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Slama L, Reddy S, Phair J, Palella FJ, Brown TT. Changes in bone turnover markers with HIV seroconversion and ART initiation. J Antimicrob Chemother 2018; 72:1456-1461. [PMID: 28175307 DOI: 10.1093/jac/dkx011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/05/2017] [Indexed: 12/28/2022] Open
Abstract
Background Osteoporosis is common among HIV-infected persons and contributes to risk of fragility fracture. While ART initiation is associated with decreases in bone mineral density and increases in bone turnover, the impact of HIV on bone metabolism is unclear. Methods We identified men at the Chicago site of the Multicenter AIDS Cohort Study who HIV seroconverted while under observation. Concentrations of 25-OH vitamin D, bone turnover markers [procollagen type 1 N terminal propeptide (P1NP), osteocalcin (OC), C-telopeptide (CTX)] and sclerostin were measured from stored serum obtained at pre-HIV infection, pre-ART and post-ART initiation timepoints. Mixed models, with each biomarker as an outcome, were fitted. Timepoint, age, CD4 count (cells/mm 3 ), HIV-viral suppression, season and an age by timepoint interaction term were considered as fixed effects. Results Data from 52 participants revealed that median duration between HIV seroconversion and ART initiation was 8.7 years (IQR 3.7-11.6). Median CD4 and plasma HIV-RNA concentrations were 445 (IQR 298.5-689) and 20 184 copies/mL (IQR 6237-64 340), respectively, at the pre-ART timepoint. Multivariate analyses demonstrated pre-HIV infection levels of OC that were higher than pre-ART levels (6.8 versus 5.7 ng/mL, P = 0.04); and pre-ART levels of sclerostin that were higher than post-ART levels (0.033 versus 0.02 ng/mL, P <0.001). No changes in P1NP, CTX and 25-OH vitamin D levels were detected. Conclusions HIV seroconversion was associated with decreased OC levels while ART initiation was associated with decreases in sclerostin, a negative regulator of bone formation. Our results suggest that both HIV infection and ART have an impact on bone metabolism in white men.
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Affiliation(s)
- Laurence Slama
- Hôpital Hôtel-Dieu, APHP, Service de Thérapeutique en Immuno-Infectiologie, 1 Place du Parvis Notre-Dame, 75181 Paris cedex 04, France.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Susheel Reddy
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John Phair
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Mathiesen IH, Salem M, Gerstoft J, Gaardbo JC, Obel N, Pedersen C, Ullum H, Nielsen SD, Hansen ABE. Complete manuscript Title: Changes in RANKL during the first two years after cART initiation in HIV-infected cART naïve adults. BMC Infect Dis 2017; 17:262. [PMID: 28399815 PMCID: PMC5387326 DOI: 10.1186/s12879-017-2368-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/30/2017] [Indexed: 11/22/2022] Open
Abstract
Background By assessing the changes in concentration of soluble receptor activator of nuclear factor κ B ligand (RANKL) and osteoprotegrin (OPG) after initiation of combination antiretroviral therapy (cART) in treatment-naïve HIV-infected patients we aimed to evaluate whether the initial accelerated bone loss could be mediated by increased soluble RANKL (sRANKL) levels associated with CD4+ T cell recovery. Methods We used multiplex immunoassays to determine sRANKL and OPG concentrations in plasma from 48 HIV patients at baseline and 12, 24, 48 and 96 weeks after cART initiation. Results Soluble RANKL changed significantly over time (overall p = 0.02) with 25% decrease (95% CI: -42 to −5) at week 24 compared to baseline and stabilized at a lower level thereafter. We found no correlation between CD4+ T cell count increment and changes in sRANKL or between percentage change in BMD and changes in sRANKL. Conclusion In this study there was no indication that the accelerated bone loss after cART initiation was mediated by early changes in sRANKL due to CD4+ T cell recovery. Future studies should focus on the initial weeks after initiation of cART. Trial registration Clinical-Trial.gov. id NCT00135460, August 25, 2005. The study was approved by the Danish Data Protection Agency, Danish Medicines Agency and Regional Ethics Committee.
