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Risk Factors for CSF/Plasma HIV-1 RNA Discordance in HIV-Infected Patients. J Acquir Immune Defic Syndr 2022; 91:S20-S26. [PMID: 36094511 DOI: 10.1097/qai.0000000000003046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few large investigations have evaluated the association of cerebrospinal fluid/plasma (CSF/plasma) discordance with opportunistic neurological infections. We aimed to determine risk factors for CSF/plasma discordance to further assess whether CSF/plasma discordance is associated with antiretroviral therapy (ART) and opportunistic neurological infections. METHODS A retrospective study was conducted based on HIV RNA viral load and associated risk factors in plasma and CSF samples from 491 HIV-infected patients. HIV RNA levels higher in CSF compared with plasma was defined as CSF/plasma discordance. RESULTS In this study, the rate of CSF/plasma discordance was 18.3%. We observed that headache, cryptococcal antigen, CSF cell count, Treponema pallidum particle assay positivity, and ART use were significantly associated with CSF/plasma discordance in the multivariate logistic regression model. The CSF RNA/plasma RNA ratio was significantly higher in HIV-infected patients with neurological infections than in HIV-infected cases without neurological infections (P < 0.001). CSF/plasma discordance was significantly different between HIV-infected patients without central nervous system (CNS) infection and those with CNS infection, tuberculous meningitis, cryptococcal meningitis, and neurosyphilis (P < 0.05). CONCLUSIONS ART and CNS inflammation may influence CSF/plasma discordance.
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Association of High Ratio of CSF/Plasma HIV-1 RNA with Central Nervous System Co-Infection in HIV-1-Positive Treatment-Naive Patients. Brain Sci 2022; 12:brainsci12060791. [PMID: 35741676 PMCID: PMC9221150 DOI: 10.3390/brainsci12060791] [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: 04/21/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023] Open
Abstract
Cerebrospinal fluid (CSF) human immunodeficiency virus-1 (HIV-1) ribonucleic acid (RNA) at higher levels than in plasma has been observed in HIV-1-positive patients and defined as CSF/plasma discordance or CSF escape. Discordance is particularly seen in untreated patients with antiretroviral agents. Quantitative data regarding its association with blood−brain barrier (BBB) damage and intracranial co-infection with other pathogens are limited. Therefore, we used the CSF to plasma HIV-1 RNA ratio (HRR) to determine its relation to central nervous system (CNS) co-infection in HIV-1-positive treatment-naïve individuals. We retrospectively recruited the subjects with HIV-1-positive and potential neurological deficits. A lumbar puncture was performed before the antiretroviral therapy. The paired CSF/plasma HIV-1 RNA samples were analyzed. Univariate and multivariate logistic regression models and multiple spine regression analyses were performed to assess the association between the HRR and CNS co-infection. A total of 195 patients with 78% males (median age: 49 years) were included in this study, of whom 98 (50.2%) had CNS co-infection with other pathogens. The receiver-operating characteristic curve analysis showed that the optimal cutoff value for the HRR to predict the CNS co-infection was 1.00. Higher HRR (≥1) was significantly associated with tuberculous meningitis (OR 6.50, 95% CI 2.08−20.25, p = 0.001), cryptococcus meningitis (OR 7.58, 95% CI 2.10−27.32, p = 0.001), and multiple co-infection (OR 4.04, 95% CI 1.02−16.04, p = 0.047). Higher HRR (≥1) (OR 3.01, 95% CI 1.09−8.73, p = 0.032) was independently associated with the CNS co-infection after adjusting for covariates. No significant nonlinear association was found between the HRR and CNS co-infection in the multivariate spline regression (p > 0.05) and a positive relationship was found between the HRR and CNS co-infection when the HRR was ≥0.78. Higher HRR was associated with an increased risk of CNS co-infection in HIV-1-positive patients. The relationship between the HRR and CNS co-infection may be related to the BBB disturbance and warrants further investigation with a large, longitudinal cohort.
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Yoon HA, Riska PF, Jain R, Morales C, Pirofski LA. Unexpected case of cryptococcal meningoencephalitis in a patient with long-standing well-controlled HIV infection. Med Mycol Case Rep 2021; 32:14-16. [PMID: 33552883 PMCID: PMC7851412 DOI: 10.1016/j.mmcr.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
Cryptococcal meningoencephalitis (CM) classically occurs in individuals with advanced HIV infection, solid organ transplants, or other immunocompromising conditions. We report a case of fatal CM in a 78-year-old woman with well-controlled HIV infection who had delayed diagnosis, persistently elevated intracranial pressure and pleocytosis of the cerebrospinal fluid. Initial suspicion for CM was low due to her relatively high CD4+ T cell counts, which likely contributed to greater inflammation.
