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Nakanjako D, Nabatanzi R, Ssinabulya I, Bayigga L, Kiragga A, Banturaki G, Castelnuovo B. Chronic immune activation and accelerated immune aging among HIV-infected adults receiving suppressive antiretroviral therapy for at least 12 years in an African cohort. Heliyon 2024; 10:e31910. [PMID: 38882354 PMCID: PMC11177148 DOI: 10.1016/j.heliyon.2024.e31910] [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: 11/22/2023] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
Background HIV-associated alterations innate and adaptive immune cell compartments are reminiscent of the process of immune aging. Objectives We described immune aging phenotypes among ART-treated HIV-infected adults relative to age-matched HIV-negative counterparts. Methods In a cross-sectional comparative study of HIV-infected adults with CD4≥500 cells/μl after at least 12 years of suppressive ART and age-and-gender-matched HIV-negative individuals, immune activation and immune aging phenotypes were measured, using multi-color flowcytometry. Results ART-treated HIV-infected individuals had higher body mass index (P = 0.004), waist-hip circumference (P = 0.041), hip circumference (P < 0.001), and diastolic blood pressure (P = 0.012) and immune activation (CD4+CD38+HLADR+; median 4.15,IQR(1.030,14.6)] relative to the HIV-negative age-matched individuals [median 3.14,IQR(1.030, 6.68)]; P=0.0034. Immune aging markers [CD4+CD57+T-cells; median 13.00 IQR (0.45,64.1)] were higher among HIV-infected ART-treated adults<50 years relative to HIV-negative<50 years[median 8.020,IQR(0.004,21.2)]; P=0.0010. Naïve CD4 T-cells, Central memory CD4 T-cells, Terminal Effector Memory T cells (TEMRA: CD27-CD45RA + CCR7-) and immune senescence CD4/CD8+CD28-/CD57+ T-cells were similar among ART-treated HIV-infected individuals<45 years relative to 60 years-and-older HIV-negative counterparts≥; p = 0.0932, p = 0.05357, p = 0.0950 and p = 0.5714 respectively. Conclusion ART-treated adults are immunologically two decades older than their HIV-negative counterparts. Accelerated immune aging among individuals aging with HIV underscores the need for an HIV cure to avert the unprecedented complications of accelerated immune senescence and the associated NCD risk in African settings with protracted exposure to endemic co-infections.
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Affiliation(s)
- Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rose Nabatanzi
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Uganda Heart Institute, Kampala, Uganda
| | - Lois Bayigga
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Banturaki
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Li Y, Lai S, Kan X. Causal relationship between immune cells and telomere length: mendelian randomization analysis. BMC Immunol 2024; 25:19. [PMID: 38459464 PMCID: PMC10924351 DOI: 10.1186/s12865-024-00610-6] [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: 11/07/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The causal relationship between immune cells and telomere length remains controversial. METHODS Data on the immune cells were obtained from a previous study with 3,757 participants. Data on telomere length were obtained from the OpenGWAS database. Genome-Wide Association Study (GWAS) data were obtained and screened for eligible instrumental variables (IVs) using the TwoSampleMR package and the Phenoscanner database. To investigate the genetic causality between immune cells and telomere length, Mendelian randomization (MR) analysis and Bayesian weighted Mendelian randomization (BWMR) analysis were used. RESULTS MR analysis showed that there is indeed a genetic causal relationship between immune cells and telomere length. A total of 16 immune cells were successfully validated. A positive correlation was found between telomere length and immune cells such as CD28 + CD45RA + CD8br %CD8br (OR = 1.002, 95%CI: 1.000-1.003). A negative correlation was found between telomere length and immune cells such as Transitional AC (OR = 0.991, 95%CI: 0.984-0.997) (P < 0.05). Reverse MR analysis similarly confirmed that telomere length can affect four types of immune cells, including CD25 on IgD + CD24- (OR = 1.291, 95%CI: 1.060-1.571), at the genetic level. CONCLUSION There is indeed a mutual genetic causality between immune cells and telomere length, which will provide theoretical basis and support for more subsequent clinical studies.
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Affiliation(s)
- Yujian Li
- Department of Pediatrics, General Hospital of Tianjin Medical University, No.154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Shenglin Lai
- Department of Pediatrics, General Hospital of Tianjin Medical University, No.154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Xuan Kan
- Department of Pediatrics, General Hospital of Tianjin Medical University, No.154, Anshan Road, Heping District, Tianjin, 300052, China.
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van de Sandt CE, Nguyen THO, Gherardin NA, Crawford JC, Samir J, Minervina AA, Pogorelyy MV, Rizzetto S, Szeto C, Kaur J, Ranson N, Sonda S, Harper A, Redmond SJ, McQuilten HA, Menon T, Sant S, Jia X, Pedrina K, Karapanagiotidis T, Cain N, Nicholson S, Chen Z, Lim R, Clemens EB, Eltahla A, La Gruta NL, Crowe J, Lappas M, Rossjohn J, Godfrey DI, Thomas PG, Gras S, Flanagan KL, Luciani F, Kedzierska K. Newborn and child-like molecular signatures in older adults stem from TCR shifts across human lifespan. Nat Immunol 2023; 24:1890-1907. [PMID: 37749325 PMCID: PMC10602853 DOI: 10.1038/s41590-023-01633-8] [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: 03/24/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023]
Abstract
CD8+ T cells provide robust antiviral immunity, but how epitope-specific T cells evolve across the human lifespan is unclear. Here we defined CD8+ T cell immunity directed at the prominent influenza epitope HLA-A*02:01-M158-66 (A2/M158) across four age groups at phenotypic, transcriptomic, clonal and functional levels. We identify a linear differentiation trajectory from newborns to children then adults, followed by divergence and a clonal reset in older adults. Gene profiles in older adults closely resemble those of newborns and children, despite being clonally distinct. Only child-derived and adult-derived A2/M158+CD8+ T cells had the potential to differentiate into highly cytotoxic epitope-specific CD8+ T cells, which was linked to highly functional public T cell receptor (TCR)αβ signatures. Suboptimal TCRαβ signatures in older adults led to less proliferation, polyfunctionality, avidity and recognition of peptide mutants, although displayed no signs of exhaustion. These data suggest that priming T cells at different stages of life might greatly affect CD8+ T cell responses toward viral infections.
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Affiliation(s)
- Carolien E van de Sandt
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thi H O Nguyen
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nicholas A Gherardin
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Jerome Samir
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Mikhail V Pogorelyy
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Simone Rizzetto
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christopher Szeto
- Viral and Structural Immunology Laboratory, Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jasveen Kaur
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Nicole Ranson
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Sabrina Sonda
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Alice Harper
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Samuel J Redmond
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Hayley A McQuilten
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Tejas Menon
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sneha Sant
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Xiaoxiao Jia
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kate Pedrina
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Natalie Cain
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Zhenjun Chen
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ratana Lim
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - E Bridie Clemens
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Auda Eltahla
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nicole L La Gruta
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jane Crowe
- Deepdene Surgery, Deepdene, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jamie Rossjohn
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Dale I Godfrey
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephanie Gras
- Viral and Structural Immunology Laboratory, Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Katie L Flanagan
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Fabio Luciani
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
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Lurain K, Polizzotto MN, Krug LT, Shoemaker G, Singh A, Jensen SMR, Wyvill KM, Ramaswami R, Uldrick TS, Yarchoan R, Sereti I. Immunophenotypic analysis in participants with Kaposi sarcoma following pomalidomide administration. AIDS 2023; 37:1693-1703. [PMID: 37352498 PMCID: PMC10527758 DOI: 10.1097/qad.0000000000003627] [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] [Indexed: 06/25/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate baseline differences by HIV status and the impact of pomalidomide on lymphocyte counts and T-cell subsets in patients with Kaposi sarcoma. DESIGN We prospectively evaluated CD4 + and CD8 + T-cell phenotypes in 19 participants with Kaposi sarcoma enrolled on a phase 1/2 study of pomalidomide (NCT01495598), seven without HIV and 12 with HIV on antiretroviral therapy. METHODS Trial participants received pomalidomide 5 mg orally for 21 days of 28-day cycles for up to 1 year. Flow cytometry was performed on peripheral blood mononuclear cells at baseline, after three cycles, and at end-of-treatment. Lymphocyte count and T-cell subset comparisons were evaluated by Wilcoxon signed-rank and Mann--Whitney tests. RESULTS At baseline, HIV + participants had lower CD4 + cell counts (median 416 vs. 742 CD4 + T cells/μl, P = 0.006), and a decreased proportion of CD57 + (senescent) CD8 + T cells ( P = 0.007) compared with HIV - participants. After three cycles, pomalidomide led to an increased proportion of CD45RO + CD27 + (central memory) CD4 + ( P = 0.002) and CD8 + ( P = 0.002) T cells, a decrease in CD45RO - CD27 - (effector) CD4 + cells ( P = 0.0002), and expansion of CD38 + /HLADR + (activated) CD4 + ( P = 0.002) and CD8 + ( P ≤ 0.0001) T cells. Increased numbers of activated CD8 + T cells persisted at end-of-treatment ( P = 0.002). After three cycles and at end-of-treatment, there was reduction in the proportion of CD57 + (senescent) CD4 + ( P = 0.001, 0.0006), and CD8 + ( P = < 0.0001, 0.0004) T cells. CONCLUSION Administration of pomalidomide decreased T-cell senescence and increased T-cell activation in patients with Kaposi sarcoma, suggesting pomalidomide activity in Kaposi sarcoma stems in part from its immunomodulatory effects.
