1
|
Trøseid M, Molinaro A, Gelpi M, Vestad B, Kofoed KF, Fuchs A, Køber L, Holm K, Benfield T, Ueland PM, Hov JR, Nielsen SD, Knudsen AD. Gut Microbiota Alterations and Circulating Imidazole Propionate Levels Are Associated With Obstructive Coronary Artery Disease in People With HIV. J Infect Dis 2024; 229:898-907. [PMID: 38195204 PMCID: PMC10938217 DOI: 10.1093/infdis/jiad604] [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: 09/28/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The impact of gut microbiota and its metabolites on coronary artery disease (CAD) in people with human immunodeficiency virus (PWH) is unknown. Emerging evidence suggests that imidazole propionate (ImP), a microbial metabolite, is linked with cardiometabolic diseases. METHODS Fecal samples from participants of the Copenhagen Comorbidity in HIV infection (COCOMO) study were processed for 16S rRNA sequencing and ImP measured with liquid chromatography-tandem mass spectrometry. CAD severity was investigated by coronary computed tomography-angiography, and participants grouped according to obstructive CAD (n = 60), nonobstructive CAD (n = 80), or no CAD (n = 114). RESULTS Participants with obstructive CAD had a gut microbiota with lower diversity and distinct compositional shift, with increased abundance of Rumiococcus gnavus and Veillonella, known producers of ImP. ImP plasma levels were associated with this dysbiosis, and significantly elevated in participants with obstructive CAD. However, gut dysbiosis but not plasma ImP was independently associated with obstructive CAD after adjustment for traditional and HIV-related risk factors (adjusted odds ratio, 2.7; 95% confidence interval, 1.1-7.2; P = .048). CONCLUSIONS PWH with obstructive CAD displays a distinct gut microbiota profile and increased circulating ImP plasma levels. Future studies should determine whether gut dysbiosis and related metabolites such as ImP are predictive of incident cardiovascular events.
Collapse
Affiliation(s)
- Marius Trøseid
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Antonio Molinaro
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Marco Gelpi
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Beate Vestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark
| | | | - Johannes R Hov
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Qiao NN, Fang Q, Zhang XH, Ke SS, Wang ZW, Tang G, Leng RX, Fan YG. Effects of alcohol on the composition and metabolism of the intestinal microbiota among people with HIV: a cross-sectional study. Alcohol 2024:S0741-8329(24)00019-3. [PMID: 38387693 DOI: 10.1016/j.alcohol.2024.02.003] [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: 10/07/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Alcohol consumption is not uncommon among people with HIV (PWH) and may exacerbate HIV-induced intestinal damage, and further lead to dysbiosis and increased intestinal permeability. This study aimed to determine the changes in the faecal microbiota and its association with alcohol consumption in HIV-infected patients. METHODS A cross-sectional survey was conducted between November 2021 and May 2022, and 93 participants were recruited. To investigate the alterations of alcohol misuse on fecal microbiology in HIV-infected individuals, we performed 16s rDNA gene sequencing on fecal samples from the low to moderate drinking (n=21) and non-drinking (n=72) groups. RESULTS Comparison between groups using alpha and beta diversity showed that the diversity of stool microbiota in the low to moderate drinkinge group did not differ from that of the non-drinking group (all P>0.05). The Linear discriminant Analysis effect size (LEfSe) algorithm was to determine the bacterial taxa associated with alcohol consumption, and the results showed altered fecal bacterial composition in HIV-infected patients who consumed alcohol, with Coprobacillus, Pseudobutyrivibrio and Peptostreptococcaceae enriched, and Pasteurellaceae and Xanthomonadaceae were depleted. In addition, by using the Kyoto Encyclopedia of Genes and Genomes (KEGG) functional microbiome features were also found to be altered in the low to moderate drinking group, showing a reduction in metabolic pathways (P=0.036) and cardiovascular disease pathway (P=0.006). CONCLUSION Low to moderate drinking will change the composition, metabolism and cardiovascular disease pathway of the gut microbiota of HIV-infected patients.
Collapse
Affiliation(s)
- Ni-Ni Qiao
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Quan Fang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Xin-Hong Zhang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Su-Su Ke
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Zi-Wei Wang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Gan Tang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Rui-Xue Leng
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China.
| | - Yin-Guang Fan
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China.
| |
Collapse
|
3
|
Li B, Lin X, Chen S, Qian Z, Wu H, Liao G, Chen H, Kang Z, Peng J, Liang G. The association between fear of progression and medical coping strategies among people living with HIV: a cross-sectional study. BMC Public Health 2024; 24:440. [PMID: 38347483 PMCID: PMC10860317 DOI: 10.1186/s12889-024-17969-1] [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: 06/07/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Due to the chronic nature of HIV, mental health has become a critical concern in people living with HIV (PLWHIV). However, little knowledge exists about the association between fear of progression (FoP) and medical coping modes (MCMs) in PLWHIV in China. METHODS A cohort of 303 PLWHIV were consecutively enrolled and their demographic, clinical and psychological information was collected. The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS), Internalized HIV Stigma Scale (IHSS) and MCMs Questionnaire were utilized. RESULTS Of the participants, 215 PLWHIV were classified into the low-level FoP group, and 88 were grouped into the high-level FoP group based on their FoP-Q-SF scores, according to the criteria for the classification of dysfunctional FoP in cancer patients. The high-level group had a higher proportion of acquired immunodeficiency syndrome (AIDS) stage (P = 0.005), lower education levels (P = 0.027) and lower income levels (P = 0.031). Additionally, the high-level group had lower scores in social support (P < 0.001) and its three dimensions, with total SSRS scores showing a negative correlation with two dimensions of FoP-Q-SF, namely physical health (r2 = 0.0409, P < 0.001) and social family (r2 = 0.0422, P < 0.001). Further, the high-level group had higher scores in four dimensions of internalized HIV stigma, and a positive relationship was found to exist between IHSS scores and FoP-Q-SF scores for physical health (r2 = 0.0960, P < 0.001) and social family (r2 = 0.0719, P < 0.001). Social support (OR = 0.929, P = 0.001), being at the AIDS stage (OR = 3.795, P = 0.001), and internalized HIV stigma (OR = 1.028, P < 0.001) were independent factors for FoP. Furthermore, intended MCMs were evaluated. FoP were positively correlated with avoidance scores (r2 = 0.0886, P < 0.001) and was validated as the only factor for the mode of confrontation (OR = 0.944, P = 0.001) and avoidance (OR = 1.059, P = 0.001) in multivariate analysis. CONCLUSION The incidence of dysfunctional FoP in our study population was relatively high. High-level FoP was associated with poor social support, high-level internalized HIV stigma and a negative MCM among PLWHIV.
