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Labuschagne Naidoo RB, Steel HC, Theron AJ, Anderson R, Tintinger GR, Rossouw TM. Persistently Elevated Expression of Systemic, Soluble Co-Inhibitory Immune Checkpoint Molecules in People Living with HIV before and One Year after Antiretroviral Therapy. Pathogens 2024; 13:540. [PMID: 39057767 PMCID: PMC11279922 DOI: 10.3390/pathogens13070540] [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: 05/21/2024] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Increasing drug resistance and the absence of a cure necessitates exploration of novel treatment strategies for people living with HIV (PLWH). Targeting of soluble co-inhibitory immune checkpoint molecules (sICMs) represents a novel, potentially effective strategy in the management of HIV. METHODS In this retrospective, longitudinal, observational study, the plasma levels of five prominent co-inhibitory sICMs-CTLA-4, LAG-3, PD-1 and its ligand PD-L1, as well as TIM-3-were quantified in 68 PLWH-before and one year after antiretroviral therapy (ART)-and compared with those of 15 healthy control participants. RESULTS Relative to control participants, PLWH had substantially elevated pre-treatment levels of all five co-inhibitory sICMs (p < 0.0001-p < 0.0657), which, over the 12-month period of ART, remained significantly higher than those of controls (p < 0.0367-p < 0.0001). PLWH with advanced disease, reflected by a CD4+ T cell count <200 cells/mm3 before ART, had the lowest levels of CTLA-4 and LAG-3, while participants with pre-treatment HIV viral loads ≥100,000 copies/mL had higher pre-treatment levels of TIM-3, which also persisted at 12 months. CONCLUSIONS Plasma levels of CTLA-4, LAG-3, PD-1, PD-L1 and TIM-3 were significantly elevated in treatment-naïve PLWH and remained so following one year of virally-suppressive ART, possibly identifying LAG-3 and TIM-3 in particular as potential targets for adjuvant immunotherapy.
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Affiliation(s)
- Robyn-Brooke Labuschagne Naidoo
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria 0002, South Africa; (R.-B.L.N.); (G.R.T.)
| | - Helen C. Steel
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.C.S.); (A.J.T.); (R.A.)
| | - Annette J. Theron
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.C.S.); (A.J.T.); (R.A.)
| | - Ronald Anderson
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.C.S.); (A.J.T.); (R.A.)
| | - Gregory R. Tintinger
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria 0002, South Africa; (R.-B.L.N.); (G.R.T.)
| | - Theresa M. Rossouw
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.C.S.); (A.J.T.); (R.A.)
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Heil M. Self-DNA driven inflammation in COVID-19 and after mRNA-based vaccination: lessons for non-COVID-19 pathologies. Front Immunol 2024; 14:1259879. [PMID: 38439942 PMCID: PMC10910434 DOI: 10.3389/fimmu.2023.1259879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/26/2023] [Indexed: 03/06/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic triggered an unprecedented concentration of economic and research efforts to generate knowledge at unequalled speed on deregulated interferon type I signalling and nuclear factor kappa light chain enhancer in B-cells (NF-κB)-driven interleukin (IL)-1β, IL-6, IL-18 secretion causing cytokine storms. The translation of the knowledge on how the resulting systemic inflammation can lead to life-threatening complications into novel treatments and vaccine technologies is underway. Nevertheless, previously existing knowledge on the role of cytoplasmatic or circulating self-DNA as a pro-inflammatory damage-associated molecular pattern (DAMP) was largely ignored. Pathologies reported 'de novo' for patients infected with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 to be outcomes of self-DNA-driven inflammation in fact had been linked earlier to self-DNA in different contexts, e.g., the infection with Human Immunodeficiency Virus (HIV)-1, sterile inflammation, and autoimmune diseases. I highlight particularly how synergies with other DAMPs can render immunogenic properties to normally non-immunogenic extracellular self-DNA, and I discuss the shared features of the gp41 unit of the HIV-1 envelope protein and the SARS-CoV 2 Spike protein that enable HIV-1 and SARS-CoV-2 to interact with cell or nuclear membranes, trigger syncytia formation, inflict damage to their host's DNA, and trigger inflammation - likely for their own benefit. These similarities motivate speculations that similar mechanisms to those driven by gp41 can explain how inflammatory self-DNA contributes to some of most frequent adverse events after vaccination with the BNT162b2 mRNA (Pfizer/BioNTech) or the mRNA-1273 (Moderna) vaccine, i.e., myocarditis, herpes zoster, rheumatoid arthritis, autoimmune nephritis or hepatitis, new-onset systemic lupus erythematosus, and flare-ups of psoriasis or lupus. The hope is to motivate a wider application of the lessons learned from the experiences with COVID-19 and the new mRNA vaccines to combat future non-COVID-19 diseases.
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Affiliation(s)
- Martin Heil
- Departamento de Ingeniería Genética, Laboratorio de Ecología de Plantas, Centro de Investigación y de Estudios Avanzados (CINVESTAV)-Unidad Irapuato, Irapuato, Mexico
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Okubo S, Mano T, Sudo A, Goto R, Yano S, Hara M, Ishiura H, Satake W, Yanagimoto S, Ogata H, Toda T. Anti-neurofascin 155 Antibody-positive Neuropathy in a Human Immunodeficiency Virus-infected Patient. Intern Med 2024; 63:565-569. [PMID: 37380455 PMCID: PMC10937119 DOI: 10.2169/internalmedicine.1919-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Human immunodeficiency virus (HIV)-associated neuropathy is a common complication of HIV infection and has several clinical subtypes. HIV-associated chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a demyelinating neuropathy whose clinical features are known to differ from those of CIDP in the HIV-uninfected population. We herein report a case of CIDP in an HIV-infected patient who was finally diagnosed with anti-neurofascin 155 (NF155) antibody-positive neuropathy. The clinical features, including clinical findings and therapeutic responses, were typical of paranodal antibody-mediated neuropathy. To our knowledge, this is the first case of anti-NF155 antibody-associated neuropathy in an HIV-infected patient.
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Affiliation(s)
- So Okubo
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsuo Mano
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Atsushi Sudo
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Ryoji Goto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoka Yano
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Manato Hara
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Wataru Satake
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Shintaro Yanagimoto
- Department of Infectious Disease, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hidenori Ogata
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
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Ramadoss I, ArulRajamurugan P, Varadhan MS, Ramamoorthy R, Priya SV. An unusual duo: Immunodeficiency disorder and scleroderma. Indian J Sex Transm Dis AIDS 2024; 45:52-54. [PMID: 38989079 PMCID: PMC11233034 DOI: 10.4103/ijstd.ijstd_63_23] [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: 07/12/2023] [Revised: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 07/12/2024] Open
Abstract
A 45-year-old woman on treatment for HIV infection with highly active antiretroviral therapy for the past 10 years presented to us with a history of Raynaud's phenomenon and hyperpigmentation of the skin for 2 years. She was diagnosed to have pulmonary arterial hypertension 8 months ago. On examination, she had salt-and-pepper pigmentation and sclerodactyly. Her biochemical workup was normal. She had positive antinuclear antibody by indirect immunofluorescence method. Skin biopsy was consistent with systemic sclerosis. HIV has its own musculoskeletal manifestations. The paradox of autoimmunity in the background of immunodeficiency was intriguing. Treating autoimmunity in the presence of immunodeficiency was challenging. The attribution and differentiation of pulmonary hypertension were difficult. There has been a homology identified between human immunodeficiency virus 1 (HIV 1) and centromere B protein (CENP B). This case is reported because of the unusual occurrence of systemic sclerosis in an HIV patient.
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Affiliation(s)
- Ishwarya Ramadoss
- Department of Rheumatology Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
| | - PonniahSubramanian ArulRajamurugan
- Department of Rheumatology Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
| | - Mythili Seetharaman Varadhan
- Department of Rheumatology Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
| | - Ramesh Ramamoorthy
- Department of Rheumatology Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
| | - S. Vishnu Priya
- Department of Rheumatology Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
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Geteneh A, Andualem H, Belay DM, Kiros M, Biset S. Immune reconstitution inflammatory syndrome, a controversial burden in the East African context: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1192086. [PMID: 37636563 PMCID: PMC10450628 DOI: 10.3389/fmed.2023.1192086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction It is well established that starting antiretroviral therapy (ART) increases a patient's life expectancy among HIV-positive individuals. Considering the HIV pandemic, the major concern is initiation of ARTs to the large segment of HIV infected population, not adverse events from immune restoration. The prevalence of HIV-associated immune reconstitution inflammatory syndrome (IRIS) is poorly estimated due to Africa's underdeveloped infrastructure, particularly in Eastern Africa. Therefore, this study compiled data regarding the magnitude and associated factors of IRIS in the context of Eastern Africa. Methods The electronic databases such as Google Scholar, PubMed, Web of Science, and free Google access were searched till 5 June 2021, and the search was lastly updated on 30 June 2022 for studies of interest. The pooled prevalence, and associated factors with a 95% confidence interval were estimated using the random effects model. The I2 and Egger's tests were used for heterogeneity and publication bias assessment, respectively. Results The development of HIV-associated IRIS in Eastern Africa was estimated to be 18.18% (95% CI 13.30-23.06) in the current review. The two most common predictors of IRIS associated with Eastern Africa were the lower pre-ART CD4 T-cell count of 50 cells/μl and the low baseline body mass index level. Therefore, attention should be focused on the early detection and care of HIV-associated IRIS to reduce the morbidity and death caused by IRIS.
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Affiliation(s)
- Alene Geteneh
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Henok Andualem
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Kiros
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Aksum University, Aksum, Ethiopia
| | - Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nosik M, Belikova MG, Ryzhov K, Avdoshina D, Sobkin A, Zverev V, Svitich O. Unique Profile of Proinflammatory Cytokines in Plasma of Drug-Naïve Individuals with Advanced HIV/TB Co-Infection. Viruses 2023; 15:1330. [PMID: 37376629 DOI: 10.3390/v15061330] [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: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
HIV-1 infection is characterized by aberrant immune activation, and infection with M. tuberculosis by an unbalanced production of proinflammatory cytokines. The expression of these cytokines in HIV-1/TB coinfection is still understudied. Here, we aimed to compare the production of proinflammatory cytokines in drug-naive patients coinfected with HIV-1 and M. tuberculosis (HIV/TB) compared to patients with respective monoinfections. Plasma samples of patients with HIV/TB coinfection (n = 36), HIV-1 monoinfection (n = 36), and TB monoinfection (n = 35) and healthy donors (n = 36) were examined for the levels of eight proinflammatory cytokines. Their levels were significantly increased in all patient groups compared to healthy donors. At the same time, a drastic decrease in the plasma levels of IFN-γ, TNF-α, Il-1β, IL-15, and IL-17 was detected in patients with HIV/TB coinfection compared to patients with HIV-1 or TB monoinfections. The plasma levels of IL-17 characterized the TB severity: in HIV/TB-coinfected patients with disseminated TB, plasma levels of IL-17 were eight times lower than in patients with less severe TB forms (infiltrative TB or TB of intrathoracic lymph nodes; p < 0.0001). At the same time, HIV/TB-coinfected patients had increased plasma levels of IL-8, IL-12, and IL-18, with the levels of IL-8 correlating with mortality (p < 0.0001). Thus, on the contrary to the patients with HIV-1 or TB monoinfections, HIV/TB-coinfected patients had suppressed production of most of the proinflammatory cytokines associated with antimicrobial immune response, specifically of T-cells involved in the containment of both infections. At the same time, they demonstrated an expansion of proinflammatory cytokines known to originate from both hematopoietic and nonhematopoietic cells, and manifest tissue inflammation. In HIV-1/TB coinfection, this leads to the disruption of granuloma formation, contributing to bacterial dissemination and enhancing morbidity and mortality.
