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Chow FC, Nance RM, Becker K, Ho EL, Huffer A, Kalani R, Marra CM, Zunt JR, Bamford L, Burkholder GA, Cachay E, Eron JJ, Keruly J, Kitahata MM, Napravnik S, Saag MS, Willig AL, Moore RD, Tirschwell DL, Delaney JA, Crane HM. Sex Differences in the Risk of Stroke Associated With Traditional and Non-Traditional Factors in a US Cohort of People With HIV Infection. Neurology 2024; 103:e209726. [PMID: 39088772 DOI: 10.1212/wnl.0000000000209726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although stroke risk associated with HIV may be greater for women than men, little is known about whether the impact of different factors on cerebrovascular risk varies by sex in people with HIV (PWH) and contributes to stroke risk disparities in this population. The primary objective of this study was to examine whether sex modifies the effect of demographics, cardiometabolic factors, health-related behaviors, and HIV-specific variables on stroke risk in PWH from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. METHODS In this observational cohort study, we analyzed data from clinical encounters for PWH followed at 5 CNICS sites from approximately 2005 to 2020. All potential stroke events were adjudicated by neurologists. Patient-reported outcomes collected at clinic visits, including substance use and depression, were also available. We used Cox proportional hazards models to determine whether sex modified the association of predictors of interest with incident stroke. RESULTS Among 13,573 PWH (19% female sex at birth, mean age 44 years, mean follow-up 5.6 years), female sex was associated with a higher risk of stroke only among individuals aged 50 years or younger (hazard ratio [HR] 2.01 at age 40 [1.25-3.21] vs HR 0.60 at age 60 [0.34-1.06]; p = 0.001 for the interaction). Younger female participants who developed a stroke were more likely to have treated hypertension, a higher cardiovascular risk score, and detectable HIV than younger male participants whereas these factors were comparable by sex among older participants who developed a stroke. Sex modified the effect of detectable HIV (HR 4.66 for female participants [2.48-8.74] vs HR 1.30 for male participants [0.83-2.03]; p = 0.001 for the interaction), methamphetamine use (HR 4.78 for female participants [1.47-15.56] vs HR 1.19 for male participants [0.62-2.29]; p = 0.04 for the interaction), and treated hypertension (HR 3.44 for female participants [1.74-6.81] vs HR 1.66 for male participants [1.14-2.41]; p = 0.06 for the interaction) on stroke risk. DISCUSSION Younger female participants with HIV were at elevated cerebrovascular risk compared with younger male participants. Several risk factors had a greater adverse effect on stroke risk in female participants than in male participants, including HIV viremia, methamphetamine use, and treated hypertension. These findings underscore the importance of a personalized approach to predict and prevent cerebrovascular risk among PWH.
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Affiliation(s)
- Felicia C Chow
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Robin M Nance
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Kyra Becker
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Emily L Ho
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Andrew Huffer
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Rizwan Kalani
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Christina M Marra
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Joseph R Zunt
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Laura Bamford
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Greer A Burkholder
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Edward Cachay
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Joseph J Eron
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Jeanne Keruly
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Mari M Kitahata
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Sonia Napravnik
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Michael S Saag
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Amanda L Willig
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Richard D Moore
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - David L Tirschwell
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Joseph A Delaney
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
| | - Heidi M Crane
- From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada
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Katlama C, Bisshop F, Bogner J, Pérez Elías MJ, Di Giambenedetto S, Clarke E, Hodder S, Nwokolo N, Ait-Khaled M, Oyee J, Grove R, Wynne B, Okoli C, Jones B, Kisare M. Efficacy and safety of dolutegravir/lamivudine in virologically suppressed female participants: week 48 data from the pooled TANGO and SALSA studies. HIV Med 2024; 25:873-884. [PMID: 38760011 DOI: 10.1111/hiv.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women represent >50% of people with HIV globally but have historically been underrepresented in clinical trials. We evaluated the efficacy and safety of switching to dolutegravir/lamivudine (DTG/3TC) vs continuing their current antiretroviral regimen (CAR) by sex assigned at birth (female and male) in virologically suppressed adults with HIV-1 without prior virological failure in a pooled analysis of two randomized controlled trials. METHODS This analysis included 48-week data from the phase 3 TANGO and SALSA studies. Primary and key secondary endpoints included proportions of participants with HIV-1 RNA ≥50 and <50 copies/mL at week 48, respectively. Safety was also assessed. RESULTS Of 1234 participants, 250 (DTG/3TC, n = 133; CAR, n = 117) were female at birth. Week 48 proportions of participants with Snapshot HIV-1 RNA ≥50 copies/mL were similar regardless of sex at birth (DTG/3TC vs CAR: female, <1% [1/133] vs 2% [2/117]; male, <1% [1/482] vs <1% [3/502]). Proportions with HIV-1 RNA <50 copies/mL were high across sexes and treatment groups (DTG/3TC vs CAR: female, 91% [121/133] vs 89% [104/117]; male, 94% [455/482] vs 94% [471/502]). Immunological response with DTG/3TC was slightly higher in female participants. Incidences of adverse events leading to withdrawal and serious adverse events were low and comparable between treatment groups and across sexes. Weight gain was higher with DTG/3TC than with CAR among female participants aged ≥50 years (treatment difference 2.08 kg [95% confidence interval 0.40-3.75]). CONCLUSIONS Results confirm the robustness of DTG/3TC as a switch option in virologically suppressed females with HIV-1, with outcomes similar to those in males.
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Affiliation(s)
- C Katlama
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, INSERM-Sorbonne Universités, Paris, France
| | - F Bisshop
- Holdsworth House Medical Brisbane, Fortitude Valley, Queensland, Australia
| | - J Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - S Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Clarke
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, West Virginia, USA
| | | | | | | | | | - B Wynne
- ViiV Healthcare, Durham, North Carolina, USA
| | - C Okoli
- ViiV Healthcare, Brentford, UK
| | - B Jones
- ViiV Healthcare, Brentford, UK
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Pasin C, Nuñez DG, Kusejko K, Hachfeld A, Buvelot H, Cavassini M, Damonti L, Fux C, de Tejada BM, Notter J, Trkola A, Günthard HF, Aebi-Popp K, Kouyos RD, Abela IA. Impact of hormonal therapy on HIV-1 immune markers in cis women and gender minorities. HIV Med 2024. [PMID: 38830635 DOI: 10.1111/hiv.13677] [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] [Received: 01/31/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Although sex hormones are recognized to induce immune variations, the effect of hormonal therapy use on immunity is only poorly understood. Here, we quantified how hormonal therapy use affects HIV-1 immune markers in cis women (CW) and trans women and non-binary people (TNBP) with HIV. METHODS We considered CD4, CD8 and lymphocyte measurements from cis men (CM), CW and TNBP in the Swiss HIV Cohort Study. We modelled HIV-1 markers using linear mixed-effects models with an interaction between 'gender' (CW, TNBP) and 'hormonal therapy use' (yes/no). Models were adjusted on age, ethnicity, education level, time since start of antiretroviral therapy and use of intravenous drugs. We assessed the inflammatory effect of hormonal therapy use in 31 TNBP using serum proteomics measurements of 92 inflammation markers. RESULTS We included 54 083 measurements from 3092 CW and 83 TNBP, and 147 230 measurements from 8611 CM. Hormonal therapy use increased CD4 count and CD4:CD8 ratio in TNBP more than in CW (pinteraction = 0.02 and 0.007, respectively). TNBP with hormonal therapy use had significantly higher CD4 counts [median = 772 cells/μL, interquartile range (IQR): 520-1006] than without (617 cells/μL, 426-892). This was similar to the effect of CW versus CM on CD4 T cells. Hormonal therapy use did not affect serum protein concentrations in TNBP. CONCLUSION This study highlights the potential role of hormonal therapy use in modulating the immune system among other biological and social factors, especially in TNBP with HIV.
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Affiliation(s)
- Chloé Pasin
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Collegium Helveticum, Zurich, Switzerland
| | - David Garcia Nuñez
- Center for Gender Variance, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Hélène Buvelot
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
- Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Christoph Fux
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
| | - Begoña Martinez de Tejada
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Julia Notter
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Irene A Abela
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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4
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Jones R, Robinson AT, Beach LB, Lindsey ML, Kirabo A, Hinton A, Erlandson KM, Jenkins ND. Exercise to Prevent Accelerated Vascular Aging in People Living With HIV. Circ Res 2024; 134:1607-1635. [PMID: 38781293 PMCID: PMC11126195 DOI: 10.1161/circresaha.124.323975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Given advances in antiretroviral therapy, the mortality rate for HIV infection has dropped considerably over recent decades. However, people living with HIV (PLWH) experience longer life spans coupled with persistent immune activation despite viral suppression and potential toxicity from long-term antiretroviral therapy use. Consequently, PLWH face a cardiovascular disease (CVD) risk more than twice that of the general population, making it the leading cause of death among this group. Here, we briefly review the epidemiology of CVD in PLWH highlighting disparities at the intersections of sex and gender, age, race/ethnicity, and the contributions of social determinants of health and psychosocial stress to increased CVD risk among individuals with marginalized identities. We then overview the pathophysiology of HIV and discuss the primary factors implicated as contributors to CVD risk among PLWH on antiretroviral therapy. Subsequently, we highlight the functional evidence of premature vascular dysfunction as an early pathophysiological determinant of CVD risk among PLWH, discuss several mechanisms underlying premature vascular dysfunction in PLWH, and synthesize current research on the pathophysiological mechanisms underlying accelerated vascular aging in PLWH, focusing on immune activation, chronic inflammation, and oxidative stress. We consider understudied aspects such as HIV-related changes to the gut microbiome and psychosocial stress, which may serve as mechanisms through which exercise can abrogate accelerated vascular aging. Emphasizing the significance of exercise, we review various modalities and their impacts on vascular health, proposing a holistic approach to managing CVD risks in PLWH. The discussion extends to critical future study areas related to vascular aging, CVD, and the efficacy of exercise interventions, with a call for more inclusive research that considers the diversity of the PLWH population.
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Affiliation(s)
- Raymond Jones
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Lauren B. Beach
- Department of Medical Social Sciences, Northwestern, Chicago, IL
- Department of Preventive Medicine, Northwestern, Chicago, IL
| | - Merry L. Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, TN
- Research Service, Nashville VA Medical Center, Nashville, TN
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Immunobiology, Nashville, TN
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN
- Vanderbilt Institute for Global Health, Nashville, TN
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | | | - Nathaniel D.M. Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
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5
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Al-Hassinah S, Al-Daihan S, Alahmadi M, Alghamdi S, Almulhim R, Obeid D, Arabi Y, Alswaji A, Aldriwesh M, Alghoribi M. Interplay of Demographic Influences, Clinical Manifestations, and Longitudinal Profile of Laboratory Parameters in the Progression of SARS-CoV-2 Infection: Insights from the Saudi Population. Microorganisms 2024; 12:1022. [PMID: 38792852 PMCID: PMC11124088 DOI: 10.3390/microorganisms12051022] [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] [Received: 04/28/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Understanding the factors driving SARS-CoV-2 infection progression and severity is complex due to the dynamic nature of human physiology. Therefore, we aimed to explore the severity risk indicators of SARS-CoV-2 through demographic data, clinical manifestations, and the profile of laboratory parameters. The study included 175 patients either hospitalized at King Abdulaziz Medical City-Riyadh or placed in quarantine at designated hotels in Riyadh, Saudi Arabia, from June 2020 to April 2021. Hospitalized patients were followed up through the first week of admission. Demographic data, clinical presentations, and laboratory results were retrieved from electronic patient records. Our results revealed that older age (OR: 1.1, CI: [1.1-1.12]; p < 0.0001), male gender (OR: 2.26, CI: [1.0-5.1]; p = 0.047), and blood urea nitrogen level (OR: 2.56, CI: [1.07-6.12]; p = 0.034) were potential predictors of severity level. In conclusion, the study showed that apart from laboratory parameters, age and gender could potentially predict the severity of SARS-CoV-2 infection in the early stages. To our knowledge, this study is the first in Saudi Arabia to explore the longitudinal profile of laboratory parameters among risk factors, shedding light on SARS-CoV-2 infection progression parameters.
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Affiliation(s)
- Sarah Al-Hassinah
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia; (S.A.-H.); (S.A.); (Y.A.); (A.A.); (M.A.)
- Biochemistry Department, College of Science, King Saud University, Riyadh 11495, Saudi Arabia;
| | - Sooad Al-Daihan
- Biochemistry Department, College of Science, King Saud University, Riyadh 11495, Saudi Arabia;
| | - Mashael Alahmadi
- Research Office, Saudi National Institute of Health (SNIH), Riyadh 12382, Saudi Arabia;
| | - Sara Alghamdi
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia; (S.A.-H.); (S.A.); (Y.A.); (A.A.); (M.A.)
| | - Rawabi Almulhim
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh 14611, Saudi Arabia;
| | - Dalia Obeid
- King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Yaseen Arabi
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia; (S.A.-H.); (S.A.); (Y.A.); (A.A.); (M.A.)
- Intensive Care Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Abdulrahman Alswaji
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia; (S.A.-H.); (S.A.); (Y.A.); (A.A.); (M.A.)
| | - Marwh Aldriwesh
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia; (S.A.-H.); (S.A.); (Y.A.); (A.A.); (M.A.)
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Majed Alghoribi
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia; (S.A.-H.); (S.A.); (Y.A.); (A.A.); (M.A.)
