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Metz M, Among VH, Dzinamarira T, Ussery F, Nkurunziza P, Bahizi J, Biraro S, Ogollah FM, Musinguzi J, Kirungi W, Naluguza M, Mwangi C, Birhanu S, Nelson LJ, Longwe H, Winterhalter FS, Voetsch AC, Parekh BS, Patel HK, Duong YT, Bray R, Farley SM. People Who Self-Reported Testing HIV-Positive but Tested HIV-Negative: A Multi-Country Puzzle of Data, Serology, and Ethics, 2015-2021. Trop Med Infect Dis 2024; 9:220. [PMID: 39330909 PMCID: PMC11435972 DOI: 10.3390/tropicalmed9090220] [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: 07/04/2024] [Revised: 08/30/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
During population-based HIV impact assessments (PHIAs), some participants who self-reported testing HIV-positive (PSRP) tested negative in one or more subsequent survey HIV tests. These unexpected discrepancies between their self-reported results and the survey results draw into question the validity of either the self-reported status or the test results. We analyzed PSRP with negative test results aged 15-59 years old using data collected from 2015 to 2021 in 13 countries, assessing prevalence, self-report status, survey HIV status, viral load, rapid tests and confirmatory tests, and answers to follow-up questions (such as years on treatment). Across these surveys, 19,026 participants were PSRP, and 256 (1.3%) of these were concluded to be HIV-negative after additional survey-based testing and review. PSRP determined to be HIV-negative trended higher in countries with a higher HIV prevalence, but their number was small enough that accepting self-reported HIV-positive status without testing would not have significantly affected the prevalence estimates for HIV or viral load suppression. Additionally, using more detailed information for Uganda, we examined 107 PSRP with any negative test results and found no significant correlation with years on treatment or age. Using these details, we examined support for the possible reasons for these discrepancies beyond misdiagnosis and false reporting. These findings suggest that those conducting surveys would benefit from a nuanced understanding of HIV testing among PSRP to conduct surveys ethically and produce high-quality results.
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Affiliation(s)
- Melissa Metz
- ICAP at Columbia University, New York, NY 10032, USA; (F.S.W.); (S.M.F.)
| | | | | | - Faith Ussery
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (F.U.); (S.B.); (A.C.V.); (B.S.P.); (H.K.P.)
| | - Peter Nkurunziza
- ICAP Uganda, Plot 1 Lourdel Rd, 5th Floor Lourdel Towers, Kampala, Uganda; (P.N.); (J.B.); (S.B.)
| | - Janet Bahizi
- ICAP Uganda, Plot 1 Lourdel Rd, 5th Floor Lourdel Towers, Kampala, Uganda; (P.N.); (J.B.); (S.B.)
| | - Samuel Biraro
- ICAP Uganda, Plot 1 Lourdel Rd, 5th Floor Lourdel Towers, Kampala, Uganda; (P.N.); (J.B.); (S.B.)
| | | | | | - Wilford Kirungi
- Uganda Ministry of Health, Kampala P.O. Box 7272, Uganda (W.K.)
| | - Mary Naluguza
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Kampala P.O. Box 7007, Uganda; (M.N.); (L.J.N.)
| | - Christina Mwangi
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Kampala P.O. Box 7007, Uganda; (M.N.); (L.J.N.)
| | - Sehin Birhanu
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (F.U.); (S.B.); (A.C.V.); (B.S.P.); (H.K.P.)
| | - Lisa J. Nelson
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Kampala P.O. Box 7007, Uganda; (M.N.); (L.J.N.)
| | - Herbert Longwe
- ICAP South Africa, Erasmuskloof, Pretoria P.O Box 11203, South Africa;
| | | | - Andrew C. Voetsch
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (F.U.); (S.B.); (A.C.V.); (B.S.P.); (H.K.P.)
| | - Bharat S. Parekh
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (F.U.); (S.B.); (A.C.V.); (B.S.P.); (H.K.P.)
| | - Hetal K. Patel
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA; (F.U.); (S.B.); (A.C.V.); (B.S.P.); (H.K.P.)
| | - Yen T. Duong
- ICAP at Columbia University, New York, NY 10032, USA; (F.S.W.); (S.M.F.)
| | - Rachel Bray
- ICAP at Columbia University, New York, NY 10032, USA; (F.S.W.); (S.M.F.)
| | - Shannon M. Farley
- ICAP at Columbia University, New York, NY 10032, USA; (F.S.W.); (S.M.F.)