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Affiliation(s)
- Marina Nosik
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia
| | - Maria G Belikova
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Russian Academy of Sciences, 108819 Moscow, Russia
- Translational Medicine Cluster, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | | | - Darya Avdoshina
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Russian Academy of Sciences, 108819 Moscow, Russia
| | - Alexandr Sobkin
- Department for Treatment of TB Patients with HIV Infection, G.A. Zaharyan Moscow Tuberculosis Clinic, 125466 Moscow, Russia
| | - Vitaly Zverev
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia
| | - Oxana Svitich
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia
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Abstract
PURPOSE OF REVIEW It is now recognized that SARS-CoV-2 infection can have a long-term impact on health. This review summarizes the current state of knowledge regarding Long COVID in people living with HIV (PLWH). RECENT FINDINGS PLWH may be at elevated risk of experiencing Long COVID. Although the mechanisms contributing to Long COVID are incompletely understood, there are several demographic and clinical factors that might make PLWH vulnerable to developing Long COVID. SUMMARY PLWH should be aware that new or worsening symptoms following SARS-CoV-2 infection might represent Long COVID. HIV providers should be aware of this clinical entity and be mindful that their patients recovering from SARS-CoV-2 infection may be at higher risk.
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Affiliation(s)
- Michael J. Peluso
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA 94110
| | - Annukka A. R. Antar
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Ramos-Ruperto L, Busca C, Díez-Vidal A, Robles-Marhuenda Á, Díaz-Almirón M, Mican R, Montejano R, Valencia ME, Montes ML, Martin-Carbonero L, Delgado-Hierro A, Bernardino JI. Prevalence and Temporal Trends of Autoimmune Diseases in People Living with HIV. AIDS Res Hum Retroviruses 2023; 39:130-135. [PMID: 36594538 DOI: 10.1089/aid.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Since the introduction of modern antiretroviral treatment for HIV and hepatitis C virus (HCV), the pattern of autoimmune diseases (ADs) in people living with HIV (PWH) might have changed. This is a retrospective study in a cohort of 5,665 PWH at the HIV Clinic of Hospital Universitario La Paz (Spain) to estimate the prevalence of ADs from January 1990 to June 2020. We divided the timeline into four periods: <1996, 1996-2006, 2006-2015, and 2015-2020. In total 369 participants were diagnosed with at least one AD, with a prevalence of 5.3% (95% confidence interval 4.7-5.9). In total, 302 (81%) participants were diagnosed simultaneously or after HIV diagnosis. Most prevalent diseases were immune thrombopenia (IT) (n = 90), cutaneous psoriasis (n = 52), autoimmune thyroid disorders (n = 36), spondylarthritis (n = 24), and inflammatory bowel disease (IBD) (n = 21). There was a significant trend for more ADs in recent periods (p = .037). In recent years, participants with ADs were older, had a long time since HIV diagnosis, and had higher CD4+ T cell count and higher CD4+ T cell nadir (temporal linear trend p < .001). There was a change in the pattern of ADs over time with a decrease in IT and an increase in spondylarthritis, arthritis, IBD, and thyroid disorders. One hundred thirty-nine participants (46%) were coinfected with HCV, with a steady decline throughout the study period. Only cryoglobulinemia was statistically associated with HCV infection. AD increases over time in PWH with reasonable immune virological control. We observed a higher frequency of spondylarthritis, arthritis, autoimmune thyroid disorders, and IBD in recent years.
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Affiliation(s)
- Luis Ramos-Ruperto
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - Carmen Busca
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | | | | | | | - Rafael Mican
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - Rocio Montejano
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - M Eulalia Valencia
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - Marisa L Montes
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - Luz Martin-Carbonero
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - Ana Delgado-Hierro
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
| | - Jose I Bernardino
- HIV and Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, CIBER Enfermedades Infecciosas, Madrid, Spain
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Drobyshevskaya E, Lebedev A, Pronin A, Bobkova M. Factors Associated with Fatal COVID-19 Outcomes among People Living with HIV: A Cohort Study. Curr HIV Res 2023; 21:367-377. [PMID: 38037993 DOI: 10.2174/011570162x277788231128111517] [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] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND People living with HIV (PLHIV) are at increased risk of COVID-19 death. However, information about whether factors related to the HIV-infection influence the COVID-19 outcome still remains conflicting. OBJECTIVE Here, we evaluate the risk factors for fatal COVID-19 in a cohort of PLHIV from the Moscow region, aged >18 years and diagnosed with COVID-19 between March 2020 and December 2021. METHODS Demographic, clinical and laboratory data were compared between different COVID-19 outcomes. To analyze the risk factors associated with COVID-19 death, we employed the logistic regression method. A total of 566 PLHIV were included in the analysis. RESULTS The majority of individuals, 338 (59.7%), were male; 194 (34.3%) were on antiretroviral therapy; 296 (52.3%) had a comorbidity; 174 (30.7%) of patients had drug and/or alcohol dependence; 160 (33.1%) patients had CD4 counts <200 cells/μl; 253 (51.9%) had undetectable viral load. Our analysis revealed that PLHIV >55 years old (OR, 12.88 [95% CI, 2.32-71.62]), patients with a viral load of more than 1000 copies/ml (OR, 2.45 [95%CI, 1.01-5.98]) and with CD4 counts <200 cell/μl (OR, 2.54 [95%CI, 1.02-6.28]), as well as with a history of cachexia (OR, 3.62 [95%CI, 1.26-10.39]) and pneumocystis pneumonia (OR, 2.47 [95%CI, 1.03-5.92]), and drug/alcohol dependence (OR, 2.70 [95%CI, 1.36-5.39]) were significantly more likely to die from COVID-19. CONCLUSION These data show that people with advanced HIV-1 infection have an increased risk of fatal COVID-19 outcomes and that there is a need to improve this population's access to health services and, hence, increase their survival rates.
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Affiliation(s)
- Elena Drobyshevskaya
- Medical Department, Moscow Regional Center for the Prevention and Control of AIDS and Infectious Diseases, Moscow, Russia
| | - Aleksey Lebedev
- Laboratory of T-Lymphotropic Viruses, Gamaleya National Research Center for Epidemiology and Microbiology, Moscow, Russia
- Department of Virology, I. Mechnikov Institute of Vaccine and Sera, Moscow, Russia
| | - Alexander Pronin
- Medical Department, Moscow Regional Center for the Prevention and Control of AIDS and Infectious Diseases, Moscow, Russia
| | - Marina Bobkova
- Department of Virology, I. Mechnikov Institute of Vaccine and Sera, Moscow, Russia
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Impact and Tolerance of Immunosuppressive Treatments in Patients Living with HIV with Inflammatory or Autoimmune Diseases. Microorganisms 2022; 10:microorganisms10101891. [PMID: 36296168 PMCID: PMC9610421 DOI: 10.3390/microorganisms10101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Patients living with HIV (PLWHIV) can develop autoimmune diseases (AD) needing immunosuppressive treatments (IST). This study aims to describe the impact of IST in PLWHIV. Methods: This was a multicentric retrospective observational study in six HIV referral centers on PLWHIV under IST for AD. Demographic factors, viral co-infections, immunovirological status before and under IST, infectious events, and their descriptions were collected and described focusing on infectious events, immunovirological variations, and IST effectiveness. Results: 9480 PLWHIV were screened for inclusion. Among them, 138 (1.5%) had a history of auto-immune disease, among which 32 (23%) received IST. There was mainly spondyloarthropathy (28%) and the most commonly used IST was methotrexate. The median follow-up under IST was 3.8 years (2.7; 5.9). There were 15 infectious events (0.5 events/individuals) concerning nine patients. At the last medical follow-up, 81% of these were in remission of their AD. Under IST, there was an increase in CD4 during follow-up (629 vs. 827 CD4/mm3, p = 0.04). No HIV virological failure was noted. Conclusions: This study supports a growing evidence base that IST can be used safely and effectively in PLWHIV with careful monitoring.
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Elmahdi R, Kochhar GS, Iversen AT, Allin KH, Dulai PS, Desai A, Jess T. Development of Inflammatory Bowel Disease in HIV Patients: A Danish Cohort Study (1983-2018) With American Validation (1999-2018). GASTRO HEP ADVANCES 2022; 1:1114-1121. [PMID: 36531445 PMCID: PMC9757766 DOI: 10.1016/j.gastha.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Human immunodeficiency virus (HIV) infection is associated with several immune-mediated disorders. However, the risk of inflammatory bowel disease (IBD) in people living with HIV (PLWH) remains unclear. We aimed to assess the risk of IBD among PLWH using a nationwide, population-based Danish cohort and to validate findings in a large American insurance-based database. METHODS Using Danish registries (1983-2018), we identified 8995 PLWH and age- and sex-matched them to 449,750 HIV-negative individuals. Cox regression analysis was undertaken to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for IBD diagnosis. Results were stratified by sex, age, and year of HIV diagnosis. Using an American insurance-based cohort, Explorys (1999-2018), we assessed the prevalence odds ratio (OR) and 95% CI of IBD diagnosis in PLWH compared with HIV-negative individuals. RESULTS IBD diagnosis among PLWH in Denmark was increased (HR: 2.25, 95% CI: 1.78-2.83) compared with matched HIV-negative individuals. This was seen for both Crohn's disease (HR: 2.25, 95% CI: 1.47-3.44) and ulcerative colitis (HR: 2.24, 95% CI: 1.70-2.96) and in male (HR: 2.75, 95% CI: 2.15-3.52) but not female (HR: 0.93, 95% CI: 0.48-1.79) PLWH. Explorys analysis also showed an increased odds of IBD diagnoses among PLWH (OR: 1.41; 95% CI: 1.35-1.49). CONCLUSION This study finds an increased risk of IBD diagnosis among PLWH in both a Danish and US cohort, highlighting a need to consider IBD in PLWH with new-onset gastrointestinal symptoms. Further research into the role of antiretroviral therapy in this relationship is required.