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Affiliation(s)
- Hyun Ah Yoon
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Paul F Riska
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Ruchika Jain
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Cariane Morales
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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4
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Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches. Life (Basel) 2021; 11:life11020095. [PMID: 33514007 PMCID: PMC7912256 DOI: 10.3390/life11020095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 12/31/2022] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with Cryptococcus who have initiated ART.
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5
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Kelentse N, Moyo S, Mogwele ML, Ditshwanelo D, Mokaleng B, Moraka NO, Lechiile K, Leeme TB, Lawrence DS, Musonda R, Kasvosve I, Harrison TS, Jarvis JN, Gaseitsiwe S. HIV-1C env and gag Variation in the Cerebrospinal Fluid and Plasma of Patients with HIV-Associated Cryptococcal Meningitis in Botswana. Viruses 2020; 12:E1404. [PMID: 33297399 PMCID: PMC7762280 DOI: 10.3390/v12121404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
HIV-1 compartmentalization in reservoir sites remains a barrier to complete HIV eradication. It is unclear whether there is variation in HIV-1 env and gag between cerebrospinal fluid (CSF) and plasma of individuals with HIV-associated cryptococcal meningitis (CM). We compared HIV-1 env characteristics and the gag cytotoxic T-lymphocyte (CTL) escape mutations from CSF and plasma samples. Employing population-based Sanger sequencing, we sequenced HIV-1 env from CSF of 25 patients and plasma of 26 patients. For gag, 15 CSF and 21 plasma samples were successfully sequenced. Of these, 18 and 9 were paired env and gag CSF/plasma samples, respectively. There was no statistically significant difference in the proportion of CCR5-using strains in the CSF and plasma, (p = 0.50). Discordant CSF/plasma virus co-receptor use was found in 2/18 pairs (11.1%). The polymorphisms in the HIV-1 V3 loop were concordant between the two compartments. From the HIV-1 gag sequences, three pairs had discordant CTL escape mutations in three different epitopes of the nine analyzed. These findings suggest little variation in the HIV-1 env between plasma and CSF and that the CCR5-using strains predominate in both compartments. HIV-1 gag CTL escape mutations also displayed little variation in CSF and plasma suggesting similar CTL selective pressure.
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MESH Headings
- AIDS-Related Opportunistic Infections/blood
- AIDS-Related Opportunistic Infections/cerebrospinal fluid
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/metabolism
- Adult
- Amino Acid Sequence
- Amino Acid Substitution
- Botswana
- CD4 Lymphocyte Count
- Cross-Sectional Studies
- Disease Susceptibility
- Female
- HIV Infections/complications
- HIV Infections/virology
- Humans
- Immunocompromised Host
- Male
- Meningitis, Cryptococcal/blood
- Meningitis, Cryptococcal/cerebrospinal fluid
- Meningitis, Cryptococcal/etiology
- Meningitis, Cryptococcal/metabolism
- Middle Aged
- Mutation
- RNA, Viral
- Viral Load
- env Gene Products, Human Immunodeficiency Virus/blood
- env Gene Products, Human Immunodeficiency Virus/cerebrospinal fluid
- env Gene Products, Human Immunodeficiency Virus/metabolism
- gag Gene Products, Human Immunodeficiency Virus/blood
- gag Gene Products, Human Immunodeficiency Virus/cerebrospinal fluid
- gag Gene Products, Human Immunodeficiency Virus/metabolism
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Affiliation(s)
- Nametso Kelentse
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana;
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Mompati L. Mogwele
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Doreen Ditshwanelo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
| | - Baitshepi Mokaleng
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana;
| | - Natasha O. Moraka
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Department of Pathology, Stellenbosch University, Stellenbosch 7505, South Africa
| | - Kwana Lechiile
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Tshepo B. Leeme
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - David S. Lawrence
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana;
| | - Thomas S. Harrison
- Centre for Global Health, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK;
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; (N.K.); (S.M.); (M.L.M.); (D.D.); (B.M.); (N.O.M.); (K.L.); (T.B.L.); (D.S.L.); (R.M.); (J.N.J.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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6
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Kelentse N, Moyo S, Mogwele M, Lechiile K, Moraka NO, Maruapula D, Seatla KK, Esele L, Molebatsi K, Leeme TB, Lawrence DS, Musonda R, Kasvosve I, Harrison TS, Jarvis JN, Gaseitsiwe S. Differences in human immunodeficiency virus-1C viral load and drug resistance mutation between plasma and cerebrospinal fluid in patients with human immunodeficiency virus-associated cryptococcal meningitis in Botswana. Medicine (Baltimore) 2020; 99:e22606. [PMID: 33031315 PMCID: PMC7544309 DOI: 10.1097/md.0000000000022606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/14/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022] Open
