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Shi X, Sims MD, Hanna MM, Xie M, Gulick PG, Zheng YH, Basson MD, Zhang P. Neutropenia during HIV infection: adverse consequences and remedies. Int Rev Immunol 2014; 33:511-36. [PMID: 24654626 DOI: 10.3109/08830185.2014.893301] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neutropenia frequently occurs in patients with Human immunodeficiency virus (HIV) infection. Causes for neutropenia during HIV infection are multifactoral, including the viral toxicity to hematopoietic tissue, the use of myelotoxic agents for treatment, complication with secondary infections and malignancies, as well as the patient's association with confounding factors which impair myelopoiesis. An increased prevalence and severity of neutropenia is commonly seen in advanced stages of HIV disease. Decline of neutrophil phagocytic defense in combination with the failure of adaptive immunity renders the host highly susceptible to developing fatal secondary infections. Neutropenia and myelosuppression also restrict the use of many antimicrobial agents for treatment of infections caused by HIV and opportunistic pathogens. In recent years, HIV infection has increasingly become a chronic disease because of progress in antiretroviral therapy (ART). Prevention and treatment of severe neutropenia becomes critical for improving the survival of HIV-infected patients.
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Cosenza-Nashat M, Zhao ML, Marshall HD, Si Q, Morgello S, Lee SC. Human immunodeficiency virus infection inhibits granulocyte-macrophage colony-stimulating factor-induced microglial proliferation. J Neurovirol 2008; 13:536-48. [PMID: 18097885 DOI: 10.1080/13550280701549417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
It is well known that infection by the human immunodeficiency virus (HIV) dysregulates cell physiology, but little information is available on the consequences of HIV infection in primary macrophages and microglia. The authors examined the relationship between cell proliferation and HIV infection in primary cultures of microglia and in human central nervous system (CNS). In cultures infected with HIV (ADA and BaL), granulocyte-macrophage colony-stimulating factor (GM-CSF)-mediated cell proliferation was reduced in productively infected (p24+) cells as compared to p24- cells. The reduction was observed with both Ki67 and BrdU labeling, suggesting a G1/S block. The reduction was insignificant when microglia were infected with a Vpr- mutant virus. In human CNS, proliferating (Ki67+) cells were rare but were increased in the HIV+ and HIV encephalitis (HIVE) groups compared to the HIV- group. A positive correlation between GM-CSF immunoreactivity and Ki67 counts, implicating GM-CSF as a growth factor in human CNS was found. The relationship between total macrophage (CD68+) proliferation and infected macrophage (p24+) proliferation was assessed in HIVE by double labeling. Whereas 1.2% of total CD68+ cells were Ki67+, only 0.5% of HIV p24+ cells were Ki67+ (P < .05). Furthermore, staining for CD45RB (as opposed to CD68) facilitated the identification of Ki67+ microglia, indicating that CD68 could underestimate proliferating microglia. The authors conclude that although there is increased expression of GM-CSF and increased cell proliferation in the CNS of HIV-seropositive individuals, cell proliferation in the productively infected population is actually suppressed. These data suggest that there might be a viral gain in the suppressed host cell proliferation.
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Affiliation(s)
- Melissa Cosenza-Nashat
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Increased in vivo activation of microglia and astrocytes in the brains of mice transgenic for an infectious R5 human immunodeficiency virus type 1 provirus and for CD4-specific expression of human cyclin T1 in response to stimulation by lipopolysaccharides. J Virol 2008; 82:5562-72. [PMID: 18353948 DOI: 10.1128/jvi.02618-07] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Inflammatory mediators and viral products produced by human immunodeficiency virus (HIV)-infected microglia and astrocytes perturb the function and viability of adjacent uninfected neuronal and glial cells and contribute to the pathogenesis of HIV-associated neurocognitive disorders (HAND). In vivo exposure to lipopolysaccharide (LPS) activates parenchymal microglia and astrocytes and induces cytokine and chemokine production in the brain. HIV-infected individuals display increased circulating LPS levels due to microbial translocation across a compromised mucosa barrier. We hypothesized that HIV-infected microglia and astrocytes display increased sensitivity to the proinflammatory effects of LPS, and this combines with the increased levels of systemic LPS in HIV-infected individuals to contribute to the development of HAND. To examine this possibility, we determined the in vivo responsiveness of HIV-infected microglia and astrocytes to LPS using our mouse model, JR-CSF/human cyclin T1 (JR-CSF/hu-cycT1) mice, which are transgenic for both an integrated full-length infectious HIV type 1 (HIV-1) provirus derived from the primary R5-tropic clinical isolate HIV-1(JR-CSF) regulated by the endogenous HIV-1 long terminal repeat and the hu-cycT1 gene under the control of a CD4 promoter. In the current report, we demonstrated that in vivo-administered LPS more potently activated JR-CSF/hu-cycT1 mouse microglia and astrocytes and induced a significantly higher degree of monocyte chemoattractant protein production by JR-CSF/hu-cycT1 astrocytes compared to that of the in vivo LPS response of control littermate mouse microglia and astrocytes. These results indicate that HIV infection increases the sensitivity of microglia and astrocytes to inflammatory stimulation and support the use of these mice as a model to investigate various aspects of the in vivo mechanism of HIV-induced neuronal dysfunction.