- Department of Basic Science, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
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6
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Lindh M, Brännström J, Reepalu A, Svedhem V, Mellgren Å. Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study. HIV Med 2024; 25:540-553. [PMID: 38196293 DOI: 10.1111/hiv.13607] [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: 09/15/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs). METHODS The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011-2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size. RESULTS The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10-1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79-3.17) and men (RR 1.84, 95% CI: 1.40-2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10-2.02). CONCLUSIONS This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.
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Affiliation(s)
- Maria Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Södra Älvsborg Hospital, Department of Research, Education and Innovation, Borås, Sweden
- Department of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Johanna Brännström
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
| | - Anton Reepalu
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Veronica Svedhem
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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7
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Maged G, Abdelsamed MA, Wang H, Lotfy A. The potency of mesenchymal stem/stromal cells: does donor sex matter? Stem Cell Res Ther 2024; 15:112. [PMID: 38644508 PMCID: PMC11034072 DOI: 10.1186/s13287-024-03722-3] [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: 02/19/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Mesenchymal stem/stromal cells (MSCs) are a promising therapeutic tool in cell therapy and tissue engineering because of their multi-lineage differentiation capacity, immunomodulatory effects, and tissue protective potential. To achieve optimal results as a therapeutic tool, factors affecting MSC potency, including but not limited to cell source, donor age, and cell batch, have been investigated. Although the sex of the donor has been attributed as a potential factor that can influence MSC potency and efficacy, the impact of donor sex on MSC characteristics has not been carefully investigated. In this review, we summarize published studies demonstrating donor-sex-related MSC heterogeneity and emphasize the importance of disclosing donor sex as a key factor affecting MSC potency in cell therapy.
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Affiliation(s)
- Ghada Maged
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Menna A Abdelsamed
- Biotechnology and Life Sciences Department, Faculty of Postgraduate studies for Advanced Sciences, Beni-Suef University, Beni Suef, Egypt
| | - Hongjun Wang
- Department of Surgery, Medical University of South Carolina, 29425, Charleston, SC, USA.
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | - Ahmed Lotfy
- Department of Surgery, Medical University of South Carolina, 29425, Charleston, SC, USA.
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8
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Bose D, Deb Adhikary N, Xiao P, Rogers KA, Ferrell DE, Cheng-Mayer C, Chang TL, Villinger F. SHIV-C109p5 NHP induces rapid disease progression in elderly macaques with extensive GI viral replication. J Virol 2024; 98:e0165223. [PMID: 38299866 PMCID: PMC10878093 DOI: 10.1128/jvi.01652-23] [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: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
CCR5-tropic simian/human immunodeficiency viruses (SHIV) with clade C transmitted/founder envelopes represent a critical tool for the investigation of HIV experimental vaccines and microbicides in nonhuman primates, although many such isolates lead to spontaneous viral control post infection. Here, we generated a high-titer stock of pathogenic SHIV-C109p5 by serial passage in two rhesus macaques (RM) and tested its virulence in aged monkeys. The co-receptor usage was confirmed before infecting five geriatric rhesus macaques (four female and one male). Plasma viral loads were monitored by reverse transcriptase-quantitative PCR (RT-qPCR), cytokines by multiplex analysis, and biomarkers of gastrointestinal damage by enzyme-linked immunosorbent assay. Antibodies and cell-mediated responses were also measured. Viral dissemination into tissues was determined by RNAscope. Intravenous SHIV-C109p5 infection of aged RMs leads to high plasma viremia and rapid disease progression; rapid decrease in CD4+ T cells, CD4+CD8+ T cells, and plasmacytoid dendritic cells; and wasting necessitating euthanasia between 3 and 12 weeks post infection. Virus-specific cellular immune responses were detected only in the two monkeys that survived 4 weeks post infection. These were Gag-specific TNFα+CD8+, MIP1β+CD4+, Env-specific IFN-γ+CD4+, and CD107a+ T cell responses. Four out of five monkeys had elevated intestinal fatty acid binding protein levels at the viral peak, while regenerating islet-derived protein 3α showed marked increases at later time points in the three animals surviving the longest, suggesting gut antimicrobial peptide production in response to microbial translocation post infection. Plasma levels of monocyte chemoattractant protein-1, interleukin-15, and interleukin-12/23 were also elevated. Viral replication in gut and secondary lymphoid tissues was extensive.IMPORTANCESimian/human immunodeficiency viruses (SHIV) are important reagents to study prevention of virus acquisition in nonhuman primate models of HIV infection, especially those representing transmitted/founder (T/F) viruses. However, many R5-tropic SHIV have limited fitness in vivo leading to many monkeys spontaneously controlling the virus post acute infection. Here, we report the generation of a pathogenic SHIV clade C T/F stock by in vivo passage leading to sustained viral load set points, a necessity to study pathogenicity. Unexpectedly, administration of this SHIV to elderly rhesus macaques led to extensive viral replication and fast disease progression, despite maintenance of a strict R5 tropism. Such age-dependent rapid disease progression had previously been reported for simian immunodeficiency virus but not for R5-tropic SHIV infections.
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Affiliation(s)
- Deepanwita Bose
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Nihar Deb Adhikary
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Peng Xiao
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Kenneth A. Rogers
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Douglas E. Ferrell
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | | | - Theresa L. Chang
- The Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Francois Villinger
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
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9
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Nguyen AN, Plotkin AL, Odumade OA, De Armas L, Pahwa S, Morrocchi E, Cotugno N, Rossi P, Foster C, Domínguez-Rodríguez S, Tagarro A, Syphurs C, Diray-Arce J, Fatou B, Ozonoff A, Levy O, Palma P, Smolen KK. Effective early antiretroviral therapy in perinatal-HIV infection reduces subsequent plasma inflammatory profile. Pediatr Res 2023; 94:1667-1674. [PMID: 37308683 DOI: 10.1038/s41390-023-02669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The long-term immunologic effects of antiretroviral therapy (ART) in children with perinatally-acquired HIV (PHIV) have not been fully elucidated. Here, we investigated how the timing of ART initiation affects the long-term immune profile of children living with PHIV by measuring immunomodulatory plasma cytokines, chemokines, and adenosine deaminases (ADAs). METHODS 40 PHIV participants initiated ART during infancy. 39 participant samples were available; 30 initiated ART ≤6 months (early-ART treatment); 9 initiated ART >6 months and <2 years (late-ART treatment). We compared plasma cytokine and chemokine concentrations and ADA enzymatic activities between early-ART and late-ART treatment 12.5 years later and measured correlation with clinical covariates. RESULTS Plasma concentrations of 10 cytokines and chemokines (IFNγ, IL-12p70, IL-13, IL-17A, IL-IRA, IL-5, IL-6, and IL-9 as well as CCL7, CXCL10), ADA1, and ADA total were significantly higher in late-ART compared to early-ART treatment. Furthermore, ADA1 was significantly positively correlated with IFNγ, IL-17A, and IL-12p70. Meanwhile, total ADA was positively correlated with IFNγ, IL-13, IL-17A, IL-1RA, IL-6, and IL-12p70 as well as CCL7. CONCLUSIONS Elevation of several pro-inflammatory plasma analytes in late-ART despite 12.5 years of virologic suppression compared to early-ART treatment suggests that early treatment dampens the long-term plasma inflammatory profile in PHIV participants. IMPACT This study examines differences in the plasma cytokine, chemokine, and ADA profiles 12.5 years after treatment between early (≤6months) and late (>6 months and <2 years) antiretroviral therapy (ART) treatment initiation in a cohort of European and UK study participants living with PHIV. Several cytokines and chemokines (e.g., IFNγ, IL-12p70, IL-6, and CXCL10) as well as ADA-1 are elevated in late-ART treatment in comparison to early-ART treatment. Our results suggest that effective ART treatment initiated within 6 months of life in PHIV participants dampens a long-term inflammatory plasma profile as compared to late-ART treatment.
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Affiliation(s)
- Athena N Nguyen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Alec L Plotkin
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Oludare A Odumade
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Lesley De Armas
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Savita Pahwa
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Elena Morrocchi
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Cotugno
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paolo Rossi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caroline Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Sara Domínguez-Rodríguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Department of Pediatrics, Hospital Universitario Infanta Sofía. Fundación para la Investigación Biomédica e Innovación del Hospital Infanta Sofía y del Henares (FIIB HUIS HHEN). Universidad Europea de Madrid, Madrid, Spain
| | - Caitlin Syphurs
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joann Diray-Arce
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Benoit Fatou
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Al Ozonoff
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT & Harvard, Cambridge, MA, USA
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT & Harvard, Cambridge, MA, USA
| | - Paolo Palma
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Kinga K Smolen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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10
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Horn C, Sprute R, Kretschmer AC, Do C, Cornely OA, Jung N, Lehmann C, Fischer J. [Sex in infectious diseases-How sex differences influence the immune response to infections]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:752-757. [PMID: 37016079 PMCID: PMC10072806 DOI: 10.1007/s00108-023-01498-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
The humoral and cellular immune responses to antigen stimulation, vaccinations and infections differ between women and men. Genetic, epigenetic and hormonal factors contribute to the sex-specific immunity. The expression of genes on the X‑chromosome and the effect of sex hormones substantially influence the immune defence against infections. Females show stronger cellular and humoral immune responses to infections than males, but the enhanced immune response often leads to aberrant inflammatory reactions and autoimmune diseases. Men are principally more prone to bacterial, viral and fungal infections and more often show severe disease courses. In contrast, a more reactive female immune system results in significantly more adverse reactions to vaccinations. In order to be able to better identify the multiple sex-specific that have an influence on the immune system, sex-specific differences should be investigated in a differentiated way. The better understanding of the sex-specific differences in the immune response will have a long-term influence on the prevention, diagnostics and treatment of infectious diseases, and will ultimately contribute to improving healthcare of both women and men.
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Affiliation(s)
- Carola Horn
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
| | - Rosanne Sprute
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Lehrstuhl für Translationale Forschung, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Köln, Excellenz Zentrum Medizinische Mykologie (ECMM), Universität zu Köln, Köln, Deutschland
| | - Alina Chloé Kretschmer
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
| | - Carolin Do
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
| | - Oliver A Cornely
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Lehrstuhl für Translationale Forschung, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für klinische Studien (ZKS Köln), Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Köln, Excellenz Zentrum Medizinische Mykologie (ECMM), Universität zu Köln, Köln, Deutschland
| | - Norma Jung
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
| | - Clara Lehmann
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
| | - Julia Fischer
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland.
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland.
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland.
- Klinik 1 für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50931, Köln, Deutschland.
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11
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Ghahari N, Telittchenko R, Loucif H, Isnard S, Routy JP, Olagnier D, van Grevenynghe J. Harnessing Autophagy to Overcome Antigen-Specific T-Cell Dysfunction: Implication for People Living with HIV-1. Int J Mol Sci 2023; 24:11018. [PMID: 37446195 DOI: 10.3390/ijms241311018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Like other chronic viral infections, HIV-1 persistence inhibits the development of antigen-specific memory T-cells, resulting in the exhaustion of the immune response and chronic inflammation. Autophagy is a major lysosome-dependent mechanism of intracellular large-target degradation such as lipid and protein aggregates, damaged organelles, and intracellular pathogens. Although it is known that autophagy may target HIV-1 for elimination, knowledge of its function as a metabolic contributor in such viral infection is only in its infancy. Recent data show that elite controllers (EC), who are HIV-1-infected subjects with natural and long-term antigen (Ag)-specific T-cell protection against the virus, are characterized by distinct metabolic autophagy-dependent features in their T-cells compared to other people living with HIV-1 (PLWH). Despite durable viral control with antiretroviral therapy (ART), HIV-1-specific immune dysfunction does not normalize in non-controller PLWH. Therefore, the hypothesis of inducing autophagy to strengthen their Ag-specific T-cell immunity against HIV-1 starts to be an enticing concept. The aim of this review is to critically analyze promises and potential limitations of pharmacological and dietary interventions to activate autophagy in an attempt to rescue Ag-specific T-cell protection among PLWH.