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Affiliation(s)
- Rahma Elmahdi
- Department of Clinical Medicine, Center for the Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
- Department for Lung and Infectious Disease Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | - Gursimran S. Kochhar
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Aske T. Iversen
- Department of Clinical Medicine, Center for the Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
| | - Kristine H. Allin
- Department of Clinical Medicine, Center for the Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Parambir S. Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Aakash Desai
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Tine Jess
- Department of Clinical Medicine, Center for the Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
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12
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Bertagnolio S, Thwin SS, Silva R, Nagarajan S, Jassat W, Fowler R, Haniffa R, Reveiz L, Ford N, Doherty M, Diaz J. Clinical features of, and risk factors for, severe or fatal COVID-19 among people living with HIV admitted to hospital: analysis of data from the WHO Global Clinical Platform of COVID-19. Lancet HIV 2022; 9:e486-e495. [PMID: 35561704 PMCID: PMC9090268 DOI: 10.1016/s2352-3018(22)00097-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND WHO has established a Global Clinical Platform for the clinical characterisation of COVID-19 among hospitalised individuals. We assessed whether people living with HIV hospitalised with COVID-19 had increased odds of severe presentation and of in-hospital mortality compared with individuals who were HIV-negative and associated risk factors. METHODS Between Jan 1, 2020, and July 1, 2021, anonymised individual-level data from 338 566 patients in 38 countries were reported to WHO. Using the Platform pooled dataset, we performed descriptive statistics and regression analyses to compare outcomes in the two populations and identify risk factors. FINDINGS Of 197 479 patients reporting HIV status, 16 955 (8·6%) were people living with HIV. 16 283 (96.0%) of the 16 955 people living with HIV were from Africa; 10 603 (62·9%) were female and 6271 (37·1%) were male; the mean age was 45·5 years (SD 13·7); 6339 (38·3%) were admitted to hospital with severe illness; and 3913 (24·3%) died in hospital. Of the 10 166 people living with HIV with known antiretroviral therapy (ART) status, 9302 (91·5%) were on ART. Compared with individuals without HIV, people living with HIV had 15% increased odds of severe presentation with COVID-19 (aOR 1·15, 95% CI 1·10-1·20) and were 38% more likely to die in hospital (aHR 1·38, 1·34-1·41). Among people living with HIV, male sex, age 45-75 years, and having chronic cardiac disease or hypertension increased the odds of severe COVID-19; male sex, age older than 18 years, having diabetes, hypertension, malignancy, tuberculosis, or chronic kidney disease increased the risk of in-hospital mortality. The use of ART or viral load suppression were associated with a reduced risk of poor outcomes; however, HIV infection remained a risk factor for severity and mortality regardless of ART and viral load suppression status. INTERPRETATION In this sample of hospitalised people contributing data to the WHO Global Clinical Platform for COVID-19, HIV was an independent risk factor for both severe COVID-19 at admission and in-hospital mortality. These findings have informed WHO immunisation policy that prioritises vaccination for people living with HIV. As the results mostly reflect the data contribution from Africa, this analysis will be updated as more data from other regions become available. FUNDING None. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Silvia Bertagnolio
- Department of Global HIV, STI & Hepatitis Programmes, WHO, Geneva, Switzerland,Correspondence to: Dr Silvia Bertagnolio, Department of Global HIV, STI & Hepatitis Programmes, WHO, Geneva 1211, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ronaldo Silva
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Sairaman Nagarajan
- Departments of Internal Medicine and Pediatrics, SUNY Downstate Medical Center, New York, USA
| | - Waasila Jassat
- National Institute for Communicable Diseases, Johannesburg, South Africa,Right to Care, Pretoria, South Africa
| | - Robert Fowler
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK,National Intensive Care Surveillance-MORU, Colombo, Sri Lanka
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Incident Management Systems, Pan American Health Organization, Washington DC, USA
| | - Nathan Ford
- Department of Global HIV, STI & Hepatitis Programmes, WHO, Geneva, Switzerland
| | - Meg Doherty
- Department of Global HIV, STI & Hepatitis Programmes, WHO, Geneva, Switzerland
| | - Janet Diaz
- Department of Country Readiness Strengthening, Health Emergencies Programme, WHO, Geneva, Switzerland
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13
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Ndondo AP, Eley B, Wilmshurst JM, Kakooza-Mwesige A, Giannoccaro MP, Willison HJ, Cruz PMR, Heckmann JM, Bateman K, Vincent A. Post-Infectious Autoimmunity in the Central (CNS) and Peripheral (PNS) Nervous Systems: An African Perspective. Front Immunol 2022; 13:833548. [PMID: 35356001 PMCID: PMC8959857 DOI: 10.3389/fimmu.2022.833548] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
The direct impact and sequelae of infections in children and adults result in significant morbidity and mortality especially when they involve the central (CNS) or peripheral nervous system (PNS). The historical understanding of the pathophysiology has been mostly focused on the direct impact of the various pathogens through neural tissue invasion. However, with the better understanding of neuroimmunology, there is a rapidly growing realization of the contribution of the innate and adaptive host immune responses in the pathogenesis of many CNS and PNS diseases. The balance between the protective and pathologic sequelae of immunity is fragile and can easily be tipped towards harm for the host. The matter of immune privilege and surveillance of the CNS/PNS compartments and the role of the blood-brain barrier (BBB) and blood nerve barrier (BNB) makes this even more complex. Our understanding of the pathogenesis of many post-infectious manifestations of various microbial agents remains elusive, especially in the diverse African setting. Our exploration and better understanding of the neuroimmunology of some of the infectious diseases that we encounter in the continent will go a long way into helping us to improve their management and therefore lessen the burden. Africa is diverse and uniquely poised because of the mix of the classic, well described, autoimmune disease entities and the specifically "tropical" conditions. This review explores the current understanding of some of the para- and post-infectious autoimmune manifestations of CNS and PNS diseases in the African context. We highlight the clinical presentations, diagnosis and treatment of these neurological disorders and underscore the knowledge gaps and perspectives for future research using disease models of conditions that we see in the continent, some of which are not uniquely African and, where relevant, include discussion of the proposed mechanisms underlying pathogen-induced autoimmunity. This review covers the following conditions as models and highlight those in which a relationship with COVID-19 infection has been reported: a) Acute Necrotizing Encephalopathy; b) Measles-associated encephalopathies; c) Human Immunodeficiency Virus (HIV) neuroimmune disorders, and particularly the difficulties associated with classical post-infectious autoimmune disorders such as the Guillain-Barré syndrome in the context of HIV and other infections. Finally, we describe NMDA-R encephalitis, which can be post-HSV encephalitis, summarise other antibody-mediated CNS diseases and describe myasthenia gravis as the classic antibody-mediated disease but with special features in Africa.
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Affiliation(s)
- Alvin Pumelele Ndondo
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Jo Madeleine Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Department of Paediatric Neurology, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Angelina Kakooza-Mwesige
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria Pia Giannoccaro
- Laboratory of Neuromuscular Pathology and Neuroimmunology, Istituto di Ricovero e Cura a CarattereScientifico (IRCCS) Instiuto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation (3I), University of Glasgow, Glasgow, United Kingdom
| | - Pedro M Rodríguez Cruz
- Centro Nacional de Analisis Genomico - Centre for Genomic Regulation (CNAG-CRG ), Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Department of Neuromuscular Disease, University College London (UCL) Queen Square Institute of Neurology, London, United Kingdom.,Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Jeannine M Heckmann
- Neurology Division, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.,The University of Cape Town (UCT) Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Kathleen Bateman
- Neurology Division, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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14
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[This is how I treat patients with inflammatory rheumatic diseases and HIV/AIDS with DMARDs]. Z Rheumatol 2022; 81:332-334. [PMID: 35359175 DOI: 10.1007/s00393-022-01202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
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15
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Zang Q, Wang Y, Guo J, Long L, Zhang S, Cui C, Song D, Yu B, Tang F, Teng J, Miao W. Treatment of Severe Japanese Encephalitis Complicated With Hashimoto's Thyroiditis and Guillain-Barré Syndrome With Protein A Immunoadsorption: A Case Report. Front Immunol 2022; 12:807937. [PMID: 35069593 PMCID: PMC8777188 DOI: 10.3389/fimmu.2021.807937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
A severely comatose female patient was diagnosed with Japanese encephalitis (JE). Her condition was complicated by Hashimoto’s thyroiditis (HT) and Guillain-Barré syndrome (GBS). After antiviral, glucocorticoid, and immunoglobulin treatment, the patient’s consciousness was restored, and she could breathe spontaneously. Following this, new-onset, primarily demyelinating GBS developed, which progressed to demyelination combined with axonal injury. The patient was switched to protein A immunoadsorption (PAIA) therapy, and her Hughes score decreased rapidly, from 4 to 1 after 6 months. This patient is the first to receive PAIA combined with an antiviral-glucocorticoid-immunoglobulin regimen to treat encephalitis, meningitis, HT, and GBS caused by JE infection, thereby reflecting the importance of clinical application of PAIA in the treatment of immunological complications of JE.
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Affiliation(s)
- Qiuling Zang
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yating Wang
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junshuang Guo
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyang Long
- Traditional Chinese Medicine Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Kaili, China
| | - Shuyu Zhang
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Can Cui
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dandan Song
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Boguang Yu
- Guangdong Provincial Key Laboratory of Hemoadsorption Technology, Guangzhou, China
| | - Fenlan Tang
- Guangdong Provincial Key Laboratory of Hemoadsorption Technology, Guangzhou, China
| | - Junfang Teng
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wang Miao
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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16
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Damba JJ, Laskine M, Peet MM, Jin Y, Sinyavskaya L, Durand M. Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population. J Int Assoc Provid AIDS Care 2022; 21:23259582221107196. [PMID: 35695209 PMCID: PMC9203947 DOI: 10.1177/23259582221107196] [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] [Indexed: 11/29/2022] Open
Abstract
Background: People living with HIV (PLWH) have been shown to have an increased risk of autoimmune diseases. Corticosteroids are the cornerstone of autoimmune diseases treatment, but their use is associated with an increased risk of infections. It is unclear how HIV status affects the risk of infection associated with corticosteroids use. Methods: We conducted a retrospective cohort study from 1991 to 2011, using a medico-administrative database from Quebec. Medical billing codes were used to identify PLWH, and we matched them on age, sex, and index date with up to 4 HIV-negative controls. The exposure of interest was the use of corticosteroids, defined as a systemic corticosteroid dispensation lasting at least 20 days. The outcome of interest was hospitalization for severe infection. Crude and adjusted incidence rates ratios of infection were obtained using a random effect Poisson model, and results were stratified by HIV status. Results: In total, 4798 PLWH were matched to 17 644 HIV-negative controls, among which 1083 (22.6%) PLWH and 1854 (10.5%) HIV-negative controls received at least one course of corticosteroid. The mean duration of corticosteroids use was 4 ± 4.4 months in PLWH and 1.6 ± 5.5 months in HIV-negative controls. The incidence rate ratio (IRR) for infections associated with corticosteroids use was 2.49[1.71–3.60] in PLWH and 1.32[0.71–2.47] in HIV-negative controls (P value for interaction 0.18). The most frequent infections were pulmonary infections (50.4%), followed by urinary tract infections (26%) and opportunistic infections (10.5%). Conclusion: Although our interaction term did not reach significance, the increased risk of infection associated with corticosteroids use was more pronounced in PLWH. However, further research with contemporary data is warranted to confirm if the risk associated with corticosteroids use remains high in PLWH with well-controlled HIV infection.