Abstract
To determine effects of cryptococcal meningitis (CM) on human immunodeficiency virus (HIV)-1C cerebrospinal fluid (CSF) viral escape, CSF/plasma viral discordance, and drug resistance mutation (DRM) discordance between CSF and plasma compartments, we compared CSF and plasma viral load (VL) and DRMs in individuals with HIV-associated CM in Botswana.This cross-sectional study utilized 45 paired CSF/plasma samples from participants in a CM treatment trial (2014-2016). HIV-1 VL was determined and HIV-1 protease and reverse transcriptase genotyping performed. DRMs were determined using the Stanford HIV database. CSF viral escape was defined as HIV-1 ribonucleic acid ≥0.5 log10 higher in CSF than plasma and VL discordance as CSF VL > plasma VL.HIV-1 VL was successfully measured in 39/45 pairs, with insufficient sample volume in 6; 34/39 (87.2%) participants had detectable HIV-1 in plasma and CSF, median 5.1 (interquartile range: 4.7-5.7) and 4.6 (interquartile range:3.7-4.9) log10 copies/mL, respectively (P≤.001). CSF viral escape was present in 1/34 (2.9%) and VL discordance in 6/34 (17.6%). Discordance was not associated with CD4 count, antiretroviral status, fungal burden, CSF lymphocyte percentage nor mental status. Twenty-six of 45 (57.8%) CSF/plasma pairs were successfully sequenced. HIV-1 DRM discordance was found in 3/26 (11.5%); 1 had I84IT and another had M46MI in CSF only. The third had K101E in plasma and V106 M in CSF.Our findings suggest that HIV-1 escape and DRM discordance may occur at lower rates in participants with advanced HIV-disease and CM compared to those with HIV associated neurocognitive impairment.
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Affiliation(s)
- Nametso Kelentse
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Department of Medical Laboratory Sciences, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, United States
| | - Mompati Mogwele
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Department of Biological Sciences, Gaborone, Botswana
| | | | - Natasha O. Moraka
- Botswana Harvard AIDS Institute Partnership
- Stellenbosch University, Department of Pathology, Stellenbosch, South Africa
| | - Dorcas Maruapula
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Department of Biological Sciences, Gaborone, Botswana
| | - Kaelo K. Seatla
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Department of Medical Laboratory Sciences, Gaborone, Botswana
| | | | - Kesaobaka Molebatsi
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Department of Statistics, Gaborone, Botswana
| | - Tshepo B. Leeme
- Botswana Harvard AIDS Institute Partnership
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - David S. Lawrence
- Botswana Harvard AIDS Institute Partnership
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, United States
| | - Ishmael Kasvosve
- University of Botswana, Department of Medical Laboratory Sciences, Gaborone, Botswana
| | - Thomas S. Harrison
- Centre for Global Health, Institute for Infection and Immunity, St. George's University of London, United Kingdom
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, United States
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7
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Adewumi OM, Dukhovlinova E, Shehu NY, Zhou S, Council OD, Akanbi MO, Taiwo B, Ogunniyi A, Robertson K, Kanyama C, Hosseinipour MC, Swanstrom R. HIV-1 Central Nervous System Compartmentalization and Cytokine Interplay in Non-Subtype B HIV-1 Infections in Nigeria and Malawi. AIDS Res Hum Retroviruses 2020; 36:490-500. [PMID: 31914800 DOI: 10.1089/aid.2019.0245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
HIV-1 compartmentalization in the central nervous system (CNS) and its contribution to neurological disease have been well documented. Previous studies were conducted among people infected with subtypes B or C where CNS compartmentalization has been observed when comparing viral sequences in the blood to virus in cerebrospinal fluid (CSF). However, little is known about CNS compartmentalization in other HIV-1 subtypes. Using a deep sequencing approach with Primer ID, we conducted a cross-sectional study among Nigerian and Malawian HIV-1 cohorts with or without fungal Cryptococcus infection diagnosed as cryptococcal meningitis (CM) to determine the extent of CSF/CNS compartmentalization with CM. Paired plasma and CSF samples from 45 participants were also analyzed for cytokine/chemokine levels. Viral populations comparing virus in the blood and the CSF ranged from compartmentalized to equilibrated, including minor or partial compartmentalization or clonal amplification of a single viral sequence. The frequency of compartmentalized viral populations in the blood and CSF was similar between the CM- and CM+ participants. We confirmed the potential to see compartmentalization with subtype C infection and have also documented CNS compartmentalization of an HIV-1 subtype G infection. Cytokine profiles indicated a proinflammatory environment, especially within the CSF/CNS. However, sCD163 was suppressed in the CSF in the presence of CM, perhaps due to elevated levels of IL-4, which were also a feature of the cytokine profile, showing a distinct cytokine profile with CM.