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Affiliation(s)
- Nazanin Ghahari
- Institut National de la Recherche Scientifique (INRS), Centre Armand-Frappier Santé Biotechnologie, 531 Boulevard des Prairies, Laval, QC H7V 1M7, Canada
| | - Roman Telittchenko
- Institut National de la Recherche Scientifique (INRS), Centre Armand-Frappier Santé Biotechnologie, 531 Boulevard des Prairies, Laval, QC H7V 1M7, Canada
| | - Hamza Loucif
- EVAH Corp., 500 Boulevard Cartier Ouest, Laval, QC H7V 5B7, Canada
| | - Stephane Isnard
- Chronic Viral Illness Service and Division of Hematology, McGill University Health Centre, Glen Site, Montreal, QC H4A 3J1, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service and Division of Hematology, McGill University Health Centre, Glen Site, Montreal, QC H4A 3J1, Canada
| | - David Olagnier
- Department of Biomedicine, Research Center for Innate Immunology, Aarhus University, 8000 Aarhus, Denmark
| | - Julien van Grevenynghe
- Institut National de la Recherche Scientifique (INRS), Centre Armand-Frappier Santé Biotechnologie, 531 Boulevard des Prairies, Laval, QC H7V 1M7, Canada
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12
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Oliveira MF, Pankow A, Vollbrecht T, Kumar NM, Cabalero G, Ignacio C, Zhao M, Vitomirov A, Gouaux B, Nakawawa M, Murrell B, Ellis RJ, Gianella S. Evaluation of Archival HIV DNA in Brain and Lymphoid Tissues. J Virol 2023; 97:e0054323. [PMID: 37184401 PMCID: PMC10308944 DOI: 10.1128/jvi.00543-23] [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: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
HIV reservoirs persist in anatomic compartments despite antiretroviral therapy (ART). Characterizing archival HIV DNA in the central nervous system (CNS) and other tissues is crucial to inform cure strategies. We evaluated paired autopsy brain-frontal cortex (FC), occipital cortex (OCC), and basal ganglia (BG)-and peripheral lymphoid tissues from 63 people with HIV. Participants passed away while virally suppressed on ART at the last visit and without evidence of CNS opportunistic disease. We quantified total HIV DNA in all participants and obtained full-length HIV-envelope (FL HIV-env) sequences from a subset of 14 participants. We detected HIV DNA (gag) in most brain (65.1%) and all lymphoid tissues. Lymphoid tissues had higher HIV DNA levels than the brain (P < 0.01). Levels of HIV gag between BG and FC were similar (P > 0.2), while OCC had the lowest levels (P = 0.01). Females had higher HIV DNA levels in tissues than males (gag, P = 0.03; 2-LTR, P = 0.05), suggesting possible sex-associated mechanisms for HIV reservoir persistence. Most FL HIV-env sequences (n = 143) were intact, while 42 were defective. Clonal sequences were found in 8 out of 14 participants, and 1 participant had clonal defective sequences in the brain and spleen, suggestive of cell migration. From 10 donors with paired brain and lymphoid sequences, we observed evidence of compartmentalized sequences in 2 donors. Our data further the idea that the brain is a site for archival HIV DNA during ART where compartmentalized provirus may occur in a subset of people. Future studies assessing FL HIV-provirus and replication competence are needed to further evaluate the HIV reservoirs in tissues. IMPORTANCE HIV infection of the brain is associated with adverse neuropsychiatric outcomes, despite efficient antiretroviral treatment. HIV may persist in reservoirs in the brain and other tissues, which can seed virus replication if treatment is interrupted, representing a major challenge to cure HIV. We evaluated reservoirs and genetic features in postmortem brain and lymphoid tissues from people with HIV who passed away during suppressed HIV replication. We found a differential distribution of HIV reservoirs across brain regions which was lower than that in lymphoid tissues. We observed that most HIV reservoirs in tissues had intact envelope sequences, suggesting they could potentially generate replicative viruses. We found that women had higher HIV reservoir levels in brain and lymphoid tissues than men, suggesting possible sex-based mechanisms of maintenance of HIV reservoirs in tissues, warranting further investigation. Characterizing the archival HIV DNA in tissues is important to inform future HIV cure strategies.
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Affiliation(s)
- Michelli F. Oliveira
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alec Pankow
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Vollbrecht
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Nikesh M. Kumar
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Gemma Cabalero
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Caroline Ignacio
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Mitchell Zhao
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Andrej Vitomirov
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ben Gouaux
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Masato Nakawawa
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ben Murrell
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ronald J. Ellis
- Department of Neurosciences and Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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13
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Masenga SK, Mweene BC, Luwaya E, Muchaili L, Chona M, Kirabo A. HIV-Host Cell Interactions. Cells 2023; 12:1351. [PMID: 37408185 DOI: 10.3390/cells12101351] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 07/07/2023] Open
Abstract
The development of antiretroviral drugs (ARVs) was a great milestone in the management of HIV infection. ARVs suppress viral activity in the host cell, thus minimizing injury to the cells and prolonging life. However, an effective treatment has remained elusive for four decades due to the successful immune evasion mechanisms of the virus. A thorough understanding of the molecular interaction of HIV with the host cell is essential in the development of both preventive and curative therapies for HIV infection. This review highlights several inherent mechanisms of HIV that promote its survival and propagation, such as the targeting of CD4+ lymphocytes, the downregulation of MHC class I and II, antigenic variation and an envelope complex that minimizes antibody access, and how they collaboratively render the immune system unable to mount an effective response.
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Affiliation(s)
- Sepiso K Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia
- Vanderbilt University Medical Center, Department of Medicine, Division of Clinical Pharmacology, Room 536 Robinson Research Building, Nashville, TN 37232-6602, USA
| | - Bislom C Mweene
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia
| | - Emmanuel Luwaya
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia
| | - Lweendo Muchaili
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia
| | - Makondo Chona
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia
| | - Annet Kirabo
- Vanderbilt University Medical Center, Department of Medicine, Division of Clinical Pharmacology, Room 536 Robinson Research Building, Nashville, TN 37232-6602, USA
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14
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Nijhawan P, Carraro A, Vita S, Del Borgo C, Tortellini E, Guardiani M, Zingaropoli MA, Mengoni F, Petrozza V, Di Troia L, Marcucci I, Kertusha B, Scerpa MC, Turriziani O, Vullo V, Ciardi MR, Mastroianni CM, Marocco R, Lichtner M. Systemic, Mucosal Immune Activation and Psycho-Sexual Health in ART-Suppressed Women Living with HIV: Evaluating Biomarkers and Environmental Stimuli. Viruses 2023; 15:v15040960. [PMID: 37112940 PMCID: PMC10144999 DOI: 10.3390/v15040960] [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: 01/20/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Gender medicine is now an approach that can no longer be neglected and must be considered in scientific research. We investigated the systemic and mucosal immune response in a population of women living with HIV (WLWH) who were receiving successful ART and the sexual and psychological repercussions of HIV infection on the women's health. As control group, healthy women (HW) matched for age and sex distribution, without any therapy, were included. In summary, our study highlighted the persistence of immune-inflammatory activation in our population, despite virological suppression and a normal CD4 cell count. We found a hyperactivation of the systemic monocyte and an increase in inflammatory cytokine concentrations at the systemic level. The analysis carried out showed a significantly higher risk of HPV coinfection in WLWH compared to HW. Furthermore, our data revealed that WLWH have a profile compatible with sexual dysfunction and generalized anxiety disorders. Our study underlines that patients living with HIV should be evaluated by multidisciplinary teams. These findings also support the idea that more and different immunological markers, in addition to those already used in clinical practice, are needed. Further studies should be carried out to clarify which of these could represent future therapy targets.
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Affiliation(s)
- Parni Nijhawan
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Serena Vita
- INMI IRCCS Lazzaro Spallanzani, via Portuense, 00149 Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Vincenzo Petrozza
- UOC of Pathology, Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome Polo Pontino, I.C.O.T, 04100 Latina, Italy
| | - Luciana Di Troia
- Department of Andrology and Pathophysiology of Reproduction, Santa Maria (SM) Goretti Hospital, 04100 Latina, Italy
| | - Immacolata Marcucci
- Department of Andrology and Pathophysiology of Reproduction, Santa Maria (SM) Goretti Hospital, 04100 Latina, Italy
| | - Blerta Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Maria Cristina Scerpa
- Hematology Unit, Santa Maria (SM) Goretti Hospital, AUSL Latina, 04100 Latina, Italy
| | - Ombretta Turriziani
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Raffaella Marocco
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
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15
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Philip AA, King J, Durham J. Lived experiences of persons with disabilities living with HIV in accessing HIV services in Africa: a qualitative systematic review. Disabil Rehabil 2023; 45:937-949. [PMID: 35298321 DOI: 10.1080/09638288.2022.2051079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This qualitative review applies an intersectional lens to explore the lived experiences of persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in accessing HIV services. METHODS Using thematic analysis, the intersections relating to HIV, disability, gender, stigma, and poverty were explored. RESULTS Three themes were identified from the analysis: (1) intersection of gender, HIV, and disability - "For a man, it is easier because we women have a lot to take care of at the home and would not have enough time to go get services"; (2) intersection of stigma, HIV, and disability - "…Look at that one. He's disabled, at the same time HIV-positive. He doesn't even feel sorry for himself … to die quietly at home"; (3) intersection of poverty, HIV, and disability - "…maybe you don't even have money to buy food and if you're on medication you need to eat frequently". The findings highlighted how stigma, poverty, and gender collide in a hierarchy of identities to impede accessibility to HIV services. CONCLUSIONS Researchers and programme implementers should note the intersecting issues of marginalisation that influence inequities in access to HIV services for PWDs living with HIV. National Strategic Plans should address these specific barriers to ensure accessibility for this marginalised population.Implications for rehabilitationGovernments within Africa should commit to including persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in National Strategic Plans (NSPs), which will support disability-inclusive HIV programming. The development process of NSPs should also include PWDs living with HIV.The inaccessibility of HIV services for PWDs living with HIV is multifaceted and intersectional. Interventions that consider the different social identities such as gender and socioeconomic status of PWDs living with HIV may be more impactful.Understanding the specific dimensions of access that impacted both the demand and supply side will facilitate efficient HIV programming for PWDs living with HIV.
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Affiliation(s)
- Aaron Akpu Philip
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Julie King
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Joanne Durham
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
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16
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Altfeld M, Scully EP. Sex Differences in HIV Infection. Curr Top Microbiol Immunol 2023; 441:61-73. [PMID: 37695425 DOI: 10.1007/978-3-031-35139-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Biological sex has wide-ranging impacts on HIV infection spanning differences in acquisition risk, the pathogenesis of untreated infection, impact of chronic treated disease and prospects for HIV eradication or functional cure. This chapter summarizes the scope of these differences and discusses several features of the immune response thought to contribute to the clinical outcomes.
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Affiliation(s)
- Marcus Altfeld
- Department Virus Immunology, Leibniz Institute for Virology, Hamburg, Germany
| | - Eileen P Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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17
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Briggs J, Murray M, Nideffer J, Jagannathan P. Sex-Linked Differences in Malaria Risk Across the Lifespan. Curr Top Microbiol Immunol 2023; 441:185-208. [PMID: 37695429 DOI: 10.1007/978-3-031-35139-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Despite the high burden of malaria worldwide, there is surprisingly scarce research on sex-based differences in malaria outside of pregnancy. A more thorough understanding of sexual dimorphism in malaria, and what underlies these sex-based differences, could elucidate the underlying mechanisms driving malaria pathogenesis and has the potential to inform malaria control efforts, including new vaccines. This review summarizes our current understanding of sex-based differences in the epidemiology of malaria across the lifespan, potential sex- or gender-based mechanisms driving these differences, and the knowledge gaps that need to be addressed.
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Affiliation(s)
- Jessica Briggs
- Department of Medicine, University of California, San Francisco, California, United States
| | - Margaret Murray
- Department of Medicine, University of California, San Francisco, California, United States
| | - Jason Nideffer
- Department of Medicine, Stanford University, Stanford, California, United States
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States.
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18
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Toribio M, Awadalla M, Drobni ZD, Quinaglia T, Wang M, Durbin CG, Alagpulinsa DA, Fourman LT, Suero-Abreu GA, Nelson MD, Stanley TL, Longenecker CT, Burdo TH, Neilan TG, Zanni MV. Cardiac strain is lower among women with HIV in relation to monocyte activation. PLoS One 2022; 17:e0279913. [PMID: 36584183 PMCID: PMC9803182 DOI: 10.1371/journal.pone.0279913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women with HIV (WWH) face heightened risks of heart failure; however, insights on immune/inflammatory pathways potentially contributing to left ventricular (LV) systolic dysfunction among WWH remain limited. SETTING Massachusetts General Hospital, Boston, Massachusetts. METHODS Global longitudinal strain (GLS) is a sensitive measure of LV systolic function, with lower cardiac strain predicting incident heart failure and adverse heart failure outcomes. We analyzed relationships between GLS (cardiovascular magnetic resonance imaging) and monocyte activation (flow cytometry) among 20 WWH and 14 women without HIV. RESULTS WWH had lower GLS compared to women without HIV (WWH vs. women without HIV: 19.4±3.0 vs. 23.1±1.9%, P<0.0001). Among the whole group, HIV status was an independent predictor of lower GLS. Among WWH (but not among women without HIV), lower GLS related to a higher density of expression of HLA-DR on the surface of CD14+CD16+ monocytes (ρ = -0.45, P = 0.0475). Further, among WWH, inflammatory monocyte activation predicted lower GLS, even after controlling for CD4+ T-cell count and HIV viral load. CONCLUSIONS Additional studies among WWH are needed to examine the role of inflammatory monocyte activation in the pathogenesis of lower GLS and to determine whether targeting this immune pathway may mitigate risks of heart failure and/or adverse heart failure outcomes. TRIAL REGISTRATION Clinical trials.gov registration: NCT02874703.