Collapse
Affiliation(s)
- Bing Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaoli Lin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Suling Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhe Qian
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Houji Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guichan Liao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zixin Kang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Guangyu Liang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
4
|
Ng RQM, Yip KF, Teh YE. An overview of neurocognitive impairment in older people living with HIV. PROCEEDINGS OF SINGAPORE HEALTHCARE 2023. [DOI: 10.1177/20101058231160605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Background With improved survival among People Living with HIV (PLHIV), many are confronted with age associated comorbidities and geriatric syndromes. Neurocognitive impairment is one of the three most frequent conditions that affects quality of life of PLHIV despite achieving viral suppression. Healthcare providers face challenges in early identification of neurocognitive impairment, performing comprehensive assessment and managing older PLHIV. Objectives This paper aims to review available evidence regarding aetiology and management of older PLHIV who develop neurocognitive impairment, suggest improvements on current management and postulate future study direction. Methods A PubMed search for original articles and Clinical Guidelines was conducted from September 2021 to August 2022 using a combination of keywords related to neurocognitive impairment in PLHIV. The citations from all selected articles were reviewed for additional studies. Results Older PLHIV tend to be frailer than their uninfected counterparts, are plagued with multi-morbidity and are at increased risk of cognitive impairment. The aetiologies for neurocognitive impairment are multifactorial, multi-dimensional and complex. The management of neurocognitive impairment in older PLHIV involves identifying and optimizing predisposing factors, physical function, social and psychological health with appropriate care navigation. Conclusion Identification and management of neurocognitive impairment in older PLHIV through interdisciplinary collaboration among stakeholders is important. This exemplifies an integrated model of care for older PLHIV and promotes the notion of living well beyond viral suppression.
Collapse
Affiliation(s)
- Rachel QM Ng
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | - KF Yip
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | - YE Teh
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
5
|
Jacobsen MHB, Knudsen AD, Benfield T, Ostrowski SR, Afzal S, Sørensen EW, Nielsen SD, Gelpi M. Metabolic syndrome, soluble CD40L, and biomarkers of endothelial dysfunction in people living with HIV. APMIS 2023; 131:705-709. [PMID: 37849049 DOI: 10.1111/apm.13354] [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: 06/29/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
In the present study, we aimed to investigate the association between soluble CD40 ligand (sCD40L, a marker of platelet activation), soluble thrombomodulin, and syndecan-1 (both well-described markers of endothelial dysfunction) and metabolic syndrome in a large cohort of well-treated people with HIV (PWH) and to elucidate their association with HIV-specific variables. We included 862 PWH with undetectable viral replication. Our hypotheses were tested using uni- and multivariable logistic regression models a priori adjusted for well-known confounders. While no association of soluble thrombomodulin and syndecan-1 with MetS was found, high levels of sCD40L (aOR 1.54 [1.07-2.22]) were associated with excess risk of MetS. Given the previously described association between sCD40L, vascular inflammation and endothelial damage, the results presented in our study may suggest a potential role for sCD40L in the well-known association between cardiometabolic comorbidity and HIV infection.
Collapse
Affiliation(s)
- Mads-Holger B Jacobsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas D Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Edith W Sørensen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marco Gelpi
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Falutz J, Lee D. Frailty and cognition in older people with HIV: recognizing the importance of geriatric syndromes. AIDS 2023; 37:2247-2249. [PMID: 37877280 DOI: 10.1097/qad.0000000000003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Julian Falutz
- Division of Geriatrics and Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
| | - Daniel Lee
- Division of Infectious Diseases & Global Public Health, University of California, San Diego Health, San Diego, California, USA
| |
Collapse
|
7
|
Lee D. The importance of exercise and physical activity in older adults with HIV. AIDS 2023; 37:1905-1907. [PMID: 37646590 DOI: 10.1097/qad.0000000000003664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Daniel Lee
- Division of Infectious Diseases & Global Public Health, University of California
- Owen Clinic, University of California, San Diego Health System, San Diego, California, USA
| |
Collapse
|
8
|
Slama L, Hardy WD, Quiñones-Mateu ME, Kuritzkes DR. Alternative options for treatment-experienced people with HIV. AIDS 2023; 37:1165-1166. [PMID: 37139652 DOI: 10.1097/qad.0000000000003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Laurence Slama
- Department of Infectious Diseases, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - W David Hardy
- Division of Infectious Diseases, Los Angeles County-University of Southern California Medical Center and Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Miguel E Quiñones-Mateu
- Department of Pathology & Laboratory Medicine, Schulich Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Clemente T, Caccia R, Galli L, Galli A, Poli A, Marchetti GC, Bandera A, Zazzi M, Santoro MM, Cinque P, Castagna A, Spagnuolo V. Inflammation burden score in multidrug-resistant HIV-1 infection. J Infect 2023; 86:453-461. [PMID: 36913985 DOI: 10.1016/j.jinf.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 12/22/2022] [Accepted: 03/09/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES Four-class drug-resistant (4DR) people living with HIV (PLWH) are a fragile population with a high burden of disease. No data on their inflammation and T-cell exhaustion markers are currently available. METHODS Inflammation, immune activation and microbial translocation biomarkers were measured through ELISA in 30 4DR-PLWH with HIV-1 RNA ≥ 50 copies/mL, 30 non-viremic 4DR-PLWH and 20 non-viremic non-4DR-PLWH. Groups were matched by age, gender and smoking habit. T-cell activation and exhaustion markers were assessed by flow cytometry in 4DR-PLWH. An inflammation burden score (IBS) was calculated from soluble marker levels and associated factors were estimated through multivariate regression. RESULTS The highest plasma biomarker concentrations were observed in viremic 4DR-PLWH, the lowest ones in non-4DR-PLWH. Endotoxin core immunoglobulin G showed an opposite trend. Among 4DR-PLWH, CD38/HLA-DR and PD-1 were more expressed on CD4+ (p = 0.019 and 0.034, respectively) and CD8+ (p = 0.002 and 0.032, respectively) cells of viremic compared to non-viremic subjects. An increased IBS was significantly associated with 4DR condition, higher values of viral load and a previous cancer diagnosis. CONCLUSIONS Multidrug-resistant HIV infection is associated with a higher IBS, even when viremia is undetectable. Therapeutic approaches aimed to reduce inflammation and T-cell exhaustion in 4DR-PLWH need to be investigated.