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Affiliation(s)
- Joseph Junior Damba
- Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Mikhael Laskine
- Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada.,Internal Medicine Service, Centre hospitalier universitaire de Montréal (CHUM), Montréal, Québec, Canada
| | - Marc Messier Peet
- Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Yulan Jin
- Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Liliya Sinyavskaya
- Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Madeleine Durand
- Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada.,Internal Medicine Service, Centre hospitalier universitaire de Montréal (CHUM), Montréal, Québec, Canada
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17
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Wong CS, Buckner CM, Lage SL, Pei L, Assis FL, Dahlstrom EW, Anzick SL, Virtaneva K, Rupert A, Davis JL, Zhou T, Laidlaw E, Manion M, Galindo F, Anderson M, Seamon CA, Sneller MC, Lisco A, Deleage C, Pittaluga S, Moir S, Sereti I. Rapid Emergence of T Follicular Helper and Germinal Center B Cells Following Antiretroviral Therapy in Advanced HIV Disease. Front Immunol 2021; 12:752782. [PMID: 34938286 PMCID: PMC8686113 DOI: 10.3389/fimmu.2021.752782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/09/2021] [Indexed: 02/01/2023] Open
Abstract
Low nadir CD4 T-cell counts in HIV+ patients are associated with high morbidity and mortality and lasting immune dysfunction, even after antiretroviral therapy (ART). The early events of immune recovery of T cells and B cells in severely lymphopenic HIV+ patients have not been fully characterized. In a cohort of lymphopenic (CD4 T-cell count < 100/µL) HIV+ patients, we studied mononuclear cells isolated from peripheral blood (PB) and lymph nodes (LN) pre-ART (n = 40) and 6-8 weeks post-ART (n = 30) with evaluation of cellular immunophenotypes; histology on LN sections; functionality of circulating T follicular helper (cTfh) cells; transcriptional and B-cell receptor profile on unfractionated LN and PB samples; and plasma biomarker measurements. A group of 19 healthy controls (HC, n = 19) was used as a comparator. T-cell and B-cell lymphopenia was present in PB pre-ART in HIV+ patients. CD4:CD8 and CD4 T- and B-cell PB subsets partly normalized compared to HC post-ART as viral load decreased. Strikingly in LN, ART led to a rapid decrease in interferon signaling pathways and an increase in Tfh, germinal center and IgD-CD27- B cells, consistent with histological findings of post-ART follicular hyperplasia. However, there was evidence of cTfh cells with decreased helper capacity and of limited B-cell receptor diversification post-ART. In conclusion, we found early signs of immune reconstitution, evidenced by a surge in LN germinal center cells, albeit limited in functionality, in HIV+ patients who initiate ART late in disease.
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Affiliation(s)
- Chun-Shu Wong
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Clarisa M. Buckner
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Silvia Lucena Lage
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Luxin Pei
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Felipe L. Assis
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Eric W. Dahlstrom
- Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, MT, United States
| | - Sarah L. Anzick
- Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, MT, United States
| | - Kimmo Virtaneva
- Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, MT, United States
| | - Adam Rupert
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Jeremy L. Davis
- Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ting Zhou
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Elizabeth Laidlaw
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Maura Manion
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Frances Galindo
- Intramural Clinical Management and Operations Branch, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Megan Anderson
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Catherine A. Seamon
- Critical Care Medicine, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Michael C. Sneller
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Andrea Lisco
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Claire Deleage
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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18
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Peluso MJ, Hellmuth J, Chow FC. Central Nervous System Effects of COVID-19 in People with HIV Infection. Curr HIV/AIDS Rep 2021; 18:538-548. [PMID: 34843065 PMCID: PMC8628487 DOI: 10.1007/s11904-021-00582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 10/28/2022]
Abstract
The convergence of the HIV and SARS-CoV-2 pandemics is an emerging field of interest. In this review, we outline the central nervous system (CNS) effects of COVID-19 in the general population and how these effects may manifest in people with HIV (PWH). We discuss the hypothetical mechanisms through which SARS-CoV-2 could impact the CNS during both the acute and recovery phases of infection and the potential selective vulnerability of PWH to these effects as a result of epidemiologic, clinical, and biologic factors. Finally, we define key research questions and considerations for the investigation of CNS sequelae of COVID-19 in PWH.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA
| | - Joanna Hellmuth
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Felicia C Chow
- Weill Institute for Neurosciences, Departments of Neurology and Medicine (Infectious Diseases), University of California, San Francisco, CA, USA.
- San Francisco General Hospital, 1001 Potrero Avenue, Building 1, Suite 101, CA, San Francisco, USA.
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19
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Dumonceau AG, Ameli R, Rogemond V, Ruiz A, Joubert B, Muñiz-Castrillo S, Vogrig A, Picard G, Ambati A, Benaiteau M, Rulquin F, Ciron J, Deiva K, de Broucker T, Kremer L, Kerschen P, Sellal F, Bouldoires B, Genet R, Biberon J, Bigot A, Duval F, Issa N, Rusu EC, Goudot M, Dutray A, Devoize JL, Hopes L, Kaminsky AL, Philbert M, Chanson E, Leblanc A, Morvan E, Andriuta D, Diraison P, Mirebeau G, Derollez C, Bourg V, Bodard Q, Fort C, Grigorashvili-Coin I, Rieul G, Molinier-Tiganas D, Bonnan M, Tchoumi T, Honnorat J, Marignier R. Glial Fibrillary Acidic Protein Autoimmunity: A French Cohort Study. Neurology 2021; 98:e653-e668. [PMID: 34799461 PMCID: PMC8829963 DOI: 10.1212/wnl.0000000000013087] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives To report the clinical, biological, and imaging features and clinical course of a French cohort of patients with glial fibrillary acidic protein (GFAP) autoantibodies. Methods We retrospectively included all patients who tested positive for GFAP antibodies in the CSF by immunohistochemistry and confirmed by cell-based assay using cells expressing human GFAPα since 2017 from 2 French referral centers. Results We identified 46 patients with GFAP antibodies. Median age at onset was 43 years, and 65% were men. Infectious prodromal symptoms were found in 82%. Other autoimmune diseases were found in 22% of patients, and coexisting neural autoantibodies in 11%. Tumors were present in 24%, and T-cell dysfunction in 23%. The most frequent presentation was subacute meningoencephalitis (85%), with cerebellar dysfunction in 57% of cases. Other clinical presentations included myelitis (30%) and visual (35%) and peripheral nervous system involvement (24%). MRI showed perivascular radial enhancement in 32%, periventricular T2 hyperintensity in 41%, brainstem involvement in 31%, leptomeningeal enhancement in 26%, and reversible splenial lesions in 4 cases. A total of 33 of 40 patients had a monophasic course, associated with a good outcome at last follow-up (Rankin Score ≤2: 89%), despite a severe clinical presentation. Adult and pediatric features are similar. Thirty-two patients were treated with immunotherapy. A total of 11/22 patients showed negative conversion of GFAP antibodies. Discussion GFAP autoimmunity is mainly associated with acute/subacute meningoencephalomyelitis with prodromal symptoms, for which tumors and T-cell dysfunction are frequent triggers. The majority of patients followed a monophasic course with a good outcome.
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Affiliation(s)
- Alice Gravier Dumonceau
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France
| | - Roxana Ameli
- Service d'imagerie médicale, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France
| | - Veronique Rogemond
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Anne Ruiz
- Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, 69003 Lyon, France
| | - Bastien Joubert
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Sergio Muñiz-Castrillo
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Alberto Vogrig
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Geraldine Picard
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Aditya Ambati
- Stanford University Center for Sleep Sciences and Medecine, Palo Alto, CA, USA
| | - Marie Benaiteau
- Service de neurologie cognitive, épilepsie, sommeil et mouvements anormaux, Hôpital Pierre-Paul Riquet, Hôpitaux de Toulouse, 31059 Toulouse, France
| | - Florence Rulquin
- Service de neurologie inflammatoire et neuro-oncologie, Hôpital Pierre-Paul Riquet, Hôpitaux de Toulouse, 31059 Toulouse, France
| | - Jonathan Ciron
- Service de neurologie inflammatoire et neuro-oncologie, Hôpital Pierre-Paul Riquet, Hôpitaux de Toulouse, 31059 Toulouse, France
| | - Kumaran Deiva
- Service de neuropédiatrie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France
| | - Thomas de Broucker
- Service de neurologie, Hôpital Delafontaine, Centre Hospitalier de Saint-Denis, 93205 Saint-Denis, France
| | - Laurent Kremer
- Service de neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Philippe Kerschen
- Service de neurologie, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg
| | - François Sellal
- Service de neurologie, Hôpitaux Civils de Colmar, 68000 Colmar, France ; Unité INSERM U-1118, Faculté de Médecine, Université de Strasbourg
| | - Bastien Bouldoires
- Service de médecine interne, Hôpitaux civils de Colmar, 68000 Colmar, France
| | - Roxana Genet
- Service de médecine interne, Hôpital d'Instruction des Armées Legouest, 57000 Metz, France
| | - Jonathan Biberon
- Service de neurologie, Centre Hospitalier Régional Universitaire de Tours, 37044 Tours, France
| | - Adrien Bigot
- Service de médecine interne et immunologie clinique, Centre Hospitalier Régional Universitaire de Tours, 37044 Tours, France
| | - Fanny Duval
- Service de neurologie et maladies neuromusculaires, Groupe Hospitalier Pellegrin, Hôpitaux de Bordeaux, 33000 Bordeaux, France
| | - Nahema Issa
- Service de médecine intensive et réanimation, Hôpital Saint André, 33000 Bordeaux, France
| | - Elena-Camelia Rusu
- Service de neurologie, Hôpital Sainte Musse, Centre Hospitalier Intercommunal de Toulon, 83056 Toulon, France
| | - Mathilde Goudot
- Service de neurologie, Hôpital Emile Muller, 68100 Mulhouse, France
| | - Anais Dutray
- Service de neurologie, Centre Hospitalier de Perpignan, 66046 Perpignan, France
| | - Jean Louis Devoize
- Pôle Cardio-vasculaire et métabolique, Centre hospitalier de Cayenne, 97300 Cayenne, France
| | - Lucie Hopes
- Service de neurologie, Hôpital Central, CHRU Nancy, 54035 Nancy, France
| | - Anne-Laure Kaminsky
- Service de neurologie, CHU de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Marion Philbert
- Service de neuropédiatrie, Site Mère Enfant, CHU Martinique, 97200 Fort-de-France, France
| | - Eve Chanson
- Service de neurologie, CHU Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Amelie Leblanc
- Service de neurologie, Hôpital d'Instruction des Armées Clermont-Tonnerre, 29240 Brest, France
| | - Erwan Morvan
- Service de neurologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - Daniela Andriuta
- Service de Neurologie et Laboratoire de Neurosciences Fonctionnelles et Pathologies, Centre Hospitalier universitaire d'Amiens et Université de Picardie Jules Verne, Amiens, France
| | - Philippe Diraison
- Service de neurologie, Hôpital Laënnec, Centre Hospitalier de Cornouaille, 29107 Quimper, France
| | - Gabriel Mirebeau
- Service de neurologie, Centre Hospitalier Universitaire de La Réunion, 97410 Saint Pierre, France
| | - Celine Derollez
- Service de neurologie, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, 59037 Lille, France
| | - Veronique Bourg
- Service de neurologie, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France
| | - Quentin Bodard
- Service de médecine interne et maladies infectieuses, Centre Hospitalier d'Angoulême, 16959 Angoulême, France
| | - Clementine Fort
- Service de neurologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Lyon/Bron, France
| | | | - Guillaume Rieul
- Service de réanimation, Centre Hospitalier de Saint-Brieuc, 22027 Saint-Brieuc, France
| | - Daniela Molinier-Tiganas
- Service de médecine polyvalente et de médecine interne, Centre Hospitalier Le Mans, 72037 Le Mans, France
| | - Mickaël Bonnan
- Service de neurologie, Centre Hospitalier de Pau, 64046 Pau, France
| | - Thierry Tchoumi
- Service de neurologie/UNV, Centre Hospitalier de Saintonge, 17100 Saintes, France
| | - Jérôme Honnorat
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Romain Marignier
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France.,Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, 69003 Lyon, France
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Moodley K, Bill PLA, Patel VB. A Comparison of Clinical, Electro-Diagnostic, Laboratory, and Treatment Outcome Differences in a Cohort of HIV-Infected and HIV-Uninfected Patients With Myasthenia Gravis. Front Neurol 2021; 12:738813. [PMID: 34721269 PMCID: PMC8553930 DOI: 10.3389/fneur.2021.738813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited literature comparing the clinical parameters and treatment outcomes in HIV-infected and HIV-uninfected myasthenia gravis (MG) patients. The aim of the study was to investigate the clinical differences and treatment outcomes in the two categories of patients, particularly the safe use of immunosuppressive therapy in immunocompromised patients. The study was a retrospective analysis of medical records of MG patients from the neuromuscular unit at Inkosi Albert Luthuli Central Hospital in Kwa-Zulu Natal between 2003 and 2019. One hundred and seventy-eight (178) patients fulfilled the clinical criteria for MG. Twenty-four (13.4%) were HIV-infected and 154 (86.5%) were HIV-uninfected. There were 116 (65%) females, median 45 years, (IQR 40–62), 90 (50.5%) black African, 66 (37%) Indian, 20 (11.2%) white, and 2 (1.1%) of mixed ancestry. In the HIV-infected cohort, 20 (87%) had generalized MG, 12 (50%) bulbar, and 14 (60.9%) respiratory onset MG, 12 (50%) presented with MG Foundation of America (MGFA) class five diseases at diagnosis, six (25%) presented with MG crisis during the 5-year follow-up. Thirteen (54%) of the HIV-infected group required rescue therapy using (plasma exchange or IV immunoglobulin) combined with pulse cyclophosphamide compared with 17 (11%) in the HIV-uninfected cohort, respectively. At 5 years, 8 (33%) of the HIV-infected group remained refractory to treatment compared with 10 (6.5%) HIV-uninfected cohort, respectively. No adverse events were documented in HIV-infected patients receiving combination rescue therapy (PLEX or IVIG combined with IV cyclophosphamide). In conclusion HIV-infected MG patients are more likely to require combination rescue therapy with PE/IVIG and IV cyclophosphamide compared with those who were HIV-uninfected. No side effects were documented in the HIV-infected group receiving the above therapy.