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Affiliation(s)
- Mabel Toribio
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Magid Awadalla
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Zsofia D. Drobni
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Thiago Quinaglia
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Melissa Wang
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Claudia G. Durbin
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - David A. Alagpulinsa
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Lindsay T. Fourman
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Giselle Alexandra Suero-Abreu
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Michael D. Nelson
- Department of Kinesiology, Applied Physiology and Advanced Imaging Laboratory, University of Texas at Arlington, Arlington, TX, United States of America
| | - Takara L. Stanley
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Christopher T. Longenecker
- Division of Cardiology and Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Tricia H. Burdo
- Department of Microbiology, Immunology, and Inflammation, Center for Neurovirology and Gene Editing, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Tomas G. Neilan
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Markella V. Zanni
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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19
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Karim QA, Archary D, Barré-Sinoussi F, Broliden K, Cabrera C, Chiodi F, Fidler SJ, Gengiah TN, Herrera C, Kharsany ABM, Liebenberg LJP, Mahomed S, Menu E, Moog C, Scarlatti G, Seddiki N, Sivro A, Cavarelli M. Women for science and science for women: Gaps, challenges and opportunities towards optimizing pre-exposure prophylaxis for HIV-1 prevention. Front Immunol 2022; 13:1055042. [PMID: 36561760 PMCID: PMC9763292 DOI: 10.3389/fimmu.2022.1055042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Preventing new HIV infections remains a global challenge. Young women continue to bear a disproportionate burden of infection. Oral pre-exposure prophylaxis (PrEP), offers a novel women-initiated prevention technology and PrEP trials completed to date underscore the importance of their inclusion early in trials evaluating new HIV PrEP technologies. Data from completed topical and systemic PrEP trials highlight the role of gender specific physiological and social factors that impact PrEP uptake, adherence and efficacy. Here we review the past and current developments of HIV-1 prevention options for women with special focus on PrEP considering the diverse factors that can impact PrEP efficacy. Furthermore, we highlight the importance of inclusion of female scientists, clinicians, and community advocates in scientific efforts to further improve HIV prevention strategies.
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Affiliation(s)
- Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kristina Broliden
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Center for Molecular Medicine, Stockholm, Sweden
| | - Cecilia Cabrera
- AIDS Research Institute IrsiCaixa, Institut de Recerca en Ciències de la Salut Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Sarah J. Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London UK and Imperial College NIHR BRC, London, United Kingdom
| | - Tanuja N. Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carolina Herrera
- Department of Infectious Disease, Section of Virology, Faculty of Medicine, Imperial College London, London, United Kingdom,*Correspondence: Carolina Herrera,
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lenine J. P. Liebenberg
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sharana Mahomed
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Menu
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France,MISTIC Group, Department of Virology, Institut Pasteur, Paris, France
| | - Christiane Moog
- Laboratoire d’ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Gabriella Scarlatti
- Viral Evolution and Transmission Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nabila Seddiki
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa,JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Mariangela Cavarelli
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
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20
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Tosiano MA, Mar H, Hoeth D, Eron JJ, Gandhi RT, McMahon DK, Bosch RJ, Mellors JW, Cyktor JC. Comparative sensitivity of automated (Abbott M2000) and manual plasma HIV-1 RNA PCR assays for the detection of persistent viremia after long-term antiretroviral therapy. J Virus Erad 2022; 8:100095. [PMID: 36479541 PMCID: PMC9720429 DOI: 10.1016/j.jve.2022.100095] [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] [Received: 09/16/2022] [Revised: 10/19/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background The ability of automated, FDA-cleared plasma HIV-1 RNA assays to detect low-level viremia, compared to manual, highly sensitive research-only methods, is not well-defined. We therefore tested paired plasma samples from people with HIV-1 (PWH) on long-term antiretroviral therapy (ART) with both the Abbott M2000 RealTime HIV-1 Viral Load assay (Abbott) and a quantitative reverse transcriptase (RT)-initiated PCR assay that has a reported 95% detection limit of 1 HIV-1 RNA copy/ml (single copy assay, SCA). Methods Plasma samples from 309 participants in the AIDS Clinical Trials Group study A5321 were tested by both Abbott and SCA. Participants were mostly men (82%). All were on stable ART for a median of 7 years with HIV-1 RNA <40 copies/mL by Abbott. Pooled plasma from each donor was divided and tested. Abbott results were reported as target detected <40 copies/mL but not quantifiable (target detected <40) or target not detected (TND), and SCA results were classified as HIV-1 RNA detected or not detected. Results By Abbott, 17% (51/309) of sample results were target detected <40, whereas 83% (258/309) were TND. Of the samples that were target detected <40 by Abbott, 73% (37/51) had HIV-1 RNA detected by SCA. By contrast, 43% of samples that were TND by Abbott (110/258) had HIV-1 RNA detected by SCA (p < 0.001). Conclusion Plasma samples from PWH with HIV-1 RNA detected but <40 copies/ml by the automated Abbott M2000 assay are likely (73% of 51 samples) to have HIV-1 RNA detected by an optimized manual assay with single copy sensitivity. An Abbott HIV-1 RNA result of target not detected did not exclude low-level viremia: 43% of 258 samples had HIV-1 RNA detected by the single copy assay. These findings indicate that the Abbott M2000 assay cannot exclude the persistence of viremia on ART and thus may have less utility, compared to a manual single copy assay, for assessing the impact of experimental interventions designed to eliminate low-level viremia as a step towards achieving ART-free HIV-1 remission.
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Affiliation(s)
| | - Hanna Mar
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - for the A5321 Team
- University of Pittsburgh, Pittsburgh, PA, USA
- Harvard TH Chan School of Public Health, Boston, MA, USA
- University of North Carolina, Chapel Hill, NC, USA
- Massachusetts General Hospital, Boston, MA, USA
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21
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Weiser B, Shi B, Kemal K, Burger H, Minkoff H, Shi Q, Gao W, Robison E, Holman S, Schroeder T, Gormley A, Anastos K, Ramirez C. Long-term antiretroviral therapy mitigates mortality and morbidity independent of HIV tropism: 18 years follow-up in a women's cohort. AIDS 2022; 36:1979-1986. [PMID: 35848576 PMCID: PMC9617757 DOI: 10.1097/qad.0000000000003337] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE CXCR4 (X4)-tropic HIV-1 was found previously to herald CD4 + cell depletion and disease progression in individuals who were antiretroviral-naive or took combination antiretroviral therapy (cART) for less than 5 years. We updated this finding by investigating whether the deleterious effect of X4-tropic strains is mitigated by long-term cART. DESIGN We examined morbidity and mortality in relation to HIV-1 tropism and cART in 529 participants followed up to 18 years in the Women's Interagency HIV Study; 91% were women of color. METHODS Plasma-derived HIV-1 tropism was determined genotypically. RESULTS We categorized participants according to the number of visits reported on cART after initiation. Group 1: three or less visits, 74% of these participants reporting no cART; group 2: at least four visits and less than 70% of visits on cART; group 3: at least 70% of visits on cART. AIDS mortality rates for participants in each group with X4 virus compared with those with R5 virus exclusively were, respectively: 62 vs. 40% ( P = 0.0088); 23% vs. 22% [nonsignificant (NS)]; 7% vs. 14% (NS). Kaplan-Meier curves showed accelerated progression to AIDS death or AIDS-defining illness in participants with three or less cART visits and X4 viruses ( P = 0.0028) but no difference in progression rates stratified by tropism in other groups. Logistic regression found that HIV-1 suppression for at least 10 semiannual visits (≥5 years total) mitigated X4 tropism's deleterious effect on mortality, controlling for maximal viral load, and CD4 + nadir. CONCLUSION Long-term cART markedly mitigated the deleterious effect of X4 viruses on AIDS morbidity and mortality. Mitigation was correlated with duration of viral suppression, supporting HIV-1 suppression as a crucial goal.
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Affiliation(s)
- Barbara Weiser
- Department of Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Medicine, Veterans Affairs Northern California Healthcare System, Sacramento Medical Center, Mather, CA
| | - Binshan Shi
- Department of Basic and Clinical Sciences, Albany College of Pharmacy and Health Sciences
| | - Kimdar Kemal
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Harold Burger
- Department of Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Medicine, Veterans Affairs Northern California Healthcare System, Sacramento Medical Center, Mather, CA
| | - Howard Minkoff
- Department of Obstetrics/Gynecology, State University of New York Health Science Center at Brooklyn
| | - Qiuhu Shi
- Department of Statistics, School of Health Sciences and Practice, New York Medical College, Valhalla
| | - Wei Gao
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health Systems, Bronx
| | - Esther Robison
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health Systems, Bronx
| | - Susan Holman
- Department of Medicine, State University of New York Health Science Center at Brooklyn, NY
| | - Tamara Schroeder
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Alissa Gormley
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health Systems, Bronx
| | - Christina Ramirez
- Department of Biostatistics, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
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22
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Shelton BA, Sawinski D, MacLennan PA, Lee W, Wyatt C, Nadkarni G, Fatima H, Mehta S, Crane HM, Porrett P, Julian B, Moore RD, Christopoulos K, Jacobson JM, Muller E, Eron JJ, Saag M, Peter I, Locke JE. Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study. EClinicalMedicine 2022; 53:101653. [PMID: 36159042 PMCID: PMC9489495 DOI: 10.1016/j.eclinm.2022.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023] Open
Abstract
Background Women represent a meaningful proportion of new HIV diagnoses, with Black women comprising 58% of new diagnoses among women. As HIV infection also increases risk of chronic kidney disease (CKD), understanding CKD risk among women with HIV (WWH), particularly Black women, is critical. Methods In this longitudinal cohort study of people with HIV (PWH) enrolled in CFAR Network of Integrated Clinical Systems (CNICS), a multicentre study comprised of eight academic medical centres across the United States from Jan 01, 1996 and Nov 01, 2019, adult PWH were excluded if they had ≤2 serum creatinine measurements, developed CKD prior to enrollment, or identified as intersex or transgendered, leaving a final cohort of 33,998 PWH. The outcome was CKD development, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1·73 m2 calculated using the CKD-EPI equation, for ≥90 days with no intervening higher values. Findings Adjusting for demographic and clinical characteristics, WWH were 61% more likely to develop CKD than men (adjusted hazard ratio [aHR]: 1·61, 95% CI: 1·46-1·78, p<0·001). This difference persisted after further adjustment for APOL1 risk variants (aHR female sex: 1·92, 95% CI: 1·63-2·26, p<0·001) and substance abuse (aHR female sex: 1·70, 95% CI: 1·54-1·87, p<0·001). Interpretation WWH experienced increased risk of CKD. Given disparities in care among patients with end-stage kidney disease, efforts to engage WWH in nephrology care to improve chronic disease management are critical. Funding US National Institutes of Health.
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Affiliation(s)
- Brittany A. Shelton
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
| | | | - Paul A. MacLennan
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Wonjun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Girish Nadkarni
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Huma Fatima
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Shikha Mehta
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Heidi M. Crane
- University of Washington School of Medicine, United States
| | - Paige Porrett
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Bruce Julian
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | | | | | | | - Elmi Muller
- Stellenbosch University, Medicine and Health Sciences, South Africa
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill School of Medicine, United States
| | - Michael Saag
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jayme E. Locke
- University of Alabama at Birmingham Heersink School of Medicine, United States
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23
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Looby SE, Kantor A, Burdo TH, Currier JS, Fichtenbaum CJ, Overton ET, Aberg JA, Malvestutto CD, Bloomfield GS, Erlandson KM, Cespedes M, Kallas EG, Masiá M, Thornton AC, Smith MD, Flynn JM, Kileel EM, Fulda E, Fitch KV, Lu MT, Douglas PS, Grinspoon SK, Ribaudo HJ, Zanni MV. Factors Associated With Systemic Immune Activation Indices in a Global Primary Cardiovascular Disease Prevention Cohort of People With Human Immunodeficiency Virus on Antiretroviral Therapy. Clin Infect Dis 2022; 75:1324-1333. [PMID: 35235653 PMCID: PMC9555837 DOI: 10.1093/cid/ciac166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Among antiretroviral therapy (ART)-treated people with human immunodeficiency virus (PWH), persistent systemic immune activation contributes to atherogenesis atherosclerotic, cardiovascular disease (CVD) events, and mortality. Factors associated with key immune activation indices have not previously been characterized among a global primary CVD prevention cohort of PWH. METHODS Leveraging baseline Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) data, we evaluated factors associated with soluble CD14 (sCD14) and oxidized low-density lipoprotein (oxLDL). RESULTS The primary analysis cohort included 4907 participants from 5 global-burden-of-disease regions (38% female, 48% Black, median age 50 years). In fully adjusted models for sCD14, female sex and White race (among those in high-income regions) were associated with higher sCD14 levels, while higher body mass index (BMI) and current use of nucleoside reverse transcriptase inhibitor + integrase strand transfer inhibitor ART were associated with lower sCD14 levels. In fully adjusted models for oxLDL, male sex, residence in high-income regions, White race (among those in high-income regions), and higher BMI were associated with higher oxLDL levels. In a subanalysis cohort of 1396 women with HIV, increased reproductive age was associated with higher sCD14 levels but not with higher oxLDL levels. CONCLUSIONS Factors associated with sCD14 and oxLDL, 2 key indices of immune-mediated CVD risk, differ. Future studies will elucidate ways in which medications (eg, statins) and behavioral modifications influence sCD14 and oxLDL and the extent to which dampening of these markers mediates CVD-protective effects. CLINICAL TRIALS REGISTRATION NCT0234429.
