Randomized Clinical Study. Clin Infect Dis 2021; 72:1042-1050. [PMID: 32107526 PMCID: PMC7958774 DOI: 10.1093/cid/ciaa167] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In addition to demonstrated public health benefits on reducing transmission, it remains unclear how early antiretroviral therapy (ART) must be started after acquisition of human immunodeficiency virus (HIV) to maximize individual benefits. METHODS We conducted an open-label randomized clinical study in Lima, Peru among adult men who have sex with men and transgender women with acute (HIV-antibody negative/HIV-1 RNA positive) or recent (confirmed negative HIV-antibody or RNA test within 3 months) HIV infection, who were randomized to start ART immediately versus defer by 24 weeks. We evaluated outcomes by treatment arm and immunologic markers by days since estimated date of detectible infection (EDDI). RESULTS Of 216 participants, 105 were assigned to immediate arm and 111 to deferred arm (median age 26.8 years, 37% with acute HIV). The incidence of non-ART-related adverse events was lower in immediate versus deferred arm (83 vs 123/100 person-years, IRR 0.67 (95% confidence interval [CI] .47, .95; P = .02), the difference dominated by fewer infections in those treated immediately. After 24 weeks of ART, between-group differences in CD4/CD8 cell ratio lessened (P = .09 overall), but differences between those initiating ART ≤ 30 days from EDDI (median 1.03, interquartile range [IQR] 0.84, 1.37), and those initiating > 90 days (0.88, IQR 0.61, 1.11) remained, P = .02. Principal components analysis of 20 immune biomarkers demonstrated distinct patterns between those starting ART > 90 days from EDDI versus those starting within 30 or 90 days (both P < .001). CONCLUSIONS To our knowledge, this is the only evaluation of randomized ART initiation during primary HIV and provides evidence to explicitly consider acute HIV in World Health Organization recommendations for universal ART. CLINICAL TRIALS REGISTRATION NCT01815580.
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Affiliation(s)
- Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Perú
| | - Rachel A Bender Ignacio
- University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ricardo Alfaro
- Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Jessica Rios
- Asociacion Civil Impacta Salud y Educacion, Lima, Perú
| | - Jorge Gallardo Cartagena
- Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Rogelio Valdez
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Carolyn Bain
- Program for the Appropriate Use of Technology in Health, Seattle, Washington, USA
| | - Karin Sosa Barbarán
- Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Manuel V Villaran
- Asociacion Civil Impacta Salud y Educacion, Lima, Perú
- Auna, Lima, Perú
| | - Christopher D Pilcher
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, California, USA
| | | | - Jorge Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Perú
- Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Ann Duerr
- University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Okhai H, Vivancos-Gallego MJ, Hill T, Sabin CA. CD4+:CD8+ T Cell Ratio Normalization and the Development of AIDS Events in People with HIV Starting Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:808-816. [PMID: 32664736 PMCID: PMC7549010 DOI: 10.1089/aid.2020.0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We identify factors associated with the normalization of the CD4+:CD8+ T cell ratio among UK Collaborative HIV Cohort study participants, and describe the association of the CD4+ and CD8+ T cell counts and the CD4+:CD8+ T cell ratio, with the risk of new AIDS events among individuals who achieve a suppressed viral load. Participants initiating combination antiretroviral therapy (cART) after 2006 with a CD4+:CD8+ T cell ratio <1, and viral suppression within 6 months were included. Cox proportional hazard models were used to examine associations with ratio normalization (ratio ≥1). Poisson regression models were used to investigate factors associated with the development of AIDS after viral load suppression. A total of 13,178 participants [median age: 37 (interquartile range: 31–44)] were followed for 75,336 person-years. Of the 4,042 (32.9%) who experienced ratio normalization, individuals with a high CD4+ T cell count [>500 vs. ≤200 cells/mm3, adjusted hazard ratio (95% confidence interval): 7.93 (6.97–9.01)], low CD8+ T cell count [>1,150 vs. ≤500 cells/mm3: 0.18 (0.16–0.21)], and low CD4+:CD8+ T cell ratio [>0.8 vs. <0.2: 12.36 (10.41–14.68)] at cART initiation were more likely to experience ratio normalization. Four hundred and nineteen people developed a new AIDS event. Most recent CD4+ T cell count [>500 vs. ≤200 cells/mm3: adjusted rate ratio 0.24 (0.16–0.34)] and CD4+:CD8+ T cell ratio [>0.8 vs. <0.2: 0.33 (0.21–0.52)] were independently associated with a new AIDS event. One third of study participants experienced ratio normalization after starting cART. CD4+ T cell count and CD4+:CD8+ T cell ratio are both individually associated with ratio normalization and the development of new AIDS events after cART.
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Affiliation(s)
- Hajra Okhai
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London United Kingdom
| | - María Jesús Vivancos-Gallego
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramon y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Teresa Hill
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London United Kingdom
| | - Caroline A. Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London United Kingdom
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Amico KR, Miller J, Schairer C, Gianella S, Little SJ, Hoenigl M. I wanted it as soon as possible: a qualitative exploration of reactions to access to same-day ART start among participants in San Diego's ART-NET project. AIDS Care 2020; 32:1191-1197. [PMID: 31713432 PMCID: PMC7214217 DOI: 10.1080/09540121.2019.1687831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022]
Abstract
Rapid start of antiretroviral therapy (ART) is quickly becoming best practice around the world. In the US, programs exist to facilitate rapid ART start, but little is known about the experiences of newly diagnosed individuals receiving these recommendations and services. Twenty participants (19 men who have sex with men and 1 transgender woman) from an early ART start program were interviewed to better understand these experiences. Interviews were analyzed for main themes in three general areas: reasons to start, reasons to delay, and factors influencing early ART adherence. Participants reported starting anywhere from right away (same visit as diagnosis) to within a few weeks (median 10.5 days). Reasons to start right away included fear of what could happen if not treated, personal health, influence of people/resources at the clinic, and study participation. Most had small delays in ART start because of structural (insurance, costs) and intentional delays (getting additional medical consultations). Adherence facilitators included desires to improve CD4/viral load and positive beliefs in benefits of suppression. Participants were largely supportive of rapid ART start and appeared to rely on CD4/viral load as "proof" of need for ART, which may be particularly helpful for asymptomatic, newly diagnosed individuals starting ART.