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Mihealsick E, Word A, Scully EP. The impact of sex on HIV immunopathogenesis and therapeutic interventions. J Clin Invest 2024; 134:e180075. [PMID: 39286972 PMCID: PMC11405047 DOI: 10.1172/jci180075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Globally, the majority of people living with HIV are women or girls, but they have been a minority of participants in clinical trials and observational studies of HIV. Despite this underrepresentation, differences in the pathogenesis of HIV have been observed between men and women, with contributions from both gender- and sex-based factors. These include differences in the risk of HIV acquisition, in viral load set point and immune activation in responses to viremia, and differences in HIV reservoir maintenance. These differences obligate adequate study in both males and females in order to optimize treatments, but also provide a powerful leverage point for delineating the mechanisms of HIV pathogenesis. The shifts in exposure to sex steroid hormones across a lifespan introduce additional complexity, which again can be used to focus on either genetic or hormonal influences as the driver of an outcome. In this Review, we discuss consistent and reproducible differences by sex across the spectrum of HIV, from acquisition through pathogenesis, treatment, and cure, and explore potential mechanisms and gaps in knowledge.
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Affiliation(s)
| | | | - Eileen P Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Arenas VR, Rugeles MT, Perdomo-Celis F, Taborda N. Recent advances in CD8 + T cell-based immune therapies for HIV cure. Heliyon 2023; 9:e17481. [PMID: 37441388 PMCID: PMC10333625 DOI: 10.1016/j.heliyon.2023.e17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Achieving a cure for HIV infection is a global priority. There is substantial evidence supporting a central role for CD8+ T cells in the natural control of HIV, suggesting the rationale that these cells may be exploited to achieve remission or cure of this infection. In this work, we review the major challenges for achieving an HIV cure, the models of HIV remission, and the mechanisms of HIV control mediated by CD8+ T cells. In addition, we discuss strategies based on this cell population that could be used in the search for an HIV cure. Finally, we analyze the current challenges and perspectives to translate this basic knowledge toward scalable HIV cure strategies.
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Affiliation(s)
| | - María T. Rugeles
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | | | - Natalia Taborda
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
- Grupo de Investigaciones Biomédicas Uniremington, Programa de Medicina, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellin, Colombia
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Abstract
PURPOSE OF REVIEW The quest for HIV-1 cure could take advantage of the study of rare individuals that control viral replication spontaneously (elite controllers) or after an initial course of antiretroviral therapy (posttreatment controllers, PTCs). In this review, we will compare back-to-back the immunological and virological features underlying viral suppression in elite controllers and PTCs, and explore their possible contributions to the HIV-1 cure research. RECENT FINDINGS HIV-1 control in elite controllers shows hallmarks of an effective antiviral response, favored by genetic background and possibly associated to residual immune activation. The immune pressure in elite controllers might select against actively transcribing intact proviruses, allowing the persistence of a small and poorly inducible reservoir. Evidence on PTCs is less abundant but preliminary data suggest that antiviral immune responses may be less pronounced. Therefore, these patients may rely on distinct mechanisms, not completely elucidated to date, suppressing HIV-1 transcription and replication. SUMMARY PTCs and elite controllers may control HIV replication using distinct pathways, the elucidation of which may contribute to design future interventional strategies aiming to achieve a functional cure.
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Affiliation(s)
- Joel N Blankson
- Center for AIDS Research, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Lau CY, Adan MA, Maldarelli F. Why the HIV Reservoir Never Runs Dry: Clonal Expansion and the Characteristics of HIV-Infected Cells Challenge Strategies to Cure and Control HIV Infection. Viruses 2021; 13:2512. [PMID: 34960781 PMCID: PMC8708047 DOI: 10.3390/v13122512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 12/13/2022] Open
Abstract
Antiretroviral therapy (ART) effectively reduces cycles of viral replication but does not target proviral populations in cells that persist for prolonged periods and that can undergo clonal expansion. Consequently, chronic human immunodeficiency virus (HIV) infection is sustained during ART by a reservoir of long-lived latently infected cells and their progeny. This proviral landscape undergoes change over time on ART. One of the forces driving change in the landscape is the clonal expansion of infected CD4 T cells, which presents a key obstacle to HIV eradication. Potential mechanisms of clonal expansion include general immune activation, antigenic stimulation, homeostatic proliferation, and provirus-driven clonal expansion, each of which likely contributes in varying, and largely unmeasured, amounts to maintaining the reservoir. The role of clinical events, such as infections or neoplasms, in driving these mechanisms remains uncertain, but characterizing these forces may shed light on approaches to effectively eradicate HIV. A limited number of individuals have been cured of HIV infection in the setting of bone marrow transplant; information from these and other studies may identify the means to eradicate or control the virus without ART. In this review, we describe the mechanisms of HIV-1 persistence and clonal expansion, along with the attempts to modify these factors as part of reservoir reduction and cure strategies.