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Crotti A, Lusic M, Lupo R, Lievens PMJ, Liboi E, Della Chiara G, Tinelli M, Lazzarin A, Patterson BK, Giacca M, Bovolenta C, Poli G. Naturally occurring C-terminally truncated STAT5 is a negative regulator of HIV-1 expression. Blood 2007; 109:5380-9. [PMID: 17332243 DOI: 10.1182/blood-2006-08-042556] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
CD4(+) cells of most individuals infected with HIV-1 harbor a C-terminally truncated and constitutively activated form of signal transducer and activator of transcription-5 (STAT5 Delta). We report that the chronically HIV-infected U1 cell line expresses STAT5 Delta but not full-length STAT5. Granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulation of U1 cells promoted early activation of STAT5 Delta and of extracellular signal regulated kinases (ERKs), followed by later activation of activator protein 1 (AP-1) and HIV expression. Inhibition of ERK/AP-1 by PD98,059 abolished, whereas either tyrphostin AG490 or a STAT5 small interfering RNA (siRNA) enhanced, virion production in GM-CSF-stimulated U1 cells. Chromatin immunoprecipitation demonstrated the induction of STAT5 Delta binding to STAT consensus sequences in the HIV-1 promoter together with a decreased recruitment of RNA polymerase II after 1 hour of GM-CSF stimulation of U1 cells. Down-regulation of STAT5 Delta by siRNA resulted in the up-regulation of both HIV-1 gag-pol RNA and p24 Gag antigen expression in CD8-depleted leukocytes of several HIV-positive individuals cultivated ex vivo in the presence of interleukin-2 but not of interleukin-7. Thus, the constitutively activated STAT5 Delta present in the leukocytes of most HIV-positive individuals acts as a negative regulator of HIV expression.
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Affiliation(s)
- Andrea Crotti
- AIDS Immunopathogenesis Unit and the Division of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
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Carroll-Anzinger D, Al-Harthi L. Gamma interferon primes productive human immunodeficiency virus infection in astrocytes. J Virol 2007; 80:541-4. [PMID: 16352578 PMCID: PMC1317538 DOI: 10.1128/jvi.80.1.541-544.2006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Considerable controversy exists over whether astrocytes can support human immunodeficiency virus (HIV) infection. We evaluated the impact of three cytokines critical to the development of HIV neuropathogenesis, gamma interferon (IFN-gamma), granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor alpha, on priming astrocytes for HIV infection. We demonstrate that IFN-gamma was the most potent in its ability to facilitate substantial productive HIV infection of an astroglioma cell line (U87MG) and human fetal astrocytes (HFA). The mechanism of IFN-gamma-mediated priming of HIV in HFA is unlikely to be at the level of up-regulation of receptors and coreceptors relevant to HIV entry. These data demonstrate that cytokine priming can alter HIV replication in astrocytes.
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Affiliation(s)
- Deborah Carroll-Anzinger
- Rush University Medical Center, Department of Immunology/Microbiology, 1735 W. Harrison Street, 614 Cohn, Chicago, IL 60612, USA
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Use of a Biopolymer Polyalkylimide Filler for Facial Lipodystrophy in HIV-Positive Patients Undergoing Treatment with Antiretroviral Drugs. Dermatol Surg 2006. [DOI: 10.1097/00042728-200606000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Chronic infection with hepatitis C virus (HCV) can progress to cirrhosis, hepatocellular carcinoma, and end-stage liver disease. The current best treatment for HCV infection is combination therapy with pegylated interferon and ribavirin. Although this regimen produces sustained virologic responses (SVRs) in approximately 50% of patients, it can be associated with a potentially dose-limiting hemolytic anemia. Hemoglobin concentrations decrease mainly as a result of ribavirin-induced hemolysis, and this anemia can be problematic in patients with HCV infection, especially those who have comorbid renal or cardiovascular disorders. In general, anemia can increase the risk of morbidity and mortality, and may have negative effects on cerebral function and quality of life. Although ribavirin-associated anemia can be reversed by dose reduction or discontinuation, this approach compromises outcomes by significantly decreasing SVR rates. Recombinant human erythropoietin has been used to manage ribavirin-associated anemia but has other potential disadvantages. Viramidine, a liver-targeting prodrug of ribavirin, has the potential to maintain the virologic efficacy of ribavirin while decreasing the risk of hemolytic anemia in patients with chronic hepatitis C.
