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Noël N, Saez-Cirion A, Avettand-Fenoël V, Boufassa F, Lambotte O. HIV controllers: to treat or not to treat? Is that the right question? Lancet HIV 2019; 6:e878-e884. [PMID: 31624011 DOI: 10.1016/s2352-3018(19)30264-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
The term HIV controller refers to the small proportion of individuals infected with HIV who can spontaneously control viraemia to maintain very low viral loads. One major unresolved question is whether HIV controllers should receive antiretroviral therapy, given that international guidelines recommend treatment for all individuals who are infected with HIV. Differences in the definitions of a controller (in terms of the viral-load cutoff and the duration of viral control) and contrasting reports on CD4 T-cell decline, chronic immune activation, the cardiovascular risk, and loss of viral control in controllers have prevented the development of a consensus view.
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Affiliation(s)
- Nicolas Noël
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay aux Roses, France; Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Asier Saez-Cirion
- Institut Pasteur, Unité HIV, Inflammation et Persistance, Paris, France
| | - Véronique Avettand-Fenoël
- Assistance Publique-Hôpitaux de Paris, Laboratoire de Microbiologie clinique, CHU Necker-Enfants Malades, Paris, France; CNRS 8104, INSERM U1016, Université Paris Descartes, Paris, France
| | - Faroudy Boufassa
- INSERM CESP U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay aux Roses, France; Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, Le Kremlin Bicêtre, France.
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Sivay MV, Fogel JM, Wang J, Zhang Y, Piwowar-Manning E, Clarke W, Breaud A, Blankson J, Hamilton EL, Kahn K, Selin A, Gomez-Olive FX, MacPhail C, Hughes JP, Pettifor A, Eshleman SH. Natural control of HIV infection in young women in South Africa: HPTN 068. HIV CLINICAL TRIALS 2018; 19:202-208. [PMID: 30522410 DOI: 10.1080/15284336.2018.1531534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Some individuals control HIV replication without antiretroviral (ARV) therapy. OBJECTIVE To analyze viral suppression in young women in rural South Africa enrolled in a trial evaluating a behavioral intervention for HIV prevention. METHODS Plasma samples were obtained from women ages 13-24 (81 infected at enrollment, 164 seroconverters). ARV testing was performed using an assay that detects 20 ARV drugs. Women were classified as viremic controllers if they were virally suppressed for ≥12 months with no ARV drug use. RESULTS Samples from 216/245 (88.2%) women had no ARV drugs detected at their first HIV-positive visit. Thirty-four (15.7%) of the 216 women had a viral load <2,000 copies/mL. Fifteen of the 34 women were followed for ≥12 months; 12 were virally suppressed with no ARV drugs detected during follow-up. These women were classified as viremic controllers (overall: 12/216 = 5.6%). The median CD4 cell count at the first HIV-positive visit was higher among the 12 controllers than among the 204 women who were not using ARV drugs (759 vs. 549 cells/mm3, p = 0.02). Some women had a viral load <40 copies/mL at a single study visit, but none were classified as elite controllers (viral load <40 copies/mL for ≥12 months with no ARV drug use). CONCLUSIONS In this cohort, 5.6% of women who were not using ARV drugs had sustained viral suppression. This represents a minimum estimate of the frequency of viremic controllers in this cohort, since some women were not followed long enough to meet the criteria for classification.
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Affiliation(s)
- Mariya V Sivay
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Jessica M Fogel
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Jing Wang
- b Statistical Center for HIV/ AIDS Research & Prevention (SCHARP) , Seattle , Washington , USA
| | - Yinfeng Zhang
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Estelle Piwowar-Manning
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - William Clarke
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Autumn Breaud
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Joel Blankson
- c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Erica L Hamilton
- d Science Facilitation Department , FHI 360 , Durham , North Carolina , USA
| | - Kathleen Kahn
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Amanda Selin
- f University of North Carolina at Chapel Hill, Carolina Population Center , Chapel Hill , North Carolina , USA
| | - F Xavier Gomez-Olive
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Catherine MacPhail
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,g School of Health and Society , University of Wollongong , Wollongong , Australia
| | - James P Hughes
- h Department of Biostatistics , University of Washington , Seattle , Washington , USA
| | - Audrey Pettifor
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,i Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Susan H Eshleman
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
