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Allavena C, Bastides F, Moroy A, Occhipinti S, Durand F, Barriere G, Micoulaud-Franchi JA, Ghosn J. The screening and management of sleep disturbances in people living with HIV: Delphi consensus. J Sleep Res 2024; 33:e14070. [PMID: 37941027 DOI: 10.1111/jsr.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023]
Abstract
Sleep disturbances in people living with HIV (PLHIV) are frequent but their management remains insufficient. In the absence of specific recommendations, a DELPHI consensus research project was conducted in France to establish best practice. A multidisciplinary Steering Committee (STC) undertook a literature review and used it with clinical expertise to create statements that were voted on. Two profiles of healthcare professionals with significant experience in monitoring PLHIV were selected for the voting: physicians and nurses/psychologists. Votes were collected electronically, independently, and anonymously. The STC created 27 statements covering six areas: Screening of sleep disturbances, Investigation, First-line management, Referral to a specialist, Antiretroviral treatment (ARV), and Prevention. Two rounds of votes included 42 physicians and 32 nurses/psychologists. Consensus was reached for 24 out of 27 statements (89%) including: to assess quantity and quality of sleep among PLHIV at least annually, ideally using a common methodology within the medical department; to consider the temporary addition of a hypnotic treatment in cases of acute insomnia not improved by the rules of sleep hygiene, with full awareness of potential drug-drug interactions and risk of dependence; to correct ferritinaemia if <100 ng/mL before referral to a specialist when restless legs syndrome is suspected; to consider changing the time of ARV administration or an ARV switch within the same class when sleep disturbances are caused by an ARV. This DELPHI Consensus provides best practice for screening and managing sleep disturbances in PLHIV and optimising their quality of life.
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Affiliation(s)
- Clotilde Allavena
- Infectious Diseases Department, INSERM EA1413, CHU Nantes, Nantes, France
| | | | - Anne Moroy
- Centre du Sommeil et de la Vigilance, Hôtel Dieu Hospital, AP-HP, Paris, France
- Sleep Unit, Department of Psychiatry, CHU Lille, Lille, France
| | | | | | | | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, University Sleep Clinic, University Hospital of Bordeaux, Bordeaux, France
| | - Jade Ghosn
- APHP.Nord, Department of Infectious Diseases, Bichat University Hospital, Paris, France
- Université Paris Cité, INSERM, UMR 1137 IAME, Paris, France
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Wagstaff RA, Mullens AB, Daken K, Cysique LA, Le Clercq D, Howard C, Gilling S, Piovesana A, Thompson CL. HIV associated neurocognitive disorder screening and diagnosis pathways in Australia: a scoping review and international implications. AIDS Care 2024:1-12. [PMID: 38685763 DOI: 10.1080/09540121.2024.2343768] [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: 05/09/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Symptomatic HIV-associated neurocognitive disorder (HAND) is a complication of HIV (cognitive impairment, difficulties with everyday functioning). If detected early, interventions assist with optimizing care, avoiding rapid decline and enhancing coping. There remains inconsistency surrounding screening/diagnosis information within Australian healthcare professionals and community settings. A scoping review of academic literature, government policies and non-government organisations (NGOs) was conducted to map existing screening/diagnosis information using the guidelines of Joanna Briggs Institute. A literature search of EBSCOhost and Medline (dates: 2015-2021), the Australian government NGO web domains, Google and unpublished academic works was conducted (July 2021) and updated (December 2022) to identify Australian items (past 5 years). Seventeen items met the inclusion criteria. No government guidelines were identified. Various HIV-related organisations proposed different diagnostic guidelines. Most HAND research originated in Sydney. The most accessible information was from Dementia Australia, with some inaccuracies noted. There is scant Australian research/information on HAND screening/diagnosis. HAND translational research and screening/diagnosis standards are urgently needed to inform best practices. The Australian context is used to discuss international implications regarding higher-income countries with similar patterns/healthcare.