Collapse
Affiliation(s)
- Tommaso Clemente
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Roberta Caccia
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Andrea Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Andrea Poli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | | | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy.
| | | | - Paola Cinque
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella Castagna
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
10
|
Differential Impact of IL-32 Isoforms on the Functions of Coronary Artery Endothelial Cells: A Potential Link with Arterial Stiffness and Atherosclerosis. Viruses 2023; 15:v15030700. [PMID: 36992409 PMCID: PMC10052544 DOI: 10.3390/v15030700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
Chronic inflammation is associated with higher risk of cardiovascular disease (CVD) in people living with HIV (PLWH). We have previously shown that interleukin-32 (IL-32), a multi-isoform proinflammatory cytokine, is chronically upregulated in PLWH and is linked with CVD. However, the mechanistic role of the different IL-32 isoforms in CVD are yet to be identified. In this study, we aimed to investigate the potential impact of IL-32 isoforms on coronary artery endothelial cells (CAEC), whose dysfunction represents a major factor for atherosclerosis. Our results demonstrated that the predominantly expressed IL-32 isoforms (IL-32β and IL-32γ) have a selective impact on the production of the proinflammatory cytokine IL-6 by CAEC. Furthermore, these two isoforms induced endothelial cell dysfunction by upregulating the expression of the adhesion molecules ICAM-I and VCAM-I and the chemoattractants CCL-2, CXCL-8 and CXCL-1. IL-32-mediated expression of these chemokines was sufficient to drive monocyte transmigration in vitro. Finally, we demonstrate that IL-32 expression in both PLWH and controls correlates with the carotid artery stiffness, measured by the cumulated lateral translation. These results suggest a role for IL-32-mediated endothelial cell dysfunction in dysregulation of the blood vessel wall and that IL-32 may represent a therapeutic target to prevent CVD in PLWH.
Collapse
|
11
|
Wang NC, Chen HW, Lin TY. Association of protein disulfide isomerase family A, member 4, and inflammation in people living with HIV. Int J Infect Dis 2023; 126:79-86. [PMID: 36375691 DOI: 10.1016/j.ijid.2022.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Protein disulfide isomerase (PDI) family members are specific endoplasmic reticulum proteins associated with inflammation, obesity, and cancer. In HIV infection, the role of PDI family A, member 4 (PDIA4), is unclear. This study aimed to clarify the association between plasma PDIA4 levels and inflammation in people living with HIV (PLWH). METHODS In this study, 287 PLWH and 74 healthy participants were enrolled. The plasma PDIA4 values, demographic data, laboratory data, and other inflammatory markers were recorded. The association between PDIA4 level and inflammatory extent was analyzed using logistic regression and Spearman rank-order correlations. Other results were analyzed using Student's t-test or chi-square test. RESULTS In PLWH, the PDIA4 levels were positively associated with the inflammatory markers, interleukin 6 (r = 0.209, p = 0.001), and tumor necrosis factor-α (r = 0.162, p = 0.01) levels, but not with high-sensitivity C-reactive protein levels. Moreover, the plasma PDIA4 level of PLWH decreased after anti-viral treatment (p = 0.0001). CONCLUSION Plasma PDIA4 levels are closely associated with inflammation in PLWH and have a positive correlation with the viral load during anti-viral therapy.
Collapse
Affiliation(s)
- Ning-Chi Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Wei Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Yu Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
12
|
Marcantoni E, Garshick MS, Schwartz T, Ratnapala N, Cambria M, Dann R, O’Brien M, Heguy A, Berger JS. Antiplatelet Effects of Clopidogrel Vs Aspirin in Virologically Controlled HIV: A Randomized Controlled Trial. JACC Basic Transl Sci 2022; 7:1086-1097. [PMID: 36687270 PMCID: PMC9849466 DOI: 10.1016/j.jacbts.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Patients with HIV exhibit platelet activation and increased risk of cardiovascular disease, the prevention of which is not fully known. Fifty-five HIV-positive patients were randomized to clopidogrel, aspirin, or no-treatment for 14 days, and the platelet phenotype and ability to induce endothelial inflammation assessed. Clopidogrel as opposed to aspirin and no-treatment reduced platelet activation (P-selectin and PAC-1 expression). Compared with baseline, platelet-induced proinflammatory transcript expression of cultured endothelial cells were reduced in those assigned to clopidogrel, with no change in the aspirin and no-treatment arms. In HIV, clinical trials of clopidogrel to prevent cardiovascular disease are warranted. (Antiplatelet Therapy in HIV; NCT02559414).
Collapse
Affiliation(s)
- Emanuela Marcantoni
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Michael S. Garshick
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Tamar Schwartz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Nicole Ratnapala
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Matthew Cambria
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA
| | - Rebecca Dann
- New York Medical College, Valhalla, New York, USA
| | - Meagan O’Brien
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Adriana Heguy
- Genome Technology Center, New York University School of Medicine, New York, New York, USA
| | - Jeffrey S. Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA,Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA,Address for correspondence: Dr Jeffrey S. Berger, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 435 East 30th Street, 7th Floor, New York, New York 10016, USA. @plateletdoc
| |
Collapse
|
13
|
Ward AR, Thomas AS, Stevenson EM, Huang SH, Keating SM, Gandhi RT, McMahon DK, Bosch RJ, Macatangay BJ, Cyktor JC, Eron JJ, Mellors JW, Jones RB. No evidence that circulating HIV-specific immune responses contribute to persistent inflammation and immune activation in persons on long-term ART. AIDS 2022; 36:1617-1628. [PMID: 35730388 PMCID: PMC9444951 DOI: 10.1097/qad.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE People with HIV (PWH) have persistently elevated levels of inflammation and immune activation despite suppressive antiretroviral therapy (ART), with specific biomarkers showing associations with non-AIDS-defining morbidities and mortality. We investigated the potential role of the HIV-specific adaptive immune response, which also persists under ART, in driving levels of these clinically relevant biomarkers. DESIGN Cohort-based study. METHODS HIV-specific IFN-γ-producing T-cell responses and antibody concentrations were measured in blood at study entry in the ACTG A5321 cohort, following a median of 7 years of suppressive ART. HIV persistence measures including cell-associated (CA)-DNA, CA-RNA, and plasma HIV RNA (single-copy assay) were also assessed at study entry. Plasma inflammatory biomarkers and T-cell activation and cycling were measured at a pre-ART time point and at study entry. RESULTS Neither the magnitudes of HIV-specific T-cell responses nor HIV antibody levels were correlated with levels of the inflammatory or immune activation biomarkers, including hs-CRP, IL-6, neopterin, sCD14, sCD163, TNF-α, %CD38 + HLA-DR + CD8 + and CD4 + cells, and %Ki67 + CD8 + and CD4 + cells - including after adjustment for pre-ART biomarker level. Plasma HIV RNA levels were modestly correlated with CD8 + T-cell activation ( r = 0.25, P = 0.027), but other HIV persistence parameters were not associated with these biomarkers. In mediation analysis, relationships between HIV persistence parameters and inflammatory biomarkers were not influenced by either HIV-specific T-cell responses or antibody levels. CONCLUSION Adaptive HIV-specific immune responses do not appear to contribute to the elevated inflammatory and immune activation profile in persons on long-term ART.