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Circulating CXCR5-Expressing CD8+ T-Cells Are Major Producers of IL-21 and Associate With Limited HIV Replication. J Acquir Immune Defic Syndr 2018; 78:473-482. [DOI: 10.1097/qai.0000000000001700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Feria MG, Taborda NA, Hernandez JC, Rugeles MT. HIV replication is associated to inflammasomes activation, IL-1β, IL-18 and caspase-1 expression in GALT and peripheral blood. PLoS One 2018; 13:e0192845. [PMID: 29672590 PMCID: PMC5909617 DOI: 10.1371/journal.pone.0192845] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/31/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) promotes an inflammatory process, leading to the progressive loss of the functional capacity of the immune system. The HIV infection induces alterations in several tissues, but mainly in the gut-associated lymphoid tissue (GALT). However, the degree of GALT deterioration varies among infected individuals. In fact, it has been shown that HIV-controllers, who spontaneously control viral replication, exhibit a lower inflammatory response, and a relative normal frequency and function of most of the immune cells. Inflammasomes are molecular complexes involved in the inflammatory response, being NLRP1, NLRP3, NLRC4, AIM2 and Pyrin inflammasomes, the best characterized so far. These complexes regulate the maturation of cytokines of the IL-1 family, including IL-1β and IL-18. These cytokines have been associated with immune activation and expansion of HIV target cells, promoting viral replication. Interesting, some reports indicate that HIV induces the activation of the NLRP3 inflammasome, but the role of this, and other inflammasomes during HIV infection, especially in GALT, remains unclear. OBJECTIVE To compare the relative expression of inflammasome components and the proinflammatory response related to their activity, between HIV-progressors and HIV-controllers. METHODS GALT biopsies and peripheral blood mononuclear cells (PBMCs) from 15 HIV-controllers and 15 HIV-progressors were obtained. The relative expression of the following inflammasome components were evaluated by RT-PCR: NLRP3, NLRC4, NLRP1, AIM2, ASC, Caspase-1, IL-1β and IL-18. In addition, plasma concentration of IL-18 was evaluated as an indicator of baseline proinflammatory status. Finally, in supernatants of PBMCs in vitro stimulated with inflammasome agonists, the concentrations of IL-1β and IL-18 were quantified by ELISA. RESULTS HIV-progressors exhibited higher expression of IL-1β, IL-18 and caspase-1 genes in GALT and PBMCs compared with HIV-controllers. In addition, HIV-progressors had also increased expression of ASC in PBMCs. When plasma levels were evaluated, IL-18 was increased in HIV-progressors. Interesting, these patients also showed an increased production of IL-1β in supernatants of PBMCs stimulated in vitro with the agonists of AIM2, NLRP1 and NLRC4 inflammasomes. Finally, the expression of caspase-1, NLRP1, IL-1β and IL-18 in GALT or peripheral blood was correlated with CD4+ T-cell count and viral load. CONCLUSION Our results suggest that during HIV-infection, the required signals to induce the expression of different components of the inflammasomes are produced, both in GALT and in periphery. The activation of these molecular complexes could increase the number of target cells, favoring HIV replication and cell death, promoting the disease progression.
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Affiliation(s)
- Manuel Gerónimo Feria
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Natalia Andrea Taborda
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia UdeA, Medellín, Colombia
- Grupo de Investigaciones Biomédicas Uniremington, Programa de Medicina, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Juan C. Hernandez
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia UdeA, Medellín, Colombia
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Maria Teresa Rugeles
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia UdeA, Medellín, Colombia
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Grauer OM, Reichelt D, Grüneberg U, Lohmann H, Schneider-Hohendorf T, Schulte-Mecklenbeck A, Gross CC, Meuth SG, Wiendl H, Husstedt IW. Neurocognitive decline in HIV patients is associated with ongoing T-cell activation in the cerebrospinal fluid. Ann Clin Transl Neurol 2015; 2:906-19. [PMID: 26401512 PMCID: PMC4574808 DOI: 10.1002/acn3.227] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 01/30/2023] Open
Abstract
Objective HIV-associated neurocognitive disorders (HAND) remain a challenge despite combination antiretroviral therapy (cART). Immune cell activation has been implicated to play a major role in the development of HAND. Methods In this study, we used multicolor flow cytometry on peripheral blood (PB) and cerebrospinal fluid (CSF) samples to determine the expression of HLA-DR and programmed death-1 (PD-1) on CD4+ and CD8+ T cells in patients with chronic HIV infection. Expression levels were correlated with HI virus load in PB and CSF, classification of HAND and severity of magnetic resonance imaging (MRI) signal abnormalities. Results In a cohort of 86 HIV patients we found that the grade of neurocognitive impairment and the severity of MRI signal abnormalities correlated with decreasing CD4/CD8-ratios and increased frequencies of HLA-DR expressing CD4+ and CD8+ T cells reaching the highest values in the CSF samples. Importantly, HLA-DR upregulation was still detectable in virologically suppressed HIV patients. Further, T-cell subpopulation analysis of 40 HIV patients showed a significant shift from naïve to effector memory (EM) T cells that was negatively correlated with the grade of neurocognitive impairment in the PB samples. Moreover, PD-1 was significantly increased on CD4+ memory T cells with highest levels on EM T cells in HIV patients with mild or severe neurocognitive alterations. Interpretation The CD4/CD8 ratio, the proportion of EM to naïve T cells and the immune activation profile of CD4+ and CD8+ T cells in PB and CSF might be useful parameters to monitor the efficacy of cART and to identify HIV patients at risk of further neurocognitive deterioration.
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Affiliation(s)
- Oliver M Grauer
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Doris Reichelt
- Department of Internal Medicine D, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Ute Grüneberg
- Department of Internal Medicine D, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Hubertus Lohmann
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Tilman Schneider-Hohendorf
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Catharina C Gross
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Ingo W Husstedt
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
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