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Affiliation(s)
- Sara E Looby
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tricia H Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Judith S Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Gerald S Bloomfield
- Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kristine M Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado–nschutz Medical Campus, Aurora, Colorado, USA
| | - Michelle Cespedes
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Esper G Kallas
- Departmento de Molestias Infecciosas e Parasitárias, University of Sao Paulo, Sao Paulo, Brazil
| | - Mar Masiá
- Department of Infectious Diseases, Hospital General Universitario de Elche, Alicante, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain
| | - Alice C Thornton
- Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Mandy D Smith
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacqueline M Flynn
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emma M Kileel
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Evelynne Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela S Douglas
- Duke University Research Institute, Duke University School of Medicine, Durham North Carolina, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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24
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McNeill J, Okello S, Sentongo R, Kakuhikire B, Tsai AC, Christiani DC, Zanni MV, Siedner MJ, North CM. Chronic Human Immunodeficiency Virus Infection Is Associated with Accelerated Decline of Forced Expiratory Volume in 1 Second among Women but Not among Men: A Longitudinal Cohort Study in Uganda. Ann Am Thorac Soc 2022; 19:1779-1783. [PMID: 35767026 PMCID: PMC9753523 DOI: 10.1513/annalsats.202111-1275rl] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jenna McNeill
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Samson Okello
- Mbarara University of Science and TechnologyMbarara, Uganda
- Harvard T.H. Chan School of Public HealthBoston, Massachusetts
| | - Ruth Sentongo
- Mbarara University of Science and TechnologyMbarara, Uganda
| | | | - Alexander C. Tsai
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - David C. Christiani
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- Harvard T.H. Chan School of Public HealthBoston, Massachusetts
| | | | - Mark J. Siedner
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- Mbarara University of Science and TechnologyMbarara, Uganda
| | - Crystal M. North
- Massachusetts General HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
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25
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Kentoffio K, Temu TM, Shakil SS, Zanni MV, Longenecker CT. Cardiovascular disease risk in women living with HIV. Curr Opin HIV AIDS 2022; 17:270-278. [PMID: 35938460 PMCID: PMC9370828 DOI: 10.1097/coh.0000000000000756] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To synthesize current evidence on the impact of cardiovascular disease among women living with HIV (WLWH) with a particular focus on disease prevalence, mechanisms and prevention. RECENT FINDINGS HIV-related cardiovascular disease risk is 1.5-fold to 2-fold higher for women than for men. Mechanisms of enhanced risk are multifactorial and include reinforcing pathways between traditional risk factors, metabolic dysregulation, early reproductive aging and chronic immune activation. These pathways influence both the presentation of overt syndromes of myocardial infarction, stroke and heart failure, as well as subclinical disease, such as microvascular dysfunction and cardiac fibrosis. Cardiovascular disease, therefore, remains a consistent threat to healthy aging among WLWH. SUMMARY Although no specific prevention strategies exist, patient-centered risk mitigation approaches that are adaptable to the needs of aging individuals are essential to combat disparities in cardiovascular outcomes among WLWH. Further research into the optimal prevention approach for CVD among WLWH, particularly for women living in under-resourced health systems, is needed.
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Affiliation(s)
- Katherine Kentoffio
- Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Tecla M Temu
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Saate S Shakil
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Markella V. Zanni
- Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Chris T. Longenecker
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
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26
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Gianella S, Rawlings SA, Dobrowolski C, Nakazawa M, Chaillon A, Strain M, Layman L, Caballero G, Scully E, Scott B, Pacis C, Weber KM, Landay A, Anderson C, Karn J. Sex Differences in Human Immunodeficiency Virus Persistence and Reservoir Size During Aging. Clin Infect Dis 2022; 75:73-80. [PMID: 34612493 PMCID: PMC9402699 DOI: 10.1093/cid/ciab873] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sex differences in human immunodeficiency virus (HIV) reservoir dynamics remain underexplored. METHODS Longitudinal samples from virally suppressed midlife women (n = 59, median age 45 years) and age-matched men (n = 31) were analyzed retrospectively. At each time point, we measured sex hormones (by means of enzyme-linked immunosorbent assay) and cellular HIV DNA and RNA (by means of digital droplet polymerase chain reaction). Number of inducible HIV RNA+ cells, which provides an upper estimate of the replication-competent reservoir, was quantified longitudinally in a different subset of 14 women, across well-defined reproductive stages. Mixed-effects models included normalized reservoir outcomes and sex, time since antiretroviral therapy (ART) initiation, and the sex-by-time interaction as predictors. RESULTS At ART initiation, women and men had median (interquartile range [IQR]) CD4+ T-cell counts of 204/μL (83-306/μL) versus 238/μL (120-284/μL), respectively; median ages of 45 (42-48) versus 47 (43-51) years; and median follow-up times of 79.2/μL (60.5-121.1/μL) versus 66.2/μL (43.2-80.6/μL) months. We observed a significant decline of total HIV DNA over time in both men and women (P < .01). However, the rates of change differed significantly between the sexes (P < .01), with women having a significantly slower rate of decline than men, more pronounced with age. By contrast, the levels of inducible HIV RNA increased incrementally over time in women during reproductive aging (P < .01). CONCLUSIONS In contrast to men, in whom the HIV reservoir steadily declines with aging, the HIV reservoir in women is more dynamic. Total HIV DNA (including intact and defective genomes) declines more slowly in women than in men, while the inducible HIV RNA+ reservoir, which is highly enriched in replication-competent virus, increases in women after menopause.
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Affiliation(s)
- Sara Gianella
- University of California San Diego, La Jolla, California, USA
| | | | - Curtis Dobrowolski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, Georgia, USA
| | - Masato Nakazawa
- University of California San Diego, La Jolla, California, USA
| | | | - Matthew Strain
- University of California San Diego, La Jolla, California, USA
| | - Laura Layman
- University of California San Diego, La Jolla, California, USA
| | - Gemma Caballero
- University of California San Diego, La Jolla, California, USA
| | | | - Brianna Scott
- University of California San Diego, La Jolla, California, USA
| | - Caitleen Pacis
- University of California San Diego, La Jolla, California, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine/Cook County Health, Chicago, Illinois, USA
| | - Alan Landay
- Rush University Medical Center, Chicago, Illinois, USAand
| | | | - Jonathan Karn
- Case Western Reserve University, Cleveland, Ohio, USA
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27
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Vanpouille C, Wells A, Wilkin T, Mathad JS, Morris S, Margolis L, Gianella S. Sex differences in cytokine profiles during suppressive antiretroviral therapy. AIDS 2022; 36:1215-1222. [PMID: 35608113 PMCID: PMC9283283 DOI: 10.1097/qad.0000000000003265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite lower plasma HIV RNA levels, women progress faster to AIDS than men. The reasons for these differences are not clear but might be a consequence of an elevated inflammatory response in women. METHODS We investigated sex differences in cytokine profiles by measuring the concentrations of 36 cytokines/chemokines by Luminex in blood of women and men (sex at birth) with chronic HIV infection under suppressive therapy. We initially performed a principal component analysis to see if participants clustered by sex, and then fit a partial least squares discriminant analysis (PLS-DA) model where we used cytokines to predict sex at birth. The significance of the difference in nine cytokines with VIP greater than 1 was tested using Wilcoxon test-rank. Further, potential confounding factors were tested by multivariate linear regression models. RESULTS Overall, we predicted sex at birth in the PLS-DA model with an error rate of approximately 13%. We identified five cytokines, which were significantly higher in women compared with men, namely the pro-inflammatory chemokines CXCL1 (Gro-α), CCL5 (RANTES), CCL3 (MIP-1α), CCL4 (MIP-1β), as well as the T-cell homeostatic factor IL-7. The effect of sex remained significant after adjusting for CD4 + , age, ethnicity, and race for all cytokines, except for CCL3 and race. CONCLUSION The observed sex-based differences in cytokines might contribute to higher immune activation in women compared with men despite suppressive therapy. Increased levels of IL-7 in women suggest that homeostatic proliferation may have a differential contribution to HIV reservoir maintenance in female and male individuals. Our study emphasizes the importance of sex-specific studies of viral pathogenesis.
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Affiliation(s)
- Christophe Vanpouille
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Alan Wells
- Department of Medicine, University of California San Diego, La Jolla, CA
| | | | | | - Sheldon Morris
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Leonid Margolis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sara Gianella
- Department of Medicine, University of California San Diego, La Jolla, CA
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Clinical characteristics and risk factors for COVID-19 infection and disease severity: A nationwide observational study in Estonia. PLoS One 2022; 17:e0270192. [PMID: 35709192 PMCID: PMC9202832 DOI: 10.1371/journal.pone.0270192] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/06/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has led to overloading of health systems all over the world. For reliable risk stratification, knowledge on factors predisposing to SARS-CoV-2 infection and to severe COVID-19 disease course is needed for decision-making at the individual, provider, and government levels. Data to identify these factors should be easily obtainable. METHODS AND FINDINGS Retrospective cohort study of nationwide e-health databases in Estonia. We used longitudinal health records from 66,295 people tested positive for SARS-CoV-2 RNA from 26 February 2020 to 28 February 2021 and 254,958 randomly selected controls from the reference population with no known history of SARS-CoV-2 infection or clinical COVID-19 diagnosis (case to control ratio 1:4) to predict risk factors of infection and severe course of COVID-19. We analysed sociodemographic and health characteristics of study participants. The SARS-CoV-2 infection risk was slightly higher among women, and was higher among those with comorbid conditions or obesity. Dementia (RRR 3.77, 95%CI 3.30⎼4.31), renal disease (RRR 1.88, 95%CI 1.56⎼2.26), and cerebrovascular disease (RRR 1.81, 95%CI 1.64⎼2.00) increased the risk of infection. Of all SARS-CoV-2 infected people, 92% had a non-severe disease course, 4.8% severe disease (requiring hospitalisation), 1.7% critical disease (needing intensive care), and 1.5% died. Male sex, increasing age and comorbid burden contributed significantly to more severe COVID-19, and the strength of association for male sex increased with the increasing severity of COVID-19 outcome. The strongest contributors to critical illness (expressed as RRR with 95% CI) were renal disease (7.71, 4.71⎼12.62), the history of previous myocardial infarction (3.54, 2.49⎼5.02) and obesity (3.56, 2.82⎼4.49). The strongest contributors to a lethal outcome were renal disease (6.48, 3.74⎼11.23), cancer (3.81, 3.06⎼4.75), liver disease (3.51, 1.36⎼9.02) and cerebrovascular disease (3.00, 2.31⎼3.89). CONCLUSIONS We found divergent effect of age and gender on infection risk and severity of COVID-19. Age and gender did not contribute substantially to infection risk, but did so for the risk of severe disease Co-morbid health conditions, especially those affecting renin-angiotensin system, had an impact on both the risk of infection and severe disease course. Age and male sex had the most significant impact on the risk of severe COVID-19. Taking into account the role of ACE2 receptors in the pathogenesis of SARS-CoV-2 infection, as well as its modulating action on the renin-angiotensin system in cardiovascular and renal diseases, further research is needed to investigate the influence of hormonal status on ACE2 expression in different tissues, which may be the basis for the development of COVID-19 therapies.
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Congy-Jolivet N, Cenac C, Dellacasagrande J, Puissant-Lubrano B, Apoil PA, Guedj K, Abbas F, Laffont S, Sourdet S, Guyonnet S, Nourhashemi F, Guéry JC, Blancher A. Monocytes are the main source of STING-mediated IFN-α production. EBioMedicine 2022; 80:104047. [PMID: 35561451 PMCID: PMC9108881 DOI: 10.1016/j.ebiom.2022.104047] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Type I interferon (IFN-I) production by plasmacytoid dendritic cells (pDCs) occurs during viral infection, in response to Toll-like receptor 7 (TLR7) stimulation and is more vigorous in females than in males. Whether this sex bias persists in ageing people is currently unknown. In this study, we investigated the effect of sex and aging on IFN-α production induced by PRR agonist ligands. METHODS In a large cohort of individuals from 19 to 97 years old, we measured the production of IFN-α and inflammatory cytokines in whole-blood upon stimulation with either R-848, ODN M362 CpG-C, or cGAMP, which activate the TLR7/8, TLR9 or STING pathways, respectively. We further characterized the cellular sources of IFN-α. FINDINGS We observed a female predominance in IFN-α production by pDCs in response to TLR7 or TLR9 ligands. The higher TLR7-driven IFN-α production in females was robustly maintained across ages, including the elderly. The sex-bias in TLR9-driven interferon production was lost after age 60, which correlated with the decline in circulating pDCs. By contrast, STING-driven IFN-α production was similar in both sexes, preserved with aging, and correlated with circulating monocyte numbers. Indeed, monocytes were the primary cellular source of IFN-α in response to cGAMP. INTERPRETATION We show that the sex bias in the TLR7-induced IFN-I production is strongly maintained through ages, and identify monocytes as the main source of IFN-I production via STING pathway. FUNDING This work was supported by grants from Région Occitanie/Pyrénées-Méditerranée (#12052910, Inspire Program #1901175), University Paul Sabatier, and the European Regional Development Fund (MP0022856).
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Affiliation(s)
- Nicolas Congy-Jolivet
- Laboratoire d'Immunologie, CHU de Toulouse, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France
| | - Claire Cenac
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (INFINITY), INSERM UMR1291, CNRS, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Bénédicte Puissant-Lubrano
- Laboratoire d'Immunologie, CHU de Toulouse, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France
| | - Pol André Apoil
- Laboratoire d'Immunologie, CHU de Toulouse, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France
| | - Kevin Guedj
- Laboratoire d'Immunologie, CHU de Toulouse, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France
| | - Flora Abbas
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (INFINITY), INSERM UMR1291, CNRS, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Sophie Laffont
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (INFINITY), INSERM UMR1291, CNRS, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Sandrine Sourdet
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, CHU de Toulouse, Toulouse, France
| | - Sophie Guyonnet
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, CHU de Toulouse, Toulouse, France
| | - Fati Nourhashemi
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, CHU de Toulouse, Toulouse, France; Maintain Aging Research team, CERPOP, INSERM, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Jean-Charles Guéry
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (INFINITY), INSERM UMR1291, CNRS, Université de Toulouse, Université Paul Sabatier, Toulouse, France.
| | - Antoine Blancher
- Laboratoire d'Immunologie, CHU de Toulouse, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (INFINITY), INSERM UMR1291, CNRS, Université de Toulouse, Université Paul Sabatier, Toulouse, France.