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Affiliation(s)
- K Rivet Amico
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Miller
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia Schairer
- Department of Psychiatry, San Diego School of Medicine, University of California, La Jolla, CA, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
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Muscatello A, Nozza S, Fabbiani M, De Benedetto I, Ripa M, Dell'acqua R, Antinori A, Pinnetti C, Calcagno A, Ferrara M, Focà E, Quiros-Roldan E, Ripamonti D, Campus M, Maurizio Celesia B, Torti C, Cosco L, Di Biagio A, Rusconi S, Marchetti G, Mussini C, Gulminetti R, Cingolani A, D'ettorre G, Madeddu G, Franco A, Orofino G, Squillace N, Gori A, Tambussi G, Bandera A. Enhanced Immunological Recovery With Early Start of Antiretroviral Therapy During Acute or Early HIV Infection-Results of Italian Network of ACuTe HIV InfectiON (INACTION) Retrospective Study. Pathog Immun 2020; 5:8-33. [PMID: 32258852 PMCID: PMC7104556 DOI: 10.20411/pai.v5i1.341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/20/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Viral load peak and immune activation occur shortly after exposure during acute or early HIV infection (AEHI). We aimed to define the benefit of early start of antiretroviral treatment (ART) during AEHI in terms of immunological recovery, virological suppression, and treatment discontinuation. SETTING Patients diagnosed with AEHI (Fiebig stages I-V) during 2008-2014 from an analysis of 20 Italian centers. METHODS This was an observational, retrospective, and multicenter study. We investigated the effect of early ART (defined as initiation within 3 months from AEHI diagnosis) on time to virological suppression, optimal immunological recovery (defined as CD4 count ≥500/µL, CD4 ≥30%, and CD4/CD8 ≥1), and first-line ART regimen discontinuation by Cox regression analysis. RESULTS There were 321 patients with AEHI included in the study (82.9% in Fiebig stage III-V). At diagnosis, the median viral load was 5.67 log10 copies/mL and the median CD4 count was 456 cells/µL. Overall, 70.6% of patients started early ART (median time from HIV diagnosis to ART initiation 12 days, IQR 6-27). Higher baseline viral load and AEHI diagnosis during 2012-2014 were independently associated with early ART. HBV co-infection, baseline CD4/CD8 ≥1, lower baseline HIV-RNA, and AEHI diagnosis in recent years (2012-2014) were independently associated with a shorter time to virological suppression. Early ART emerged as an independent predictor of optimal immunological recovery after adjustment for baseline CD4 (absolute and percentage count) and CD4/CD8 ratio. The only independent predictor of first-line ART discontinuation was an initial ART regimen including > 3 drugs. CONCLUSIONS In a large cohort of well-characterized patients with AEHI, we confirmed the beneficial role of early ART on CD4+ T-cell recovery and on rates of CD4/CD8 ratio normalization. Moreover, we recognized baseline CD4/CD8 ratio as an independent factor influencing time to virological response in the setting of AEHI, thus giving new insights into research of immunological markers associated with virological control.
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Affiliation(s)
- Antonio Muscatello
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit; Azienda Ospedaliero-Universitaria Senese; Siena, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Marco Ripa
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Raffaele Dell'acqua
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS; Rome, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS; Rome, Italy
| | - Andrea Calcagno
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Micol Ferrara
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases; University of Brescia; ASST Spedali Civili Hospital; Brescia, Italy
| | - Eugenia Quiros-Roldan
- Division of Infectious and Tropical Diseases; University of Brescia; ASST Spedali Civili Hospital; Brescia, Italy
| | - Diego Ripamonti
- Infectious Disease Unit; ASST Papa Giovanni XXIII; Bergamo, Italy
| | - Marco Campus
- Infectious Diseases Unit; SS Trinità Hospital; ASSL Cagliari, Italy
| | | | - Carlo Torti
- Unit of Infectious Diseases; Department of Medical and Surgical Sciences; University “Magna Graecia;” Catanzaro, Italy
| | - Lucio Cosco
- Infectious Diseases Unit; “Pugliese-Ciaccio” Hospital; Catanzaro, Italy
| | - Antonio Di Biagio
- Department of Infectious Diseases; IRCCS AOU San Martino IST; (DISSAL); University of Genoa; Genoa, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit; Department of Biomedical and Clinical Sciences “Luigi Sacco” Hospital; University of Milan, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases; Department of Health Sciences; University of Milan; ASST Santi Paolo e Carlo; Milan, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases; University of Modena and Reggio Emilia; Modena Hospital; Italy
| | - Roberto Gulminetti
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
| | - Antonella Cingolani
- Institute of Clinical Infectious Diseases; Agostino Gemelli Hospital; Catholic University of Sacred Heart; Rome, Italy
| | - Gabriella D'ettorre
- Infectious Diseases Unit; Umberto I Hospital; La Sapienza University; Rome, Italy
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine; Unit of Infectious Diseases; University of Sassari, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases; Divisione A; Amedeo di Savoia Hospital; Turin, Italy
| | - Nicola Squillace
- Infectious Diseases Unit; Department of Internal Medicine; ASST San Gerardo; Monza, Italy, University of Milano-Bicocca; Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy
- School of Medicine and Surger; University of Milan, Italy
| | - Giuseppe Tambussi
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy
- School of Medicine and Surger; University of Milan, Italy
| | - On Behalf Of Inaction Study Group.