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Affiliation(s)
- Kaminie Moodley
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Pierre L A Bill
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Vinod B Patel
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
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21
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Hanberg JS, Hsieh E, Akgün KM, Weinstein E, Fraenkel L, Justice AC. Incident Rheumatoid Arthritis in Human Immunodeficiency Virus Infection: Epidemiology and Treatment. Arthritis Rheumatol 2021; 73:2189-2199. [PMID: 34042306 DOI: 10.1002/art.41802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the incidence, presentation, and management of RA in persons with HIV (PWH), including use of disease-modifying anti-rheumatic drugs (DMARDs) in this immunosuppressed population. METHODS Patients were included from the Veterans Aging Cohort Study, a longitudinal cohort of Veterans with HIV and matched uninfected Veterans. We identified patients with ≥1 rheumatologist-generated International Classification of Diseases (ICD) code for RA and a measurement of rheumatoid factor (RF) or anti-CCP antibodies. Charts were reviewed using the 2010 RA Classification Criteria to identify incident RA. We recorded use and adverse effects of DMARDs during the first contiguous (no interruption greater than 6 months) course. RESULTS We included 56,250 PWH and 116,944 uninfected persons over 2,384,541 person-years. Of 2,748 patients with an RA ICD code, incident RA was identified in 215 patients, including 21 PWH. The incidence rate ratio of RA in PWH vs. uninfected was 0.29 (95% CI 0.19-0.48). Most patients (88%) with RA were seropositive. However, high autoantibody titers were less common in PWH: 5% (1/21) of PWH had both high titer anti-CCP and RF, compared to 41% (82/194) of uninfected. DMARDs were prescribed for 71% (15/21) of PWH with RA, compared to 94% (183/194) of uninfected. Among 10 PWH prescribed DMARDs, we found no signal for worse infectious safety profile compared to 158 HIV-negative controls. CONCLUSION Incident RA was less common in PWH than in matched controls. PWH with incident RA had less positive autoantibody profiles than controls and were prescribed DMARDs less frequently.
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Affiliation(s)
- Jennifer S Hanberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA
| | - Evelyn Hsieh
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA.,Section of Rheumatology, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M Akgün
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA
| | - Erica Weinstein
- Division of Infectious Diseases and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liana Fraenkel
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA.,Section of Rheumatology, Yale University School of Medicine, New Haven, CT, USA
| | - Amy C Justice
- Department of Medicine, Yale University School of Medicine, New Haven, CT, and VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Public Health, New Haven, CT, USA
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22
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Steve RJ, Alex D, Yesudhason BL, Prakash JAJ, Mathews NS, Daniel D, Ramalingam VV, Demosthenes JP, Ghale BC, Anantharam R, Rebekah G, Rupali P, Varghese GM, Kannangai R. Autoantibodies Among HIV-1 Infected Individuals and the Effect of Anti-Retroviral Therapy (ART) on It. Curr HIV Res 2021; 19:277-285. [PMID: 33596809 DOI: 10.2174/1570162x19666210217120337] [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: 09/18/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) has led to a decline in autoimmune diseases but lacks studies on its effect on autoantibodies. METHODS It is a cross-sectional study with archived samples from 100 paired HIV-1 infected ART naïve and experienced individuals and 100 prospectively collected matched blood-donor controls. Antinuclear antibody, IgG anticardiolipin antibody, IgM and IgG β2 glycoprotein-1 antibodies, and total IgG levels were detected. Results are expressed as mean with standard deviation (SD), median, percentage positivity, and a p<0.05 is considered significant. The study was approved by the Institutional Review Board. RESULTS The median viral load of the treatment naïve samples was 4.34 Log copies/mL, while all were virally suppressed post ART with a median duration of treatment for 12 months (range: 3-36 months). The percentage of antinuclear antibody positivity was 5% among ART naïve and controls, with a decrease of 2% post ART (p= 0.441). The positivity for anti-cardiolipin antibody was 15% among ART naïve while none of the ART experienced or controls were positive (p<0.05). IgM β2 glycoprotein-1 were 4%, 1% and 3% among ART naïve, treated and controls, respectively (p<0.05). IgG β2 glycoprotein-1 was 2% among ART naïve while none of the treated and controls were positive (p<0.05). The mean total IgG level among ART naïve, experienced, and controls were 21.82 (SD 6.67), 16.91 (SD 3.38), 13.70 (SD 2.24) grams/Litre, respectively (p<0.05). CONCLUSION ART has a significant effect on IgG anti-cardiolipin antibody and total IgG but only a marginal effect on ANA, IgM, and IgG β2 glycoprotein-1 antibodies.
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Affiliation(s)
- Runal John Steve
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Diviya Alex
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Binesh Lal Yesudhason
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - John Antony Jude Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Nitty Skariah Mathews
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Dolly Daniel
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - John Paul Demosthenes
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Ben Chirag Ghale
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Raghavendran Anantharam
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - George Mannil Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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23
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Wirtz PW. Dysphagia and respiratory failure in an HIV patient: MuSK myasthenia gravis. Acta Neurol Belg 2020; 120:1483-1484. [PMID: 32851549 DOI: 10.1007/s13760-020-01461-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Paul W Wirtz
- Department of Neurology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545AA, The Hague, The Netherlands.
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24
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Hughes MS, Pietropaolo M, Vasudevan MM, Marcelli M, Nguyen H. Checking the Checkpoint Inhibitors: A Case of Autoimmune Diabetes After PD-1 Inhibition in a Patient with HIV. J Endocr Soc 2020; 4:bvaa150. [PMID: 33225197 PMCID: PMC7660136 DOI: 10.1210/jendso/bvaa150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) is a known immune-related adverse event (irAE) following treatment with programmed cell death protein 1 (PD-1), with a reported 0.9% incidence. We hereby present the first case, to our knowledge, of ICI-DM following ICI use in a human immunodeficiency virus (HIV) patient. In this case, a 48-year-old man with HIV stable on highly active antiretroviral therapy (HAART) was diagnosed with Hodgkin lymphoma and initiated treatment with the PD-1 inhibitor nivolumab. His lymphoma achieved complete response after 5 months. However, at month 8, he reported sudden polydipsia and polyuria. Labs revealed a glucose level of 764 mg/dL and glycated hemoglobin A1c (HbA1c) of 7.1%. Low C-peptide and elevated glutamic acid decarboxylase 65 (GAD65) antibody levels confirmed autoimmune DM, and he was started on insulin. Major histocompatibility complex class II genetic analysis revealed homozygous HLA DRB1*03-DQA1*0501-DQB1*02 (DR3-DQ2), which is a known primary driver of genetic susceptibility to type 1 DM. Autoimmune DM has been reported as an ICI-associated irAE. However, patients with immunocompromising conditions such as HIV are usually excluded from ICI trials. Therefore, little is known about such irAEs in this population. In this case, risk of ICI-DM as an irAE was likely increased by several factors including family history, a high-risk genetic profile, islet-related immunologic abnormalities, active lymphoma, and HIV infection with a possible immune reconstitution event. Clinicians should maintain a high index of suspicion for development of irAEs associated with ICI, particularly as use of these therapies broadens. Thorough investigation for presence of higher-risk features should be conducted and may warrant inclusion of pre-therapy genetic and/or autoantibody screening.
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Affiliation(s)
- Michael S Hughes
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Madhuri M Vasudevan
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Marco Marcelli
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Ha Nguyen
- Baylor College of Medicine, Houston, Texas, USA
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Incidence of autoimmune diseases in people living with HIV compared to a matched population: a cohort study. Clin Rheumatol 2020; 40:2439-2445. [PMID: 33230683 DOI: 10.1007/s10067-020-05500-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
The objective of this paper is to estimate incidence and relative risk of autoimmune conditions in patients living with HIV compared to an HIV-negative matched population. We conducted a retrospective study in the medico-administrative database of the province of Québec, Canada. All HIV-positive patients treated with antiretrovirals were matched to up to 4 HIV-negative controls for age, sex, and period of follow-up. The following autoimmune conditions were identified using medical billing codes: vasculitis, hematological (immune thrombocytopenic purpura and immune hemolytic anemia), ankylosing spondylitis, psoriasis and psoriatic arthritis, inflammatory bowel disease and associated arthritis, connectivitis, and systemic lupus erythematosus. Incidence rates and adjusted hazard ratios (aHR) were obtained using survival models. A total of 4245 HIV-positive patients were matched to 16493 HIV-negative patients. Autoimmune diseases were diagnosed in 407 (9.6%) HIV-positive and 508 (3%) HIV-negative patients. The aHR for autoimmune diseases associated to HIV was 2.40 95% CI [2.10-2.75]. The strongest associations were seen for hematological disorders (aHR 8.34 95% CI [6.13-11.36]), followed by ankylosing spondylitis (1.82 95% CI [1.03-3.21]), inflammatory bowel disease and associated arthritis (1.80 95% CI [1.37-2.35]), psoriasis and associated arthritis (1.69 95% CI [1.23-2.33]), and rheumatoid arthritis (1.51 95% CI [1.08-2.11]).We found no association between HIV and the incidence of vasculitis, connectivitis, and systemic lupus erythematosus, but the number of cases for these diseases were few. Autoimmune diseases are more frequent among people living with HIV than age and sex-matched population-based controls. Key Points • Strength: The major strength of this study is its large sample size of 4200 people treated as HIV infection, matched to 16000 HIV negative for sex and age. • Novelty: We found that people living with HIV were more than twice as likely to suffer from auto-immune diseases than their matched counterparts.