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30
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Fert A, Raymond Marchand L, Wiche Salinas TR, Ancuta P. Targeting Th17 cells in HIV-1 remission/cure interventions. Trends Immunol 2022; 43:580-594. [PMID: 35659433 DOI: 10.1016/j.it.2022.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/14/2022]
Abstract
Since the discovery of HIV-1, progress has been made in deciphering the viral replication cycle and mechanisms of host-pathogen interactions that has facilitated the implementation of effective antiretroviral therapies (ARTs). Major barriers to HIV-1 remission/cure include the persistence of viral reservoirs (VRs) in long-lived CD4+ T cells, residual viral transcription, and lack of mucosal immunity restoration during ART, which together fuel systemic inflammation. Recently, T helper (Th)17-polarized cells were identified as major contributors to the pool of transcriptionally/translationally competent VRs. In this review, we discuss the functional features of Th17 cells that were elucidated by fundamental immunology studies in the context of autoimmunity. We also highlight recent discoveries supporting the possibility of extrapolating this knowledge toward the identification of new putative Th17-targeted HIV-1 remission/cure strategies.
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Affiliation(s)
- Augustine Fert
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Laurence Raymond Marchand
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Tomas Raul Wiche Salinas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Petronela Ancuta
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada; Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest, Bucharest, Romania; The Research Institute of the University of Bucharest, Bucharest, Romania.
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31
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Raffe S, Gilleece Y, Gilleece Y. Comorbidities in women living with HIV: A systematic review. HIV Med 2022; 23:331-361. [PMID: 35243744 PMCID: PMC9311813 DOI: 10.1111/hiv.13240] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023]
Abstract
Objectives Effective antiretroviral therapy (ART) has improved the life expectancy of women living with HIV (WLWH). This population is now experiencing age‐related comorbidities. This systematic review presents the current understanding of the prevalence and impact of comorbidities in WLWH in the modern ART era. Methods MEDLINE and Embase were searched for studies (1 January 2010 to 1 September 2020) reporting the prevalence of cardiovascular, bone, renal and neurocognitive disease in WLWH aged > 18 years. Studies were included if at least 100 participants (or > 50%) were female and data analysis included prevalence by sex. Results In all, 3050 articles were identified and screened; 153 full‐text articles were assessed for eligibility and 38 were included in the final review. Significant gaps in the literature were identified, notably a lack of data on WLWH aged > 50 years. The data suggest a high burden of cardiovascular, bone, renal and neurocognitive disease in WLWH compared with HIV negative women. Traditional risk factors, such as hypertension, diabetes and dyslipidaemia, were common and often poorly managed. Generalizability of the results was limited, as many studies were conducted in the USA. Comparisons between WLWH and men with HIV were limited by marked differences in demographic and socioeconomic factors. Conclusions Women living with HIV experience a high burden of comorbid disease. Traditional risk factors are common and often poorly managed. This review also highlights the magnitude of differences between women and men living with HIV beyond the pathophysiological. Future research must unpick the complex drivers of morbidity in WLWH, to improve the holistic management of this population.
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Affiliation(s)
- Sonia Raffe
- Lawson Unit, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Yvonne Gilleece
- Institute for Global Health, University College London, London, UK.,NIHR Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Yvonne Gilleece
- Lawson Unit, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
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32
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Birabaharan M, Strunk A, Kaelber DC, Smith DM, Martin TC. Sex differences in type 2 diabetes mellitus prevalence among persons with HIV. AIDS 2022; 36:383-389. [PMID: 34750292 PMCID: PMC8795484 DOI: 10.1097/qad.0000000000003127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether type 2 diabetes mellitus (T2DM) is more common among women with HIV (WWH) than men with HIV (MWH). DESIGN A cross-sectional analysis of a demographically heterogenous population-based sample of more than 64 million patients in the United States. METHODS Using the Explorys (IBM) database, compare the prevalence of T2DM among men and women without HIV and influence of HIV on T2DM by sex controlling for confounding factors. RESULTS From 19 182 775 persons included in the study, 39 485 were with HIV. Rates of obesity was higher among WWH than MWH (58 vs. 35%). Prevalence of T2DM among WWH was 23% compared with 16% among MWH (P < 0.001). In sex-stratified adjusted analysis, WWH had 1.31 [95% confidence interval (CI), 1.24-1.38] times the odds of having T2DM than women without HIV. Women with HIV was associated with T2DM across all demographic subgroups. In contrast, no association between HIV and T2DM was observed among men (OR 1.01; 95% CI 0.98-1.05). CONCLUSION These data suggest that HIV confers a sex-specific increase in odds of T2DM among women but not men.
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Affiliation(s)
- Morgan Birabaharan
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and
Population and Quantitative Health Sciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA
- Center for Clinical Informatics Research and Education, The
MetroHealth System, Cleveland, Ohio, USA
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
- San Diego Veterans Affairs Healthcare System, San Diego,
CA, USA
| | - Thomas C.S. Martin
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
- San Diego Veterans Affairs Healthcare System, San Diego,
CA, USA
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33
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Lau ES, Binek A, Parker SJ, Shah SH, Zanni MV, Van Eyk JE, Ho JE. Sexual Dimorphism in Cardiovascular Biomarkers: Clinical and Research Implications. Circ Res 2022; 130:578-592. [PMID: 35175850 PMCID: PMC8883873 DOI: 10.1161/circresaha.121.319916] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sex-based differences in cardiovascular disease presentation, diagnosis, and response to therapies are well established, but mechanistic understanding and translation to clinical applications are limited. Blood-based biomarkers have become an important tool for interrogating biologic pathways. Understanding sexual dimorphism in the relationship between biomarkers and cardiovascular disease will enhance our insights into cardiovascular disease pathogenesis in women, with potential to translate to improved individualized care for men and women with or at risk for cardiovascular disease. In this review, we examine how biologic sex associates with differential levels of blood-based biomarkers and influences the effect of biomarkers on disease outcomes. We further summarize key differences in blood-based cardiovascular biomarkers along central biologic pathways, including myocardial stretch/injury, inflammation, adipose tissue metabolism, and fibrosis pathways in men versus women. Finally, we present recommendations for leveraging our current knowledge of sex differences in blood-based biomarkers for future research and clinical innovation.
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Affiliation(s)
- Emily S. Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aleksandra Binek
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sarah J. Parker
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Svati H. Shah
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Markella V. Zanni
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer E Van Eyk
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jennifer E. Ho
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Barrett B, Nguyen DH, Xu J, Guo K, Shetty S, Jones ST, Mickens KL, Shepard C, Roers A, Behrendt R, Wu L, Kim B, Santiago ML. SAMHD1 Promotes the Antiretroviral Adaptive Immune Response in Mice Exposed to Lipopolysaccharide. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:444-453. [PMID: 34893529 DOI: 10.4049/jimmunol.2001389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
SAMHD1 is a potent HIV-1 restriction factor that blocks reverse transcription in monocytes, dendritic cells and resting CD4+ T cells by decreasing intracellular dNTP pools. However, SAMHD1 may diminish innate immune sensing and Ag presentation, resulting in a weaker adaptive immune response. To date, the role of SAMHD1 on antiretroviral immunity remains unclear, as mouse SAMHD1 had no impact on murine retrovirus replication in prior in vivo studies. Here, we show that SAMHD1 significantly inhibits acute Friend retrovirus infection in mice. Pretreatment with LPS, a significant driver of inflammation during HIV-1 infection, further unmasked a role for SAMHD1 in influencing immune responses. LPS treatment in vivo doubled the intracellular dNTP levels in immune compartments of SAMHD1 knockout but not wild-type mice. SAMHD1 knockout mice exhibited higher plasma infectious viremia and proviral DNA loads than wild-type mice at 7 d postinfection (dpi), and proviral loads inversely correlated with a stronger CD8+ T cell response. SAMHD1 deficiency was also associated with weaker NK, CD4+ T and CD8+ T cell responses by 14 dpi and weaker neutralizing Ab responses by 28 dpi. Intriguingly, SAMHD1 influenced these cell-mediated immune (14 dpi) and neutralizing Ab (28 dpi) responses in male but not female mice. Our findings formally demonstrate SAMHD1 as an antiretroviral factor in vivo that could promote adaptive immune responses in a sex-dependent manner. The requirement for LPS to unravel the SAMHD1 immunological phenotype suggests that comorbidities associated with a "leaky" gut barrier may influence the antiviral function of SAMHD1 in vivo.
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Affiliation(s)
- BradleyS Barrett
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - David H Nguyen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Joella Xu
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA
| | - Kejun Guo
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Shravida Shetty
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Sean T Jones
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Kaylee L Mickens
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Caitlin Shepard
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA
| | - Axel Roers
- Institute for Immunology, Faculty of Medicine, Technical University Dresden, Dresden, Germany
| | - Rayk Behrendt
- Institute for Immunology, Faculty of Medicine, Technical University Dresden, Dresden, Germany
| | - Li Wu
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, IA; and
| | - Baek Kim
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA.,Center for Drug Discovery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mario L Santiago
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO; .,Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
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Biswas S, Chen E, Gao Y, Lee S, Hewlett I, Devadas K. Modulation of HIV Replication in Monocyte-Derived Macrophages (MDM) by Host Antiviral Factors Secretory Leukocyte Protease Inhibitor and Serpin Family C Member 1 Induced by Steroid Hormones. Viruses 2022; 14:v14010095. [PMID: 35062299 PMCID: PMC8777669 DOI: 10.3390/v14010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
Abstract
The impact of steroid hormones estrogen and progesterone on human immunodeficiency virus type 1 (HIV-1) replication is well documented. However, the exact mechanism involved in the regulation of HIV-1 replication by estrogen and progesterone is still unclear. In the present study, we wanted to elucidate the molecular mechanisms underlying the modulation of HIV-1 replication by estrogen and progesterone. To achieve this goal, we used real-time quantitative PCR arrays (PCR arrays) to identify differentially expressed host genes in response to hormone treatments that are involved in antiviral responses. Our in vitro results suggest that treatment with high doses of estrogen and progesterone promotes the expression of host antiviral factors Secretory leukocyte protease inhibitor (SLPI) and Serpin family C member 1 (SERPIN C1) among others produced in response to HIV-1 infection. SLPI is an enzyme that inhibits human leukocyte elastase, human cathepsin G, human trypsin, neutrophil elastase, and mast cell chymase. SERPIN C1 is a plasma protease inhibitor that regulates the blood coagulation cascade by the inhibition of thrombin and other activated serine proteases of the coagulation system. A dose dependent downmodulation of HIV-1 replication was observed in monocyte-derived macrophages (MDMs) pre-treated with the two proteins SLPI and SERPIN C1. Further investigations suggests that the host antiviral factors, SLPI and SERPIN C1 act at the pre-integration stage, inhibiting HIV-1 viral entry and leading to the observed downmodulation of HIV-1 replication. Our studies would help identify molecular mechanisms and pathways involved in HIV-1 pathogenesis.
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Affiliation(s)
- Santanu Biswas
- Laboratory of Molecular Virology, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA; (S.B.); (E.C.); (S.L.)
| | - Emily Chen
- Laboratory of Molecular Virology, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA; (S.B.); (E.C.); (S.L.)
| | - Yamei Gao
- Laboratory of Respiratory Viral Diseases, Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA;
| | - Sherwin Lee
- Laboratory of Molecular Virology, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA; (S.B.); (E.C.); (S.L.)
| | - Indira Hewlett
- Laboratory of Molecular Virology, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA; (S.B.); (E.C.); (S.L.)
- Correspondence: (I.H.); (K.D.)
| | - Krishnakumar Devadas
- Laboratory of Molecular Virology, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA; (S.B.); (E.C.); (S.L.)
- Correspondence: (I.H.); (K.D.)
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36
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Dashti A, Singh V, Chahroudi A. HIV Reservoirs: Modeling, Quantification, and Approaches to a Cure. Methods Mol Biol 2022; 2407:215-228. [PMID: 34985668 DOI: 10.1007/978-1-0716-1871-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Biomedical research in animal models depends heavily on nonhuman primates (NHP) (Phillips et al., Am J Primatol 76(9):801-827, 2014). In their physiology, neurobiology, and, most importantly, their susceptibility to infectious diseases and subsequent immune responses, NHPs have many parallels with humans (Rhesus Macaque Genome Sequencing and Analysis Consortium et al., Science 316(5822):222-234, 2007). Different species of NHPs have served as important animal models for numerous infectious diseases spanning a wide range of pathogens (Gardner and Luciw, ILAR J 49(2):220-255, 2008). As a result of recognizing their utility in HIV research, NHPs have contributed to groundbreaking studies of disease pathogenesis, vaccination, and curative research (London et al., Lancet 2(8355):869-873, 1983; Henrickson et al., Lancet 1 (8321):388-390, 1983). Many African NHPs are considered natural hosts for SIV in which SIV infection is usually nonprogressive and does not cause acquired immunodeficiency syndrome (AIDS) (Chahroudi et al., Science 335(6073):1188-1193, 2012; Taaffe et al., J Virol 84(11):5476-5484, 2010). However, cross-species transmission of SIV strains to other NHPs or to humans (nonnatural hosts) leads to progressive disease and AIDS (Paiardini et al., Annu Rev Med 60:485-495, 2009). In particular, SIV infection of Asian rhesus macaques recapitulates many features of HIV infection in humans and therefore has become a widely used approach for contemporary HIV research into virus persistence and cure strategies (Gardner and Luciw, FASEB J 3(14):2593-2606, 1989). There are multiple factors that should be considered in HIV/SIV studies using NHPs including the particular monkey species and geographic background, age and sex, certain genetic properties, virus strain, route and dose of infection, interventional treatments, and prespecified study outcomes. Here, we discuss consideration of these factors to address specific questions in HIV cure research.