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Affiliation(s)
- Olubusuyi Moses Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elena Dukhovlinova
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nathan Y. Shehu
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Shuntai Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Olivia D. Council
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maxwell O. Akanbi
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Babafemi Taiwo
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kevin Robertson
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cecilia Kanyama
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald Swanstrom
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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8
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Chan P, Patel P, Hellmuth J, Colby DJ, Kroon E, Sacdalan C, Pinyakorn S, Jagodzinski L, Krebs S, Ananworanich J, Valcour V, Spudich S. Distribution of Human Immunodeficiency Virus (HIV) Ribonucleic Acid in Cerebrospinal Fluid and Blood Is Linked to CD4/CD8 Ratio During Acute HIV. J Infect Dis 2019; 218:937-945. [PMID: 29741638 PMCID: PMC6093332 DOI: 10.1093/infdis/jiy260] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/05/2018] [Indexed: 01/03/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) ribonucleic acid (RNA) levels in the plasma and cerebrospinal fluid (CSF) are correlated in chronic HIV infection, but their dynamics have not been characterized during acute infection. Methods This study analyzed predictors of CSF HIV RNA and relative degree of CNS viral transmigration expressed as plasma minus CSF HIV log10 RNA (PCratio) during untreated acute HIV infection. Cerebrospinal fluid immune markers were compared between groups with different PCratio. Results One hundred seventeen mostly male (97%) participants in the RV254 cohort in Bangkok, Thailand, had a median age of 28 years and an estimated median 18 days duration of infection; 43 (37%) were Fiebig stages I/II. Twenty-seven (23%) had CSF HIV RNA <80 copies/mL. Those with quantifiable levels (n = 90) had median CSF HIV RNA and PCratio of 3.76 and 2.36 log10 copies/mL, respectively. Human immunodeficiency virus RNA peaked at Fiebig III in plasma and Fiebig IV in CSF. In multivariable analyses, plasma HIV RNA and CD4/CD8 ratio independently correlated with CSF HIV RNA (P < .001), whereas CD4/CD8 ratio predicted PCratio (P = .018). Participants with PCratio <1 had higher CSF neopterin, soluble (s)CD163, interleukin-6, and sCD14 levels (all P < .05). Conclusions CD4/CD8 ratio independently correlated with CSF HIV RNA and PCratio, suggesting that immune responses modulate central nervous system viral entry at early infection.
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Affiliation(s)
- Phillip Chan
- SEARCH Thailand, Thai Red Cross AIDS Research Centre, Bangkok
| | - Payal Patel
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Joanna Hellmuth
- Memory and Aging Center, Department of Neurology, University of California San Francisco
| | - Donn J Colby
- SEARCH Thailand, Thai Red Cross AIDS Research Centre, Bangkok
| | - Eugène Kroon
- SEARCH Thailand, Thai Red Cross AIDS Research Centre, Bangkok
| | - Carlo Sacdalan
- SEARCH Thailand, Thai Red Cross AIDS Research Centre, Bangkok
| | - Suteeraporn Pinyakorn
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Linda Jagodzinski
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Shelly Krebs
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Jintanat Ananworanich
- SEARCH Thailand, Thai Red Cross AIDS Research Centre, Bangkok.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California San Francisco
| | - Serena Spudich
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research, Yale University, New Haven, Connecticut
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Summers NA, Kelley CF, Armstrong W, Marconi VC, Nguyen ML. Not a Disease of the Past: A Case Series of Progressive Multifocal Leukoencephalopathy in the Established Antiretroviral Era. AIDS Res Hum Retroviruses 2019; 35:544-552. [PMID: 30834775 DOI: 10.1089/aid.2018.0232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) and PML immune reconstitution inflammatory syndrome (PML-IRIS) can be devastating neurological processes associated with HIV, but limited knowledge of their characteristics in the established antiretroviral therapy (ART) era is available. We conducted a case series to evaluate the clinical course of PML and PML-IRIS at our urban safety-net hospital in Atlanta, GA. All HIV-positive individuals with a positive John Cunningham virus DNA polymerase chain reaction in the spinal fluid between May 1, 2013 to June 1, 2017 were