- Infectious Diseases Unit; Department of Internal Medicine; IRCCS Ca' Granda Foundation Maggiore Hospital; Milan, Italy
- Clinic of Infectious Diseases; San Raffaele Hospital; University Vita Salute; Milan, Italy
- Infectious and Tropical Diseases Unit; Azienda Ospedaliero-Universitaria Senese; Siena, Italy
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin, Italy
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS; Rome, Italy
- Division of Infectious and Tropical Diseases; University of Brescia; ASST Spedali Civili Hospital; Brescia, Italy
- Infectious Disease Unit; ASST Papa Giovanni XXIII; Bergamo, Italy
- Infectious Diseases Unit; SS Trinità Hospital; ASSL Cagliari, Italy
- Unit of Infectious Diseases; Garibaldi Hospital; Catania, Italy
- Unit of Infectious Diseases; Department of Medical and Surgical Sciences; University “Magna Graecia;” Catanzaro, Italy
- Infectious Diseases Unit; “Pugliese-Ciaccio” Hospital; Catanzaro, Italy
- Department of Infectious Diseases; IRCCS AOU San Martino IST; (DISSAL); University of Genoa; Genoa, Italy
- Infectious Diseases Unit; Department of Biomedical and Clinical Sciences “Luigi Sacco” Hospital; University of Milan, Italy
- Clinic of Infectious Diseases; Department of Health Sciences; University of Milan; ASST Santi Paolo e Carlo; Milan, Italy
- Clinic of Infectious Diseases; University of Modena and Reggio Emilia; Modena Hospital; Italy
- Institute of Clinical Infectious Diseases; Agostino Gemelli Hospital; Catholic University of Sacred Heart; Rome, Italy
- Infectious Diseases Unit; Umberto I Hospital; La Sapienza University; Rome, Italy
- Department of Clinical and Experimental Medicine; Unit of Infectious Diseases; University of Sassari, Italy
- Infectious Diseases Unit; ASP Siracusa, Italy
- Unit of Infectious Diseases; Divisione A; Amedeo di Savoia Hospital; Turin, Italy
- Infectious Diseases Unit; Department of Internal Medicine; ASST San Gerardo; Monza, Italy, University of Milano-Bicocca; Milan, Italy
- School of Medicine and Surger; University of Milan, Italy
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Ssekalembe G, Isfandiari MA, Suprianto H. Current Status Towards 90-90-90 UNAIDS Target and Factors Associated with HIV Viral Load Suppression in Kediri City, Indonesia. HIV AIDS (Auckl) 2020; 12:47-57. [PMID: 32021486 PMCID: PMC6970622 DOI: 10.2147/hiv.s231173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/02/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In 2016, UN Member States committed to reduce new HIV infections to fewer than 500,000 annually by 2020, a 75% reduction compared with 2010, reduce AIDS-related deaths to fewer than 500,000 globally as a means of ending AIDS by 2030. The UNAIDS 2020 target is to have 90% of the people living with HIV know their status, 90% of the people living with HIV (who know their HIV status as positive) are already on ART treatment, 90% of people on treatment are virally suppressed. The objective of this study is to determine the current status towards the 2020 90-9-90 UNAIDS target and the factors associated with HIV viral load suppression in Kediri city. METHODS The study was a cross-sectional study in Kediri city. The researcher collected secondary data, carried in-depth interviews, then determined the percentage of HIV-positive patients that did a HIV test and received their results as Positive, the percentage of HIV-positive patients that started ART treatment, the percentage of HIV-positive patients that have viral load suppression from the viral load tests done. A simple bivariate logistic and multivariate logistic regression was used to determine the significant factors that determine viral suppression. RESULTS The progress towards the 90-90-90 UNAIDS target was at 6.4%, 74.9%, 9.9%. The time taken by the HIV-positive patient to start ART treatment from the time of confirmation of HIV positive (AOR= 83.191, CI: 1.617-4280.115) and decrease in body weight of the patient (AOR=29.636, CI: 1.193-736.167) were found to significantly influence viral load suppression. CONCLUSION There is a need to scale up HIV case-detection capacity through creating awareness about HIV, HIV testing and counselling and expand the ART services so as to achieve the 90-0-90 UNAIDS target. Early initiation to ART treatment (Test and Treat) and encouraging body gaining behaviors are needed to achieve viral load suppression.
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Hoenigl M, Kessler HH, Gianella S. Editorial: HIV-Associated Immune Activation and Persistent Inflammation. Front Immunol 2019; 10:2858. [PMID: 31921128 PMCID: PMC6930801 DOI: 10.3389/fimmu.2019.02858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/21/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, United States.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Harald H Kessler
- Research Unit Molecular Diagnostics, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz, Austria
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, United States
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Acute HIV Infection and CD4/CD8 Ratio Normalization After Antiretroviral Therapy Initiation. J Acquir Immune Defic Syndr 2019; 79:510-518. [PMID: 30142143 DOI: 10.1097/qai.0000000000001843] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We estimated the effect of initiating virologically suppressive antiretroviral therapy (ART) during acute HIV infection versus chronic HIV infection (AHI vs. CHI) on CD4/CD8 ratio normalization. SETTING A prospective clinical cohort study. METHODS We included patients initiating ART with AHI and CHI between 2000 and 2015 and compared time from ART initiation to the first normal CD4/CD8 ratio (defined as CD4/CD8 ≥1) using Kaplan-Meier curves and multivariable Cox proportional hazards models. Patient time was censored at virologic failure, lost to follow-up, or death. We also characterized CD4, CD8, and CD4/CD8 trajectories over the first 3 years of ART. RESULTS The 1198 patients were 27% female and 60% African American, with a median age of 37 years (interquartile range 28-47) at ART initiation. The 83 AHI patients were more likely male, younger, and of white race, than CHI patients. After 2 years of suppressive ART, 70% of AHI patients achieved a normal CD4/CD8 ratio, compared to 6%-38% of CHI patients, with greater likelihood of normalization at higher baseline CD4 counts. Time to normalization was shortest among AHI patients, followed by CHI patients with higher baseline CD4. The adjusted hazard ratio for time to normalization for AHI patients compared to CHI patients with baseline CD4 >350 was 4.33 (95% CI: 3.16 to 5.93). Higher baseline CD4/CD8 ratio was also associated with time to normalization (adjusted hazard ratio 1.54; 1.46, 1.63, per 0.1 increase in ratio). CONCLUSIONS Initiating ART during AHI at higher baseline CD4 cell counts and CD4/CD8 ratios was associated with shorter time to CD4/CD8 ratio normalization.