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Affiliation(s)
- Kathryn Lurain
- HIV & AIDS Malignancy Branch, Center for Cancer Research (CCR), NCI
| | | | - Laurie T Krug
- HIV & AIDS Malignancy Branch, Center for Cancer Research (CCR), NCI
| | | | - Amrit Singh
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - Stig M R Jensen
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | | | - Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research (CCR), NCI
| | - Thomas S Uldrick
- HIV & AIDS Malignancy Branch, Center for Cancer Research (CCR), NCI
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, Center for Cancer Research (CCR), NCI
| | - Irini Sereti
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
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Openshaw MR, Gervasi E, Fulgenzi CAM, Pinato DJ, Dalla Pria A, Bower M. Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis. J Transl Med 2023; 21:283. [PMID: 37106396 PMCID: PMC10142155 DOI: 10.1186/s12967-023-04130-6] [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: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The taxonomy of Kaposi Sarcoma (KS) is based on a classification system focused on the description of clinicopathological features of KS in geographically and clinically diverse populations. The classification includes classic, endemic, epidemic/HIV associated and iatrogenic KS, and KS in men who have sex with men (MSM). We assessed the medical relevance of the current classification of KS and sought clinically useful improvements in KS taxonomy. METHODS We reviewed the demographic and clinicopathological features of 676 patients with KS, who were referred to the national centre for HIV oncology at Chelsea Westminster hospital between 2000 and 2021. RESULTS Demographic differences between the different subtypes of KS exist as tautological findings of the current classification system. However, no definitive differences in clinicopathological, virological or immunological parameters at presentation could be demonstrated between the classic, endemic or MSM KS patients. Reclassifying patients as either immunosuppressed or non-immunosuppressed, showed that the immunosuppressed group had a significantly higher proportion of adverse disease features at presentation including visceral disease and extensive oral involvement, classified together as advanced disease (chi2 P = 0.0012*) and disseminated skin involvement (chi2 P < 0.0001*). Immunosuppressed patients had lower CD4 counts, higher CD8 counts and a trend towards higher HHV8 levels compared to non-immunosuppressed patients, however overall survival and disease specific (KS) survival was similar across groups. CONCLUSION The current system of KS classification does not reflect meaningful differences in clinicopathological presentation or disease pathogenesis. Reclassification of patients based on the presence or absence of immunosuppression is a more clinically meaningful system that may influence therapeutic approaches to KS.
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Affiliation(s)
- M R Openshaw
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK.
- UK National Centre for HIV Oncology, Chelsea Westminster Hospital, London, UK.
| | - E Gervasi
- Infectious Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C A M Fulgenzi
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - D J Pinato
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - A Dalla Pria
- UK National Centre for HIV Oncology, Chelsea Westminster Hospital, London, UK
| | - M Bower
- UK National Centre for HIV Oncology, Chelsea Westminster Hospital, London, UK
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Marrella V, Facoetti A, Cassani B. Cellular Senescence in Immunity against Infections. Int J Mol Sci 2022; 23:ijms231911845. [PMID: 36233146 PMCID: PMC9570409 DOI: 10.3390/ijms231911845] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Cellular senescence is characterized by irreversible cell cycle arrest in response to different triggers and an inflammatory secretome. Although originally described in fibroblasts and cell types of solid organs, cellular senescence affects most tissues with advancing age, including the lymphoid tissue, causing chronic inflammation and dysregulation of both innate and adaptive immune functions. Besides its normal occurrence, persistent microbial challenge or pathogenic microorganisms might also accelerate the activation of cellular aging, inducing the premature senescence of immune cells. Therapeutic strategies counteracting the detrimental effects of cellular senescence are being developed. Their application to target immune cells might have the potential to improve immune dysfunctions during aging and reduce the age-dependent susceptibility to infections. In this review, we discuss how immune senescence influences the host’s ability to resolve more common infections in the elderly and detail the different markers proposed to identify such senescent cells; the mechanisms by which infectious agents increase the extent of immune senescence are also reviewed. Finally, available senescence therapeutics are discussed in the context of their effects on immunity and against infections.
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Affiliation(s)
- Veronica Marrella
- UOS Milan Unit, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, 20138 Milan, Italy
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Amanda Facoetti
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Barbara Cassani
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, Università Degli Studi di Milano, 20089 Milan, Italy
- Correspondence:
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Clutton GT, Weideman AMK, Goonetilleke NP, Maurer T. An expanded population of CD8dim T cells with features of mitochondrial dysfunction and senescence is associated with persistent HIV-associated Kaposi’s sarcoma under ART. Front Cell Dev Biol 2022; 10:961021. [PMID: 36247006 PMCID: PMC9557199 DOI: 10.3389/fcell.2022.961021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
HIV-associated Kaposi’s sarcoma (KS), which is caused by Kaposi’s sarcoma-associated herpesvirus, usually arises in the context of uncontrolled HIV replication and immunosuppression. However, disease occasionally occurs in individuals with durable HIV viral suppression and CD4 T cell recovery under antiretroviral therapy (ART). The underlying mechanisms associated with this phenomenon are unclear. Suppression of viral infections can be mediated by CD8 T cells, which detect infected cells via their T cell receptor and the CD8 coreceptor. However, CD8 T cells exhibit signs of functional exhaustion in untreated HIV infection that may not be fully reversed under ART. To investigate whether KS under ART was associated with phenotypic and functional perturbations of CD8 T cells, we performed a cross-sectional study comparing HIV-infected individuals with persistent KS under effective ART (HIV+ KS+) to HIV-infected individuals receiving effective ART with no documented history of KS (HIV+ KSneg). A subset of T cells with low cell surface expression of CD8 (“CD8dim T cells”) was expanded in HIV+ KS+ compared with HIV+ KSneg participants. Relative to CD8bright T cells, CD8dim T cells exhibited signs of senescence (CD57) and mitochondrial alterations (PGC-1α, MitoTracker) ex vivo. Mitochondrial activity (MitoTracker) was also reduced in proliferating CD8dim T cells. These findings indicate that an expanded CD8dim T cell population displaying features of senescence and mitochondrial dysfunction is associated with KS disease under ART. CD8 coreceptor down-modulation may be symptomatic of ongoing disease.
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Affiliation(s)
- Genevieve T. Clutton
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Genevieve T. Clutton,
| | - Ann Marie K. Weideman
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nilu P. Goonetilleke
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Toby Maurer
- Department of Dermatology, Indiana University, Indianapolis, IN, United States
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Lurain K, Yarchoan R, Ramaswami R. Immunotherapy for KSHV-associated diseases. Curr Opin Virol 2022; 55:101249. [PMID: 35803203 PMCID: PMC9464688 DOI: 10.1016/j.coviro.2022.101249] [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: 01/21/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
Kaposi sarcoma herpesvirus (KSHV)-associated diseases (Kaposi sarcoma, multicentric Castleman disease, primary effusion lymphoma, and KSHV inflammatory cytokine syndrome) are associated with immune suppression and dysregulation and loss of KSHV-specific immunity. These diseases are most frequent in people living with HIV as well as those with primary or iatrogenic immune deficiencies. KSHV itself can modulate the immune system via viral homologs of host cytokines or downregulation of immune-surface markers altering host immune surveillance. These factors make KSHV-associated diseases prime targets for immunotherapy approaches. Several agents have been studied or are under investigation in KSHV-associated diseases, including monoclonal antibodies, immunomodulatory agents, and therapeutic cytokines. Here, we review the role of immunotherapies in KSHV-associated diseases.
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Affiliation(s)
- Kathryn Lurain
- HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Reid EG, Shimabukuro K, Moore P, Ambinder RF, Bui JD, Han S, Martínez-Maza O, Dittmer DP, Aboulafia D, Chiao EY, Maurer T, Baiocchi R, Mitsuyasu R, Wachsman W. AMC-070: Lenalidomide Is Safe and Effective in HIV-Associated Kaposi Sarcoma. Clin Cancer Res 2022; 28:2646-2656. [PMID: 35247913 PMCID: PMC9197984 DOI: 10.1158/1078-0432.ccr-21-0645] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 10/23/2021] [Accepted: 02/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Kaposi sarcoma (KS), an endothelial cell tumor associated with KS herpesvirus (KSHV), remains among the most common malignancies occurring with HIV infection (HIV-KS). As an oral anti-inflammatory, antiangiogenic, and immunomodulatory agent, lenalidomide is potentially an attractive alternative to standard chemotherapy for KS. EXPERIMENTAL DESIGN The primary objectives of this phase I/II trial were to determine the maximum tolerated dose (MTD) and response rates for lenalidomide in HIV-KS. Secondary objectives included correlating response with natural killer (NK) and T-cell subsets, plasma cytokines, viral copy number, and KSHV gene expression in biopsies. Four dose levels of oral lenalidomide taken 21 consecutive days of 28-day cycles were evaluated in adults with HIV-KS on antiretroviral therapy with controlled viremia. RESULTS Fifteen and 23 participants enrolled in phases I and II, respectively, 76% of whom had received prior KS therapy. The MTD was not reached, declaring 25 mg as the recommended phase II dose (RP2D). The most frequent adverse events were neutropenia, fatigue, leukopenia, and diarrhea. Of the 25 evaluable participants receiving RP2D, 60% responded. Correlative studies performed in a subset of participants demonstrated a significant increase in proportions of blood T cells with T-regulatory phenotype, and plasma cytokines trended toward a less inflammatory pattern. Clinical response was associated with loss of KSHV transcription. CONCLUSIONS Lenalidomide is active in HIV-KS. The most common adverse events were manageable. With 60% of participants receiving RP2D obtaining a partial response and <10% discontinuing due to adverse events, the response and tolerability to lenalidomide support its use in HIV-KS. See related commentary by Henry and Maki, p. 2485.
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Affiliation(s)
- Erin G. Reid
- University of California, San Diego Moores Cancer Center, La Jolla, CA
| | | | | | | | - Jack D. Bui
- University of California, San Diego, La Jolla, CA
| | - Semi Han
- University of Southern California, Los Angeles, CA
| | - Otoniel Martínez-Maza
- UCLA AIDS Institute and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Dirk P. Dittmer
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, NC
| | - David Aboulafia
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Toby Maurer
- University of California San Francisco, San Francisco, CA, USA
| | - Robert Baiocchi
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Ronald Mitsuyasu
- University of California, Los Angeles, Center for AIDS Research and Education, Los Angeles, CA
| | - William Wachsman
- University of California, San Diego Moores Cancer Center, La Jolla, CA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA
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10
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Ramaswami R, Polizzotto MN, Lurain K, Wyvill KM, Widell A, George J, Goncalves P, Steinberg SM, Whitby D, Uldrick TS, Yarchoan R. Safety, Activity, and Long-term Outcomes of Pomalidomide in the Treatment of Kaposi Sarcoma among Individuals with or without HIV Infection. Clin Cancer Res 2022; 28:840-850. [PMID: 34862247 PMCID: PMC8898289 DOI: 10.1158/1078-0432.ccr-21-3364] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/08/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Kaposi sarcoma (KS) is caused by Kaposi sarcoma herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8). KS, which develops most frequently among people with HIV, is generally treated with chemotherapy, but these drugs have acute and cumulative toxicities. We previously described initial results of a trial of pomalidomide, an oral immunomodulatory derivative of thalidomide, in patients with KS. Here, we present results on the full cohort and survival outcomes. PATIENTS AND METHODS Participants with KS with or without HIV were treated with pomalidomide 5 mg once daily for 21 days per 28-day cycle with aspirin 81 mg daily for thromboprophylaxis. Participants with HIV received antiretroviral therapy. Response was defined by modified version of the AIDS Clinical Trial Group KS criteria. We evaluated tumor responses (including participants who had a second course), adverse events, progression-free survival (PFS), and long-term outcomes. RESULTS Twenty-eight participants were enrolled. Eighteen (64%) were HIV positive and 21 (75%) had advanced (T1) disease. The overall response rate was 71%: 95% confidence interval (CI) 51%-87%. Twelve of 18 HIV-positive (67%; 95% CI, 41-87%) and 8 of 10 HIV-negative participants (80%; 95% CI, 44%-97%) had a response. Two of 4 participants who received a second course of pomalidomide had a partial response. The median PFS was 10.2 months (95% CI: 7.6-15.7 months). Grade 3 neutropenia was noted among 50% of participants. In the follow-up period, 3 participants with HIV had other KSHV-associated diseases. CONCLUSIONS Pomalidomide is a safe and active chemotherapy-sparing agent for the treatment of KS among individuals with or without HIV.