identified from the electronic health records (EHRs) using the HIV Disease Registry. Demographics, symptom presentation, laboratory data, imaging results, treatment, and outcomes were abstracted from the EHR. PML and PML-IRIS were defined using the American Association of Neurology criteria. Of the 32 individuals identified, 6 (19%) were felt to have asymptomatic positive results. Of the remainder, 15 (58%) HIV-positive patients had PML and 11 (42%) PML-IRIS (2 with an unmasking presentation and 9 with a paradoxical presentation). The most common presenting symptoms were motor weakness (18, 69%), cognitive deficits (15, 58%), and dysarthria (11, 42%). Corticosteroids were used in 12 patients and maraviroc in 3 patients. Outcomes were dismal with 7 (47%) patients with PML and 9 (82%) with PML-IRIS dying or being referred to hospice, with median survival times of 266 days in the PML group and 109 days in the PML-IRIS group. Despite widespread access to ART, patients with PML continue to have poor outcomes, particularly among those who develop PML-IRIS. More research is needed to understand the risks for and prevention of PML-IRIS.
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Affiliation(s)
- Nathan A. Summers
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Health Systems, Atlanta, Georgia
| | - Colleen F. Kelley
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Health Systems, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Wendy Armstrong
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Health Systems, Atlanta, Georgia
| | - Vincent C. Marconi
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Health Systems, Atlanta, Georgia
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Minh Ly Nguyen
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Health Systems, Atlanta, Georgia
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Sojane K, Kangethe RT, Chang CC, Moosa MYS, Lewin SR, French MA, Ndung'u T. Individuals with HIV-1 Subtype C Infection and Cryptococcal Meningitis Exhibit Viral Genetic Intermixing of HIV-1 Between Plasma and Cerebrospinal Fluid and a High Prevalence of CXCR4-Using Variants. AIDS Res Hum Retroviruses 2018; 34:607-620. [PMID: 29658309 PMCID: PMC6314437 DOI: 10.1089/aid.2017.0209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The genotypic properties of human immunodeficiency virus type 1 (HIV-1) subtype C in individuals presenting with cryptococcal meningitis (CM) are not well established. Employing single-genome amplification as well as bulk PCR, cloning and sequencing strategies, we evaluated the genetic properties of HIV-1 subtype C env in 16 antiretroviral therapy-naive study participants with CM. Eleven of the 16 participants had matched blood plasma and cerebrospinal fluid (CSF) evaluated, with the rest having either a plasma or CSF sample evaluated. Before antiretroviral therapy initiation, matched plasma and CSF-derived env sequences of all 11 participants displayed genetic intermixing between the two compartments. Overall, 7 of the 16 (∼43.8%) participants harbored CXCR4-using variants in plasma and/or CSF, according to coreceptor usage prediction algorithms. This study suggests that HIV-1 subtype C genetic intermixing between peripheral blood and the central nervous system is common in individuals presenting with CM, and that CXCR4 usage is present in one or both compartments in approximately 44% of individuals.
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Affiliation(s)
- Katlego Sojane
- 1 HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban, South Africa
| | - Richard T Kangethe
- 1 HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban, South Africa
| | - Christina C Chang
- 2 Department of Infectious Diseases, Alfred Hospital and Monash University , Melbourne, Australia
| | - Mahomed-Yunus S Moosa
- 3 Department of Infectious Diseases, King Edward VIII Hospital, University of KwaZulu-Natal , Durban, South Africa
| | - Sharon R Lewin
- 2 Department of Infectious Diseases, Alfred Hospital and Monash University , Melbourne, Australia
- 4 The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital , Melbourne, Australia
| | - Martyn A French
- 5 Medical School and School of Biomedical Sciences, University of Western Australia , Perth, Australia
- 6 Department of Clinical Immunology, Royal Perth Hospital and PathWest Laboratory Medicine , Perth, Australia
| | - Thumbi Ndung'u
- 1 HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban, South Africa
- 7 Africa Health Research Institute , Durban, South Africa
- 8 Ragon Institute of MGH, MIT and Harvard University , Cambridge, Massachusetts
- 9 Max Planck Institute for Infection Biology , Berlin, Germany
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