Collapse
Affiliation(s)
- Adam R. Ward
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC USA
- PhD Program in Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Allison S. Thomas
- Department of Microbiology, Boston University School of Medicine, Boston, MA USA
| | - Eva M. Stevenson
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Szu-Han Huang
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC USA
| | - Sheila M. Keating
- GigaGen, Inc., San Francisco, CA USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA USA
| | - Rajesh T. Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA USA
| | - Deborah K. McMahon
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Ronald J. Bosch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Bernard J. Macatangay
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Joshua C. Cyktor
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Joseph J. Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John W. Mellors
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - R. Brad Jones
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC USA
| | | |
Collapse
|
14
|
Ruiz GO, Herrera CFL, Bohórquez JAM, Betancur JE. Mortality in patients with acquired human immunodeficiency virus infection hospitalized in an intensive care unit during the period 2017-2019. Sci Rep 2022; 12:15644. [PMID: 36123430 PMCID: PMC9483872 DOI: 10.1038/s41598-022-19904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Identify risk factors associated with mortality in HIV patients admitted to an ICU in the city of Bogotá. Retrospective cohort study of patients treated in an ICU during the years 2017–2019. The analysis included descriptive statistics, association tests, and a logistic regression model. A predictive model of mortality at the time of admission to the ICU was developed. 110 HIV patients were identified. Association was found between a Charlson index ≥ 6 and mortality (OR = 2.3, 95% CI 1.0–5.1) and an increase in mortality in the first 21 days of ICU stay (OR = 2.2, 95% CI 1.0–4.9). In the logistic regression analysis, the absence of highly active antiretroviral therapy (HAART) upon admission to the ICU (OR = 2.5 95% CI 1.0–6.1) and the first 21 days of ICU stay (OR = 2.3 95% CI 1.0–5.4) were associated with an increase in mortality. The predictive mortality model established that mortality was higher in patients admitted to the ICU without having previously received HAART than in those who did receive therapy at the time of admission to the ICU. In patients with HIV admitted to the ICU, the absence of HAART will negatively impact mortality during their hospital stay.
Collapse
Affiliation(s)
- Guillermo Ortiz Ruiz
- Critical Medicine and Intensive Care and Pulmonology, Universidad del Bosque, Bogotá, Colombia.,National Academy of Medicine, Hospital Santa Clara, Bogotá, Colombia
| | | | | | | |
Collapse
|
15
|
Serrano-Villar S, Wu K, Hunt PW, Lok JJ, Ron R, Sainz T, Moreno S, Deeks SG, Bosch RJ. Predictive value of CD8+ T cell and CD4/CD8 ratio at two years of successful ART in the risk of AIDS and non-AIDS events. EBioMedicine 2022; 80:104072. [PMID: 35644125 PMCID: PMC9156990 DOI: 10.1016/j.ebiom.2022.104072] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While increased CD8 counts and low CD4/CD8 ratio during treated HIV correlate with immunosenescence, their additional predictive values to identify individuals with HIV at higher risk of clinical events remain controversial. METHODS We selected treatment-naive individuals initiating ART from ACTG studies 384, 388, A5095, A5142, A5202, and A5257 who had achieved viral suppression at year 2. We examined the effect of CD8+ T cell counts and CD4/CD8 at year 2 on the probability of AIDS and serious non-AIDS events in years 3-7. We used inverse probability weighting methods to address informative censoring, combined with multivariable logistic regression models. FINDINGS We analyzed 5133 participants with a median age of 38 years; 959 (19%) were female, pre-ART median CD4 counts were 249 (Q1-Q3 91-372) cell/µL. Compared to participants with CD8 counts between 500/µL and 1499/µL, those with >1500/µL had a higher risk of clinical events during years 3-7 (aOR 1.75; 95%CI 1.33-2.32). CD4/CD8 ratio was not predictive of greater risk of events through year 7. Additional analyses revealed consistent CD8 count effect sizes for the risk of AIDS events and noninfectious non-AIDS events, but opposite effects for the risk of severe infections, which were more frequent among individuals with CD8 counts <500/µL (aOR 1.70; 95%CI 1.09-2.65). INTERPRETATION The results of this analysis with pooled data from clinical trials support the value of the CD8 count as a predictor of clinical progression. People with very high CD8 counts during suppressive ART might benefit from closer monitoring and may be a target population for novel interventions. FUNDING This research was supported by NIH/NIAID awards UM1 AI068634, UM1 AI068636, and UM1 AI106701 and Carlos III Health Institute and FEDER funds (BA21/00017 and BA21/00022).
Collapse
Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; San Francisco General Hospital, San Francisco, CA, USA.
| | - Kunling Wu
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter W Hunt
- San Francisco General Hospital, San Francisco, CA, USA
| | | | - Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | - Talía Sainz
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
16
|
Tedaldi E, Armon C, Li J, Mahnken J, Simoncini G, Palella F, Carlson K, Buchacz K. A Heavy Burden: Preexisting Physical and Psychiatric Comorbidities and Differential Increases Among Male and Female Participants After Initiating Antiretroviral Therapy in the HIV Outpatient Study, 2008-2018. AIDS Res Hum Retroviruses 2022; 38:519-529. [PMID: 35451335 DOI: 10.1089/aid.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 2008-2018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates, including insurance type, CD4+ cell count, ART regimen, and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/mm3), 79% were male, 66% non-white, 44% publicly insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥30 kg/m2. Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads (VL) were associated with most physical comorbidities, and being a current/former smoker and higher VL were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment.