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Affiliation(s)
- Inger Hee Mathiesen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mohammad Salem
- Department of Microbiology & Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Christine Gaardbo
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre Hospital, Kettegaard Allé 30, -2650, Copenhagen, DK, Denmark.
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Jourjy J, Dahl K, Huesgen E. Antiretroviral Treatment Efficacy and Safety in Older HIV-Infected Adults. Pharmacotherapy 2016; 35:1140-51. [PMID: 26684554 DOI: 10.1002/phar.1670] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Highly active antiretroviral therapy (ART) and its widespread availability have revolutionized the landscape of HIV care and patient outcomes, transforming infection with HIV into a manageable chronic condition rather than a life-limiting disease. This transformation has created an older patient demographic. The effect that older age has on the outcomes of ART is not completely understood. Limited data are available in older individuals due to underrepresentation in clinical trials. To better understand this relationship, we conducted a literature search to assess the impact of older age on the outcomes of ART in the older HIV-infected population, including immunologic and virologic outcomes, mortality, disease progression, toxicity of ART, and pharmacokinetic considerations. In addition, package inserts of antiretroviral (ARV) medications were reviewed for efficacy, safety, and pharmacokinetic information pertaining to the older population. Most studies in older adults (50 yrs or older) demonstrated slower and blunted CD4 immune recovery but better virologic suppression in response to ART. Higher rates of mortality and faster disease progression have been observed in adults 50 years and older, particularly during the first year after ART initiation. HIV-infected patients aged 50 years and older appear to be at greater risk for certain ART-associated toxicities including nephrotoxicity, decline in bone mineral density and bone fracture, symptomatic peripheral neuropathy, and cardiovascular disease including myocardial infarction. The available literature suggests that clinicians should consider avoiding agents such as tenofovir disoproxil fumarate (TDF) in older patients with risk factors for renal impairment and/or osteoporosis. If TDF is used in patients aged 50 years or older, more frequent monitoring should be considered. Older age was a significant predictor for higher atazanavir exposure and higher lopinavir trough concentration at 24 weeks. The clinical implications of these findings are unknown. It is imperative that future development of novel ARV drug therapies includes a greater proportion of older subjects in clinical trials.
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Affiliation(s)
- Jacqueline Jourjy
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Keelin Dahl
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Emily Huesgen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
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Abstract
PURPOSE OF REVIEW HIV infection is an established risk factor for osteoporosis and bone fracture. Combination antiretroviral therapy (cART) increases bone resorption leading to an additional 2-6% bone mineral density (BMD) loss within the first 1-2 years of therapy. Although tenofovir disoproxil fumarate is often blamed for antiretroviral drug-associated bone loss, evidence abounds to suggest that other agents, including the protease inhibitors (PIs), have adverse bone effects. In the current review, we examine bone loss associated with protease inhibitor use, describing the relative magnitude of bone loss reported for individual protease inhibitors. We also review the potential mechanisms associated with protease inhibitor-induced bone loss. RECENT FINDINGS As a class, protease inhibitors contribute to a greater degree of bone loss than other anchor drugs. HIV disease reversal and the associated immune reconstitution following cART initiation play an important role in protease inhibitor-mediated bone loss in addition to plausible direct effects of protease inhibitors on bone cells. SUMMARY Protease inhibitors remain an important component of cART despite their adverse effects on bone. A better understanding of factors that drive HIV/cART-induced bone loss is needed to stem the rising rate of fracture in the HIV-infected population.