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Abstract
HIV infected macrophages infiltrate the nervous system early in the progression of HIV infection, leading to a complex set of neuropathological alterations including HIV encephalitis (HIVE), leukoencephalopathy and vacuolar myelopathy that in turn result in neurodegeneration of selective cellular populations and pathways involved in regulating cognitive and motor functioning. Rapid progress in the development of highly active antiretroviral therapy (HAART) has changed the patterns of HIV related neuropathology and neurological manifestations in the past 10 years. The prevalence of opportunistic infections and central nervous system (CNS) neoplasms has decreased, and some groups have proposed that the frequency of chronic forms of HIVE have been rising as the HAART-treated HIV population ages. Accordingly, clinical manifestations have shifted from severe dementia forms to more subtle minor cognitive impairment, leading to the suggestion of a classification of HIV associated neurological conditions into an inactive form, a chronic variety, and a 'transformed' variant. From a neuropathological point of view these variants might correspond to: a) aggressive forms with severe HIVE and white matter injury, b) extensive perivascular lymphocytic infiltration, c) 'burnt-out' forms of HIVE and d) aging-associated amyloid accumulation with Alzheimer's-like neuropathology. Factors contributing to the emergence of these variants of HIVE include the development of viral resistance, immune reconstitution, anti-retroviral drug toxicity and co-morbid factors (e.g., methamphetamine, HCV). More detailed characterization of these proposed variants of HIVE is important in order to better understand the pathogenesis of HIV-associated neurological damage and to design more effective treatments to protect the nervous system.
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Affiliation(s)
- I P Everall
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0624, USA
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Agius LM. Is repetitive opportunistic infection in AIDS patients the effective mechanism for neurodegeneration in terms of endlessly amplifying cytokine/chemokine effect? Med Hypotheses 2004; 62:587-92. [PMID: 15050112 DOI: 10.1016/s0306-9877(03)00273-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 07/30/2003] [Indexed: 10/26/2022]
Abstract
With strict reference to how AIDS dementia somehow evolves from HIV infection through stages of initial monocyte-macrophage stimulation via a series of transendothelial and infiltrative events, it is perhaps significant to consider systemic body involvement by the HIV-associated processes to culminate in a concerted series of effects involving cascades and amplifications of action of cytokines and chemokines. Indeed, in terms that would implicate neurons only secondarily in AIDS dementia, one might perhaps consider HIV-1-dementia as an effective result of ongoing inflammation in the brain dependent not only on macrophage-microglial activation and replication, but also on glial participation in an overall process particularly conducive to increasing the brain HIV-1 load. In effect, perhaps, HIV encephalitis would constitute a system of mutually self-enhancing series of events ranging from macrophage-monocyte activation and replication on the one hand, and also HIV-1-induced cellular effects on the other that would result in progressively amplifying neuronal injury induced by cytokines and chemokines in AIDS patients suffering from repetitive opportunistic infections.
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Affiliation(s)
- Lawrence M Agius
- Department of Pathology, St Luke's Hospital, Gwardamangia, University of Malta, Msida, Malta.
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Abstract
In this article I will review the findings of the potential interactive effects of HIV infection and heroin use as observed in both clinical and laboratory studies. Some of the findings are discrepant and I will endeavour to propose models that could accommodate these variant results as well as suggest factors that could be considered in analysing future investigations in order to resolve these apparent discrepancies.
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Affiliation(s)
- Ian Paul Everall
- Section of Experimental Neuropathology and Psychiatry, Institute of Psychiatry, King's College London, DeCrespigny Park, London SE5 8AF, UK.
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Trillo-Pazos G, Kandanearatchi A, Eyeson J, King D, Vyakarnam A, Everall IP. Infection of stationary human brain aggregates with HIV-1 SF162 and IIIB results in transient neuronal damage and neurotoxicity. Neuropathol Appl Neurobiol 2003; 30:136-47. [PMID: 15043711 DOI: 10.1046/j.0305-1846.2003.00519.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The cellular basis of HIV associated dementia has been correlated with microglial activation and neuronal dysfunction in symptomatic HIV-1 disease. As a cellular model of HIV-1 infection of brain tissue in vitro, we established a stationary human brain aggregate (SHBA) system to compare infection of HIV-1 SF162 (R5 virus) to that of IIIB (X4 virus). Aggregates were analysed by immunohistochemistry, morphometry, flow cytometry and p24 ELISA. SHBAs had a 1 mm(3) size with a mixed cellular composition of 36% neurones, 27% astrocytes, 2% macrophages/microglia and 14% oligodendrocytes. Infection of SHBA's with the R5 HIV-1 SF162 virus led to the expression of HIV-1 p24 antigen in 6% of cells. Infection with this R5 using virus culminated in transient neuronal damage and a decrease in mitotically active progenitor cells within aggregates. Infection with X4 using HIV-1 IIIB was associated with astrocytosis and neurotoxicity. We propose that: (1) the pattern of cellular damage elicited by HIV-1 infection of brain tissue in vitro depends on virus subtype as determined by its preferential use of R5 or X4 chemokine receptors for entry into cells; (2) SHBAs are a reliable and readily established model of the cellular complexity of human brain tissue in vitro.