Collapse
Affiliation(s)
- Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Jun Li
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Gina Simoncini
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Frank Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kate Buchacz
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
17
|
Knudsen AD, Bouazzi R, Afzal S, Gelpi M, Benfield T, Høgh J, Thomsen MT, Trøseid M, Nordestgaard BG, Nielsen SD. Monocyte count and soluble markers of monocyte activation in people living with HIV and uninfected controls. BMC Infect Dis 2022; 22:451. [PMID: 35546661 PMCID: PMC9097376 DOI: 10.1186/s12879-022-07450-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Monocytes play an important role in inflammation, and monocytosis and monocyte activation are features of chronic inflammation. We aimed to investigate if HIV status was associated with monocyte count and monocyte activation and to assess the relationship between monocyte count and monocyte activation markers and HIV-related factors. Methods Persons living with HIV (PLWH) with measured monocyte count and sCD14 and sCD163 were included from the Copenhagen Comorbidity in HIV infection (COCOMO) study and matched 1:5 on sex and age with uninfected controls. In addition, 74 uninfected individuals from COCOMO with measured sCD14 and sCD163 were included. Identical protocols and equipment were used to determine monocyte counts and monocyte activation in PLWH and uninfected controls. Linear regression adjusted for age, sex, smoking and waist-to-hip-ratio was used to analyze the association between possible risk factors and monocyte outcomes. Results We included 871 PLWH and 4355 uninfected controls. PLWH had − 0.021 [− 0.031 − 0.011] × 109/L) lower monocyte count than uninfected controls, and in adjusted analyses HIV status was independently associated with − 0.035 [− 0.045, − 0.025] × 109/L lower monocyte count. In contrast, PLWH had higher sCD163 and sCD14 concentrations than uninfected controls. After adjustment, HIV-status was associated with higher sCD14 and sCD163 concentrations (588 [325, 851] ng/ml, and 194 [57, 330] ng/ml, respectively). Conclusion PLWH had lower monocyte counts than controls, but the absolute difference was small, and any clinical impact is likely limited. In contrast, concentrations of monocyte activation markers, previously implicated as drivers of non-AIDS comorbidity, were higher in PLWH than in controls. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07450-y.
Collapse
Affiliation(s)
- Andreas D Knudsen
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark.,Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Randa Bouazzi
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark
| | - Shoaib Afzal
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Marco Gelpi
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Julie Høgh
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark
| | - Magda Teresa Thomsen
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark
| | - Marius Trøseid
- Section of Clinical Immunology and Infectious Disease, Oslo University Hospital, Oslo, Norway
| | - Børge G Nordestgaard
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Susanne D Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark.
| |
Collapse
|
18
|
Serrano-Villar S, López-Huertas MR, Jiménez D, Galera C, Martínez-Sanz J, Moreno E, Muriel A, Gutiérrez F, Busca C, Portilla J, Bisbal O, Iribarren JA, Tejerina F, de Los Santos I, Moreno S. Long-Term Changes of Inflammatory Biomarkers in Individuals on Suppressive Three-Drug or Two-Drug Antiretroviral Regimens. Front Immunol 2022; 13:848630. [PMID: 35359950 PMCID: PMC8964183 DOI: 10.3389/fimmu.2022.848630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Because inflammation is associated with mortality and has been linked to HIV transcription in lymphoid tissues during ART, it is necessary to address the long-term effects of switching 3-drug (3DR) to 2-drug regimens (2DR) on inflammation. Methods Nested study in the Spanish AIDS Research Network. We selected PWH ART-naive initiating 3DR who achieved viral suppression in the first 48 weeks and either remained on 3DR or switched to 2DR (3TC+bPI; 3TC+DTG; DTG+RPV). We assessed the trajectories on inflammatory markers during ART using multivariate piecewise mixed models. Results We analyzed 619 plasma samples from 148 patients (3DR, N=90; 2DR, N=58), the median follow-up was 4.6 (IQR 3.2-6.2) years. There were no significant differences in baseline characteristics between groups. After adjusting for potential confounders, patients with 3DR experienced a slow decline of IL6, hs-CRP, sCD14, sCD163, and D-dimer over time. In contrast, compared to 3DR, switching to 2DR was associated with increases in IL-6 (p=0.001), hs-CRP (p=0.003), and D-dimer (p=0.001) after year 3 from virologic suppression. 2DR was associated with a higher risk of hs-CRP quartile increase (aOR 3.3, 95%CI 1.1-10) and D-dimer quartile increase (aOR 3.7, 95%CI 1.1-13). The adjusted biomarker trajectories did not reveal a distinct pattern according to the type of 2DR used (bPI vs DTG). Conclusions In this study in virally suppressed individuals, maintaining 3DR was associated with a more favorable long-term inflammatory profile than switching to 2DR. The potential clinical implications of these findings on the development of non-AIDS events deserve further investigation.
Collapse
Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Daniel Jiménez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Galera
- HIV Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Gutiérrez
- CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain.,Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Carmen Busca
- CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain.,HIV Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Joaquín Portilla
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain
| | - Otilia Bisbal
- HIV Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
19
|
Gruevska A, Moragrega ÁB, Galindo MJ, Esplugues JV, Blas-García A, Apostolova N. Down-Regulation of the Longevity-Associated Protein SIRT1 in Peripheral Blood Mononuclear Cells of Treated HIV Patients. Cells 2022; 11:cells11030348. [PMID: 35159154 PMCID: PMC8834054 DOI: 10.3390/cells11030348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
The activity of sirtuin 1 (SIRT1), a class III histone deacetylase with a critical role in several biological functions, decreases with age and its deficiency is associated with many inflammatory and age-related diseases. It also regulates the chronic immune activation and viral latency during an HIV infection. The life-span and particularly the health span of HIV patients are substantially shortened; however, the participation of SIRT1 in these effects is not clear. We performed a prospective cross-sectional monocentric study that included 70 HIV-infected patients and 43 BMI-, age- and sex-matched uninfected individuals. We found that in the PBMCs of the HIV patients, SIRT1 mRNA levels were significantly lower (p < 0.0001). This decrease, which was corroborated at the protein level, occurred irrespectively of the antiretroviral regimen these patients received and was not significantly related to the general, HIV-related or comorbidity-related parameters. The levels of the major mitochondrial sirtuin SIRT3 were not altered. Moreover, the strong correlations of SIRT1 with the leukocyte markers CD8A and CD19 present in the uninfected individuals were absent in the HIV patients. In conclusion, this study showed that the PBMCs of the HIV patients displayed diminished SIRT1 levels and altered correlations of SIRT1 with markers of CD8+ T cells and B cells, findings which may be relevant for understanding the complex pathogenic milieu in HIV patients.
Collapse
Affiliation(s)
- Aleksandra Gruevska
- Departamento de Farmacología, Universidad de Valencia, 46010 Valencia, Spain; (A.G.); (Á.B.M.); (J.V.E.)
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain;
| | - Ángela B. Moragrega
- Departamento de Farmacología, Universidad de Valencia, 46010 Valencia, Spain; (A.G.); (Á.B.M.); (J.V.E.)
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain;
| | - María J. Galindo
- Unidad de Enfermedades Infecciosas—Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Juan V. Esplugues
- Departamento de Farmacología, Universidad de Valencia, 46010 Valencia, Spain; (A.G.); (Á.B.M.); (J.V.E.)