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Affiliation(s)
- Caitlin A. Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Grady Healthcare System, Atlanta, GA USA
| | - M. Neale Weitzmann
- Division of Endocrinology & Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Grady Healthcare System, Atlanta, GA USA
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Crespo M, Navarro J, Martinez-Rebollar M, Podzamczer D, Domingo P, Mallolas J, Saumoy M, Mateo GM, Curran A, Gatell J, Ribera E. Improvement of BMD after Switching from Lopinavir/R Plus Two Nucleos(T)ide Reverse Transcriptase Inhibitors to Lopinavir/R Plus Lamivudine: OLE-LIP Substudy. HIV CLINICAL TRIALS 2016; 17:89-95. [PMID: 27125363 DOI: 10.1080/15284336.2016.1149929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare 48-week changes in bone mineral density (BMD) and body fat distribution between patients continuing lopinavir/ritonavir and two NRTIs and those switching to lopinavir/ritonavir and lamivudine. METHODS Substudy of a randomized, open-label, multicenter OLE study was carried out. Adult HIV-infected patients with <50 copies/mL for ≥6 months were randomized (1:1) to continue lopinavir/ritonavir and two NRTIs or switching to lopinavir/ritonavir and lamivudine. Dual-energy X-ray absorptiometry (DXA) was performed at baseline and after 48 weeks to measure bone composition and body fat distribution in both the groups. RESULTS Forty-one patients (dual-therapy, n = 23; triple-therapy, n = 18) of 239, who received at least one dose of study medication, completed the study: median age, 42 years, 71% male, 73% Caucasian. At week 48, total BMD increased by 1.04% (95% CI, 0.06 to 2.01%) among patients switching to dual-therapy, whereas no significant changes occurred in patients maintaining triple-therapy. Dual-therapy and older age were independently associated with total BMD increase. Among patients discontinuing tenofovir-DF, a significant increase was seen in total BMD (1.43; 95% CI, -0.04 to 2.91) and total hip (1.33%; 95% CI, 0.44 to 2.22%). A non-statistically significant decrease in femoral and spinal BMD was observed in patients who discontinued abacavir and in those continuing triple-therapy. Regarding fat distribution, no significant changes were seen in both the treatment groups. DISCUSSION BMD increased following switching to lopinavir/ritonavir plus lamivudine in HIV-infected patients on suppressive triple-therapy with lopinavir/ritonavir and two NRTIs including tenofovir-DF.
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Affiliation(s)
- M Crespo
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain.,b Vall d'Hebron Research Institute , Barcelona , Spain
| | - J Navarro
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain.,b Vall d'Hebron Research Institute , Barcelona , Spain
| | | | - D Podzamczer
- d Hospital Universitario de Bellvitge , Barcelona , Spain
| | - P Domingo
- e Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - J Mallolas
- c Hospital Clínic/IDIBAPS , University of Barcelona , Barcelona , Spain
| | - M Saumoy
- d Hospital Universitario de Bellvitge , Barcelona , Spain
| | - G M Mateo
- e Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - A Curran
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain
| | - J Gatell
- c Hospital Clínic/IDIBAPS , University of Barcelona , Barcelona , Spain
| | - E Ribera
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain
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Wang Q, Liu J, Ding H, Geng W, Xu J, Guo X, Sun A, Kang J, Li X, Li Y, Jiang Y, Shang H. Reduced bone mineral density among ART-naive male patients with HIV in China. Future Virol 2015. [DOI: 10.2217/fvl.15.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: To evaluate the prevalence and associated factors of reduced bone mineral density (BMD) among antiretroviral therapy (ART) naive HIV-infected male patients in China. Methods: We compared BMD between HIV-infected male patients and healthy controls. Risk factors of reduced BMD were studied using multivariable linear regression. Results: Reduced BMD rate of chronic HIV infection patients was higher. HIV infection was independently associated with decreased BMD after adjusting for demographic factors. Older age, lower BMI and men who have sex with men (MSM) were revealed as the risk factors of lower BMD in HIV-infected male patients. Conclusion: Reduced BMD rate of HIV-infected patients was high. Policies are needed for prevention and treatment.
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Affiliation(s)
- Qi Wang
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Liu
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaolin Guo
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Amy Sun
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Kang
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaolin Li
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Yushu Li
- Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology & Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, P. R. China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health & Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P. R. China
- Collaborative Innovation Center for Diagnosis & Treatment of Infectious Diseases, Hangzhou, China
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Tenofovir: What We Have Learnt After 7.5 Million Person-Years of Use. Infect Dis Ther 2015; 4:145-57. [PMID: 26032649 PMCID: PMC4471058 DOI: 10.1007/s40121-015-0070-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Indexed: 01/09/2023] Open
Abstract
Tenofovir was licensed for use in patients with HIV in 2001 and since then has become a firmly established anti-retroviral in both guidelines and routine practice. Data have been presented from many pivotal studies—informing on its efficacy, use, and adverse features—and there are also over 7.5 million patient-years of experience to date. We explore the data on this nucleotide reverse transcriptase inhibitor in HIV presented since 2008—focusing on efficacy, side effects, and utility.