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Affiliation(s)
- Ramya Ramaswami
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Mark N Polizzotto
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Kathryn Lurain
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Kathleen M Wyvill
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Anaida Widell
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Jomy George
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Priscila Goncalves
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institutes, National Institutes of Health
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Thomas S Uldrick
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
| | - Robert Yarchoan
- HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health
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11
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Valantin MA, Royston L, Hentzien M, Jary A, Makinson A, Veyri M, Ronot-Bregigeon S, Isnard S, Palich R, Routy JP. Therapeutic Perspectives in the Systemic Treatment of Kaposi's Sarcoma. Cancers (Basel) 2022; 14:484. [PMID: 35158752 PMCID: PMC8833559 DOI: 10.3390/cancers14030484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Abstract
In patients with Kaposi's sarcoma (KS), the therapeutic goal is to achieve a durable remission in the size and number of skin and visceral lesions. Although most patients show tumor regression in response to standard systemic chemotherapy regimens, alternative systemic treatments are needed for patients who develop refractory KS. Anti-angiogenic therapies represent attractive therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis. Pomalidomide, which exhibits such anti-angiogenic activity through inhibition of VEGF, currently constitutes the most promising agent of this class and has been recently approved by the FDA. In addition, immune checkpoint blockade also represents an interesting alternative therapeutic approach through the restoration of immunity against HHV-8, the causative agent of KS, and improvement of tumor control. Although small series of cases treated successfully with these drugs have been reported, there is no marketing approval for anti-immune checkpoint antibodies for KS to date. In the present review, we will discuss potential therapeutic options for patients with recurrent or refractory KS, including systemic chemotherapies, immune checkpoint inhibitors, anti-herpesvirus agents, and anti-angiogenic drugs. Well-conducted clinical trials in this population are urgently needed to correctly address the efficacy of targeted agents and immunomodulators, while monitoring for adverse effects.
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Affiliation(s)
- Marc-Antoine Valantin
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Léna Royston
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Infectious Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Maxime Hentzien
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, CHU Robert Debré, 51090 Reims, France;
| | - Aude Jary
- Service de Virologie, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Alain Makinson
- Infectious Diseases Department, INSERM U1175, University Hospital of Montpellier, 34000 Montpellier, France;
| | - Marianne Veyri
- Service d’Oncologie Médicale, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Sorbonne University, 75013 Paris, France;
| | - Sylvie Ronot-Bregigeon
- Service d’Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Aix Marseille Université, 13009 Marseille, France;
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Hematology, McGill University Health Centre, Montréal, QC H4A3J1, Canada
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12
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Séverin D, Bessaoud F, Meftah N, Du Thanh A, Tretarre B, Guillot B, Makinson A. A comparative study of classic and HIV-viremic and aviremic AIDS Kaposi sarcoma. AIDS 2021; 35:399-405. [PMID: 33181532 DOI: 10.1097/qad.0000000000002744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Kaposi sarcoma in people living with HIV (PLHIV) is the most common AIDS-associated malignancy. There is increased interest in Kaposi sarcoma in PLHIV with controlled HIV viremia. OBJECTIVES To describe Kaposi sarcoma occurring in PLHIV despite virological control and to compare their clinical presentations with viremic AIDS-Kaposi sarcoma (AIDS-KS) and classic Kaposi sarcoma (CKS). METHODS This was a monocentric retrospective study, including all Kaposi sarcoma patients registered between the 1 January of 2000 and 31 December 2017 in a comprehensive data bank for all cancers in the Hérault region, South of France. AIDS-KS were also described using chart reviews from the Infectious diseases Department, which followed more than 90% of PLHIV from the same region. We defined aviremic AIDS-KS as Kaposi sarcoma occurring in persons taking HAART with a HIV viral load less than 50 copies for more than 12 months. We compared clinical characteristics of persons with aviremic AIDS-KS, viremic AIDS-KS and CKS, using the Kriegel score and number and topography of skin lesions, and presence of lymphedema. RESULTS We retrieved 187 Kaposi sarcoma cases, of which 12 occurred in PLHIV with aviremic AIDS-KS. Kriegel score stage I was found in 10 (83%) of the aviremic AIDS-KS, 34 (68%) of CKS and 38 (58.4%) of viremic AIDS-KS cases, with similar clinical presentations between aviremic AIDS-KS and CKS groups, and viremic AIDS-KS persons having more aggressive presentations. One person with aviremic AIDS-KS had visceral involvement. CONCLUSION We showed that Kaposi sarcoma in PLHIV with controlled viremia were generally indolent, similarly to CKS. Visceral involvement is, however, possible.
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Affiliation(s)
| | | | - Nadia Meftah
- COREVIH, Saint Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | | | | | | | - Alain Makinson
- Department of Infectiology, Inserm U1175, Saint Eloi Hospital and Montpellier University Hospital
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13
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Yoon HA, Riska PF, Jain R, Morales C, Pirofski LA. Unexpected case of cryptococcal meningoencephalitis in a patient with long-standing well-controlled HIV infection. Med Mycol Case Rep 2021; 32:14-16. [PMID: 33552883 PMCID: PMC7851412 DOI: 10.1016/j.mmcr.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
Cryptococcal meningoencephalitis (CM) classically occurs in individuals with advanced HIV infection, solid organ transplants, or other immunocompromising conditions. We report a case of fatal CM in a 78-year-old woman with well-controlled HIV infection who had delayed diagnosis, persistently elevated intracranial pressure and pleocytosis of the cerebrospinal fluid. Initial suspicion for CM was low due to her relatively high CD4+ T cell counts, which likely contributed to greater inflammation.
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Affiliation(s)
- Hyun Ah Yoon
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Paul F Riska
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Ruchika Jain
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Cariane Morales
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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14
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Bedier H, Lin J, Julien LA, Routy JP. Concurrent development of HIV-negative Kaposi's sarcoma and mycosis fungoides in an elderly Inuit from Canada. BMJ Case Rep 2021; 14:14/1/e238644. [PMID: 33509877 PMCID: PMC7845731 DOI: 10.1136/bcr-2020-238644] [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: 11/21/2022] Open
Abstract
An 88-year-old Inuit man from Northern Canada presented with an extensive skin rash associated with numerous violaceous skin nodules on his palms and lower extremities. Biopsy of a skin nodule revealed Kaposi’s sarcoma (KS), a human herpesvirus 8 (HHV8)-associated malignancy, whereas biopsy of the erythematous skin showed an atypical infiltrate of CD4-positive T-cells that, together with TCR gene rearrangement and presence of clonal T-cells in peripheral blood by flow cytometry, was consistent with a T-cell lymphoma, mycosis fungoides (MF) subtype. Serology was negative for HIV and HTLV-I/II and no immunodeficiency syndrome was identified. The patient was successfully treated with an oral retinoid for KS, and with topical hydrocortisone and ultraviolet B (UVB) phototherapy for MF. This case highlights the existence of HHV8-related lesions in native persons of Northern Canada, and also that MF-induced immunosuppression combined with immunosenescence may play a role in the development of non-HIV-related KS.
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Affiliation(s)
- Helbies Bedier
- Division of Haematology, McGill University Health Centre, Montreal, Quebec, Canada
| | - John Lin
- Infectious Disease and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada
| | - Louis-André Julien
- Department of Pathology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Jean-Pierre Routy
- Division of Haematology, McGill University Health Centre, Montreal, Quebec, Canada .,Infectious Disease and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada
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15
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Palich R, Veyri M, Valantin MA, Marcelin AG, Guihot A, Pourcher V, Jary A, Solas C, Makinson A, Poizot-Martin I, Costagliola D, Spano JP, Katlama C. Recurrence and Occurrence of Kaposi's Sarcoma in Patients Living With Human Immunodeficiency Virus (HIV) and on Antiretroviral Therapy, Despite Suppressed HIV Viremia. Clin Infect Dis 2021; 70:2435-2438. [PMID: 31626689 DOI: 10.1093/cid/ciz762] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/18/2019] [Indexed: 11/14/2022] Open
Abstract
In 21 cutaneous and/or visceral Kaposi's sarcoma cases, occurring in patients living with human immunodeficiency virus (HIV) who were on antiretroviral therapy with suppressed HIV viremia and high CD4 T cell counts, the efficacy of conventional chemotherapies was limited due to cumulative toxicities, comedications, and a lack of immune improvement.