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
| | - Ana Blas-García
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
- Departamento de Fisiología, Universidad de Valencia, 46010 Valencia, Spain
| | - Nadezda Apostolova
- Departamento de Farmacología, Universidad de Valencia, 46010 Valencia, Spain; (A.G.); (Á.B.M.); (J.V.E.)
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-96-3983767; Fax: +34-96-3983879
| |
Collapse
|
20
|
Agus A, Agus S, Suka A. Interleukin-15 is a significant predictor of sarcopenia in human immunodeficiency virus infected patients on antiretroviral therapy: A cross-sectional study. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.354418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
Ishizaka A, Koga M, Mizutani T, Parbie PK, Prawisuda D, Yusa N, Sedohara A, Kikuchi T, Ikeuchi K, Adachi E, Koibuchi T, Furukawa Y, Tojo A, Imoto S, Suzuki Y, Tsutsumi T, Kiyono H, Matano T, Yotsuyanagi H. Unique Gut Microbiome in HIV Patients on Antiretroviral Therapy (ART) Suggests Association with Chronic Inflammation. Microbiol Spectr 2021; 9:e0070821. [PMID: 34378948 PMCID: PMC8552706 DOI: 10.1128/spectrum.00708-21] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic inflammation is a hallmark of human immunodeficiency virus (HIV) infection and a risk factor for the development and progression of age-related comorbidities. Although HIV-associated gut dysbiosis has been suggested to be involved in sustained chronic inflammation, there remains a limited understanding of the association between gut dysbiosis and chronic inflammation during HIV infection. Here, we investigated compositional changes in the gut microbiome and its role in chronic inflammation in patients infected with HIV. We observed that the gut microbiomes of patients with low CD4 counts had reduced alpha diversity compared to those in uninfected controls. Following CD4 recovery, alpha diversity was restored, but intergroup dissimilarity of bacterial composition remained unchanged between patients and uninfected controls. Patients with HIV had higher abundance of the classes Negativicutes, Bacilli, and Coriobacteriia, as well as depletion of the class Clostridia. These relative abundances positively correlated with inflammatory cytokines and negatively correlated with anti-inflammatory cytokines. We found that gut dysbiosis accompanying HIV infection was characterized by a depletion of obligate anaerobic Clostridia and enrichment of facultative anaerobic bacteria, reflecting increased intestinal oxygen levels and intestinal permeability. Furthermore, it is likely that HIV-associated dysbiosis shifts the immunological balance toward inflammatory Th1 responses and encourages proinflammatory cytokine production. Our results suggest that gut dysbiosis contributes to sustaining chronic inflammation in patients with HIV infection despite effective antiretroviral therapy and that correcting gut dysbiosis will be effective in improving long-term outcomes in patients. IMPORTANCE Chronic inflammation is a hallmark of HIV infection and is associated with the development and progression of age-related comorbidities. Although the gastrointestinal tract is a major site of HIV replication and CD4+ T-cell depletion, the role of HIV-associated imbalance of gut microbiome in chronic inflammation is unclear. Here, we aimed to understand the causal relationship between abnormalities in the gut microbiome and chronic inflammation in patients with HIV. Our results suggest HIV-associated gut dysbiosis presents a more aerobic environment than that of healthy individuals, despite prolonged viral suppression. This dysbiosis likely results from a sustained increase in intestinal permeability, which supports sustained bacterial translocation in HIV patients, despite effective therapy. Additionally, we observed that several bacterial taxa enriched in HIV patients were associated with increased expression of inflammatory cytokines. Collectively, these results suggest that gut dysbiosis plays an important role in chronic inflammation in HIV patients.
Collapse
Affiliation(s)
- Aya Ishizaka
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- International Research and Development Center for Mucosal Vaccines, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mizutani
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- International Research and Development Center for Mucosal Vaccines, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Prince Kofi Parbie
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Diki Prawisuda
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Nozomi Yusa
- Department of Applied Genomics, Research Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Ayako Sedohara
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tadashi Kikuchi
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ikeuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tomohiko Koibuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoichi Furukawa
- Department of Applied Genomics, Research Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Laboratory Medicine, Research Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Data Science, Health Intelligence Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Takeya Tsutsumi
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kiyono
- International Research and Development Center for Mucosal Vaccines, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Department of AIDS Vaccine Development, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
22
|
Yu X, Westra JR, Giordano TP, Berenson AB, Baillargeon JG, Kuo YF. Assessing comorbidities and survival in HIV-infected and uninfected matched Medicare enrollees. AIDS 2021; 35:1667-1675. [PMID: 34049353 PMCID: PMC8286326 DOI: 10.1097/qad.0000000000002963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE People with HIV infection experience excessive mortality compared with their noninfected counterparts. It is unclear whether the impact of HIV infection on mortality varies by comorbidities or whether sex difference exists in this relationship. This study assessed the effect of newly diagnosed HIV infection on overall mortality among Medicare beneficiaries for both disabled and older adults (≥65 years old) based on their original entitlement. METHODS We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries between 1996 and 2015. People with incident HIV diagnoses were individually matched to up to three controls based on demographics. Cox proportional hazards models adjusted for baseline demographics and comorbidities were used to assess the effect of HIV status on survival among four disabled groups by sex strata. Within each stratum, interactions between comorbidity variables and HIV status were examined. RESULTS People with HIV, especially older women, had a higher prevalence of baseline comorbidities than controls. HIV--mortality association varied according to sex in older adults (P = 0.004). Comorbidity--HIV interactions were more pronounced in disabled groups (P < 0.0001). People with HIV with more chronic conditions had a less pronounced increase in the risk of death than those with fewer conditions, compared with uninfected controls. CONCLUSION Medicare enrollees with newly diagnosed HIV had more prevalent baseline comorbidities and were at higher risk of death than people without HIV. HIV infection has a more pronounced effect among those with fewer comorbidities. Sex differences in HIV--mortality association exist among older Medicare enrollees.