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Mulligan K, Glidden DV, Anderson PL, Liu A, McMahan V, Gonzales P, Ramirez-Cardich ME, Namwongprom S, Chodacki P, de Mendonca LMC, Wang F, Lama JR, Chariyalertsak S, Guanira JV, Buchbinder S, Bekker LG, Schechter M, Veloso VG, Grant RM. Effects of Emtricitabine/Tenofovir on Bone Mineral Density in HIV-Negative Persons in a Randomized, Double-Blind, Placebo-Controlled Trial. Clin Infect Dis 2015; 61:572-80. [PMID: 25908682 DOI: 10.1093/cid/civ324] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/09/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Daily preexposure prophylaxis (PrEP) with oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) decreases the risk of human immunodeficiency virus (HIV) acquisition. Initiation of TDF decreases bone mineral density (BMD) in HIV-infected people. We report the effect of FTC/TDF on BMD in HIV-seronegative men who have sex with men and in transgender women. METHODS Dual-energy X-ray absorptiometry was performed at baseline and 24-week intervals in a substudy of iPrEx, a randomized, double-blind, placebo-controlled trial of FTC/TDF PrEP. Plasma and intracellular tenofovir concentrations were measured in participants randomized to FTC/TDF. RESULTS In 498 participants (247 FTC/TDF, 251 placebo), BMD in those randomized to FTC/TDF decreased modestly but statistically significantly by 24 weeks in the spine (net difference, -0.91% [95% confidence interval {CI}, -1.44% to -.38%]; P = .001) and hip (-0.61% [95% CI, -.96% to -.27%], P = .001). Changes within each subsequent 24-week interval were not statistically significant. Changes in BMD by week 24 correlated inversely with intracellular tenofovir diphosphate (TFV-DP), which was detected in 53% of those randomized to FTC/TDF. Net BMD loss by week 24 in participants with TFV-DP levels indicative of consistent dosing averaged -1.42% ± 29% and -0.85% ± 19% in the spine and hip, respectively (P < .001 vs placebo). Spine BMD tended to rebound following discontinuation of FTC/TDF. There were no differences in fractures (P = .62) or incidence of low BMD. CONCLUSIONS In HIV-uninfected persons, FTC/TDF PrEP was associated with small but statistically significant decreases in BMD by week 24 that inversely correlated with TFV-DP, with more stable BMD thereafter. CLINICAL TRIALS REGISTRATION NCT00458393.
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Affiliation(s)
| | | | | | - Albert Liu
- University of California, San Francisco Bridge HIV, San Francisco Department of Public Health, California
| | - Vanessa McMahan
- Gladstone Institute of Virology and Immunology, San Francisco, California
| | | | | | | | - Piotr Chodacki
- Desmond Tutu HIV Centre and Department of Medicine, University of Cape Town, South Africa
| | | | | | - Javier R Lama
- Asociacion Civil Impacta Salud y Education, Lima, Peru
| | - Suwat Chariyalertsak
- Chiang Mai University, Thailand Research Institute for Health Sciences, Chiang Mai, Thailand
| | | | - Susan Buchbinder
- University of California, San Francisco Bridge HIV, San Francisco Department of Public Health, California
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre and Department of Medicine, University of Cape Town, South Africa
| | - Mauro Schechter
- Federal University of Rio de Janeiro, Brazil Projeto Praca Onze, Hospital Escola Sao Francisco de Assis
| | - Valdilea G Veloso
- Instituto de Pesquisa Clinica Evandro Chagas-Fundaçao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Robert M Grant
- University of California, San Francisco Gladstone Institute of Virology and Immunology, San Francisco, California
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