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Affiliation(s)
- Romain Palich
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Marianne Veyri
- Medical Oncology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Marc-Antoine Valantin
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Anne-Geneviève Marcelin
- Virology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Amélie Guihot
- Immunology, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris
| | - Valérie Pourcher
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Aude Jary
- Virology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Caroline Solas
- Pharmacology Toxicology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Institut National de la Santé et de la Recherche Médicale (INSERM) Centre de Recherche en Cancérologie de Marseille, Hôpital de la Timone, Aix-Marseille Univ, Marseille
| | - Alain Makinson
- Infectious Diseases, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Institut de Recherche et de Développement (IRD) Unit 233, INSERM U1175, Université de Montpellier, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Assistance Publique - Hôpitaux de Marseille, INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Hôpital Sainte-Marguerite, Aix Marseille Univ, Marseille
| | - Isabelle Poizot-Martin
- Service d'Immuno-hématologie clinique, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Assistance Publique - Hôpitaux de Marseille, INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Hôpital Sainte-Marguerite, Aix Marseille Univ, Marseille
| | | | - Jean-Philippe Spano
- Medical Oncology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Christine Katlama
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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16
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Caby F, Guiguet M, Weiss L, Winston A, Miro JM, Konopnicki D, Le Moing V, Bonnet F, Reiss P, Mussini C, Poizot-Martin I, Taylor N, Skoutelis A, Meyer L, Goujard C, Bartmeyer B, Boesecke C, Antinori A, Quiros-Roldan E, Wittkop L, Frederiksen C, Castagna A, Thurnheer MC, Svedhem V, Jose S, Costagliola D, Mary-Krause M, Grabar S. CD4/CD8 Ratio and the Risk of Kaposi Sarcoma or Non-Hodgkin Lymphoma in the Context of Efficiently Treated Human Immunodeficiency Virus (HIV) Infection: A Collaborative Analysis of 20 European Cohort Studies. Clin Infect Dis 2020; 73:50-59. [PMID: 34370842 DOI: 10.1093/cid/ciaa1137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A persistently low CD4/CD8 ratio has been reported to inversely correlate with the risk of non-AIDS defining cancer in people living with human immunodeficiency virus (HIV; PLWH) efficiently treated by combination antiretroviral therapy (cART). We evaluated the impact of the CD4/CD8 ratio on the risk of Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL), still among the most frequent cancers in treated PLWH. METHODS PLWH from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) were included if they achieved virological control (viral load ≤ 500 copies/mL) within 9 months following cART and without previous KS/LNH diagnosis. Cox models were used to identify factors associated with KS or NHL risk, in all participants and those with CD4 ≥ 500/mm3 at virological control. We analyzed the CD4/CD8 ratio, CD4 count and CD8 count as time-dependent variables, using spline transformations. RESULTS We included 56 708 PLWH, enrolled between 2000 and 2014. At virological control, the median (interquartile range [IQR]) CD4 count, CD8 count, and CD4/CD8 ratio were 414 (296-552)/mm3, 936 (670-1304)/mm3, and 0.43 (0.28-0.65), respectively. Overall, 221 KS and 187 NHL were diagnosed 9 (2-37) and 18 (7-42) months after virological control. Low CD4/CD8 ratios were associated with KS risk (hazard ratio [HR] = 2.02 [95% confidence interval {CI } = 1.23-3.31]) when comparing CD4/CD8 = 0.3 to CD4/CD8 = 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HR = 3.14 [95% CI = 1.58-6.22]) when comparing CD8 = 3000/mm3 to CD8 = 1000/mm3). Similar results with increased associations were found in PLWH with CD4 ≥ 500/mm3 at virological control (HR = 3.27 [95% CI = 1.60-6.56] for KS; HR = 5.28 [95% CI = 2.17-12.83] for NHL). CONCLUSIONS Low CD4/CD8 ratios and high CD8 counts despite effective cART were associated with increased KS/NHL risks respectively, especially when CD4 ≥ 500/mm3.
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Affiliation(s)
- Fabienne Caby
- Unité VIH-IST, Service d'Immuno-Hématologie, Hôpital Victor Dupouy, Argenteuil, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Marguerite Guiguet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Laurence Weiss
- Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Centre Hôtel Dieu, Paris, France
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Deborah Konopnicki
- St Pierre University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Vincent Le Moing
- Department of Infectious Disease, University Hospital of Montpellier, Montpellier, France
| | - Fabrice Bonnet
- CHU de Bordeaux and INSERM U1219, ISPED, Université de Bordeaux, Bordeaux, France
| | - Peter Reiss
- HIV Monitoring Foundation, Amsterdam, The Netherlands, and Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Isabelle Poizot-Martin
- Aix Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Hôpital Sainte- Marguerite, Service d'Immuno-hématologie clinique, Marseille, France
| | - Ninon Taylor
- Department of Dermatology, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Athanasios Skoutelis
- 5th Department of Medicine and Infectious Diseases "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris-Saclay, APHP Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- Service de Médecine interne et d'Immunologie clinique, AP-HP Université Paris-Saclay, Hôpital Bicêtre, Faculté de Médecine-Université Paris-Saclay, Centre de recherche en épidémiologie et santé des populations CESP-Inserm U1018, Le Kremlin Bicêtre, France
| | - Barbara Bartmeyer
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Christoph Boesecke
- German Centre for Infection Research, Cologne-Bonn; Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - Andrea Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, Universitá degli Studi di Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Linda Wittkop
- Université Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, Bordeaux, France
| | - Casper Frederiksen
- University of Copenhagen, Section of Forensic Genetics, Copenhagen, Denmark
| | | | | | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital and Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sophie Jose
- Transforming Cancer Services Team-Public Health England Partnership, National Cancer Registration and Analysis Service, Wellington House, London United Kingdom
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Murielle Mary-Krause
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Biostatistique et Epidémiologie, Hôpital cochin, Paris, France
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17
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Fonda-Pascual P, Fernandez-Gonzalez P, Sanchez-Los Arcos L, Alcantara-Nicolas F, Lopez-Galan C, Canseco-Martin M, Vidal-Asensi S. Treatment of cutaneous Kaposi sarcoma with methylaminolevulinate photodynamic therapy: A case series. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:392-395. [PMID: 32304332 DOI: 10.1111/phpp.12564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Pablo Fonda-Pascual
- Department of Dermatology, Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
| | | | | | | | - Carmen Lopez-Galan
- Department of Pathology, Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
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18
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Kaposi sarcoma in people living with HIV: incidence and associated factors in a French cohort between 2010 and 2015. AIDS 2020; 34:569-577. [PMID: 31764070 DOI: 10.1097/qad.0000000000002450] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Kaposi sarcoma is still observed among people living with HIV (PLHIV) including those on ART with undetectable HIV viral load (HIV-VL). We aimed to assess Kaposi sarcoma incidence and trends between 2010 and 2015 in France and to highlight associated factors. DESIGN Retrospective study using longitudinal data from the Dat'AIDS cohort including 44 642 PLWH. For the incidence assessment, Kaposi sarcoma cases occurring within 30 days of cohort enrollment were excluded. METHODS Demographic, immunological, and therapeutic characteristics collected at time of Kaposi sarcoma diagnosis or at last visit for patients without Kaposi sarcoma. RESULTS Among 180 216.4 person-years, Kaposi sarcoma incidence was 76 (95% CI 64.3-89.9)/10 person-years. Multivariate analysis (Poisson regression) revealed the positive association with male sex, MSM transmission route, lower CD4 T-cell count, higher CD8 T-cell count, not to be on ART, whereas HIV follow-up time, duration with an HIV-VL 50 copies/ml or less were negatively associated with Kaposi sarcoma. According to the different models tested, HIV-VL, CD4 : CD8 ratio and nadir CD4 cell count were associated with Kaposi sarcoma. Moreover, stratified analysis showed that patients with a CD4 : CD8 ratio 0.5 or less or a CD8 T-cell count greater than 1000 cells/μl were at higher risk of Kaposi sarcoma regardless of the CD4 T-cell count. CONCLUSION This study showed that in a resource-rich country setting with high ART coverage, Kaposi sarcoma still occurred among PLWH. CD8 hyperlymphocytosis and CD4 : CD8 ratio should be now considered as two useful markers to better identify patients at increased Kaposi sarcoma risk, including those with a CD4 T-cell count greater than 500 cells/μl.
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Lopes TRR, Gonçales JP, Silva Júnior JVJ, Lorena VMBD, Toscano ALCC, Akamatsu SM, Salles AC, Tozetto-Mendoza TR, Morais VMSD, Coêlho MRCD. Association of IL-6, IL-10 and CXCL10 serum concentrations with visceral Kaposi's sarcoma in people living with HIV/AIDS. Hum Immunol 2019; 81:26-31. [PMID: 31866063 DOI: 10.1016/j.humimm.2019.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 01/23/2023]
Abstract
Human gammaherpesvirus 8 (HHV-8) is the etiologic agent of Kaposi's sarcoma (KS), one of the most common cancers in people living with HIV/AIDS. It is believe that the course of both HIV and HHV-8 infection is associated with the imbalance of anti- and/or pro-inflammatory cytokines. Here, we evaluated the IL-6, TNF-α, IL-10, CCL2 and CXCL10 serum concentrations in HIV- and HIV/HHV-8 (without KS) individuals, and in patients with cutaneous or visceral AIDS-KS. Serum concentrations of IL-6, IL-10 and CXCL10 were significantly higher in the AIDS-KS group compared to HIV and HIV/HHV-8 individuals. Similarly, the concentrations of theses cytokines were higher in patients with visceral than in those with cutaneous AIDS-KS. The TNF-α concentration was significantly higher in the HIV group compared to HIV/HHV-8 (with and without KS) individuals, and CCL2 levels did not present significant difference among the groups. The HIV viral load was undetectable in all patients from the HIV and HIV/HHV-8 groups. On the other hand, in the AIDS-KS group, most patients had detectable HIV viral load. In this context, we believe that the cytokine levels in AIDS-KS may be result of a complex interaction between HIV, HHV-8 and immunity.
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Affiliation(s)
- Thaísa Regina Rocha Lopes
- Virology Sector, Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Juliana Prado Gonçales
- Virology Sector, Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - José Valter Joaquim Silva Júnior
- Virology Sector, Department of Preventive Veterinary Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil; Departament of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | | | | | | | - Tania Regina Tozetto-Mendoza
- LIM 52, Laboratory of Virology, Institute of Tropical Medicine of Sao Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Maria Rosângela Cunha Duarte Coêlho
- Virology Sector, Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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Puronen CE, Ford ES, Uldrick TS. Immunotherapy in People With HIV and Cancer. Front Immunol 2019; 10:2060. [PMID: 31555284 PMCID: PMC6722204 DOI: 10.3389/fimmu.2019.02060] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022] Open
Abstract
HIV infection alters the natural history of several cancers, in large part due to its effect on the immune system. Immune function in people living with HIV may vary from normal to highly dysfunctional and is largely dependent on the timing of initiation (and continuation) of effective antiretroviral therapy (ART). An individual's level of immune function in turn affects their cancer risk, management, and outcomes. HIV-associated lymphocytopenia and immune dysregulation permit immune evasion of oncogenic viruses and premalignant lesions and are associated with inferior outcomes in people with established cancers. Various types of immunotherapy, including monoclonal antibodies, interferon, cytokines, immunomodulatory drugs, allogeneic hematopoietic stem cell transplant, and most importantly ART have shown efficacy in HIV-related cancer. Emerging data suggest that checkpoint inhibitors targeting the PD-1/PD-L1 pathway can be safe and effective in people with HIV and cancer. Furthermore, some cancer immunotherapies may also affect HIV persistence by influencing HIV latency and HIV-specific immunity. Studying immunotherapy in people with HIV and cancer will advance clinical care of all people living with HIV and presents a unique opportunity to gain insight into mechanisms for HIV eradication.