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Affiliation(s)
- Amir Dashti
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Vidisha Singh
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann Chahroudi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
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Peer V, Schwartz N, Green MS. Gender differences in tuberculosis incidence rates-A pooled analysis of data from seven high-income countries by age group and time period. Front Public Health 2022; 10:997025. [PMID: 36703824 PMCID: PMC9873377 DOI: 10.3389/fpubh.2022.997025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Gender differences in the incidence rates for tuberculosis are occasionally reported. However, the magnitude and consistency of the differences by age group, among different populations, and over extended periods of time are not clear. Materials and methods We obtained national data from seven countries from open-access internet sites or personal communications with official representatives. We computed the male-to-female incidence rate ratios (IRRs) by country and year for every age group and pooled these ratios using meta-analytic methods. Meta-regression analysis was performed to estimate the contribution of age, country, and calendar years to the variation in the IRRs. Results In the age groups of < 1, 1-4, 5-9, and 10-14, the pooled male-to-female IRRs (with 95% CI) were as follows: 1.21 (1.05, 1.40), 0.99 (0.95, 1.04), 1.01 (0.96, 1.06), and 0.83 (0.77, 0.89), respectively. In the age groups 15-44, 45-64, and 65+ years, incidence rates were significantly higher in men, with IRRs of 1.25 (1.16, 1.35), 1.79 (1.56, 2.06), and 1.81 (1.66, 1.96), respectively. Meta-regression analysis revealed that age significantly contributed to the variation in the IRRs. Conclusions There were gender differences in the incidence rates for tuberculosis, with higher rates in boys aged less than one, no significant differences in boys of ages 1-9, and higher rates in boys/men older than 15. The only excess in female gender was in the age group 10-14 years. The age-related gender differences in tuberculosis incidence rates observed over several countries indicate the importance of including sex as a biological variable when assessing the risk factors for tuberculosis.
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Affiliation(s)
- Victoria Peer
- School of Public Health, University of Haifa, Haifa, Israel
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
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Orkin C, Ajana F, Kityo C, Koenig E, Natukunda E, Gandhi-Patel B, Wang H, Liu Y, Wei X, White K, Makadzange T, Pikora C, McNicholl I, Collins SE, Brainard D, Chuck SK. Brief Report: Efficacy and Safety of Bictegravir/Emtricitabine/Tenofovir Alafenamide in Females Living With HIV: An Integrated Analysis of 5 Trials. J Acquir Immune Defic Syndr 2021; 88:393-398. [PMID: 34506342 PMCID: PMC8547745 DOI: 10.1097/qai.0000000000002789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We characterized the efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in a broad population of pediatric/adolescent/adult/elderly females living with HIV (FWH). SETTING Integrated analysis. METHODS Available data from 5 trials were integrated. Week 48 virologic suppression (HIV-1 RNA <50 copies/mL), resistance, adverse events (AEs), and laboratory parameters were assessed. RESULTS Three hundred and seventy-three FWH [304 virologically suppressed; 69 antiretroviral therapy (ART)-naive] received B/F/TAF [data from comparator regimens available for 306 individuals (236 virologically suppressed and 70 ART-naive participants)]. Virologic suppression rates with B/F/TAF at week 48 were high regardless of age in participants virologically suppressed at baseline (≥95%) and in ART-naive participants (≥87%). Virologic suppression rates were similar in B/F/TAF and comparator regimens (both virologically suppressed and ART-naive groups). Treatment-emergent resistance was not detected in the B/F/TAF group. AEs considered related to study drugs were experienced by 9.2% (B/F/TAF) and 5.5% (comparator regimen) of virologically suppressed participants and 15.9% (B/F/TAF) and 31.4% (comparator regimen) of ART-naive participants. For virologically suppressed and ART-naive FWH combined, only 1 of the 373 B/F/TAF-treated and 2 of the 306 comparator-regimen participants discontinued because of AEs (none were bone/renal/hepatic AEs); grade 3/4 AEs were experienced by 5.1% (B/F/TAF) and 7.8% (comparator regimen); and grade 3/4 elevation of low-density lipoprotein/total cholesterol occurred in 2.7%/0.3% (B/F/TAF) and 5.9%/2.0% (comparator regimen). At week 48, median changes from baseline estimated glomerular filtration rate in adults were <5 mL/min; results were similar in B/F/TAF and comparator-regimen groups. CONCLUSION B/F/TAF treatment was effective and well tolerated over 48 weeks, confirming B/F/TAF as an option for a broad population of FWH.
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Affiliation(s)
- Chloe Orkin
- Ambrose King Centre, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Faiza Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Ellen Koenig
- Instituto Dominicano de Estudios Virologicos (IDEV), Santo Domingo, Dominican Republic; and
| | | | | | - Hui Wang
- Gilead Sciences, Foster City, CA
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Guéry JC. Sex Differences in Primary HIV Infection: Revisiting the Role of TLR7-Driven Type 1 IFN Production by Plasmacytoid Dendritic Cells in Women. Front Immunol 2021; 12:729233. [PMID: 34512664 PMCID: PMC8432934 DOI: 10.3389/fimmu.2021.729233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Plasmacytoid dendritic cells (pDCs) produce type I interferon (IFN-I) during HIV-1 infection in response to TLR7 stimulation. However, IFN-I-signaling has been shown to play opposite effects in HIV-1 and SIV infection. TLR7-driven type I interferon production in pDCs is higher in women than in men due to the cell-intrinsic actions of estrogen and X-chromosome complement. Indeed, TLR7 is encoded on the X-chromosome, and the TLR7 gene escapes the X-chromosome inactivation in immune cells of women which express significantly higher levels of TLR7 protein than male cells. Following HIV infection, women have a lower viremia during acute infection and exhibit stronger antiviral responses than men, which has been attributed to the increased capacity of female pDCs to produce IFN-α upon TLR7-stimulation. However, a deleterious functional impact of an excessive TLR7 response on acute viremia in women has been recently revealed by the analysis of the frequent rs179008 c.32A>T SNP of TLR7. This SNP was identified as a sex-specific protein abundance quantitative trait locus (pQTL) causing a difference in the TLR7 protein dosage and effector function in females only. T allele expression was associated with a lower TLR7 protein synthesis, blunted production of IFN-α by pDCs upon TLR7 stimulation, and an unexpectedly lower viral load during primary HIV-1 infection in women. In the present review, the author will revisit the role of TLR7-driven pDC innate function in the context of HIV-1 infection to discuss at what stage of primary HIV-1 infection the TLR7 rs179008 T allele is likely to be protective in women.
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Affiliation(s)
- Jean-Charles Guéry
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (INFINITY), Université de Toulouse, INSERM, CNRS, UPS, Toulouse, France
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Patel HK, Duong YT, Birhanu S, Dobbs T, Lupoli K, Moore C, Detorio M, Sleeman K, Manjengwa J, Wray-Gordon F, Yavo D, Jackson K, Domaoal RA, Yufenyuy EL, Vedapuri S, Ndongmo CB, Ogollah FM, Dzinamarira T, Rubinstein P, Sachathep KK, Metz M, Longwe H, Saito S, Brown K, Voetsch AC, Parekh BS. A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project. J Acquir Immune Defic Syndr 2021; 87:S17-S27. [PMID: 34166309 DOI: 10.1097/qai.0000000000002702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
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Affiliation(s)
- Hetal K Patel
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Sehin Birhanu
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Trudy Dobbs
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Kathryn Lupoli
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Carole Moore
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Mervi Detorio
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Katrina Sleeman
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Floris Wray-Gordon
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Daniel Yavo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Keisha Jackson
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Robert A Domaoal
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ernest L Yufenyuy
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Shanmugam Vedapuri
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Clement B Ndongmo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | | | | | | | | | | | | | - Kristin Brown
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Andrew C Voetsch
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Bharat S Parekh
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
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McLeod DV, Wild G, Úbeda F. Epigenetic memories and the evolution of infectious diseases. Nat Commun 2021; 12:4273. [PMID: 34257309 PMCID: PMC8277771 DOI: 10.1038/s41467-021-24580-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Genes with identical DNA sequence may show differential expression because of epigenetic marks. Where epigenetic marks respond to past conditions, they represent a form of "memory". Despite their medical relevance, the impact of memories on the evolution of infectious diseases has rarely been considered. Here we explore the evolution of virulence in pathogens that carry memories of the sex of their previous host. We show that this form of memory provides information about the sex of present and future hosts when the sexes differ in their pathogen's transmission pattern. Memories of past hosts enable the evolution of greater virulence in infections originating from one sex and infections transmitted across sexes. Thus, our results account for patterns of virulence that have, to date, defied medical explanation. In particular, it has been observed that girls infected by boys (or boys infected by girls) are more likely to die from measles, chickenpox and polio than girls infected by girls (or boys infected by boys). We also evaluate epigenetic therapies that tamper with the memories of infecting pathogens. More broadly, our findings imply that pathogens can be selected to carry memories of past environments other than sex. This identifies new directions in personalised medicine.
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Affiliation(s)
- David V McLeod
- Centre D'Ecologie Fonctionnelle & Evolutive, CNRS, Montpellier, France
- Institute of Integrative Biology, ETH Zürich, Zürich, Switzerland
| | - Geoff Wild
- Department of Applied Mathematics, The University of Western Ontario, London, ON, Canada
| | - Francisco Úbeda
- Department of Biology, Royal Holloway University of London, Egham, Surrey, UK.
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Stadtler H, Shaw G, Neigh GN. Mini-review: Elucidating the psychological, physical, and sex-based interactions between HIV infection and stress. Neurosci Lett 2021; 747:135698. [PMID: 33540057 PMCID: PMC9258904 DOI: 10.1016/j.neulet.2021.135698] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022]
Abstract
Stress is generally classified as any mental or emotional strain resulting from difficult circumstances, and can manifest in the form of depression, anxiety, post-traumatic stress disorder (PTSD), or other neurocognitive disorders. Neurocognitive disorders such as depression, anxiety, and PTSD are large contributors to disability worldwide, and continue to affect individuals and communities. Although these disorders affect men and women, women are disproportionately represented among those diagnosed with affective disorders, a result of both societal gender roles and physical differences. Furthermore, the incidence of these neurocognitive disorders is augmented among People Living with HIV (PLWH); the physical ramifications of stress increase the likelihood of HIV acquisition, pathogenesis, and treatment, as both stress and HIV infection are characterized by chronic inflammation, which creates a more opportunistic environment for HIV. Although the stress response is facilitated by the autonomic nervous system (ANS) and the hypothalamic pituitary adrenal (HPA) axis, when the response involves a psychological component, additional brain regions are engaged. The impact of chronic stress exposure and the origin of individual variation in stress responses and resilience are at least in part attributable to regions outside the primary stress circuity, including the amygdala, prefrontal cortex, and hippocampus. This review aims to elucidate the relationship between stress and HIV, how these interact with sex, and to understand the physical ramifications of these interactions.
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Affiliation(s)
- Hannah Stadtler
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gladys Shaw
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gretchen N Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA.
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Cyktor JC, Bosch RJ, Mar H, Macatangay BJ, Collier AC, Hogg E, Godfrey C, Eron JJ, McMahon DK, Mellors JW, Gandhi RT. Association of Male Sex and Obesity With Residual Plasma Human Immunodeficiency Virus 1 Viremia in Persons on Long-Term Antiretroviral Therapy. J Infect Dis 2021; 223:462-470. [PMID: 32603416 DOI: 10.1093/infdis/jiaa373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although adipose tissue has been proposed to harbor part of the human immunodeficiency virus 1 (HIV-1) reservoir, the influence of host characteristics, including sex and body mass index (BMI), on measures of HIV-1 persistence during antiretroviral therapy (ART) are incompletely understood. METHODS We evaluated age, sex, BMI, waist circumference, years on ART, pre-ART HIV-1 RNA, pre-ART CD4+ T-cell count, and initial ART regimen with measures of HIV-1 persistence in blood (residual viremia, cellular HIV-1 DNA and RNA) in a cohort of 295 individuals with well-documented long-term virologic suppression (HIV-1 RNA <50 copies/mL) on ART (AIDS Clinical Trials Group study A5321). RESULTS Men were more likely than women to have detectable plasma HIV-1 RNA by single-copy assay (52% vs 29%; P = .003), and the proportion of participants with detectable residual viremia increased in a stepwise fashion by BMI category (normal weight or underweight, 38%; overweight, 50%; and obese, 55%). ART regimen type was not associated with measures of HIV-1 persistence after controlling for ART duration. CONCLUSIONS Sex and obesity are independently associated with residual viremia in people on long-term ART. Additional studies to confirm these relationships and to define the mechanisms by which sex and obesity affect HIV-1 persistence are needed to inform HIV-1 cure strategies.