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Nicolás D, Suárez A, Ambrosioni J, Manzardo C, Ligero C, Costa J, Fernández E, Marcos MÁ, Plana M, Mosquera MM, Sánchez-Palomino S, Gatell JM, Miró JM. Prevalence, clinical characteristics and outcome of severe primary HIV-1 infection: A prospective cohort study. Int J Infect Dis 2019; 88:73-79. [PMID: 31401201 DOI: 10.1016/j.ijid.2019.08.001] [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: 05/08/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe cases of primary HIV infection have been described in patients presenting with neurological involvement, AIDS defining events or other life-threatening events. These severe forms have not been fully studied. OBJECTIVES To determine the prevalence and characteristics of severe PHI in a hospital-based cohort of primary HIV infection, and the response to the early initiation of antiretroviral therapy (ART) at 12 months. METHODS Every patient with PHI attending Hospital Clínic of Barcelona (1997-2015) was evaluated. Severe PHI was defined using clinical, analytical and immunological criteria. Chi-squared test was used for categorical variables and Student's t-test for quantitative variables. RESULTS 33% of 224 PHI patients (95% CI: 26.84%-39.16%) had a severe PHI. These patients had more symptoms, abnormal analytical parameters and hospital admissions. The severe PHI group had a significantly higher viral load although no differences were observed at 12 months in terms of viral suppression or CD4 count recovery. None died during PHI. CONCLUSIONS Up to one third of patients in our cohort presented with a severe PHI, which was associated with higher hospitalization rates and higher plasma HIV RNA viral load. However, severe forms were not associated to a worse clinical, immunological or virological outcome at 12 months.
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Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Antoni Suárez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Carmen Ligero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Josep Costa
- Microbiology Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Emma Fernández
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - M Ángeles Marcos
- Microbiology Service, Hospital Clinic, University of Barcelona, Institute for Global Health, (ISGlobal), Barcelona, Spain.
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
| | - María Mar Mosquera
- Microbiology Service, Hospital Clinic, University of Barcelona, Institute for Global Health, (ISGlobal), Barcelona, Spain.
| | - Sonsoles Sánchez-Palomino
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
| | - Jose M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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10
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Hoenigl M, Moser CB, Funderburg N, Bosch R, Kantor A, Zhang Y, Eugen-Olsen J, Finkelman M, Reiser J, Landay A, Moisi D, Lederman MM, Gianella S. Soluble Urokinase Plasminogen Activator Receptor Is Predictive of Non-AIDS Events During Antiretroviral Therapy-mediated Viral Suppression. Clin Infect Dis 2019; 69:676-686. [PMID: 30418519 PMCID: PMC6669298 DOI: 10.1093/cid/ciy966] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/08/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite effective antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection remains associated with higher morbidity and mortality, driven, in part, by increased inflammation. Our objective was to identify associations between levels of plasma biomarkers of chronic inflammation, microbial translocation, and monocyte activation, with occurrence of non-AIDS events. METHODS Participants (141 cases, 310 matched controls) were selected from a longitudinal observational trial; all were virally suppressed on ART at year 1 and thereafter. Soluble urokinase plasminogen activator receptor (suPAR), lipopolysaccharide binding protein (LBP), beta-D-glucan (BDG), intestinal fatty-acid binding protein, oxidized low-density lipoproteins, and soluble CD163 were measured pre-ART, after 1-year of ART, and pre-event. At each time point, conditional logistic regression analysis assessed associations of the biomarkers with events and adjusted for relevant covariates to calculate odds ratios (ORs) according to 1 interquartile range (IQR) difference. RESULTS At all time points, higher levels of suPAR were associated with increased risk of non-AIDS events (OR per 1 IQR was 1.7 before ART-initiation, OR per 1 IQR was 2.0 after 1 year of suppressive ART, and OR 2.1 pre-event). Higher levels of BDG and LBP at year 1 and pre-event (but not at baseline) were associated with increased risk of non-AIDS events. No associations were observed for other biomarkers. CONCLUSIONS Elevated levels of suPAR were strongly, consistently, and independently predictive of non-AIDS events at every measured time point. Interventions that target the suPAR pathway should be investigated to explore its role in the pathogenesis of non-AIDS-related outcomes in HIV infection.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, Austria
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Carlee B Moser
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nicholas Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Ronald Bosch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Denmark
| | | | - Jochen Reiser
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Alan Landay
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Daniela Moisi
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael M Lederman
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sara Gianella
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, Austria
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11
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Development and validation of plasma miRNA biomarker signature panel for the detection of early HIV-1 infection. EBioMedicine 2019; 43:307-316. [PMID: 31005516 PMCID: PMC6557912 DOI: 10.1016/j.ebiom.2019.04.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate laboratory diagnosis of HIV is essential to reduce the risk of HIV-positive individuals transmitting HIV-1 infection. The goal of this study was to identify and assess a panel of host derived plasma miRNAs that could to serve as a prognostic and predictive biomarker to detect early/acute HIV-1 infection. Methods A total of 372 microRNAs were analyzed in nine plasma samples from HIV-1 infected individuals in the early phase of infection and three healthy controls using the miRNA PCR-array. Seventeen microRNAs were selected and validated in 80 plasma samples from HIV-1 infected individuals in the early phase of infection (20 each of eclipse stage, RNA+ stage, Ag + stage, and Ag + Ab+ stage of HIV-1 patients) and 25 healthy controls. Using the validation study results a plasma miRNA panel was developed and evaluated to detect early/acute HIV-1 infection in 49 blinded samples. Finding We identified an miRNA panel (PeHIV-1) containing four differentially expressed miRNAs (miR-16-5p, miR-20b-5p, miR-195-5p, and miR-223-3p) that could distinguish early HIV-1 infection from healthy controls with high AUC (1·000[1·00–1·00]), sensitivity (100%), and specificity (100%).We also found that miR-223-3p demonstrates 100% sensitivity and specificity (AUC 1·00[1·00–1·00]) and could distinguish eclipse stage of HIV-1 infection from healthy controls. To detect eclipse stage of HIV-1 infection we also developed a four-miRNA based (miR-16-5p, miR-206, let-7 g-3p, and miR-181c-3p) panel (PE) with AUC 0·999 (0·995–1·000), 100% sensitivity and 95·8% specificity. Interpretation The miRNA panel, PeHIV-1 is a potential biomarker for detecting early/acute stage of HIV-1infection and could help initiate early antiretroviral treatment, thus preventing the spread of HIV-1 infection.