Collapse
Affiliation(s)
- Xiaoying Yu
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
| | - Jordan R. Westra
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Abbey B. Berenson
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX, USA
| | - Jacques G. Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
| |
Collapse
|
23
|
Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 757] [Impact Index Per Article: 252.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
Collapse
|
24
|
Høgh J, Pham MHC, Knudsen AD, Thudium RF, Gelpi M, Sigvardsen PE, Fuchs A, Kühl JT, Afzal S, Nordestgaard BG, Benfield T, Køber L, Gerstoft J, Kofoed KF, Nielsen SD. HIV infection is associated with thoracic and abdominal aortic aneurysms: a prospective matched cohort study. Eur Heart J 2021; 42:2924-2931. [PMID: 34240121 DOI: 10.1093/eurheartj/ehab348] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Little is known about the prevalence of aortic aneurysms among people living with HIV (PLWH). We investigated whether HIV status is independently associated with having aortic aneurysms. Furthermore, we determined risk factors associated with aortic aneurysms in PLWH. METHODS AND RESULTS PLWH aged ≥40 years (n = 594) were recruited from the Copenhagen Comorbidity in HIV Infection study and matched for age and sex with uninfected controls (n = 1188) from the Copenhagen General Population Study. Aortic dimensions were assessed using contrast enhanced computed tomography. Aortic aneurysms were defined according to the European Society of Cardiology guidelines, i.e. an aortic dilation of ≥50% or an infrarenal aortic diameter of ≥30 mm. Among PLWH and uninfected controls, the median (interquartile range) age was 52 (47-60) and 52 (48-61) and 88% and 90% were male, respectively. We found 46 aneurysms in 42 (7.1%) PLWH and 31 aneurysms in 29 (2.4%) uninfected controls (P < 0.001). PLWH had a significantly higher prevalence of ascending aortic aneurysms and infrarenal aortic aneurysms. In an adjusted model, HIV was independently associated with aortic aneurysms (adjusted odds ratio; 4.51 [95% confidence interval 2.56-8.08], P < 0.001). Within PLWH, obesity and hepatitis B co-infection were associated with aortic aneurysms. CONCLUSION PLWH had four-fold higher odds of aortic aneurysms compared to uninfected controls, and HIV status was independently associated with aortic aneurysms. Among PLWH, age, obesity and hepatitis B co-infection were associated with higher odds of aortic aneurysms. Our findings suggest that increased attention to aortic aneurysms in PLWH may be beneficial.
Collapse
Affiliation(s)
- Julie Høgh
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Michael Huy Cuong Pham
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Rebekka Faber Thudium
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Per Ejlstrup Sigvardsen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Shoaib Afzal
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Børge Grønne Nordestgaard
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Amager Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| |
Collapse
|
25
|
Vos AG, Dodd CN, Delemarre EM, Nierkens S, Serenata C, Grobbee DE, Klipstein-Grobusch K, Venter WDF. Patterns of Immune Activation in HIV and Non HIV Subjects and Its Relation to Cardiovascular Disease Risk. Front Immunol 2021; 12:647805. [PMID: 34290695 PMCID: PMC8287326 DOI: 10.3389/fimmu.2021.647805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Insight into inflammation patterns is needed to understand the pathophysiology of HIV and related cardiovascular disease (CVD). We assessed patterns of inflammation related to HIV infection and CVD risk assessed with carotid intima media thickness (CIMT). Methods A cross-sectional study was performed in Johannesburg, South Africa, including participants with HIV who were virally suppressed on anti-retroviral therapy (ART) as well as HIV-negative participants who were family members or friends to the HIV-positive participants. Information was collected on CVD risk factors and CIMT. Inflammation was measured with the Olink panel ‘inflammation’, allowing to simultaneously assess 92 inflammation markers. Differences in inflammation patterns between HIV-positive and HIV-negative participants were explored using a principal component analysis (PCA) and ANCOVA. The impact of differentiating immune markers, as identified by ANCOVA, on CIMT was assessed using linear regression while adjusting for classic CVD risk factors. Results In total, 185 HIV-positive and 104 HIV negative participants, 63% females, median age 40.7 years (IQR 35.4 – 47.7) were included. HIV-positive individuals were older (+6 years, p <0.01) and had a higher CIMT (p <0.01). No clear patterns of inflammation were identified by use of PCA. Following ANCOVA, nine immune markers differed significantly between HIV-positive and HIV-negative participants, including PDL1. PDL1 was independently associated with CIMT, but upon stratification this effect remained for HIV-negative individuals only. Conclusion HIV positive patients on stable ART and HIV negative controls had similar immune activation patterns. CVD risk in HIV-positive participants was mediated by inflammation markers included in this study.
Collapse
Affiliation(s)
- Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caitlin N Dodd
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Eveline M Delemarre
- Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stefan Nierkens
- Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Celicia Serenata
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - W D Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
26
|
Bunet R, Nayrac M, Ramani H, Sylla M, Durand M, Chartrand-Lefebvre C, Routy JP, Landay AL, Gauchat JF, Chomont N, Ancuta P, Kaufmann DE, Bernard N, Tremblay CL, El-Far M. Loss of CD96 Expression as a Marker of HIV-Specific CD8 + T-Cell Differentiation and Dysfunction. Front Immunol 2021; 12:673061. [PMID: 34122431 PMCID: PMC8190400 DOI: 10.3389/fimmu.2021.673061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/11/2021] [Indexed: 01/01/2023] Open
Abstract
Persistent immune activation and inflammation in people living with HIV (PLWH) are associated with immunosenescence, premature aging and increased risk of non-AIDS comorbidities, with the underlying mechanisms not fully understood. In this study, we show that downregulation of the T-cell immunoglobulin receptor CD96 on CD8+ T cells from PLWH is associated with decreased expression of the co-stimulatory receptors CD27 and CD28, higher expression of the senescence marker CD57 and accumulation of a terminally differentiated T-cell memory phenotype. In addition, we show that CD96-low CD8+ T-cells display lower proliferative potential compared to their CD96-high counterparts and that loss of CD96 expression by HIV-specific CD8+ T-cells is associated with a suboptimal response to HIV antigens. In conclusion, our results suggest that CD96 marks CD8+ T-cells with competent responses to HIV and the loss of its expression might be used as a biomarker for CD8+ T-cell senescence and dysfunction in PLWH.