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26
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Heckmann JM, Marais S. Management Issues in Myasthenia Gravis Patients Living With HIV: A Case Series and Literature Review. Front Neurol 2020; 11:775. [PMID: 32973647 PMCID: PMC7472955 DOI: 10.3389/fneur.2020.00775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/24/2020] [Indexed: 12/19/2022] Open
Abstract
South Africa is home to more than seven million people living with human immunodeficiency virus (HIV) and a high prevalence of tuberculosis. Human immunodeficiency virus–infected individuals may develop myasthenia gravis (MG), which raises questions regarding their management. An MG database, with 24 years of observational data, was audited for HIV-infected persons. Case reports of MG in HIV-infected persons were reviewed. We identified 17 persons with MG and HIV infection. All had generalized MG with a mean age at onset of 37.8 years. Eleven had acetylcholine receptor antibody–positive MG; one had antibodies against muscle-specific kinase. Six developed MG prior to HIV infection (mean CD4+ 361 cells/mm3); four worsened <6 months of starting antiretrovirals. Eleven developed MG while HIV-infected (mean CD4+ 423 cells/mm3); five presented with mild MG; three in MG crisis requiring rescue therapies (intravenous immune globulin or plasma exchange and/or intravenous cyclophosphamide). Two were diagnosed with HIV infection and MG at the same time. Fifteen required maintenance steroid-sparing immune therapies, predominantly azathioprine, or methotrexate. Plasma HIV viral loads remained below detectable levels on antiretrovirals during immunosuppressant treatment. Over the average follow-up of 6 years, 10 achieved minimal manifestation status, and the remainder improved to mild symptoms. Three cases had tuberculosis before MG, but none developed tuberculosis reactivation on immunosuppressive therapy; one used isoniazid prophylaxis. Herpes zoster reactivation during treatment occurred in one. Conclusions include the following: MG in HIV-infected patients should be managed similarly to individuals without HIV infection; half develop moderate–severe MG; MG symptoms may worsen within 6 months of antiretroviral initiation; safety monitoring must include plasma HIV viral load estimation. Isoniazid prophylaxis may not be indicated in all cases.
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Affiliation(s)
- Jeannine M Heckmann
- Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Neurology Research Group, UCT Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Suzaan Marais
- Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Neurology Research Group, UCT Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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27
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Badura R, Foxall RB, Ligeiro D, Rocha M, Godinho-Santos A, Trombetta AC, Sousa AE. Early ART in Acute HIV-1 Infection: Impact on the B-Cell Compartment. Front Cell Infect Microbiol 2020; 10:347. [PMID: 32766164 PMCID: PMC7378391 DOI: 10.3389/fcimb.2020.00347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022] Open
Abstract
HIV-1 infection induces B cell defects, not fully recovered upon antiretroviral therapy (ART). Acute infection and the early start of ART provide unique settings to address the impact of HIV on the B cell compartment. We took advantage of a cohort of 21 seroconverters, grouped according to the presence of severe manifestations likely mediated by antibodies or immune complexes, such as Guillain-Barré syndrome and autoimmune thrombocytopenic purpura, with a follow-up of 8 weeks upon effective ART. We combined B and T cell phenotyping with serum immunoglobulin level measurement and quantification of sj-KRECs and ΔB to estimate bone marrow output and peripheral proliferative history of B cells, respectively. We observed marked B cell disturbances, notably a significant expansion of cells expressing low levels of CD21, in parallel with markers of both impaired bone marrow output and increased peripheral B cell proliferation. This B cell dysregulation is likely to contribute to the severe immune-mediated conditions, as attested by the higher serum IgG and the reduced levels of sj-KRECs with increased ΔB in these individuals as compared to those patients with mild disease. Nevertheless, upon starting ART, the dynamic of B cell recovery was not distinct in the two groups, featuring both persistent alterations by week 8. Overall, we showed for the first time that acute HIV-1 infection is associated with decreased bone marrow B cell output assessed by sj-KRECs. Our study emphasizes the need to intervene in both bone marrow and peripheral responses to facilitate B cell recovery during acute HIV-1 infection.
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Affiliation(s)
- Robert Badura
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Serviço de Doenças Infecciosas, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Russell B Foxall
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Dario Ligeiro
- Centro de Sangue e Transplantação de Lisboa, Instituto Português de Sangue e Transplantação, IP, Lisbon, Portugal
| | - Miguel Rocha
- Grupo de Ativistas em Tratamentos, Community Based Center for HIV and STD, CheckpointLX, Lisbon, Portugal
| | - Ana Godinho-Santos
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Amelia C Trombetta
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana E Sousa
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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28
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Cuan-Baltazar Y, Soto-Vega E. Microorganisms associated to thyroid autoimmunity. Autoimmun Rev 2020; 19:102614. [PMID: 32663624 DOI: 10.1016/j.autrev.2020.102614] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
Autoimmune thyroid diseases are a group of diseases characterized by a dysfunction of the immune system concerning the thyroid gland, associated with hypothyroidism or hyperthyroidism. The thyroid gland autoimmunity has been recognized as multifactorial. It has been reported that microorganisms may play a role on the pathogenesis of Hashimoto's thyroiditis and Graves´ disease. These could explain the high incidence of the autoimmune thyroid diseases. Helicobacter Pylori (H. pylori) and Hepatitis C virus (HCV) are the microorganisms in which the association with autoimmune thyroid diseases is clearer. The pathophysiologic mechanisms are still not well defined. For H. pylori, molecular mimicry has been the most accepted mechanism. It has been proposed Hepatitis C virus as the trigger of the thyroid autoimmunity by exacerbating the production of thyroid auto-antibodies, while some mention that the real factor that triggers the thyroid autoimmunity is the treatment with Interferon alpha (IFN-alpha) by upregulating MHC class I and inducing ligation of CD40+ cells to thyrocytes. Other microorganisms such as Toxoplasma gondii, Human Immunodeficiency virus, Herpes virus and others have reported information about their association with thyroid autoimmune diseases There are no proposals on how these last microorganisms induce thyroid autoimmunity. There is still a lack of evidence on this topic. Further research must be done to determine the interaction of these microorganisms and the best way to manage these patients.
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O'Kelly B, McNally C, McConkey S, Durcan L. HIV and systemic lupus erythematosus: where immunodeficiency meets autoimmunity. Lupus 2020; 29:1130-1132. [PMID: 32571141 DOI: 10.1177/0961203320934851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of a new diagnosis of systemic lupus erythematosus (SLE) in a patient with HIV who presented to the outpatient department with a fever, headache and lymphadenopathy. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Initial concerns were for an infectious process, and investigations for systemic and central nervous system infection were negative. Serum testing for ANA, dsDNA, nucleosome, anti-histone and ribosomal-P antibodies was positive. A magnetic brain imaging scan of the brain showed a well-circumscribed lesion in the right cerebellar peduncle on T2/FLAIR. The patient was commenced on prednisolone and rituximab, and had a good clinical response. The cerebellar lesion resolved and has not recurred with sequential imaging. SLE and HIV are both multi-systemic diseases which rarely co-occur. Autoimmune processes should be considered in HIV patients with multi-systemic symptoms and signs.
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Affiliation(s)
| | | | - Sam McConkey
- Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Ireland
| | - Laura Durcan
- Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Ireland
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Abstract
Neuromyelitis optica (NMO) is a rare and chronic disabling autoimmune astrocytopathy of the central nervous system. Current advances regarding aquaporin-4 antibody function facilitate the understanding of clinical manifestations and imaging findings beyond optic neuritis and transverse myelitis. The current definition of NMO spectrum disorder (NMOSD) includes both aquaporin-4-IgG seropositive and seronegative patients who present with characteristic findings. This review will briefly summarize the pathophysiology and the latest NMOSD diagnostic criteria and focus on the NMOSD imaging findings and its differential diagnosis.
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Affiliation(s)
- Sheng-Che Hung
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC; Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Vega LE, Espinoza LR. Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras. Clin Rheumatol 2020; 39:2515-2522. [PMID: 32297034 PMCID: PMC7159285 DOI: 10.1007/s10067-020-05082-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
Rheumatic manifestations remain an important clinical manifestation associated to HIV. To date after 4 decades of the onset of the HIV/AIDS pandemic, almost 37 million individuals are living with the infection, including close to 2 million of newly infected individuals. The status, however, of a considerable proportion of HIV/AIDS patients has changed from a near fatal disorder secondary to opportunistic infections to a chronic disease in which renal cardiovascular, diabetes, malignancy, and autoimmune co-morbid disorders have become prevalent and relevant. In addition, the spectrum of rheumatic disorders also has changed since the introduction of HAART and its diagnosis and treatment represents a challenge. The purpose of this review is to define and discuss the HIV-related rheumatic manifestations in the pre- and post-HAART eras.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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Di Stefano V, Barbone F, Ferrante C, Telese R, Vitale M, Onofrj M, Di Muzio A. Inflammatory polyradiculoneuropathies: Clinical and immunological aspects, current therapies, and future perspectives. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220942340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory polyradiculoneuropathies are heterogeneous disorders characterized by immune-mediated leukocyte infiltration of peripheral nerves and nerve roots leading to demyelination or axonal degeneration or both. Inflammatory polyradiculoneuropathies can be divided into acute and chronic: Guillain–Barré syndrome and chronic inflammatory demyelinating polyneuropathy and their variants. Despite major advances in immunology and molecular biology have been made in the last years, the pathogenesis of these disorders is not completely understood. This review summarizes the current literature of the clinical features and pathogenic mechanisms of inflammatory polyradiculoneuropathies and focuses on current therapies and new potential treatment for the future.
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Affiliation(s)
- Vincenzo Di Stefano
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Filomena Barbone
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Camilla Ferrante
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Roberta Telese
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Michela Vitale
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Marco Onofrj
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Antonio Di Muzio
- Department of Neurology, “SS. Annunziata” Hospital, Chieti, Italy
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Properzi M, Della Giustina T, Mentasti S, Castelli F, Chiesa A, Gregori N, Quiros-Roldan E. Low prevalence of symptomatic thyroid diseases and thyroid cancers in HIV-infected patients. Sci Rep 2019; 9:19459. [PMID: 31857648 PMCID: PMC6923431 DOI: 10.1038/s41598-019-56032-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022] Open
Abstract
Thyroid diseases (TDs) have been widely associated with HIV infection. However, data about TDs prevalence and distribution are controversial, and few published studies are available. The aim of our study was to assess prevalence and risk factors of symptomatic thyroid disturbances, including thyroid cancers, in a large cohort of HIV-infected patients. A retrospective cohort study was performed at the Department of Infectious and Tropical Diseases of the University of Brescia, Italy, in the period 2005–2017. We identified all HIV-positive patients with a diagnosis of symptomatic TD in the electronic database of our Department (HIVeDB); we also operated a record-linkage between our data and the Health Protection Agency database (HPADB) of Brescia Province. Multivariate logistic regression analysis was used to determine risk factors associated with TDs onset; an incidence rate analysis was also performed. During the study period, 6343 HIV-infected patients have been followed at our Department; 123 received a diagnosis of symptomatic TD (1.94% of the entire cohort). In the TDs group, almost half of patients were females (n = 59, 48%), mean age was 47.15 years (SD: 11.56). At TD diagnosis, mean T CD4+ cell count was 491 cell/uL and most patients showed undetectable HIV-RNA (n = 117, 95.12%). Among them, 81 patients were found to have hypothyroidism (63 with Hashimoto’s thyroiditis), 21 hyperthyroidism (17 suffered from Graves’ disease), while 11 subjects were diagnosed with a primitive thyroid cancer. Papillary thyroid cancer was the most frequent histotype (n = 7, 63.63%), followed by medullary (n = 2, 18.18%) and follicular thyroid cancer (n = 1, 9.1%). Male gender was a protective factor for TDs development, especially for hypothyroidism (p < 0.001); age emerged as a variable associated with both hypothyroidism (p = 0.03) and thyroid cancer (p = 0.03), while CD4+ cell nadir <200 cell/mm3 was associated with symptomatic hyperthyroidism (p = 0.005). To conclude, symptomatic thyroid dysfunctions rate in well-treated HIV-infected patients is low. Age and gender are crucial elements in the onset of thyroid abnormalities, together with T CD4+ cell nadir. Interestingly, medullary thyroid cancer seems to be much more frequent in HIV-infected patients compared to the general population.