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Affiliation(s)
- Chuen-Yen Lau
- HIV Dynamics and Replication Program, NCI, NIH, Bethesda, MD 20892, USA; (C.-Y.L.); (M.A.A.)
| | - Matthew A. Adan
- HIV Dynamics and Replication Program, NCI, NIH, Bethesda, MD 20892, USA; (C.-Y.L.); (M.A.A.)
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Frank Maldarelli
- HIV Dynamics and Replication Program, NCI, NIH, Bethesda, MD 20892, USA; (C.-Y.L.); (M.A.A.)
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Pastori C, Galli L, Siracusano G, Spagnuolo V, Muccini C, Mastrangelo A, Bruzzesi E, Ranzenigo M, Chiurlo M, Castagna A, Lopalco L. Serum IgG1 and IgG4 could contribute to partial control of viral rebound in chronically HIV-1-infected patients. AIDS 2021; 35:1549-1559. [PMID: 33993130 DOI: 10.1097/qad.0000000000002944] [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: 11/25/2022]
Abstract
OBJECTIVES Few studies have investigated chronically infected individuals after antiretroviral therapy (ART) interruption (ATI, analytical therapy interruption); thus, we investigated the association between some HIV-specific antibodies and viral control. DESIGN All enrolled patients were previously described in the APACHE study. Briefly, the study was conducted on HIV-1 chronically infected patients, with HIV-RNA less than 50 copies/ml for at least 10 years, CD4+ cell count greater than 500 cells/μl and HIV-DNA less than 100 copies/106 PBMC. The ART regimen in use at the time of ATI was resumed at confirmed viral rebound (CVR, defined as two consecutive HIV-RNA >50 copies/ml). METHODS Collection of sera and analysis of both binding antibodies (BAbs) and neutralizing antibodies (NAbs) was performed at three different time points: ATI, CVR and time of viral re-suppression after ART resumption. RESULTS IgG subclasses (IgG1, IgG2, IgG3 and IgG4) from the four patients with highest levels of neutralization were found to block viral infection. All patients had CVR after ATI at a median time of 21 days (14-56). After ART resumption, all the enrolled patients achieved HIV-RNA less than 50 copies/ml in 42 days (21-98). We observed a strong increase of either BAbs and NAbs titers from ATI to viral re-suppression in one patient, who showed the longest period of virus undetectability during ATI. In this patient, BAbs and NAbs specifically belonged to both IgG1 and IgG4 subclasses, directed to env antigen. CONCLUSION env-specific NAbs and BAbs belonging to IgG1, IgG4 subclasses could be helpful to monitor long-term responses able to control virus replication and eradicate HIV infection.
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Affiliation(s)
- Claudia Pastori
- Immunobiology of HIV, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute
| | - Laura Galli
- Infectious Diseases, San Raffaele Scientific Institute
| | - Gabriel Siracusano
- Immunobiology of HIV, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute
| | | | | | | | | | | | | | - Antonella Castagna
- Infectious Diseases, San Raffaele Scientific Institute
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Lopalco
- Immunobiology of HIV, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute
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Li JZ, Blankson JN. How elite controllers and posttreatment controllers inform our search for an HIV-1 cure. J Clin Invest 2021; 131:e149414. [PMID: 34060478 DOI: 10.1172/jci149414] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A small percentage of people living with HIV-1 can control viral replication without antiretroviral therapy (ART). These patients are called elite controllers (ECs) if they are able to maintain viral suppression without initiating ART and posttreatment controllers (PTCs) if they control HIV replication after ART has been discontinued. Both types of controllers may serve as a model of a functional cure for HIV-1 but the mechanisms responsible for viral control have not been fully elucidated. In this review, we highlight key lessons that have been learned so far in the study of ECs and PTCs and their implications for HIV cure research.
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Affiliation(s)
- Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joel N Blankson
- Center for AIDS Research, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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