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Affiliation(s)
- Camille E Puronen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Emily S Ford
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Thomas S Uldrick
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Global Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Abstract
Kaposi sarcoma (KS) is a mesenchymal tumour caused by KS-associated herpesvirus and is an AIDS-defining illness. Despite a decline in incidence since the introduction of combination anti-retroviral therapy, KS remains the most common cancer in people living with HIV in sub-Saharan Africa, where it causes significant morbidity and mortality. This review reflects on recent epidemiological data as well as current management, unmet needs and future perspectives in the treatment of HIV-associated KS with particular emphasis on the potential role of immune checkpoint inhibitors.
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Affiliation(s)
- Alessia Dalla Pria
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
| | - David J. Pinato
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
| | | | - Mark Bower
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
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Mormile R. Immune Checkpoint Inhibitor Therapy in HIV-Positive Patients with Advanced-Stage Cancer: a Golden Card to Be Played? Pathol Oncol Res 2019; 26:1357-1358. [PMID: 31222691 DOI: 10.1007/s12253-019-00686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Raffaella Mormile
- Division of Pediatrics and Neonatology, Moscati Hospital, Via A. Gramsci, 81031, Aversa, Italy.
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Association of CD4+ T-cell Count, HIV-1 RNA Viral Load, and Antiretroviral Therapy With Kaposi Sarcoma Risk Among HIV-infected Persons in the United States and Canada. J Acquir Immune Defic Syndr 2017; 75:382-390. [PMID: 28394855 DOI: 10.1097/qai.0000000000001394] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) remains common among HIV-infected persons. To better understand KS etiology and to help target prevention efforts, we comprehensively examined a variety of CD4 T-cell count and HIV-1 RNA viral load (VL) measures, as well as antiretroviral therapy (ART) use, to determine independent predictors of KS risk. SETTING North American AIDS Cohort Collaboration on Research and Design. METHODS We followed HIV-infected persons during 1996-2009 from 18 cohorts. We used time-updated Cox regression to model relationships between KS risk and recent, lagged, trajectory, and cumulative CD4 count or VL measures, as well as ART use. We used Akaike's information criterion and global P values to derive a final model. RESULTS In separate models, the relationship between each measure and KS risk was highly significant (P < 0.0001). Our final mutually adjusted model included recent CD4 count [hazard ratio (HR) for <50 vs. ≥500 cells/μL = 12.4; 95% confidence interval (CI): 6.5 to 23.8], recent VL (HR for ≥100,000 vs. ≤500 copies/mL = 3.8; 95% CI: 2.0 to 7.3), and cumulative (time-weighted mean) VL (HR for ≥100,000 vs. ≤500 copies/mL = 2.5; 95% CI: 1.0 to 5.9). Each P-trend was <0.0001. After adjusting for these measures, we did not detect an independent association between ART use and KS risk. CONCLUSIONS Our results suggested a multifactorial etiology for KS, with early and late phases of development. The cumulative VL effect suggested that controlling HIV replication promptly after HIV diagnosis is important for KS prevention. We observed no evidence for direct anti-KS activity of ART, independent of CD4 count and VL.
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Bellon M, Nicot C. Telomere Dynamics in Immune Senescence and Exhaustion Triggered by Chronic Viral Infection. Viruses 2017; 9:v9100289. [PMID: 28981470 PMCID: PMC5691640 DOI: 10.3390/v9100289] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023] Open
Abstract
The progressive loss of immunological memory during aging correlates with a reduced proliferative capacity and shortened telomeres of T cells. Growing evidence suggests that this phenotype is recapitulated during chronic viral infection. The antigenic volume imposed by persistent and latent viruses exposes the immune system to unique challenges that lead to host T-cell exhaustion, characterized by impaired T-cell functions. These dysfunctional memory T cells lack telomerase, the protein capable of extending and stabilizing chromosome ends, imposing constraints on telomere dynamics. A deleterious consequence of this excessive telomere shortening is the premature induction of replicative senescence of viral-specific CD8+ memory T cells. While senescent cells are unable to expand, they can survive for extended periods of time and are more resistant to apoptotic signals. This review takes a closer look at T-cell exhaustion in chronic viruses known to cause human disease: Epstein–Barr virus (EBV), Hepatitis B/C/D virus (HBV/HCV/HDV), human herpesvirus 8 (HHV-8), human immunodeficiency virus (HIV), human T-cell leukemia virus type I (HTLV-I), human papillomavirus (HPV), herpes simplex virus-1/2 (HSV-1/2), and Varicella–Zoster virus (VZV). Current literature linking T-cell exhaustion with critical telomere lengths and immune senescence are discussed. The concept that enduring antigen stimulation leads to T-cell exhaustion that favors telomere attrition and a cell fate marked by enhanced T-cell senescence appears to be a common endpoint to chronic viral infections.
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Affiliation(s)
- Marcia Bellon
- Department of Pathology, Center for Viral Pathogenesis, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Christophe Nicot
- Department of Pathology, Center for Viral Pathogenesis, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Abstract
OBJECTIVE Herpesvirus shedding in the oral cavity was analyzed to determine if presence in the oral compartment correlates with systemic changes in HIV-associated immune deficiency as measured by CD4 cell counts, plasma HIV viral load and presence of AIDS-defining events. DESIGN A5254 is a multicenter, cross-sectional, single-visit study to evaluate oral complications of HIV/AIDS and determine the association between clinical appearance, herpesvirus shedding, and immune status as ascertained by CD4 cell count and HIV viral load. In total, 307 HIV-infected individuals were evaluated and throat wash collected. METHODS Fisher's exact test and Kruskal-Wallis test were used to assess the association between presence of herpesviruses and the state of immunodeficiency as stratified by a combination of CD4 cell count and HIV viral load. Relationship between pathogens and HIV viral load in plasma was modeled by logistic regression. RESULTS The presence of cytomegalovirus (CMV) and herpes simplex virus-1 in throat wash was associated with decreased CD4 cell counts. By contrast, Kaposi sarcoma-associated herpesvirus and Epstein-Barr virus were similarly detectable across all levels of CD4 cell counts. One unit increase in log10 (HIV viral load) was associated with 1.31 times higher odds of detecting CMV in throat wash when controlling for oral candidiasis, CD4 cell count, and sites (95% confidence interval 1.04-1.65, P = 0.02). CONCLUSION Oral CMV shedding was significantly higher in highly immunocompromised HIV participants. Our finding supports the recommendations to start antiretroviral therapy independent of CD4 cell count as this may have the added benefit to lower the risk of herpesvirus transmission among persons infected with HIV and their partners.
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Abstract
Kaposi sarcoma (KS) is the most common neoplasm of people living with HIV today. In Sub-Saharan Africa, KS is among the most common cancers in men, overall. Not only HIV-positive individuals present with KS; any immune compromised person infected with KS-associated herpesvirus (KSHV) or human herpesvirus 8 is at risk: the elderly, children in KSHV-endemic areas, and transplant recipients. KS diagnosis is based on detection of the viral protein latency-associated nuclear antigen (LANA) in the biopsy, but not all cases of KS are the same or will respond to the same therapy. Standard KS therapy has not changed in 20 years, but newer modalities are on the horizon and will be discussed.
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Appay V, Sauce D. Assessing immune aging in HIV-infected patients. Virulence 2017; 8:529-538. [PMID: 27310730 PMCID: PMC5538339 DOI: 10.1080/21505594.2016.1195536] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/20/2016] [Indexed: 01/10/2023] Open
Abstract
Many of the alterations that affect innate and adaptive immune cell compartments in HIV-infected patients are reminiscent of the process of immune aging, characteristic of old age. These alterations define the immunological age of individuals and are likely to participate to the decline of immune competence with HIV disease progression. It is therefore important to characterize these changes, which point toward the accumulation of highly differentiated immunocompetent cells, associated with overall telomere length shortening, as well as understanding their etiology, especially related to the impact of chronic immune activation. Particular attention should be given to the exhaustion of primary immune resources, including haematopoietic progenitors and naïve cells, which holds the key for effective hematopoiesis and immune response induction, respectively. The alteration of these compartments during HIV infection certainly represents the foundation of the immune parallel with aging.
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Affiliation(s)
- Victor Appay
- Sorbonne Universités, UPMC Univ Paris 06, Center d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- INSERM U1135, CIMI-Paris, Paris, France
| | - Delphine Sauce
- Sorbonne Universités, UPMC Univ Paris 06, Center d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- INSERM U1135, CIMI-Paris, Paris, France
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Brief Report: Effect of CMV and HIV Transcription on CD57 and PD-1 T-Cell Expression During Suppressive ART. J Acquir Immune Defic Syndr 2017; 72:133-7. [PMID: 26818740 PMCID: PMC4868660 DOI: 10.1097/qai.0000000000000936] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. HIV-infected men who have sex with men are nearly universally coinfected with cytomegalovirus (CMV). In this study of 45 HIV-infected men who have sex with men virologically suppressed on ART, we found that presence of seminal CMV DNA shedding and higher levels of systemic cellular HIV RNA transcription were both independently associated with increased PD-1 expression on circulating CD4+ T cells, but not with higher levels of senescent (CD57+) T cells. In addition, greater HIV RNA transcription was associated with lower CD57 expression on CD8 T cells. Although causality cannot be inferred from this retrospective study, these results suggest that asymptomatic CMV replication and residual cellular HIV transcription may contribute to persistent immune dysregulation during suppressive ART.