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Affiliation(s)
- Martina Properzi
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
| | - Tommaso Della Giustina
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Sara Mentasti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Annacarla Chiesa
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
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Elkoshi Z. The Binary Classification Of Chronic Diseases. J Inflamm Res 2019; 12:319-333. [PMID: 31908517 PMCID: PMC6927256 DOI: 10.2147/jir.s227279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
Abstract
Acute diseases start with an insult and end when insult disappears. If the trauma induces an immune reaction (which happens in most cases), this reaction must be terminated with some type of resolution mechanism, when the cause of the trauma ceases. Chronicity develops if insult is permanent or if the resolution mechanism is defective. Another way to reach disease chronicity is a positive feedback loop, whereby the immune reaction activates an internal, insult-like reaction. A distinction between chronic states characterized by a persistent, low suppressive effect and those characterized by a persistent, high suppressive effect of regulatory T cells (Treg), is proposed. This two-class division represents two ways to reach chronicity: (a) by maintaining inflammatory reaction long after insult disappears ("low Treg"), or (b) by suppressing inflammatory reaction prior to the disappearance of insult ("high Treg"). This two-class division may explain the strong association between certain pathogens and cancer, on one hand, and between several other pathogens and autoimmunity, on the other hand. The weak association between autoimmune diseases and HIV infection and the relatively weak association between autoimmune diseases and cancer may be elucidated as well. In addition, the model rationalizes why immune-modulating drugs, which are effective in cancer, are also effective in "high Treg" viral infections, while corticosteroids, which are generally effective in autoimmune diseases, are also effective in other "low Treg" diseases (such as asthma, atopic dermatitis, and "low Treg" infections) but are not effective in solid malignancies and "high Treg" infections. Moreover, the model expounds why certain bacteria inhibit tumor growth and why these very bacteria induce autoimmune diseases.
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Affiliation(s)
- Zeev Elkoshi
- Taro Pharmaceutical Industries, Haifa Bay, Israel
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35
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Contributing awareness of autoimmune hepatitis in HIV patients. AIDS 2019; 33:2103-2105. [PMID: 31577575 DOI: 10.1097/qad.0000000000002299] [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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Chaiteerakij R, Sanpawat A, Avihingsanon A, Treeprasertsuk S. Autoimmune hepatitis in human immunodeficiency virus-infected patients: A case series and review of the literature. World J Gastroenterol 2019; 25:5388-5402. [PMID: 31558881 PMCID: PMC6761245 DOI: 10.3748/wjg.v25.i35.5388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/14/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abnormal liver chemistry is a common problem in human immunodeficiency virus (HIV)-infected patients. Common causes of abnormal liver enzymes in this population include viral hepatitis B/C or opportunistic infection, drug toxicity, and neoplasm. Autoimmune hepatitis is a rare cause of hepatitis in HIV-infected individuals; however, this condition has been increasingly reported over the past few years.
CASE SUMMARY We present 13 HIV-infected patients (5 males and 8 females) who developed autoimmune hepatitis (AIH) after their immune status was restored, i.e. all patients had stable viral suppression with undetectable HIV viral loads, and median CD4+ counts of 557 cells/× 106 L. Eleven patients presented with chronic persistent elevation of aminotransferase enzyme levels. One patient presented with acute hepatitis and the other patient presented with jaundice. The median levels of aspartate aminotransferase and alanine aminotransferase enzymes were 178 and 177 U/mL, respectively. Elevation of immunoglobulin G levels was present in 11 (85%) patients. Antinuclear antibody and anti-smooth muscle antibody were positive in 11 (85%) and 5 (38%) patients. Liver biopsy was performed in all patients. They had histopathological findings compatible with AIH. The patients were started on prednisolone for remission induction, with good response. After improvement of the liver chemistry, the dose of prednisolone was tapered, and azathioprine was added as life-long maintenance therapy. At the last follow-up visit, all were doing well, without HIV viral rebound or infectious complications.
CONCLUSION This report underscores the emergence of autoimmune hepatitis in the context of HIV infection.
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Affiliation(s)
- Roongruedee Chaiteerakij
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Anapat Sanpawat
- Department of Pathology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Anchalee Avihingsanon
- Medical Department, The HIV Netherlands Australia Thailand Research Collaboration, Bangkok 10330, Thailand
| | - Sombat Treeprasertsuk
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Human immunodeficiency virus and multiple sclerosis: a review of the literature. Neurol Res Pract 2019; 1:24. [PMID: 33324890 PMCID: PMC7650072 DOI: 10.1186/s42466-019-0030-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 01/22/2023] Open
Abstract
Multiple sclerosis (MS) and human immunodeficiency virus (HIV) infection are frequent and well-studied nosological entities. Yet, comorbidity of MS and HIV has only been rarely reported in the medical literature. We conducted a literature search using the databases PubMed, Ovid and Google Scholar, with the aim of identifying published studies and reports concerning HIV and MS. Recent epidemiological studies indicated a negative association between MS and HIV in terms of a reduced risk of developing MS in HIV positive patients. Accumulating clinical evidence additionally suggests a possibly reduced relapse rate of MS in HIV patients. Nevertheless, it remains currently unclear whether this observed inverse correlation could be due to the HIV infection itself, HIV treatment or the combination of both. Among the limited cases of MS in HIV infected patients, MS occurrence was mainly reported during acute HIV infection or during HIV seroconversion. This finding is in line with reports of HIV-related autoimmune disorders, which also occur in early phases of HIV disease. Beneficial effects of antiretroviral therapy on MS activity were reported in few clinical cases. Yet, the single phase II clinical trial (INSPIRE), which investigated the effects of antiretroviral medication (using the integrase inhibitor raltegravir) in patients with relapsing-remitting MS, failed to corroborate any beneficial effects at group level. Nevertheless, recently published experimental evidence suggests that HIV treatments may hold therapeutic potential for MS treatment. Thus, further studies are warranted to firstly, delineate the immunological mechanisms underlying possible efficacy of HIV treatments in MS, and to secondly, assess whether repurposing of HIV drugs for MS could be a worthwhile future research objective.
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Autoimmune Hepatitis (AIH) in Acquired Immune Deficiency Syndrome (AIDS): A Case Report and Review of Literature. Case Reports Hepatol 2019; 2019:5326428. [PMID: 31281688 PMCID: PMC6590560 DOI: 10.1155/2019/5326428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 11/23/2022] Open
Abstract
The common causes of abnormal liver chemistries in human immunodeficiency virus (HIV) infected patients are multifactorial. Diagnosis of autoimmune hepatitis (AIH) in HIV infected patients is intriguing but data is scarce. Unmasking of AIH during immune reconstitution in HIV patients after starting antiretroviral therapy is reported but not with advanced acquired immunodeficiency syndrome (AIDS). Here we present a fascinating case of 32-year-old African-American man with advanced AIDS who presented with elevated transaminases. He was diagnosed with AIH before starting antiretroviral therapy and successfully treated with prednisolone and azathioprine with antiretroviral therapy despite very low CD4 count.
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Abstract
BACKGROUND Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. METHODS Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. RESULTS Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. CONCLUSION Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.
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Affiliation(s)
- William P Howlett
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Center for International Health, University of Bergen, Norway
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Yang Y, Cheng Y, Wang C. Concomitant pulmonary sarcoidosis and HIV infection: A case report. Medicine (Baltimore) 2019; 98:e16210. [PMID: 31261572 PMCID: PMC6617437 DOI: 10.1097/md.0000000000016210] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Sarcoidosis is an immune-mediated systemic disease, and the increase in CD4+ T lymphocyte cells is considered as a key factor for the development of sarcoidosis. The acquired immune deficiency syndrome (AIDS) is well known as the impaired immune system and characterized by relative lack of CD4+ T lymphocytes. Thus, the coexistence of sarcoidosis and HIV infection has rarely been reported. PATIENT CONCERNS A 65-year-old female patient was admitted to our respiratory ward complained of fatigue, chest distress, and a persistent dry cough for 2 months. DIAGNOSES The chest computed tomography scan showed diffuse reticulonodular infiltrates and mediastinal and hilar lymphadenopathy. Fibreoptic bronchoscopy along with transbronchial biopsy and transbronchial needle aspiration was performed. The pathological findings revealed noncaseating granulomas, and the patient was found to be HIV-seropositive through enzyme-linked immunosorbent assay and confirmed as HIV by the centers for disease control and prevention. INTERVENTIONS The patient was administered oral methylprednisolone 20 mg/day for pulmonary sarcoidosis and then referred to the hospital for infectious diseases receiving subsequent treatment for HIV. OUTCOMES clinical symptoms relieved 3 months later after treatment. LESSONS The coexistence of sarcoidosis and HIV infection is rare because of paradoxical roles of CD4-positive T cells in the pathogenesis of AIDS and sarcoidosis.