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12
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Leite TF, Delatorre E, Côrtes FH, Ferreira ACG, Cardoso SW, Grinsztejn B, de Andrade MM, Veloso VG, Morgado MG, Guimarães ML. Reduction of HIV-1 Reservoir Size and Diversity After 1 Year of cART Among Brazilian Individuals Starting Treatment During Early Stages of Acute Infection. Front Microbiol 2019; 10:145. [PMID: 30804915 PMCID: PMC6378917 DOI: 10.3389/fmicb.2019.00145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/21/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of early combined antiretroviral therapy (cART) of HIV is to limit the seeding of the viral reservoir during the initial phase of infection and, consequently, decrease intrahost viral diversity. Here, we assessed the effect of early cART on size and complexity of the proviral reservoir. Peripheral blood mononuclear cell (PBMC) and plasma samples were obtained from ten HIV-infected Brazilian individuals diagnosed at the acute phase of infection, before (PREART) and 12 months (M12ART) after suppressive cART. HIV proviral reservoir size was determined by quantitative real-time PCR; intrahost viral diversity of the env C2-V3 region was assessed by single genome amplification or next-generation sequencing in PBMC and plasma, respectively. Mean nucleotide diversity (π) and normalized Shannon entropy (HSN) were used to infer the complexity of the viral population. Compared to PREART, M12ART saw an immunological recovery with a gain of ∼200 CD4+ T cells (P = 0.008) and a normalization of the CD4/CD8 ratio [1.0 (IQR: 0.88–1.18), P = 0.016], as well as a significant decrease in HIV-1 RNA (∼4 log, P = 0.004) and DNA (∼1 log, P = 0.002) levels. The median time to achieve viral suppression was 3 months (IQR: 2.8–5.8 months). The high intermixing between sequences from both visits suggests that the HIV-1 DNA reservoir remained remarkably stable under cART. After 1 year of cART, there was a minor reduction in proviral π (PreART = 0.20 vs. M12ART = 0.10; P = 0.156) but a significant decrease in HSN (PreART = 0.41 vs. M12ART = 0.25; P = 0.019). We found no correlation between π or HSN at PreART and the rate of HIV DNA decay, T CD4+ counts, or CD4/CD8 ratio at M12ART. Based on a small cohort of Brazilian infected individuals under early cART and analyses of the env region, 1 year of follow-up suggested a reservoir size reduction, allowed a significant decrease of HIV-1 complexity, and achieved immunological restoration regardless of the initial HIV-1 plasma viral load, CD4+ T cell counts, or HIV-1 subtype. However, further studies in the Brazilian setting aiming a longer follow-up and larger cohort are required in this field.
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Affiliation(s)
- Thaysse Ferreira Leite
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Edson Delatorre
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fernanda Heloise Côrtes
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Cristina Garcia Ferreira
- Laboratório de Pesquisa Clínica em DST e AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Laboratório de Pesquisa Clínica em DST e AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em DST e AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Michelle Morata de Andrade
- Laboratório de Pesquisa Clínica em DST e AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea Gonçalves Veloso
- Laboratório de Pesquisa Clínica em DST e AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Mariza Gonçalves Morgado
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Monick Lindenmeyer Guimarães
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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CD4/CD8 Ratio as a Predictor for the Occurrence of Metabolic Syndrome in HIV / AIDS Patients During 6 Months of cART Therapy. J Med Biochem 2019; 38:489-495. [PMID: 31496914 PMCID: PMC6708296 DOI: 10.2478/jomb-2018-0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022] Open
Abstract
Background HIV infection is characterized by progressive depletion of CD4+ T cells due to their reduced synthesis and increased destruction followed by marked activation and expansion of CD8+ T lymphocytes. CD4/CD8 ratio was traditionally described as a marker of immune system ageing in the general population, but it increasingly appears as a marker of different outcomes in the HIV-infected population. The main objective of this study is to examine the power of CD4/CD8 ratio in predicting the occurrence of metabolic syndrome (MetS) in HIV-positive patients receiving cART therapy. Methods 80 HIV/AIDS subjects were included in a retrospective case-control study. Flow cytometry was used to determine the percentage of CD4+ and CD8+ cells in peripheral blood of these patients. The values of biochemical parameters (triglycerides, HDL, blood sugar, blood counts), immunological parameters (CD4/CD8, PCR), anthropometric measurements and type of cART therapy were evaluated in this study. Results After six months of cART therapy 19 (23.8%) subjects had all the elements necessary for making the diagnosis of MetS. Using multivariate analysis CD4/CD8 ratio was statistically significant (p < 0.05) and had the largest effect on development of MetS (Wald = 9.01; OR = 0.45), followed by cART (Wald = 7.87; OR = 0.10) and triglycerides (Wald = 5.27; OR = 1.7). On the other hand, body weight and waist circumference showed no statistically significant effect on the development of MetS after six months of cART, p > 0.05. Conclusions CD4/CD8 ratio proved to be a significant marker for prediction of metabolic syndrome in HIV/AIDS patients.
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14
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Salzer HJF, Schäfer G, Hoenigl M, Günther G, Hoffmann C, Kalsdorf B, Alanio A, Lange C. Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia. Respiration 2018; 96:52-65. [PMID: 29635251 DOI: 10.1159/000487713] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 01/15/2023] Open
Abstract
The substantial decline in the Pneumocystis jirovecii pneumonia (PCP) incidence in HIV-infected patients after the introduction of antiretroviral therapy (ART) in resource-rich settings and the growing number of non-HIV-infected immunocompromised patients at risk leads to considerable epidemiologic changes with clinical, diagnostic, and treatment consequences for physicians. HIV-infected patients usually develop a subacute course of disease, while non-HIV-infected immunocompromised patients are characterized by a rapid disease progression with higher risk of respiratory failure and higher mortality. The main symptoms usually include exertional dyspnea, dry cough, and subfebrile temperature or fever. Lactate dehydrogenase may be elevated. Typical findings on computed tomography scans of the chest are bilateral ground-glass opacities with or without cystic lesions, which are usually associated with the presence of AIDS. Empiric treatment should be initiated as soon as PCP is suspected. Bronchoalveolar lavage has a higher diagnostic yield compared to induced sputum. Immunofluorescence is superior to conventional staining. A combination of different diagnostic tests such as microscopy, polymerase chain reaction, and (1,3)-β-D-glucan is recommended. Trimeth-oprim/sulfamethoxazole for 21 days is the treatment of choice in adults and children. Alternative treatment regimens include dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Patients with moderate to severe disease should receive adjunctive corticosteroids. In newly diagnosed HIV-infected patients with PCP, ART should be initiated as soon as possible. In non-HIV-infected immunocompromised patients, improvement of the immune status should be discussed (e.g., temporary reduction of immunosuppressive agents). PCP prophylaxis is effective and depends on the immune status of the patient and the underlying immunocompromising disease.