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Affiliation(s)
- G Trillo-Pazos
- Section of Experimental Neuropathology and Psychiatry, Institute of Psychiatry, King's College London, DeCrespigny Park, London SE5 8AF, UK
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Kandanearatchi A, Williams B, Everall IP. Assessing the efficacy of highly active antiretroviral therapy in the brain. Brain Pathol 2003; 13:104-10. [PMID: 12580550 PMCID: PMC8095802 DOI: 10.1111/j.1750-3639.2003.tb00011.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The devastating effects of HIV infection have been documented for the last 2 decades. Since the 1980s over 60 million people have been infected and at present 40 million people globally are living with HIV. HIV infects the central nervous system (CNS) early in the disease process. Indeed, numerous studies document the presence of HIV within the cerebrospinal fluid (CSF). Direct infection of the brain by HIV ultimately results in HIV associated dementia (HAD), which (prior to the advent of antiretroviral therapy) affected 20% of patients. An increasing number of drugs have been developed to treat this infection and delay the development of AIDS. Current treatment is aimed at inhibiting viral replication, and thus, lowering the viral load. However a subsequent increase in viral load can occur as patients become resistant to drug therapy. In the era of HAART, the incidence of HAD has been reduced, whereas the prevalence rate is increasing as people with HIV survive longer. However, in a study of initial AIDS defining illnesses, the proportion with HIV related dementia did not decline following introduction of HAART. In a separate study, no decrease was found in the incidence of dementia per se, although there was a decrease in the incidence of all AIDS-defining illnesses during this time period. It is evident from most studies that since the introduction of HAART, its effect on HAD is not entirely clear, although the majority of findings indicate that it is beneficial. Here we will outline the issues relevant to preventing HAD by HAART.
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Affiliation(s)
- Apsara Kandanearatchi
- Institute of Psychiatry, Section of Experimental Neuropathology and Psychiatry, De Crespigny Park, London United Kingdom
| | - Brenda Williams
- Institute of Psychiatry, Section of Experimental Neuropathology and Psychiatry, De Crespigny Park, London United Kingdom
| | - Ian Paul Everall
- Institute of Psychiatry, Section of Experimental Neuropathology and Psychiatry, De Crespigny Park, London United Kingdom
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Kast RE. Feedback between glial tumor necrosis factor-alpha and gp120 from HIV-infected cells helps maintain infection and destroy neurons. Neuroimmunomodulation 2002; 10:85-92. [PMID: 12372982 DOI: 10.1159/000065184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An envelope glycoprotein, gp20, of the human immunodeficiency virus (HIV) interacts with host systems to promote HIV replication. gp120 is also involved in tissue-destructive positive feedback cycles that contribute to HIV-related but non-lymphocytic-, non-immunodeficiency-related tissue-destructive morbidity. Exposure to gp120 results in tumor necrosis factor-alpha (TNF) upregulation, particularly in cells of monocyte lineage. The resultant increased TNF in the microenvironment of the TNF-producing monocyte lineage cells results in increased occupancy of TNF receptors on nearby lymphocytes, monocytes or glia in which HIV does replicate. Such TNF binding increases HIV replication. Increased replication results in increased gp120 available to bind to monocyte lineage cells, further increasing or maintaining those cells' TNF production in the face of other TNF suppressive forces. A trophic environment (TNF) for HIV replication is thereby maintained. gp120 raises cAMP levels. Increased cAMP is inherently TNF-suppressive. This is a moderating negative feedback element embedded within the larger positive feedback cycle. HIV does not effectively replicate in neurons yet many HIV infections show significant neuron loss. gp120 stimulates glia to synthesize TNF. Increased TNF stimulates HIV to replicate in the cells present in which HIV is able to replicate. TNF also damages nearby neurons. The resultant increased gp120 would further stimulate glia, and the stimulated glia's TNF would damage local neurons. Damaged neurons make factors that activate glia to upregulate TNF synthesis. These feedback cycles centering on gp120 and TNF contribute to HIV pathophysiology, neuron loss and maintenance of infection.
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Affiliation(s)
- Richard E Kast
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
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