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Affiliation(s)
- Yan Yang
- Department of Respiratory Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang
| | - Yusheng Cheng
- Department of Respiratory Medicine, Yi Ji Shan hospital of Wanna Medical college, Anhui, China
| | - Chenghui Wang
- Department of Respiratory Medicine, Yi Ji Shan hospital of Wanna Medical college, Anhui, China
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Silvestri V, D'Ettorre G, Borrazzo C, Mele R. Many Different Patterns under a Common Flag: Aortic Pathology in HIV-A Review of Case Reports in Literature. Ann Vasc Surg 2019; 59:268-284. [PMID: 31051229 DOI: 10.1016/j.avsg.2019.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Availability of highly active antiretroviral therapy (HAART) for HIV has prolonged life expectancy of patients but has also increased the incidence of non-AIDS comorbid conditions. Among these, there are cardiovascular diseases, and aortic involvement has been described in patients with HIV in the form of aortitis, aneurysms, or dissections. Our study aims to describe aortic pathology occurring in patients with HIV, focusing on clinical and surgical presentation, management, and outcome, through a review of cases published in literature. METHODS MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "aortitis" OR "aortic aneurysm" OR "aortic dissection" AND HIV. Research was restricted to English language. Only case reports were included. Data on patients' age, sex, traditional risk factors, timing from HIV diagnosis, pharmacological details, coinfection (syphilis, hepatitis C virus [HCV], and hepatitis B virus [HBV]), anatomical localization of lesion, presence of inflammatory involvement, rapid growing or rupture, and surgical treatment and outcomes were collected and summarized in tables. RESULTS Forty articles (51 cases) were included in the study. The mean age of patients was 48.8 ± 8.3 years. Male sex was preponderant (43 cases, 84.3%). Among traditional risk factors, hypertension and smoking were the most frequently reported ones (14 and 13 cases, respectively), followed by vasculopathy involving other arterial districts, dyslipidemia, diabetes, and drug addiction. In 3 cases, HIV was diagnosed in the same time as aortic pathology, whereas in most cases, aortic event occurred after five years from HIV diagnosis. In 30.5% of cases for which data on pharmacologic management were available, no treatment or poor adherence was reported. Coinfection occurred in some cases (syphilis in 6, HCV in 5, and HBV in 3). As for anatomical involvement, isolated thoracic lesions were more frequent (24, 47.1%), followed by abdominal and thoracoabdominal lesions. The etiology ranged from bacterial mycotic aneurysms to tertiary syphilis, postsurgical complications, or atherosclerosis. In 3 cases, HIV vasculitis was directly suggested, and in another 2, no other potential etiology had been diagnosed through cultural tests. Open surgical treatment was carried out in 30 cases (58.8%), and in addition, 10 endovascular (19.6%) and 2 hybrid procedures were described. Inflammatory features occurred in 7 cases, and a rapid evolution of lesions in 6. In 9 cases (17.6%), rupture occurred. Mortality was reported in 8 cases (15.7%). CONCLUSIONS Aortic pathology may occur in patients with HIV. The entanglement of different patterns of pathological involvement of the aortic wall, secondary to immune dysregulation, infectious process, or atherosclerotic damage that may co-occur in one single case, results in a very challenging management of the condition. Because of the increased life expectancy of patients and immigration from regions with both high HIV and coinfection prevalence, the incidence of aortic pathology could increase in the upcoming years, suggesting the urgent need for further studies to optimize management in these very complex cases.
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Affiliation(s)
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Rita Mele
- Surgical Science Department La Sapienza University, Roma, Italy
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Hovis IW, Namuyonga J, Kisitu GP, Ndagire E, Okello E, Longenecker CT, Sanyahumbi A, Sable CA, Penny DJ, Lwabi P, Kekitiinwa AR, Beaton A. Decreased Prevalence of Rheumatic Heart Disease Confirmed Among HIV-positive Youth. Pediatr Infect Dis J 2019; 38:406-409. [PMID: 30882733 PMCID: PMC6355385 DOI: 10.1097/inf.0000000000002161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is geographical overlap between areas endemic for rheumatic heart disease (RHD) and those endemic for HIV. A recent pilot study demonstrated that children living with HIV might be at less risk for RHD development; however, the sample size was too small to make definitive conclusions. Our objective was to determine the prevalence of RHD among HIV-positive children in Uganda. METHODS We conducted a prospective, cross-sectional study of HIV-positive children (5-15 years of age) receiving care at the Baylor Uganda HIV Clinic, Kampala, Uganda. A focused echocardiogram and chart review was performed. A sample size of 988 children was needed to provide 80% power to detect a difference in population prevalence between HIV-positive children and the general population, 2.97% [95% confidence interval (CI): 2.70-3.24%], based on previous reports. RESULTS Screening echocardiography of 993 HIV-positive children found 15 individuals (1.5%; 95% CI: 0.88%-2.54%) with RHD. Of these 15, 2 were classified as definite RHD and 13 as borderline RHD. The majority of children had isolated mitral valve disease (93%). Children found to have RHD were older than those without RHD, 12 versus 10 years of age (P = 0.004). When separated based on geographic location, the prevalence of RHD among HIV-positive children from Kampala was 1.28% (95% CI: 0.63%-2.51%) compared with 2.1% (95% CI: 0.89%-4.89%) in those from outside Kampala. CONCLUSIONS Children living with HIV have a lower prevalence of RHD than the general pediatric population. Further studies are needed to explore this protective association.
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Affiliation(s)
- Ian W. Hovis
- Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, United States
| | - Judith Namuyonga
- Uganda Heart Institute, Mulago Hospital, Binaisa Road, Kampala, Uganda
| | - Grace P. Kisitu
- Baylor College of Medicine Children’s Foundation, Mulago Hospital, New Mulago Road, Kampala, Uganda
| | - Emma Ndagire
- Uganda Heart Institute, Mulago Hospital, Binaisa Road, Kampala, Uganda
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital, Binaisa Road, Kampala, Uganda
| | - Chris T. Longenecker
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106, United States
| | - Amy Sanyahumbi
- Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX 77030
| | - Craig A. Sable
- Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, United States
| | - Daniel J. Penny
- Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX 77030
| | - Peter Lwabi
- Uganda Heart Institute, Mulago Hospital, Binaisa Road, Kampala, Uganda
| | - Adeodata R. Kekitiinwa
- Baylor College of Medicine Children’s Foundation, Mulago Hospital, New Mulago Road, Kampala, Uganda
| | - Andrea Beaton
- Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, United States
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Human Immunodeficiency Virus Infection: Spectrum of Rheumatic Manifestations. INFECTIONS AND THE RHEUMATIC DISEASES 2019. [PMCID: PMC7120519 DOI: 10.1007/978-3-030-23311-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emerging and reemerging viral infections have been a characteristic feature of the past several decades, with HIV infection being the most important example of an emergent viral infection. To date, the status of a considerable proportion of HIV/AIDS patients has changed from a near-fatal disorder secondary to opportunistic infections to a chronic disease in which a variety of co-morbid conditions have become prevalent and relevant. Arthralgia and myalgias are the most common symptoms. The rate of spondyloarthritis varies according to the geographic area, genetic and mode of transmission. Most RA and SLE patients might go into remission after the development of AIDS, but also there are patients that continue with active disease. Prevalence of DILS is highest among African Americans in less advanced stages. PAN is clinically less aggressive and peripheral neuropathy is the most common clinical manifestation. Anti-phospholipid syndrome (APS), systemic sclerosis and poly-dermatomyositis are uncommon. After the introduction of combination antiretroviral therapy (cART), a decline of spondyloarthritis disorders and of DILS and development of new syndromes such as IRIS, osteoporosis and avascular bone necrosis have occurred. The treatment of patients with rheumatic diseases and HIV infection remains a challenge.
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Belgaumkar VA, Chavan RB, Suryataley PR, Salunke AS, Patil PP, Borade SM. Systemic lupus erythematosus in HIV: An insight into clinical implications and management. Indian J Sex Transm Dis AIDS 2019; 40:64-66. [PMID: 31143863 PMCID: PMC6532495 DOI: 10.4103/ijstd.ijstd_26_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Although HIV infection can mimic the manifestations of various autoimmune disorders, the coexistence of HIV and systemic lupus erythematosus (SLE) has been rarely reported. The exact impact of HIV on SLE and vice versa is unclear. We report an HIV-seropositive female on highly active antiretroviral therapy presenting with features of SLE. Herein, an attempt has been made to discuss the various complex clinical and therapeutic implications along with the influence on disease course and prognosis.
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Myositis Mimics—a Clinical Approach to a Diagnostic Challenge. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0108-0] [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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Christoforidou A, Galanopoulos N. Diffuse connective tissue disorders in HIV-infected patients. Mediterr J Rheumatol 2018; 29:148-155. [PMID: 32185316 PMCID: PMC7046049 DOI: 10.31138/mjr.29.3.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/29/2018] [Accepted: 09/15/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Human immunodeficiency virus (HIV) infection has been associated with various autoimmune disorders. Aim: To review the spectrum of diffuse connective tissue disorders (dCTD) in HIV-infected patients, in the context of highly active anti-retroviral therapy. Methods: Electronic search of the literature was performed using the terms HIV, AIDS, autoimmune, rheumatic/rheumatological, immune reconstitution inflammatory syndrome, Systemic Lupus Erythematosus, Diffuse Infiltrative Lymphocytosis Syndrome, Sjogren’s syndrome, vasculitis, Behçet’s disease, cryoglobulins, Henoch-Schönlein purpura, and antiphospholipid syndrome. Results: We reviewed the clinical manifestations, natural history and treatment of dCTDs, since the implementation of Highly Active Anti-Retroviral Therapy (HAART), and the emergence of new pathogenic mechanisms, such as the immune reconstitution inflammatory syndrome. Conclusions: Caution in differentiating clinical and laboratory findings of dCTDs from non-specific manifestations of acute and chronic HIV infection is warranted due to the common presentation. Patients with chronic infection and access to HAART have a normal life expectancy and dCTDs, although rare, must be correctly addressed. HAART alone or combined with immunosuppressive therapy result in favourable outcomes.
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Affiliation(s)
- Anna Christoforidou
- Department of Haematology, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Nikolaos Galanopoulos
- Outpatient Department of Rheumatology, University General Hospital of Alexandroupolis, Thrace, Greece
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Madu PN, Williams VL, Noe MH, Omech BG, Kovarik CL, Wanat KA. Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review. Int J Dermatol 2018; 58:50-53. [DOI: 10.1111/ijd.14201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/10/2018] [Accepted: 08/06/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Pamela N. Madu
- Department of Dermatology Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Victoria L. Williams
- Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
- Botswana Ministry of Health Gaborone Botswana
| | - Megan H. Noe
- Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Bernard G. Omech
- Department of Internal Medicine University of Botswana School of Medicine Gaborone Botswana
| | - Carrie L. Kovarik
- Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Karolyn A. Wanat
- Department of Dermatology University of Iowa Carver College of Medicine Iowa City IA USA
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Rheumatic diseases in HIV-infected patients in the post-antiretroviral therapy era: a tertiary care center experience. Clin Rheumatol 2018; 38:71-76. [PMID: 29619587 DOI: 10.1007/s10067-018-4089-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/23/2018] [Accepted: 03/28/2018] [Indexed: 12/15/2022]
Abstract
The aim of the study was to calculate the proportion of rheumatic diseases in HIV patients who were receiving ART and to identify association of the HIV medications with the development of rheumatologic diseases. We conducted a retrospective chart review during the period of 2010 to 2016. We identified 2996 patients as having chronic HIV infection and on ART, and we collected data regarding patient's demographic characteristics, comorbidities, CD 4 count, HIV viral load, and ART. One hundred thirteen out of 2996 HIV patients (3.8%) were found to have a rheumatic condition (mean age of 48.6 years, 83% male). The most frequent musculoskeletal condition was avascular necrosis (AVN) in 39 (1.3%), and the most frequent autoimmune condition was psoriasis in 28 patients (1%). Compared with the 200 HIV patients without any diagnosis of rheumatic disease were the older patients with rheumatic conditions (mean age of 48.9 vs. 42.7 years; p < 0.01), and had a longer duration of HIV infection (mean duration of 15.5 vs. 10.3 years; p < 0.01). The odds of rheumatic conditions were 1.7 times higher in males (relative to females). Those who received integrase inhibitors were more likely (63.3%) to develop rheumatologic manifestations relative to those who never received integrase inhibitors (21.6%; p < 0.01). The proportion of rheumatic diseases in HIV patients appears to be comparable to the prevalence in the US population. Older age, longer duration of HIV infection, and the use of ART regimens containing integrase inhibitors, appear to increase the risk of developing a rheumatic condition.
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50
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HIV infection and its effects on the development of autoimmune disorders. Pharmacol Res 2018; 129:1-9. [DOI: 10.1016/j.phrs.2018.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/05/2023]
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