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Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
| | - Guido Schäfer
- Infectious Diseases Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Section of Rheumatology, 3rd Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California at San Diego, San Diego, California, USA.,Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Gunar Günther
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,Department of Internal Medicine, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg (ICH) Study Center, Hamburg, Germany.,Department of Medicine II, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
| | - Alexandre Alanio
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Institut Pasteur, Molecular Mycology Unit, CNRS CMR2000, Paris, France
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Evaluation of the Predictive Potential of the Short Acute Retroviral Syndrome Severity Score for HIV-1 Disease Progression in Individuals With Acute HIV Infection. J Acquir Immune Defic Syndr 2018; 74:e114-e117. [PMID: 28225720 DOI: 10.1097/qai.0000000000001263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Jenks JD, Hoenigl M. CD4:CD8 ratio and CD8+ cell count for prognosticating mortality in HIV-infected patients on antiretroviral therapy. ACTA ACUST UNITED AC 2018; 3. [PMID: 30167571 DOI: 10.21037/jlpm.2018.01.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey Daniel Jenks
- Division of General Internal Medicine, Department of Medicine, University of California-San Diego, San Diego, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, USA.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Pulmonology, Medical University of Graz, Graz, Austria
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17
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Viral kinetics in untreated versus treated acute HIV infection in prospective cohort studies in Thailand. J Int AIDS Soc 2017; 20:21652. [PMID: 28691436 PMCID: PMC5515031 DOI: 10.7448/ias.20.1.21652] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: The extent of viral replication during acute HIV infection (AHI) influences HIV disease progression. However, information comparing viral load (VL) kinetics with and without antiretroviral therapy (ART) in AHI is limited. The knowledge gained could inform preventive strategies aimed at reducing VL during AHI and therapeutic strategies to alter the viral kinetics that may enhance the likelihood of achieving HIV remission. Methods: The analysis utilized VL data captured during the first year of HIV infection from two studies in Thailand: the RV217 study (untreated AHI, 30 participants and 412 visits) and the RV254 study (treated AHI, 235 participants and 2803 visits). Fiebig stages were I/II (HIV RNA+, HIV IgM−) and Fiebig III/IV (HIV IgM+, Western blot-/indeterminate). Data were modelled utilizing spline effects within a linear mixed model, with a random intercept and slope to allow for between-subject variability and adjustment for the differences in variability between studies. The number of knots in the quadratic spline basis functions was determined by comparing models with differing numbers of knots via the Akaike Information Criterion. Models were fit using PROC GLIMMIX in SAS v9.3. Results: At enrolment, there were 24 Fiebig I/II and 6 Fiebig III/IV individuals in the untreated group and 137 Fiebig I/II and 98 Fiebig III/IV individuals in the treated group. Overall, the median age was 27.5 years old, most were male (89%), and CRF01_AE was the most common HIV clade (76%). By day 12 (4 days after ART in RV254), the untreated group had a 2.7-fold higher predicted mean VL level compared to those treated (predicted log VL 6.19 for RV217 and 5.76 for RV254, p = 0.05). These differences increased to 135-fold by day 30 (predicted log VL 4.89 for RV217 and 2.76 for RV254) and 1148-fold by day 120 (predicted log VL 4.68 for RV217 and 1.63 for RV254) (p < 0.0001 for both) until both curves were similarly flat at about day 150 (p = 0.17 between days 150 and 160). The VL trajectories were significantly different between Fiebig I/II and Fiebig III/IV participants when comparing the two groups and within the treated group (p < 0.001 for both). Conclusions: Initiating ART in AHI dramatically changed the trajectory of VL very early in the course of infection that could have implications for reducing transmission potential and enhancing responses to future HIV remission strategies. There is an urgency of initiating ART when acute infection is identified. New and inexpensive strategies to engage and test individuals at high risk for HIV as well as immediate treatment access will be needed to improve the treatment of acute infection globally. Clinical Trial Number: NCT00796146 and NCT00796263
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Valverde-Villegas JM, de Medeiros RM, Ellwanger JH, Santos BR, Melo MGD, Almeida SEDM, Chies JAB. High CXCL10/IP-10 levels are a hallmark in the clinical evolution of the HIV infection. INFECTION GENETICS AND EVOLUTION 2017; 57:51-58. [PMID: 29122683 DOI: 10.1016/j.meegid.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 12/17/2022]
Abstract
The aim of this study was to investigate the modulation of plasma CXCL10, CCL20, CCL22, CCL2, CCL17 and CCL24 levels in HIV-positive patients grouped according to extreme phenotypes of progression to AIDS, and at different stages of HIV infection. HIV-positive individuals with extreme phenotypes of AIDS progression (n=58) at different clinical stages (chronic individuals, both pre-HAART and under-HAART) and HIV-negative controls (n=20) were evaluated. Additionally, HIV-positive individuals that initiated HAART with >350CD4+T-cells/mm3 were compared with those who initiated treatment with <350CD4+T-cells/mm3. Plasma levels of six chemokines were quantified by a Luminex assay. Higher CXCL10 levels were observed in individuals immediately before their CD4+T-cell levels were indicative for HAART (pre-HAART), independently of their progressor status, i.e. slow (SPs) or rapid progressors (RPs). SPs pre-HAART showed higher CXCL10 levels compared to elite controllers and RPs under HAART (pc=0.009 and pc=0.007, respectively). CXCL10 levels were higher in SPs HAART CD4<350 (initiated HAART with <350 CD4+T-cells) when compared with SPs HAART CD4>350 (initiated HAART with >350 CD4+T-cells) (1096 vs. 360.33pg/mL, p=0.0101). Normalisation of CXCL10 levels seems to depend on the CD4+T-cell nadir at HAART initiation. CCL20 levels were higher in chronic SPs, SPs pre-HAART, SPs HAART and RPs HAART compared with the HIV-negative controls, indicating persistent CCL20 expression. In conclusion, our results indicate that CXCL10 levels are a hallmark in the clinical evolution of HIV infection. However, our results must be verified in a study evaluating a larger number of AIDS progressors.