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Abstract
Human immunodeficiency virus (HIV)-infected adults who take stable antiretroviral therapy (ART) are at risk for early onset of age-related diseases. This is likely due to a complex interaction between traditional risk factors, HIV infection itself, and other factors, such as underlying immune dysfunction and persistent inflammation. HIV disrupts the balance between the host and coinfecting microbes, worsening control of these potential pathogens. For example, HIV-infected adults are more likely than the general population to have subclinical bursts of cytomegalovirus (CMV) replication at mucosal sites. Production of antigens can activate the immune system and stimulate HIV replication, and it could contribute to the pathogenesis of adverse outcomes of aging, like cardiovascular disease and neurocognitive impairment. Further investigation of the relationships between CMV, immune dysfunction, and unsuccessful aging during chronic HIV infection is warranted.
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Affiliation(s)
- Sara Gianella
- Department of Medicine, Division of Infectious Disease, University of California-San Diego, La Jolla
| | - Scott Letendre
- Department of Medicine, Division of Infectious Disease, University of California-San Diego, La Jolla
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Impact of illicit opioid use on T cell subsets among HIV-infected adults. PLoS One 2017; 12:e0176617. [PMID: 28472064 PMCID: PMC5417591 DOI: 10.1371/journal.pone.0176617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 04/13/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives Opioids have immunosuppressive properties, yet opioid effects on T cell abnormalities consistent with the immune risk phenotype among HIV-infected individuals are understudied. Methods To assess associations between illicit opioid use and T cell characteristics (CD4/CD8 ratio, memory profiles based on CD45RO and CD28 expression, and senescence based on CD57 expression), we conducted an exploratory cross-sectional analysis of Russia ARCH, a cohort of antiretroviral therapy (ART)-naïve HIV-infected individuals recruited 11/2012 to 10/2014 in St. Petersburg, Russia. The main independent variable was past 30 day illicit opioid use (yes vs. no). Secondary analyses evaluated none (0 days), intermittent (1 to 7 days), and persistent (8 to 30 days) opioid use. Outcomes were determined with flow cytometry. Analyses were conducted using linear regression models. Results Among 186 participants, 38% reported any illicit opioid use (18% intermittent and 20% persistent). Any illicit opioid use was not significantly associated with T cell characteristics. Intermittent opioid use appeared to be associated with decreased memory CD8+ T cells proportion (CD45RO+CD45RA- CD8+ T cells: adjusted mean difference [AMD] [95% CI] = -6.15 [-11.50, -0.79], p = 0.02) and borderline significant increased senescent T cells (%CD57+ of total CD28-CD8+ T cells (AMD [95% CI] = 7.70 [-0.06, 15.46], p = 0.05). Conclusions Among ART-naïve HIV-infected Russians, any illicit opioid use was not significantly associated with T cell abnormalities although intermittent illicit opioid use may be associated with CD8 T cell abnormalities. Longitudinal studies are warranted to confirm these findings given increased risk of infections and comorbidities seen among HIV-infected individuals with illicit opioid use.
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Mletzko S, Pinato DJ, Robey RC, Dalla Pria A, Benson P, Imami N, Bower M. Programmed death ligand 1 (PD-L1) expression influences the immune-tolerogenic microenvironment in antiretroviral therapy-refractory Kaposi's sarcoma: A pilot study. Oncoimmunology 2017; 6:e1304337. [PMID: 28919987 DOI: 10.1080/2162402x.2017.1304337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/31/2022] Open
Abstract
Upregulation of programmed death ligand 1 (PD-L1) is a mechanism of immune escape utilized by a variety of tumors. PD-L1 expression in tumor cells or in the surrounding infiltrate correlates with clinical responsiveness to novel therapies targeting the PD-1/PD-L1 immune checkpoint. In the context of HIV-1 infection, Kaposi's sarcoma (KS) is largely responsive to restoration of immunity following combination antiretroviral therapy (cART), but there is a subset that is not. We hypothesized that this subset of cART-refractory KS may utilize the PD-L1 pathway of immune escape. We found that PD-L1 expressing KS had a denser CD8+ T cell (p = 0.03) and PD-L1 positive macrophage peritumoral infiltrate (p = 0.04) to suggest the involvement of PD-L1 in shaping an immune-tolerogenic microenvironment in cART-refractory KS. The presence of PD-L1 expression in association with immune-infiltrating cells provides rationale for the clinical development PD-1/PD-L1-targeted checkpoint inhibitors in cART-refractory KS.
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Affiliation(s)
| | | | | | | | | | | | - Mark Bower
- Imperial College London, London, UK.,Chelsea and Westminster Hospital, London, UK
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Partners in Crime: The Role of CMV in Immune Dysregulation and Clinical Outcome During HIV Infection. Curr HIV/AIDS Rep 2016; 13:10-9. [PMID: 26810437 DOI: 10.1007/s11904-016-0297-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the current era of combination antiretroviral therapy (ART), human immunodeficiency virus (HIV)-infected individuals are living longer and healthier lives. Nevertheless, HIV-infected persons are at greater risk for age-related disorders, which have been linked to residual immune dysfunction and inflammation. HIV-infected individuals are almost universally co-infected with cytomegalovirus (CMV) and both viruses are associated with inflammation-related morbidities. Therefore, a detailed investigation of the relationship between CMV and aging-related morbidities emerging during chronic HIV infection is warranted. Here, we review the literature on how CMV co-infection affects HIV infection and host immunity and we discuss the gaps in our knowledge that need elucidation.
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Abstract
PURPOSE OF REVIEW The development of serious non-AIDS-related pathologies typically associated with aging, and the premature immune aging that characterizes HIV-1-infected patients, even with suppressive antiretroviral therapy, have raised increasing concerns in recent years. Deciphering the causes of these phenomena is key for our understanding of HIV pathogenesis and for the clinical care of patients living with the virus. RECENT FINDINGS An important basis for the immune parallels between HIV infection and aging lies in the exhaustion of the lymphopoietic capacity of infected individuals, which eventually affects all compartments of the immune system. The alleged cause for these immune alterations, and the onset of age-related comorbidities, is the systemic chronic immune activation that is established in patients. However, there is a multiplicity of contributors to this immune activation. SUMMARY Our understanding of the precise link between immune activation and aging in HIV infection is complicated by the influence of coinfections and life style factors. Developing rational interventions to reduce the hyper-inflammatory status of HIV-1-infected patients requires a clearer delineation of the factors contributing to the increased levels of systemic immune activation.
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Poizot-Martin I, Allavena C, Delpierre C, Duvivier C, Obry-Roguet V, Cano CE, Guillouet de Salvador F, Rey D, Dellamonica P, Cheret A, Cuzin L, Katlama C, Cabié A, Hoen B. First-line cART regimen impacts the course of CD8+ T-cell counts in HIV-infected patients that achieve sustained undetectable viral load. Medicine (Baltimore) 2016; 95:e5087. [PMID: 27741125 PMCID: PMC5072952 DOI: 10.1097/md.0000000000005087] [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: 11/25/2022] Open
Abstract
The aim of the study was to investigate the impact of first-line combined antiretroviral therapy (cART) regimen on the course of CD8 T-cell counts in human immunodeficiency virus (HIV)-infected patients.A retrospective observational study conducted on the French DAT'AIDS Cohort of HIV-infected patients.We selected 605 patients initiating a first-line cART between 2002 and 2009, and which achieved a sustained undetectable HIV plasma viral load (pVL) for at least 12 months without cART modification. The evolution of CD8 T-cell counts according to cART regimen was assessed.CD8 T-cell counts were assessed in 572 patients treated with 2NRTIs+1PI/r (n= 297), 2NRTIs+1NNRTI (n= 207) and 3NRTIs (n= 68). In multivariate analysis, after 12 months of follow-up, the 3NRTIs regimen was associated with a significantly smaller decrease of CD8 T-cell count compared with NNRTI-containing regimens (-10.2 cells/μL in 3NRTIs vs -105.1 cells/μL; P=0.02) but not compared with PI-containing regimens (10.2 vs -60.9 cells/μL; P=0.21). After 24 months, the 3NRTIs regimen was associated with a smaller decrease of CD8 T-cell count and % compared with PI/r- and NNRTI-containing regimens (0.2 in 3NRTIs vs -9.9 with PI/r-regimens, P=0.001, and vs -11.1 with NNRTI-regimens, p < 0.0001). A focus analysis on 11 patients treated with an INSTI-containing cART regimen during the study period showed after 12 months of follow-up, a median decrease of CD8 T-cell count of -155 [inter quartile range: -302; -22] cells/μL.Our data highlight the fact that cART regimens have differential effects on CD8 pool down regulation.
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Affiliation(s)
- Isabelle Poizot-Martin
- Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Immuno-Hematology Clinic
- Inserm U912 (SESSTIM), Marseille
- Correspondence: Isabelle Poizot-Martin, Aix-Marseille University, APHM- Sainte-Marguerite Hospital, Marseille, France (e-mail: )
| | | | | | - Claudine Duvivier
- APHP- Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectious Diseases Center, IHU Imagine
- Pasteur Institut, Medical Care Center, Necker-Pasteur Infectious Diseases Center France
- Université Paris Descartes, Sorbonne Paris Cité, Paris
| | | | - Carla E. Cano
- Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Immuno-Hematology Clinic
| | | | - David Rey
- Hôpitaux Universitaires Strasbourg, Center for HIV care, Strasbourg
| | - Pierre Dellamonica
- Infectious Diseases Department, CHU of Nice, University Nice Sophia-Antipolis
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, Paris
- Hospital Tourcoing, Infectious Disease Unit, Tourcoing
| | - Lise Cuzin
- INSERM, UMR 1027, Toulouse III University, Toulouse, F-31000, France; CHU Toulouse, COREVIH Toulouse, F-31000
| | - Christine Katlama
- AP-HP, Hospital Pitie-Salpetriere, Department of Infectious Diseases
- UPMC Univ Paris
- UMRS 943, Paris
| | - André Cabié
- CHU de Fort de France, Service de maladies infectieuses et tropicales, Martinique
| | - Bruno Hoen
- Université des Antilles, Faculté de Médecine Hyacinthe Bastaraud, EA 4537; Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
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Effros RB. The silent war of CMV in aging and HIV infection. Mech Ageing Dev 2016; 158:46-52. [PMID: 26404009 PMCID: PMC4808485 DOI: 10.1016/j.mad.2015.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 12/19/2022]
Abstract
Human cytomegalovirus (CMV), the prototypical β-herpervirus, is a widespread pathogen that establishes a lifelong latent infection in myeloid progenitor, and possibly other cells as well. Although immunocompetent individuals show mild or no symptoms despite periodic reactivation during myeloid cell differentiation, CMV is responsible for considerable morbidity and mortality in older adults and in persons chronically infected with HIV. Indeed, in these individuals, reactivation of CMV can cause serious complications. This review will focus of the effects of CMV during aging and HIV/AIDS, with particular attention to the cellular immunity and age-related pathology outcomes from this persistent infection. The impact of the long-term chronic exposure to CMV antigens on the expansion of CD8 T cells with features of replicative senescence will be highlighted.