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Affiliation(s)
| | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hanna Mar
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Evelyn Hogg
- Social & Scientific Systems, Silver Spring, Maryland, USA
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator Department of State, Washington DC, USA
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Elevated Plasma Levels of sCD14 and MCP-1 Are Associated With HIV Associated Neurocognitive Disorders Among Antiretroviral-Naive Individuals in Nigeria. J Acquir Immune Defic Syndr 2021; 84:196-202. [PMID: 32084055 DOI: 10.1097/qai.0000000000002320] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mononuclear cells play key roles in the pathogenesis of HIV-associated neurocognitive disorders (HAND). Limited studies have looked at the association of markers of monocyte activation with HAND in Africa. We examined this association among HIV-1-infected patients in Nigeria. METHOD A total of 190 HIV-infected treatment-naive participants with immune marker data were included in this cross-sectional study. Plasma levels of soluble CD14 (sCD14), soluble CD163, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), and neopterin were measured. Demographically adjusted T scores obtained from a 7-domain neuropsychological test battery were generated, and functional status was assessed using activities of daily living questionnaire. Participants were classified as unimpaired, having asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), or HIV-associated dementia (HAD) in line with the "Frascati" criteria. RESULTS Thirty-two participants (16.8%) had ANI, 14 (7.4%) had MND, whereas none had HAD. In multivariable linear regression analyses, after adjusting for age, gender, education, CD4 count, and viral load, mean levels of sCD14 were higher among those with ANI and MND as compared with the unimpaired (P = 0.033 and 0.023, respectively). Similarly, the mean level of MCP-1 was greater among those with HAND as compared with the unimpaired (P = 0.047). There were also trends for higher levels of sCD163 and TNF-α among females with MND in univariable analyses. CONCLUSIONS Levels of monocyte activation markers correlate with the severity of impairment among individuals with HAND. The mechanisms that underlie these effects and the potential role of gender require further study.
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Abstract
PURPOSE OF REVIEW The global pandemic caused by the severe acute respiratory virus coronavirus 2 (SARS-CoV-2) has a male bias in mortality likely driven by both gender and sex-based differences between male and female individuals. This is consistent with sex and gender-based features of HIV infection and overlap between the two diseases will highlight potential mechanistic pathways of disease and guide research questions and policy interventions. In this review, the emerging findings from SARS-CoV-2 infection will be placed in the context of sex and gender research in the more mature HIV epidemic. RECENT FINDINGS This review will focus on the new field of literature on prevention, immunopathogenesis and treatment of SARS-CoV-2 referencing relevant articles in HIV for context from a broader time period, consistent with the evolving understanding of sex and gender in HIV infection. Sex-specific features of epidemiology and immunopathogenesis reported in COVID-19 disease will be discussed and potential sex and gender-specific factors of relevance to prevention and treatment will be emphasized. SUMMARY Multilayered impacts of sex and gender on HIV infection have illuminated pathways of disease and identified important goals for public health interventions. SARS-CoV-2 has strong evidence for a male bias in disease severity and exploring that difference will yield important insights.
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Affiliation(s)
- Eileen P Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Galbadage T, Peterson BM, Wang JS, Jayasekara A, Ramirez DA, Awada J, Walsh JP, Gunasekera RS. Molecular Mechanisms Lead to Sex-Specific COVID-19 Prognosis and Targeted Therapies. Front Med (Lausanne) 2020; 7:589060. [PMID: 33364247 PMCID: PMC7753152 DOI: 10.3389/fmed.2020.589060] [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] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Clinical and epidemiological studies have identified male sex as an important risk factor for COVID-19 clinical outcomes and mortality. This raises the question as to how this risk factor can be addressed in the prognosis, clinical management, and the treatment of patients with Coronavirus disease 2019 (COVID-19). Currently, there are no guidelines or protocols to help alter the course of sex-specific COVID-19 prognosis, especially in severe disease presentations. This is partly due to the lack of research studies characterizing the differences in male vs. female host response to the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection and a lack of a well-rounded understanding of the molecular mechanisms involved. Here, we discuss three distinct but interconnected molecular-level differences in males and females that likely play an essential role in the COVID-19 prognosis. We review interactions of SARS-CoV-2 with host cell angiotensin-converting enzyme 2 (ACE2) in the viral entry between males vs. females and discuss the differential regulation of the renin-angiotensin system (RAS) between the two sexes. Next, we present immune response disparities and how immune function and endocrine regulation may render males increasingly vulnerable to severe COVID-19. We describe the interconnected roles of these three regulatory systems in males and females in response to SARS-CoV-2 infection. Finally, we highlight the clinical implications of these mechanisms to patients with COVID-19 and propose putative targeted therapies that can help reduce COVID-19 severity in those critically ill.
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Affiliation(s)
- Thushara Galbadage
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Brent M Peterson
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Jeffrey S Wang
- Department of Infectious Diseases, Southern California Permanente Medical Group, Pasadena, CA, United States
| | - Avishka Jayasekara
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Danny A Ramirez
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - Joseph Awada
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - John P Walsh
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Richard S Gunasekera
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
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Hagen SH, Henseling F, Hennesen J, Savel H, Delahaye S, Richert L, Ziegler SM, Altfeld M. Heterogeneous Escape from X Chromosome Inactivation Results in Sex Differences in Type I IFN Responses at the Single Human pDC Level. Cell Rep 2020; 33:108485. [PMID: 33296655 PMCID: PMC7833293 DOI: 10.1016/j.celrep.2020.108485] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/11/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
Immune responses differ between women and men, and type I interferon (IFN) responses following Toll-like receptor 7 (TLR7) stimulation are higher in women. The precise mechanisms driving these sex differences in immunity are unknown. To investigate possible genetic factors, we quantify escape from X chromosome inactivation (XCI) for TLR7 and four other genes (RPS6KA3, CYBB, BTK, and IL13RA1) at the single plasmacytoid dendritic cell (pDC) level. We observe escape from XCI for all investigated genes, leading to biallelic expression patterns. pDCs with biallelic gene expression have significantly higher mRNA levels of the respective genes. Unstimulated pDCs with biallelic TLR7 expression exhibit significantly higher IFNα/β mRNA levels, and IFNα exposure results in significantly increased IFNα/β protein production by pDCs. These results identify unanticipated heterogeneity in escape from XCI of several genes in pDCs and highlight the important contribution of X chromosome factors to sex differences in type I IFN responses, which might explain observed sex differences in human diseases.
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Affiliation(s)
- Sven Hendrik Hagen
- Research Department Virus Immunology, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, Hamburg 20251, Germany
| | - Florian Henseling
- Research Department Virus Immunology, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, Hamburg 20251, Germany
| | - Jana Hennesen
- Technology Platform Flow Cytometry/FACS, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, Hamburg 20251, Germany
| | - Hélène Savel
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219 and Inria, team SISTM, Bordeaux, France
| | - Solenne Delahaye
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219 and Inria, team SISTM, Bordeaux, France
| | - Laura Richert
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219 and Inria, team SISTM, Bordeaux, France
| | - Susanne Maria Ziegler
- Research Department Virus Immunology, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, Hamburg 20251, Germany
| | - Marcus Altfeld
- Research Department Virus Immunology, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, Hamburg 20251, Germany.
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Novelli S, Delobel P, Bouchaud O, Avettand-Fenoel V, Fialaire P, Cabié A, Souala F, Raffi F, Catalan P, Weiss L, Meyer L, Goujard C. Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV-1 infection: results from a longitudinal study in the French ANRS Primo cohort. J Int AIDS Soc 2020; 23:e25485. [PMID: 32333726 PMCID: PMC7183251 DOI: 10.1002/jia2.25485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/05/2019] [Accepted: 03/04/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction Previous studies have reported better immunovirological characteristics in women compared with men after HIV seroconversion. We investigated whether differences persisted under long‐term antiretroviral therapy (ART) in individuals treated since acute and early HIV‐1 infection (AHI). Methods Data were obtained for 262 women and 1783 men enrolled between 1996 and 2017 in the French multicentre ANRS PRIMO cohort. We modelled the viral response, long‐term immune recovery and HIV DNA decay in the 143 women and 1126 men who initiated ART within the first three months of infection. Results The participants were mostly white. The mean age was 37 years at AHI diagnosis. Pre‐ART viral loads were lower in women than men, 5.2 and 5.6 log10 copies/mL (p = 0.001). After ART initiation, women more rapidly achieved viral suppression than men (adjusted hazard ratio: 1.33, 95% confidence interval 1.09 to 1.69). They also experienced a faster increase in CD4+ T‐cell count and CD4:CD8 ratio during the first months of treatment. Sex‐related differences in CD4+ T‐cell counts were more pronounced with increasing age. This led to a sustained mean difference of 99 to 168 CD4+ T‐cells/µL depending on age between women and men at 150 months of ART. Moreover, CD4:CD8 ratio of women was higher than that of men by 0.31, at 150 months of ART. There was no statistically significant difference between sexes for the levels of HIV DNA over time (mean estimate at the last modelling point: 1.9 log10 copies/106 PBMCs after 70 months of ART for both sexes). Conclusions The high level of immune recovery and decrease in total HIV DNA levels achieved after ART initiation during AHI reinforce the importance of early diagnosis of HIV infection and immediate ART initiation. The immunological benefit of being female increased throughout prolonged ART duration, which may give women additional protection from adverse clinical events and premature ageing.
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Affiliation(s)
- Sophie Novelli
- Paris-Saclay University, UVSQ, Inserm, CESP, U1018, Le Kremlin-Bicêtre, France
| | - Pierre Delobel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Olivier Bouchaud
- Department of Infectious and Tropical Diseases, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Véronique Avettand-Fenoel
- Institut Cochin - CNRS 8104, INSERM U1016, AP-HP, Laboratoire de Microbiologie clinique, Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - Pascale Fialaire
- Department of Infectious and Tropical Diseases, Angers University Hospital, Angers, France
| | - André Cabié
- Department of Infectious Diseases, University Hospital of Martinique, Fort-de-France, France
| | - Faouzi Souala
- Department of Infectious and Tropical Diseases, Rennes University Hospital, Rennes, France
| | - François Raffi
- Infectious diseases department and Inserm CIC 1413, University Hospital of Nantes, Nantes, France
| | - Pilartxo Catalan
- Department of Internal Medicine, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Laurence Weiss
- Service d'Immunologie Clinique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurence Meyer
- Inserm, CESP, U1018, Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- Inserm, CESP, U1018, Department of Internal Medicine, AP-HP, Bicêtre Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France
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49
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Abstract
PURPOSE OF REVIEW Biological and societal influences are different for men and women leading to different HIV outcomes and related infectious and non-infectious complications. This review evaluates sex differences in the epidemiology and immunological response to HIV and looks at major complications and coinfections, as well as care delivery systems focusing on low- and middle-income countries (LMICs) where most people with HIV live. RECENT FINDINGS More women than men access testing and treatment services in LMIC; women are more likely to be virologically suppressed in that environment. There is a growing recognition that the enhanced immunological response to several pathogens including HIV may result in improved outcomes for infectious comorbidities but may result in a greater burden of non-communicable diseases. Men and women have different requirements for HIV care. Attention to these differences may improve outcomes for all.
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50
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Falcinelli SD, Shook-Sa BE, Dewey MG, Sridhar S, Read J, Kirchherr J, James KS, Allard B, Ghofrani S, Stuelke E, Baker C, Roan NR, Eron JJ, Kuruc JD, Ramirez C, Gay C, Mollan KR, Margolis DM, Adimora AA, Archin NM. Impact of Biological Sex on Immune Activation and Frequency of the Latent HIV Reservoir During Suppressive Antiretroviral Therapy. J Infect Dis 2020; 222:1843-1852. [PMID: 32496542 PMCID: PMC7653086 DOI: 10.1093/infdis/jiaa298] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Persistent HIV infection of long-lived resting CD4 T cells, despite antiretroviral therapy (ART), remains a barrier to HIV cure. Women have a more robust type 1 interferon response during HIV infection relative to men, contributing to lower initial plasma viremia. As lower viremia during acute infection is associated with reduced frequency of latent HIV infection, we hypothesized that women on ART would have a lower frequency of latent HIV compared to men. METHODS ART-suppressed, HIV seropositive women (n = 22) were matched 1:1 to 22 of 39 ART-suppressed men. We also compared the 22 women to all 39 men, adjusting for age and race as covariates. We measured the frequency of latent HIV using the quantitative viral outgrowth assay, the intact proviral DNA assay, and total HIV gag DNA. We also performed activation/exhaustion immunophenotyping on peripheral blood mononuclear cells and quantified interferon-stimulated gene (ISG) expression in CD4 T cells. RESULTS We did not observe evident sex differences in the frequency of persistent HIV in resting CD4 T cells. Immunophenotyping and CD4 T-cell ISG expression analysis revealed marginal differences across the sexes. CONCLUSIONS Differences in HIV reservoir frequency and immune activation appear to be small across sexes during long-term suppressive therapy.
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Affiliation(s)
- Shane D Falcinelli
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bonnie E Shook-Sa
- Biostatistics Core, Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Morgan G Dewey
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sumati Sridhar
- Biostatistics Core, Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jenna Read
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer Kirchherr
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine S James
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brigitte Allard
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Simon Ghofrani
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin Stuelke
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caroline Baker
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nadia R Roan
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Gladstone Institutes, San Francisco, California, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - JoAnn D Kuruc
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cynthia Gay
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katie R Mollan
- Biostatistics Core, Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David M Margolis
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nancie M Archin
- HIV Cure Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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