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Affiliation(s)
- Jacqueline María Valverde-Villegas
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul - UFRGS, Brazil; Fundação Estadual de Produção e Pesquisa em Saúde - FEPPS, Brazil
| | - Rúbia Marília de Medeiros
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul - UFRGS, Brazil; Fundação Estadual de Produção e Pesquisa em Saúde - FEPPS, Brazil
| | - Joel Henrique Ellwanger
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul - UFRGS, Brazil
| | - Breno Riegel Santos
- Serviço de Infectologia, Grupo Hospitalar Nossa Senhora da Conceição, Brazil
| | | | - Sabrina Esteves de Matos Almeida
- Fundação Estadual de Produção e Pesquisa em Saúde - FEPPS, Brazil; Instituto de Ciências da Saúde, Universidade Feevale - FEEVALE, Brazil; Departamento de Genética, Universidade Federal do Rio Grande do Sul - UFRGS, Brazil
| | - José Artur Bogo Chies
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul - UFRGS, Brazil.
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20
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Abstract
OBJECTIVES A persistently low CD4/CD8 ratio despite virological control reflects a higher risk of morbidity in HIV-infected individuals. The objective of the study was to assess the probability and determinants of ratio restoration (≥1) during long-term combined antiretroviral therapy (cART). DESIGN Study cohort based on the French Hospital Database on HIV (ANRS CO4). METHODS Antiretroviral-naive HIV-1-infected individuals were included if they achieved virological control (plasma HIV RNA ≤ 500 copies/ml) within 9 months following cART, started between 2000 and 2010. Cumulative incidence of ratio restoration after virological control and predictive factors of such a favorable outcome were studied taking into account 'virological failure', 'loss to follow-up', and 'death' as competing risks for ratio restoration. RESULTS Among the 10012 individuals included, the probability of CD4/CD8 ratio restoration was 30% (95% confidence interval, 29-31) at 8 years, ranging from 17% (15 to 19) among individuals with AIDS, to 45% (41 to 50) in people with CD4 at least 500 cells/μl at cART introduction. The main factors associated with ratio restoration were cART started during primary HIV infection whatever the CD4 cell count, or starting at CD4 at least 500 cells/μl while not in primary HIV infection [subdistribution hazard ratio = 1.67 (95% confidence interval, 1.13-2.47) and 2.26 (1.92-2.66) respectively, compared with starting cART at 200-349 CD4 cells/μl], and starting cART in recent years [subdistribution hazard ratio = 2.38 (2.01-2.83) in 2009-2010, compared with 2000-2002]. Higher baseline CD8 cell count was negatively associated with ratio restoration. CONCLUSION At 8 years, only one-third of individuals achieved CD4/CD8 ratio restoration with sustained virological control. Treatment at the earliest stage, and starting cART in recent years appeared to be key determinants.
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Rutstein SE, Ananworanich J, Fidler S, Johnson C, Sanders EJ, Sued O, Saez-Cirion A, Pilcher CD, Fraser C, Cohen MS, Vitoria M, Doherty M, Tucker JD. Clinical and public health implications of acute and early HIV detection and treatment: a scoping review. J Int AIDS Soc 2017; 20:21579. [PMID: 28691435 PMCID: PMC5515019 DOI: 10.7448/ias.20.1.21579] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/29/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. METHODS We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. RESULTS AND DISCUSSION Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. CONCLUSIONS There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jintanat Ananworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Cheryl Johnson
- HIV Department, World Health Organization, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard J. Sanders
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Asier Saez-Cirion
- Institut Pasteur, HIV Inflammation and Persistance Unit, Paris, France
| | | | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Myron S. Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D. Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jia P, Zhao Z, Hulgan T, Bush WS, Samuels DC, Bloss CS, Heaton RK, Ellis RJ, Schork N, Marra CM, Collier AC, Clifford DB, Gelman BB, Sacktor N, Morgello S, Simpson DM, McCutchan JA, Barnholtz-Sloan JS, Franklin DR, Rosario D, Letendre SL, Grant I, Kallianpur AR. Genome-wide association study of HIV-associated neurocognitive disorder (HAND): A CHARTER group study. Am J Med Genet B Neuropsychiatr Genet 2017; 174:413-426. [PMID: 28447399 PMCID: PMC5435520 DOI: 10.1002/ajmg.b.32530] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/27/2017] [Indexed: 12/14/2022]
Abstract
HIV-associated neurocognitive disorder (HAND) often complicates HIV infection despite combination antiretroviral therapy (ART) and may be influenced by host genomics. We performed a genome-wide association study (GWAS) of HAND in 1,050 CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) Study participants. All participants underwent standardized, comprehensive neurocognitive, and neuromedical assessments to determine if they had cognitive impairment as assessed by the Global Deficit Score (GDS), and individuals with comorbidities that could confound diagnosis of HAND were excluded. Neurocognitive outcomes included GDS-defined neurocognitive impairment (NCI; binary GDS, 366 cases with GDS ≥ 0.5 and 684 controls with GDS < 0.5, and GDS as a continuous variable) and Frascati HAND definitions that incorporate assessment of functional impairment by self-report and performance-based criteria. Genotype data were obtained using the Affymetrix Human SNP Array 6.0 platform. Multivariable logistic or linear regression-based association tests were performed for GDS-defined NCI and HAND. GWAS results did not reveal SNPs meeting the genome-wide significance threshold (5.0 × 10-8 ) for GDS-defined NCI or HAND. For binary GDS, the most significant SNPs were rs6542826 (P = 8.1 × 10-7 ) and rs11681615 (1.2 × 10-6 ), both located on chromosome 2 in SH3RF3. The most significant SNP for continuous GDS was rs11157436 (P = 1.3 × 10-7 ) on chromosome 14 in the T-cell-receptor alpha locus; three other SNPs in this gene were also associated with binary GDS (P ≤ 2.9 × 10-6 ). This GWAS, conducted among ART-era participants from a single cohort with robust neurological phenotyping, suggests roles for several biologically plausible loci in HAND that deserve further exploration. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Peilin Jia
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William S Bush
- Department of Epidemiology and Biostatistics, and Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio
| | - David C Samuels
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Cinnamon S Bloss
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Ronald J Ellis
- Department of Neurology, University of California San Diego, San Diego, California
| | - Nicholas Schork
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Christina M Marra
- Department of Neurology, University of Washington, Seattle, Washington
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, Washington
| | - David B Clifford
- Department of Neurology, Washington University, St. Louis, Missouri
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine of Mount Sinai, New York, New York
| | - David M Simpson