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Affiliation(s)
- Rita B Effros
- Department of Pathology & Laboratory Medicine and UCLA AIDS Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Yanik EL, Achenbach CJ, Gopal S, Coghill AE, Cole SR, Eron JJ, Moore RD, Mathews WC, Drozd DR, Hamdan A, Ballestas ME, Engels EA. Changes in Clinical Context for Kaposi's Sarcoma and Non-Hodgkin Lymphoma Among People With HIV Infection in the United States. J Clin Oncol 2016; 34:3276-83. [PMID: 27507879 DOI: 10.1200/jco.2016.67.6999] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The biology of HIV-associated cancers may differ depending on immunologic and virologic context during development. Therefore, an understanding of the burden of Kaposi's sarcoma (KS) and non-Hodgkin lymphoma (NHL) relative to antiretroviral therapy (ART), virologic suppression, and CD4 count is important. PATIENTS AND METHODS KS and NHL diagnoses during 1996 to 2011 were identified among patients with HIV infection in eight clinical cohorts in the United States. Among patients in routine HIV clinical care, the proportion of cases in categories of ART use, HIV RNA, and CD4 count at diagnosis were described across calendar time. Person-time and incidence rates were calculated for each category. RESULTS We identified 466 patients with KS and 258 with NHL. In recent years, KS was more frequently diagnosed after ART initiation (55% in 1996 to 2001 v 76% in 2007 to 2011; P-trend = .02). The proportion of patients with NHL who received ART was higher but stable over time (83% overall; P-trend = .81). An increasing proportion of KS and NHL occurred at higher CD4 counts (P < .05 for KS and NHL) and with undetectable HIV RNA (P < .05 for KS and NHL). In recent years, more person-time was contributed by patients who received ART, had high CD4 counts and had undetectable HIV RNA, whereas incidence rates in these same categories remained stable or declined. CONCLUSION Over time, KS and NHL occurred at higher CD4 counts and lower HIV RNA values, and KS occurred more frequently after ART initiation. These changes were driven by an increasing proportion of patients with HIV who received effective ART, had higher CD4 counts, and had suppressed HIV RNA and not by increases in cancer risk within these subgroups. An improved understanding of HIV-associated cancer pathogenesis and outcomes in the context of successful ART is therefore important.
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Affiliation(s)
- Elizabeth L Yanik
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL.
| | - Chad J Achenbach
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Satish Gopal
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Anna E Coghill
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen R Cole
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Joseph J Eron
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Richard D Moore
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - W Christopher Mathews
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel R Drozd
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Ayad Hamdan
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Mary E Ballestas
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Eric A Engels
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
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Utay NS, Roque A, Timmer JK, Morcock DR, DeLeage C, Somasunderam A, Weintrob AC, Agan BK, Estes JD, Crum-Cianflone NF, Douek DC. MRSA Infections in HIV-Infected People Are Associated with Decreased MRSA-Specific Th1 Immunity. PLoS Pathog 2016; 12:e1005580. [PMID: 27093273 PMCID: PMC4836670 DOI: 10.1371/journal.ppat.1005580] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/28/2016] [Indexed: 11/19/2022] Open
Abstract
People with HIV infection are at increased risk for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs). Lower CD4 T-cell counts, higher peak HIV RNA levels and epidemiological factors may be associated with increased risk but no specific immune defect has been identified. We aimed to determine the immunologic perturbations that predispose HIV-infected people to MRSA SSTIs. Participants with or without HIV infection and with MRSA SSTI, MRSA colonization or negative for MRSA were enrolled. Peripheral blood and skin biopsies from study participants were collected. Flow cytometry, flow cytometry with microscopy, multiplex assays of cell culture supernatants and immunohistochemistry were used to evaluate the nature of the immune defect predisposing HIV-infected people to MRSA infections. We found deficient MRSA-specific IFNγ+ CD4 T-cell responses in HIV-infected people with MRSA SSTIs compared to MRSA-colonized participants and HIV-uninfected participants with MRSA SSTIs. These IFNγ+ CD4 T cells were less polyfunctional in HIV-infected participants with SSTIs compared to those without SSTIs. However, IFNγ responses to cytomegalovirus and Mycobacterium avium antigens and MRSA-specific IL-17 responses by CD4 T cells were intact. Upon stimulation with MRSA, peripheral blood mononuclear cells from HIV-infected participants produced less IL-12 and IL-15, key drivers of IFNγ production. There were no defects in CD8 T-cell responses, monocyte responses, opsonization, or phagocytosis of Staphylococcus aureus. Accumulation of CD3 T cells, CD4 T cells, IL-17+ cells, myeloperoxidase+ neutrophils and macrophage/myeloid cells to the skin lesions were similar between HIV-infected and HIV-uninfected participants based on immunohistochemistry. Together, these results indicate that MRSA-specific IFNγ+ CD4 T-cell responses are essential for the control of initial and recurrent MRSA infections in HIV-infected people.
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Affiliation(s)
- Netanya S. Utay
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Annelys Roque
- Human Immunology Section, Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - J. Katherina Timmer
- Human Immunology Section, Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David R. Morcock
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Claire DeLeage
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Anoma Somasunderam
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Amy C. Weintrob
- Infectious Disease Clinical Research Program (IDCRP), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Brian K. Agan
- Infectious Disease Clinical Research Program (IDCRP), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Jacob D. Estes
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Nancy F. Crum-Cianflone
- Infectious Disease Clinical Research Program (IDCRP), Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, United States of America
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, California, United States of America
| | - Daniel C. Douek
- Human Immunology Section, Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Mayor-Ibarguren A, Roldán-Puchalt MC, Sancho-Bueso T, Pérez-López C, Álvarez-Linera J, Frutos R, Álvarez-Escolá C, Regojo-Zapata R, Beato-Merino MJ, Herranz-Pinto P, Lecumberri B. Kaposi sarcoma secondary to endogenous adrenocorticotropic hormone-dependent Cushing syndrome. Br J Dermatol 2015; 174:1370-1374. [PMID: 26694762 DOI: 10.1111/bjd.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/29/2022]
Abstract
Kaposi sarcoma (KS) is an angioproliferative tumour that develops as a result of an infection by human herpesvirus 8, which is considered a necessary cause but not sufficient. Other factors - genetic, immunological and environmental - might play a role in the development of the disease. We report a case of KS secondary to endogenous Cushing syndrome (ECS) due to a pituitary adenoma, an association that has been reported only once. We also conducted a search through the Medline and PubMed databases for cases involving KS and ECS, finding only three additional cases that shared common clinical and prognostic features with ours. ECS might favour the development of KS due to immunosuppression. Dermatologists and other clinicians should be aware of this association, as it might be an underdiagnosed condition. It also has an important impact on the management of KS, and based on this review it relies on a good prognosis when ECS is well controlled.
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Affiliation(s)
- A Mayor-Ibarguren
- Department of Dermatology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - M C Roldán-Puchalt
- Department of Endocrinology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - T Sancho-Bueso
- Department of Internal Medicine, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - C Pérez-López
- Department of Neurosurgery, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - J Álvarez-Linera
- Department of Radiology, Hospital Ruber Internacional, Madrid, Spain
| | - R Frutos
- Department of Radiology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - C Álvarez-Escolá
- Department of Endocrinology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - R Regojo-Zapata
- Department of Pathology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - M J Beato-Merino
- Department of Pathology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - P Herranz-Pinto
- Department of Dermatology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
| | - B Lecumberri
- Department of Endocrinology, La Paz Hospital, Paseo de la Castellana 261, Madrid, Spain
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Cao W, Vyboh K, Routy B, Chababi-Atallah M, Lemire B, Routy JP. Imatinib for highly chemoresistant Kaposi sarcoma in a patient with long-term HIV control: a case report and literature review. ACTA ACUST UNITED AC 2015; 22:e395-9. [PMID: 26628884 DOI: 10.3747/co.22.2635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Kaposi sarcoma (ks) is a vascular tumour caused by oncogenic human herpesvirus type 8; it often occurs with hiv-associated immunosuppression. Numerous cellular signalling pathways are involved in the pathogenesis of ks, among which receptor tyrosine kinases such as the c-Kit and platelet-derived growth factor receptors play an important role. Imatinib mesylate, a tyrosine kinase inhibitor, has resulted in partial regression of ks lesions in one third of treated patients, but its mechanism of action remains unclear. Here, we report the case of a white man with recurrent ks despite well-suppressed hiv infection and multiple chemotherapies who received imatinib and showed a complete and sustained tumour response. To our knowledge, this report is the first showing the value of imatinib in the management of ks in the context of long-lasting hiv control with adequate quantitative CD4 recovery. Our case indicates that imatinib can be a treatment option for highly chemoresistant recurrent ks in patients on long-term antiretroviral therapy.