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Affiliation(s)
- Ruth A Wagstaff
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
- College of Health & Human Sciences, Charles Darwin University, Darwin, Australia
| | - Amy B Mullens
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | - Kirstie Daken
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | - Lucette A Cysique
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Faculty of Science, School of Psychology, The University of New South Wales, Sydney, Australia
- St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Diana Le Clercq
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | | | - Sue Gilling
- Queensland Positive People, Brisbane, Australia
| | - Adina Piovesana
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | - Claire L Thompson
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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Dutta D, Liu J, Xu E, Xiong H. Methamphetamine Enhancement of HIV-1 gp120-Mediated NLRP3 Inflammasome Activation and Resultant Proinflammatory Responses in Rat Microglial Cultures. Int J Mol Sci 2024; 25:3588. [PMID: 38612400 PMCID: PMC11012125 DOI: 10.3390/ijms25073588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Human Immunodeficiency Virus type 1 (HIV-1)-associated neurocognitive disorders (HANDs) remain prevalent in HIV-1-infected individuals despite the evident success of combined antiretroviral therapy (cART). The mechanisms underlying HAND prevalence in the cART era remain perplexing. Ample evidence indicates that HIV-1 envelope glycoprotein protein 120 (gp120), a potent neurotoxin, plays a pivotal role in HAND pathogenesis. Methamphetamine (Meth) abuse exacerbates HANDs, but how this occurs is not fully understood. We hypothesize that Meth exacerbates HANDs by enhancing gp120-mediated neuroinflammation. To test this hypothesis, we studied the effect of Meth on gp120-induced microglial activation and the resultant production of proinflammatory cytokines in primary rat microglial cultures. Our results show that Meth enhanced gp120-induced microglial activation, as revealed by immunostaining and Iba-1 expression, and potentiated gp120-mediated NLRP3 expression and IL-1β processing and release, as assayed by immunoblotting and ELISA. Meth also augmented the co-localization of NLRP3 and caspase-1, increased the numbers of NLRP3 puncta and ROS production, increased the levels of iNOS expression and NO production, and increased the levels of cleaved gasderminD (GSDMD-N; an executor of pyroptosis) in gp120-primed microglia. The Meth-associated effects were attenuated or blocked by MCC950, an NLRP3 inhibitor, or Mito-TEMPO, a mitochondrial superoxide scavenger. These results suggest that Meth enhances gp120-associated microglial NLRP3 activation and the resultant proinflammatory responses via mitochondria-dependent signaling.
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Affiliation(s)
- Debashis Dutta
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA; (J.L.); (E.X.)
| | | | | | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA; (J.L.); (E.X.)
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Andre-Garnier E, Bocket L, Bourlet T, Hocqueloux L, Lepiller Q, Maillard A, Reigadas S, Barriere G, Durand F, Montes B, Stefic K, Marcelin AG. Use of genotypic HIV DNA testing: a DELPHI-type consensus. J Antimicrob Chemother 2024; 79:578-588. [PMID: 38269616 PMCID: PMC10904721 DOI: 10.1093/jac/dkae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES As many disparities in the clinical use of HIV DNA sequencing are observed, a DELPHI-type consensus was initiated in France to homogenize use, techniques and interpretation of results. METHODS Based on a literature review and clinical experience, a steering committee (SC) of eight virologists and one infectious disease specialist formulated statements. Statements were submitted to an independent and anonymous electronic vote of virologists and HIV clinicians in France, between October 2022 and December 2022. RESULTS The SC developed 20 statements grouped into six categories: clinical situations for the use of HIV DNA genotyping; techniques for performing HIV DNA genotyping; consideration of apolipoprotein B mRNA editing enzyme (APOBEC) mutations; genotyping results reporting; recycling of antiretrovirals; and availability of HIV DNA genotyping tests and delays. Twenty-one virologists and 47 clinicians participated in two voting rounds and 18/20 (90%) assertions reached a 'strong' consensus. For example, that prior genotyping on HIV DNA is useful for clinical decision-making when considering switching to some long-acting regimens or to reduce the number of antiretroviral agents in virologically suppressed patients for whom RNA data are unavailable/not exploitable/not sufficiently informative. Two statements achieved no consensus: reporting any detected viral minority population for discussion in multidisciplinary meetings (virologists), and possible risk of virological failure when using a second-generation InSTI plus lamivudine or emtricitabine regimen in patients with undetectable viral load within ≥1 year and in the presence of a documented M184V mutation within the last 5 years (clinicians). CONCLUSIONS This DELPHI-type consensus will facilitate the strengthening and harmonization of good practice when performing HIV DNA sequencing.