- Department of Neurology, Icahn School of Medicine of Mount Sinai, New York, New York
| | - J Allen McCutchan
- Department of Medicine, University of California San Diego, San Diego, California
| | - Jill S Barnholtz-Sloan
- Department of Epidemiology and Biostatistics, and Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio
| | - Donald R Franklin
- Department of Medicine, University of California San Diego, San Diego, California
| | - Debralee Rosario
- Department of Medicine, University of California San Diego, San Diego, California
| | - Scott L Letendre
- Department of Medicine, University of California San Diego, San Diego, California
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Asha R Kallianpur
- Department of Genomic Medicine, Lerner Research Institute and Department of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Abstract
BACKGROUND To examine the yield of HIV partner services provided to persons newly diagnosed with acute and early HIV infection (AEH) in San Diego, United States. DESIGN Observational cohort study. METHODS The study investigated the yield (i.e. number of new HIV and AEH diagnoses, genetically linked partnerships and high-risk uninfected partners) of partner services (confidential contact tracing) for individuals with AEH enrolled in the San Diego Primary Infection Resource Consortium 1996-2014. RESULTS A total of 107 of 574 persons with AEH (19%; i.e. index cases) provided sufficient information to recruit 119 sex partners. Fifty-seven percent of the 119 recruited partners were HIV infected, and 33% of the 119 were newly HIV diagnosed. Among those newly HIV diagnosed, 36% were diagnosed during AEH. There were no significant demographic or behavioral risk differences between HIV-infected and HIV-uninfected recruited partners. Genetic sequences were available for both index cases and partners in 62 partnerships, of which 61% were genetically linked. Partnerships in which both index case and partner enrolled within 30 days were more likely to yield a new HIV diagnosis (P = 0.01) and to be genetically linked (P < 0.01). CONCLUSION Partner services for persons with AEH within 30 days of diagnosis represents an effective tool to find HIV-unaware persons, including those with AEH who are at greatest risk of HIV transmission.
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Makinson A, Reynes J. A novel marker of lung-cancer risk in people with HIV. Lancet HIV 2016; 4:e53-e55. [PMID: 27916583 DOI: 10.1016/s2352-3018(16)30218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Alain Makinson
- University Montpellier, UMI233-IRD/U1175-INSERM, Montpellier, France; Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France.
| | - Jacques Reynes
- University Montpellier, UMI233-IRD/U1175-INSERM, Montpellier, France; Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
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Rosado-Sánchez I, Herrero-Fernández I, Genebat M, Ruiz-Mateos E, Leal M, Pacheco YM. Thymic Function Impacts the Peripheral CD4/CD8 Ratio of HIV-Infected Subjects. Clin Infect Dis 2016; 64:152-158. [PMID: 27986677 DOI: 10.1093/cid/ciw711] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/18/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The persistence of an inverted CD4/CD8 ratio has been extensively associated with the increased morbimortality of chronic human immunodeficiency virus (HIV)-infected subjects. Thymic function is crucial for the maintenance of T cell homeostasis. We explored the impact of thymic function on the CD4/CD8 ratio of HIV-infected subjects. METHODS In a cohort of 53 antiretroviral-naive HIV-infected subjects, the measure of thymic volume, as a representative marker for thymic function, was available at baseline and at 12, 24, and 48 weeks post antiretroviral treatment. RESULTS Baseline thymic volume was associated with the CD4/CD8 ratio ( Ρ: = 0.413, P = .002), being this association highly dependent on the CD4 T cell levels. In subjects who achieved undetectable viral load after treatment (n = 33), a higher baseline thymic volume was associated with a higher increase in CD4 T cell counts and a decreasing trend in CD8 T cell counts during follow-up. Moreover, the baseline thymic volume was independently associated with the normalization of the CD4/CD8 ratio after 96 weeks of treatment (odds ratio, 95% confidence interval: 1.95 (1.07-3.55); P = .03). CONCLUSIONS Our data indicate the relevance of the remaining thymic function before the start of treatment to the CD4/CD8 ratio of HIV- infected subjects and, hence, potentially, in their clinical progression.
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Affiliation(s)
- I Rosado-Sánchez
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - I Herrero-Fernández
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - M Genebat
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - E Ruiz-Mateos
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - M Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Yolanda M Pacheco
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
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Rapid HIV Viral Load Suppression in those Initiating Antiretroviral Therapy at First Visit after HIV Diagnosis. Sci Rep 2016; 6:32947. [PMID: 27597312 PMCID: PMC5011704 DOI: 10.1038/srep32947] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/18/2016] [Indexed: 01/01/2023] Open
Abstract
Expert guidelines for antiretroviral therapy (ART) now recommend ART as soon as possible in all HIV infected persons to reduce the risk of disease progression and prevent transmission. The goal of this observational study was to evaluate the impact of very early ART initiation and regimen type on time to viral suppression. We evaluated time to viral suppression among 86 persons with newly-diagnosed HIV infection who initiated ART within 30 days of diagnosis. A total of 36 (42%) had acute, 27 (31%) early, and 23 (27%) had established HIV infection. The median time from an offer of immediate ART to starting ART was 8 days. A total of 56/86 (65%) initiated an integrase inhibitor-based regimen and 30/86 (35%) a protease inhibitor-based regimen. The time to viral suppression was significantly shorter in those receiving an integrase inhibitor- versus a protease inhibitor-based regimen (p = 0.022). Twenty-two (26%) initiated ART at their HIV care intake visit and 79% of these participants achieved viral suppression at week 12, 82% at week 24 and 88% at week 48. ART initiated at the intake visit led to rapid and reliable viral suppression in acute, early and chronic HIV infection, in particular when integrase inhibitor-based regimens were used.
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27
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Hoenigl M, Little SJ. How can we detect HIV during the acute or primary stage of infection? Expert Rev Mol Diagn 2016; 16:1049-1051. [PMID: 27541993 DOI: 10.1080/14737159.2016.1226805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Martin Hoenigl
- a Division of Infectious Diseases , University of California San Diego (UCSD) , San Diego , CA , USA.,b Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine , Medical University of Graz , Graz , Austria.,c Division of Pulmonology, Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - Susan J Little
- a Division of Infectious Diseases , University of California San Diego (UCSD) , San Diego , CA , USA
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