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Affiliation(s)
- W Cao
- Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC; ; Research Institute, McGill University Health Centre, Montreal, QC; ; Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, PRC
| | - K Vyboh
- Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC; ; Research Institute, McGill University Health Centre, Montreal, QC
| | - B Routy
- Institut de Cancérologie Gustave Roussy, Villejuif, France; ; Institut national de la santé et de la recherche médicale ( inserm ), Villejuif, France
| | - M Chababi-Atallah
- Department of Pathology, Centre hospitalier universitaire de Sherbrooke, Sherbooke, QC
| | - B Lemire
- Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC
| | - J P Routy
- Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC; ; Research Institute, McGill University Health Centre, Montreal, QC
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Labo N, Miley W, Benson CA, Campbell TB, Whitby D. Epidemiology of Kaposi's sarcoma-associated herpesvirus in HIV-1-infected US persons in the era of combination antiretroviral therapy. AIDS 2015; 29:1217-25. [PMID: 26035321 PMCID: PMC6680245 DOI: 10.1097/qad.0000000000000682] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine the effect of the introduction of combination antiretroviral treatment (cART) in the HIV-1-infected US population on the epidemiology of Kaposi's sarcoma-associated herpesvirus (KSHV). DESIGN, SETTING AND PARTICIPANTS We investigated the epidemiology of KSHV in 5022 HIV-1-infected, antiretroviral-naive US persons participating in six AIDS Clinical Trials Group (ACTG)-randomized clinical trials, and followed in a long-term cohort study. We tested the first and last available sera of each participant for antibodies to KSHV K8.1 and ORF73. MAIN OUTCOME MEASURES We studied prevalence and incidence of KSHV infection, incidence of Kaposi's sarcoma, and overall survival. RESULTS KSHV prevalence was 38.1% [95% confidence interval (CI) 36.8-39.5%]. Male sex, Caucasian race, age between 30 and 49 years, residence in north-eastern or western United States, and enrolment after 2001 were independently associated with prevalent infection. KSHV incidence was 4.07/100 person-years (95% CI 3.70-4.47). Male sex, Caucasian race, age below 30, and enrolment after 2001 were associated with incident infection. CD4 cell count increase following cART was associated with lower risk. Kaposi's sarcoma incidence was 104.05/100 000 person-years (95% CI 71.17-146.89). Higher baseline CD4 cell count, but not increase in CD4 cell count after cART, was associated with lower hazard of Kaposi's sarcoma. Randomized assignment of protease inhibitors was not associated with better KSHV outcomes. CONCLUSIONS HIV-1-infected individuals, in particular Caucasian men, remain at a significant risk for KSHV co-infection and Kaposi's sarcoma. Thus, optimal management of HIV-1 infection should continue to include vigilance for manifestations of KSHV co-infection, including Kaposi's sarcoma.
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Affiliation(s)
- Nazzarena Labo
- aViral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc., Frederick National Laboratory for Cancer Research, Frederick bDepartment of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland cDivision of Infectious Diseases, University of California San Diego, San Diego, California dDivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
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Abstract
HIV infection is related to an increased risk of cancer compared with general population, both AIDS-defining cancers (Kaposi's sarcoma, non Hodgkin's lymphoma, invasive cervical cancer) and non-AIDS-defining cancers. Although the advent of the highly active antiretroviral therapy era has decreased the Kaposi's sarcoma and non-Hodgkin's lymphoma incidences, non-AIDS-defining malignancies, such as lung cancer, hepatocarcinoma, anal cancer and skin cancers, remain a major cause of morbidity and death in the HIV-infected population. The clinical presentation is often different between the infected and non-infected populations, often with a more advanced stage at diagnosis, a more aggressive pathology, and associated morbidities like immunosuppression, leading to poorer outcomes. Numerous studies have focused on HIV-related malignancies' treatment, however specific guidelines are still missing. Practitioners have to be careful with interactions between antiretroviral and antineoplastic drugs, particularly through the cytochrome P 450. Because of this, a national multidisciplinary approach, "Cancer and HIV, " was started in 2013 thanks to the National Institute of Cancer (INCa). The aim of this review is to present a scientific update about AIDS-and non-AIDS-defining malignancies, both in their clinical aspects and regarding their specific therapeutic management.
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Bhutani M, Polizzotto MN, Uldrick TS, Yarchoan R. Kaposi sarcoma-associated herpesvirus-associated malignancies: epidemiology, pathogenesis, and advances in treatment. Semin Oncol 2014; 42:223-46. [PMID: 25843728 DOI: 10.1053/j.seminoncol.2014.12.027] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Kaposi sarcoma associated herpesvirus (KSHV), a γ2-herpesvirus, also known as human herpesvirus-8, is the etiologic agent of three virally associated tumors: Kaposi sarcoma, a plasmablastic form of multicentric Castleman disease (KSHV-MCD), and primary effusion lymphoma. These malignancies are predominantly seen in people with acquired immunodeficiencies, including acquired immunodeficiency syndrome and iatrogenic immunosuppression in the setting of organ transplantation, but can also develop in the elderly. Kaposi sarcoma (KS) is most frequent in regions with high KSHV seroprevalence, such as sub-Saharan Africa and some Mediterranean countries. In the era of combination antiviral therapy, inflammatory manifestations associated with KSHV-infection, including KSHV-MCD, a recently described KSHV-associated inflammatory cytokine syndrome and KS immune reconstitution syndrome also are increasingly appreciated. Our understanding of viral and immune mechanisms of oncogenesis continues to expand and lead to improved molecular diagnostics, as well as novel therapeutic strategies that employ immune modulatory agents, manipulations of the tumor microenvironment, virus-activated cytotoxic therapy, or agents that target interactions between specific virus-host cell signaling pathways. This review focuses on the epidemiology and advances in molecular and clinical research that reflects the current understanding of viral oncogenesis, clinical manifestations, and therapeutics for KSHV-associated tumors.
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Affiliation(s)
- Manisha Bhutani
- HIV and AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Mark N Polizzotto
- HIV and AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Thomas S Uldrick
- HIV and AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD.
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Different plasma markers of inflammation are influenced by immune recovery and cART composition or intensification in treated HIV infected individuals. PLoS One 2014; 9:e114142. [PMID: 25462535 PMCID: PMC4252101 DOI: 10.1371/journal.pone.0114142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV-1 infection increases plasma levels of inflammatory markers. Combination antiretroviral therapy (cART) does not restore inflammatory markers to normal levels. Since intensification of cART with raltegravir reduced CD8 T-cell activation in the Discor-Ral and IntegRal studies, we have evaluated the effect of raltegravir intensification on several soluble inflammation markers in these studies. METHODS Longitudinal plasma samples (0-48 weeks) from the IntegRal (n = 67, 22 control and 45 intensified individuals) and the Discor-Ral studies (44 individuals with CD4 T-cell counts<350 cells/µl, 14 control and 30 intensified) were assayed for 25 markers. Mann-Whitney, Wilcoxon, Spearman test and linear mixed models were used for analysis. RESULTS At baseline, different inflammatory markers were strongly associated with HCV co-infection, lower CD4 counts and with cART regimens (being higher in PI-treated individuals), but poorly correlated with detection of markers of residual viral replication. Although raltegravir intensification reduced inflammation in individuals with lower CD4 T-cell counts, no effect of intensification was observed on plasma markers of inflammation in a global analysis. An association was found, however, between reductions in immune activation and plasma levels of the coagulation marker D-dimer, which exclusively decreased in intensified patients on protease inhibitor (PI)-based cART regimens (P = 0.040). CONCLUSIONS The inflammatory profile in treated HIV-infected individuals showed a complex association with HCV co-infection, the levels of CD4 T cells and the cART regimen. Raltegravir intensification specifically reduced D-dimer levels in PI-treated patients, highlighting the link between cART composition and residual viral replication; however, raltegravir had little effect on other inflammatory markers.
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Hearps AC, Martin GE, Rajasuriar R, Crowe SM. Inflammatory co-morbidities in HIV+ individuals: learning lessons from healthy ageing. Curr HIV/AIDS Rep 2014; 11:20-34. [PMID: 24414166 DOI: 10.1007/s11904-013-0190-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Increased life expectancy due to improved efficacy of cART has uncovered an increased risk of age-related morbidities in HIV+ individuals and catalyzed significant research into mechanisms driving these diseases. HIV infection increases the risk of non-communicable diseases common in the aged, including cardiovascular disease, neurocognitive decline, non-AIDS malignancies, osteoporosis, and frailty. These observations suggest that HIV accelerates immunological ageing, and there are many immunological similarities with the aged, including shortened telomeres, accumulation of senescent T cells and altered monocyte phenotype/function. However, the most critical similarity between HIV+ individuals and the elderly, which most likely underpins the heightened risk of non-communicable diseases, is chronic inflammation and associated immune activation. Here, we review the similarities between HIV+ individuals and the aged regarding the pathogenesis of inflammatory diseases, the current evidence for mechanisms driving these processes and discuss current and potential therapeutic strategies for addressing inflammatory co-morbidity in HIV+ infection.
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Affiliation(s)
- Anna C Hearps
- Centre for Biomedical Research, Burnet Institute, GPO Box 2248, Melbourne, VIC, 3001, Australia,
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Carbone A, Vaccher E, Gloghini A, Pantanowitz L, Abayomi A, de Paoli P, Franceschi S. Diagnosis and management of lymphomas and other cancers in HIV-infected patients. Nat Rev Clin Oncol 2014; 11:223-38. [PMID: 24614140 DOI: 10.1038/nrclinonc.2014.31] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite the introduction of highly active antiretroviral therapy or combination antiretroviral therapy (HAART and cART, respectively) patients infected with HIV might develop certain types of cancer more frequently than uninfected people. Lymphomas represent the most frequent malignancy among patients with HIV. Other cancer types that have increased in these patients include Kaposi sarcoma, cancer of the cervix, anus, lung and liver. In the post-HAART era, however, patients with HIV have experienced a significant improvement in their morbidity, mortality and life expectancy. This Review focuses on the different types of lymphomas that generally occur in patients with HIV. The combination of cART and antineoplastic treatment has resulted in remarkable prolongation of disease-free survival and overall survival among patients with HIV who develop lymphoma. However, the survival in these patients still lags behind that of patients with lymphoma who are not infected with HIV. We also provide an update of epidemiological data, diagnostic issues, and strategies regarding the most-appropriate management of patients with both HIV and lymphomas.
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Affiliation(s)
- Antonino Carbone
- Department of Pathology, Centro di Riferimento Oncologico Aviano (CRO), Istituto Nazionale Tumori, Italy
| | - Emanuela Vaccher
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano (CRO), Istituto Nazionale Tumori, Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Akin Abayomi
- Department of Pathology, Division of Haematology, Tygerberg Hospital, South Africa
| | - Paolo de Paoli
- Molecular Virology and Scientific Directorate, Centro di Riferimento Oncologico Aviano (CRO), Istituto Nazionale Tumori, Italy
| | - Silvia Franceschi
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, France
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Cloarec N, Faucher O, Bregigeon S, Brunet C, Tamalet C, Cano C, Poizot Martin I. Kaposi's sarcoma in a treated and well-controlled HIV infected patient: Discussion on the role of immunosenescence. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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