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Affiliation(s)
| | - Laurence Bocket
- Virology Department, University Hospital Lille, Lille, France
| | - Thomas Bourlet
- Infectious Agents and Hygiene Department, University Hospital of Saint Etienne, Saint-Etienne, France
| | - Laurent Hocqueloux
- Infectious and Tropical Diseases Department, University Hospital Orléans, Orléans, France
| | - Quentin Lepiller
- Virology Department, University Hospital Besançon, Besançon, France
| | - Anne Maillard
- Virology Department, University Hospital Rennes, Rennes, France
| | | | | | | | - Brigitte Montes
- Virology Department, University Hospital Montpellier, Montpellier, France
| | - Karl Stefic
- Bacteriology, Virology and Hospital Hygene Department, University of Tours, INSERM U1259 MAVIVH, University Hospital Tours, Tours, France
| | - Anne-Geneviève Marcelin
- Virology Departement, Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, University Hospitals Pitié-Salpêtrière—Charles Foix, 83, Boulevard de l’hôpital, Paris 75013, France
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Dutta D, Liu J, Xu E, Xiong H. Methamphetamine enhancement of HIV-1 gp120-mediated NLRP3 inflammasome activation and resultant proinflammatory responses in rat microglial cultures. RESEARCH SQUARE 2023:rs.3.rs-3707515. [PMID: 38168345 PMCID: PMC10760309 DOI: 10.21203/rs.3.rs-3707515/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Human Immunodeficiency Virus type 1 (HIV-1)-associated neurocognitive disorders (HAND) remain prevalent in HIV-1-infected individuals despite the evident success of combined antiretroviral therapy (cART). The mechanisms under HAND prevalence in the cART era remain perplexing. Ample evidence indicates that HIV-1 envelope glycoprotein protein 120 (gp120), a potent neurotoxin, plays a pivotal role in the HAND pathogenesis. Methamphetamine (Meth) abuse exacerbates HAND. How Meth exacerbates HAND is not fully understood. This study was to test the hypothesis that Meth exacerbates HAND by enhancing gp120-mediated proinflammatory responses in the brain, worsening the pathogenesis of HAND. Methods Experiments were carried out on primary microglial cultures prepared from neonatal SD rats. The purity of microglia was determined by staining with anti-CD11b. Meth and gp120 were applied to microglial cultures. Microglial activation was revealed by immunostaining and Iba-1 expression. The protein expression levels of Pro-IL-1β, Il-1β, Iba-1, iNOS, NLRP3, GSDMD and GSDMD-N were detected by western blotting analyses. The levels of proinflammatory cytokine and NO production in the microglia culture supernatants were assayed by ELISA and Griess reagent systems, respectively. NLRP3 activation was uncovered by fluorescent microscopy images displaying NLRP3 puncta labeled by anti-NLRP3 antibody. NLRP3 co-localization with caspase-1 was labeled with antibodies. One-way ANOVA with post hoc Tukey's multiple comparison tests was employed for statistical analyses. Results Meth enhanced gp120-induced microglia activation revealed by immunostaining and Iba-1 expression, and potentiated gp120-mediated NLRP3 expression, IL-1β processing and release assayed by immunoblot and ELISA. Meth also augmented the co-localization of NLRP3 and caspase-1, increased the numbers of NLRP3 puncta and ROS production, elevated levels of iNOS expression and NO production, and enhanced levels of cleaved gasderminD (GSDMD-N, an executor of pyroptosis) in gp120-primed microglia. The Meth-associated effects were attenuated or blocked by MCC950, an NLRP3 inhibitor, or Mito-TEMPO, a mitochondrial superoxide scavenger, indicating the involvement of mitochondria in Meth enhancement of NLRP3 inflammasome activation in gp120-primed microglia. Conclusions These results suggest that Meth enhanced gp120-associated microglial NLRP3 activation and resultant proinflammatory responses via mitochondria-dependent signaling.
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Affiliation(s)
| | | | - Enquan Xu
- University of Nebraska Medical Center
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