Collapse
Affiliation(s)
- Rémi Bunet
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Manon Nayrac
- CHUM-Research Centre, Montréal, Montréal, QC, Canada
| | - Hardik Ramani
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Mohamed Sylla
- CHUM-Research Centre, Montréal, Montréal, QC, Canada
| | - Madeleine Durand
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | | | - Jean-Pierre Routy
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Jean-Francois Gauchat
- Faculté de Médecine, Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada
| | - Nicolas Chomont
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Petronela Ancuta
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Daniel E Kaufmann
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Nicole Bernard
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | - Cécile L Tremblay
- CHUM-Research Centre, Montréal, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | | |
Collapse
|
27
|
Tolentino A, Amaral S, S Souza L, Zeballos D, Brites C. Frequency of Falls and Associated Risk Factors in People Living With HIV: A Systematic Review With Meta-Analysis and Meta-Regression. J Acquir Immune Defic Syndr 2021; 86:616-625. [PMID: 33351527 DOI: 10.1097/qai.0000000000002600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Falls are considered as a predictive marker of poorer outcomes for people living with HIV (PLWHIV). However, the available evidences on the predictive value of falls are controversial. Our aim is to summarize the existing data about falls in PLWHIV. METHODS A literature search was conducted using electronic databases (MEDLINE, Embase, and LILACS) for original observational studies. The primary outcome was any and recurrent falls' frequency in PLWHIV, and secondary outcomes were factors associated with falls. We conducted a random-effects meta-analysis with meta-regression to obtain a summary frequency of falls and recurrent falls. RESULTS The pooled frequency for any fall was 26% [95% confidence interval (CI): 19% to 34%], compared with 14% for recurrent falls (95% CI: 9% to 22%). In studies comparing PLWHIV and people without HIV, we found no difference for any (pooled odds ratio 1.03, 95% CI: 0.90 to 1.17) or recurrent falls (pooled odds ratio 1.08, 95% CI: 0.92 to 1.27) between groups, but falls in middle-aged PLWHIV might be more associated with subjacent clinical conditions such as cognitive impairment, polypharmacy, use of medications with action in the central nervous system, and frailty, classic risk factors for falls in the elderly. CONCLUSIONS The overall frequency of falls in PLWHIV seems to be lower than that presented by some initial studies, and several factors associated with falls are shared with elderly adults. Although both PLWHIV and people without HIV presented similar frequency of falls, we found that these events might be qualitatively different; therefore, an appropriate method to evaluate falls in this population to prevent adverse outcomes is warranted.
Collapse
Affiliation(s)
- Arthur Tolentino
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil
| | - Sávio Amaral
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil; and
| | - Lucca S Souza
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Diana Zeballos
- Programa de Pós-graduação em Saúde Coletiva (PPgSC), Universidade Federal da Bahia, Salvador, Brazil
| | - Carlos Brites
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil; and
| |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW To evaluate the current scientific basis for administering probiotics to people living with HIV (PLHIV) to alleviate chronic inflammation and subsequently improve their prognosis. RECENT FINDINGS The gut microbiome is a potential contributing factor to low-grade inflammation in HIV infection, and there is a scientific rationale for attempting to attenuate inflammation by administering probiotics. Sixteen reports from clinical studies in antiretroviral therapy (ART)-treated PLHIV assessing inflammation after probiotic intervention have been identified; half of them randomized control trials (RCT). Some of the studies report improvement in some parameters of inflammation, but results are inconsistent. No studies report improvement of CD4 counts. None of the RCTs report improvements in any markers of inflammation when analyzed according to protocol. SUMMARY Current scientific evidence does not support the use of probiotics to alleviate inflammation in HIV infection. The potential effect of probiotic intervention in ART-treated PLHIV with high risk for inflammation remains to be investigated.
Collapse
|
29
|
Stadtler H, Shaw G, Neigh GN. Mini-review: Elucidating the psychological, physical, and sex-based interactions between HIV infection and stress. Neurosci Lett 2021; 747:135698. [PMID: 33540057 PMCID: PMC9258904 DOI: 10.1016/j.neulet.2021.135698] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022]
Abstract
Stress is generally classified as any mental or emotional strain resulting from difficult circumstances, and can manifest in the form of depression, anxiety, post-traumatic stress disorder (PTSD), or other neurocognitive disorders. Neurocognitive disorders such as depression, anxiety, and PTSD are large contributors to disability worldwide, and continue to affect individuals and communities. Although these disorders affect men and women, women are disproportionately represented among those diagnosed with affective disorders, a result of both societal gender roles and physical differences. Furthermore, the incidence of these neurocognitive disorders is augmented among People Living with HIV (PLWH); the physical ramifications of stress increase the likelihood of HIV acquisition, pathogenesis, and treatment, as both stress and HIV infection are characterized by chronic inflammation, which creates a more opportunistic environment for HIV. Although the stress response is facilitated by the autonomic nervous system (ANS) and the hypothalamic pituitary adrenal (HPA) axis, when the response involves a psychological component, additional brain regions are engaged. The impact of chronic stress exposure and the origin of individual variation in stress responses and resilience are at least in part attributable to regions outside the primary stress circuity, including the amygdala, prefrontal cortex, and hippocampus. This review aims to elucidate the relationship between stress and HIV, how these interact with sex, and to understand the physical ramifications of these interactions.
Collapse
Affiliation(s)
- Hannah Stadtler
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gladys Shaw
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gretchen N Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA.
| |
Collapse
|
30
|
Baker JV, Wolfson J, Collins G, Morse C, Rhame F, Liappis AP, Rizza S, Temesgen Z, Mystakelis H, Deeks S, Neaton J, Schacker T, Sereti I, Tracy RP. Losartan to reduce inflammation and fibrosis endpoints in HIV disease. AIDS 2021; 35:575-583. [PMID: 33252490 PMCID: PMC8062089 DOI: 10.1097/qad.0000000000002773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Persistent inflammation and incomplete immune recovery among persons with HIV (PHIV) are associated with increased disease risk. We hypothesized that the angiotensin receptor blocker (ARB) losartan would reduce inflammation by mitigating nuclear factor (NF)κB responses and promote T-cell recovery via inhibition of transforming growth factor-beta (TGFβ)-mediated fibrosis. METHODS Losartan (100 mg) versus placebo over 12 months was investigated in a randomized (1 : 1) placebo-controlled trial, among PHIV age at least 50 years, receiving antiretroviral therapy (ART), with HIV RNA less than 200 copies/ml and CD4+ cell count 600 cells/μl or less. Inflammation, fibrosis and myocardial biomarkers were measured in blood using ELISA, electrochemiluminescence and immunoturbidimetric methods, and T-cell and monocyte phenotypes were assessed with flow cytometry among a subset of participants. Changes over follow-up in (log-2 transformed) biomarkers and cell phenotypes (untransformed) were compared between losartan and placebo arms using linear mixed models. RESULTS Among 108 PHIV (n = 52 to losartan; n = 56 to placebo), 97% had a month 12 visit. Median age was 57 years and baseline CD4+ cell count was 408 cells/μl. Losartan treatment was not associated with an improvement in interleukin-6 levels, or other blood measures of inflammation, immune activation, fibrosis activity or myocardial function. CD4+ and CD8+ T cells also did not differ by treatment group. Losartan reduced SBP and DBP by 6 and 5 mmHg, respectively. CONCLUSION Among older PHIV with viral suppression, losartan did not improve blood measures of inflammation nor T-cell immune recovery. Losartan treatment is unlikely to reduce inflammation associated comorbidities to a clinically meaningful degree, beyond the benefits from lowering blood pressure. CLINICALTRIALSGOV NCT02049307.
Collapse
Affiliation(s)
- Jason V. Baker
- Hennepin Healthcare Research Institute
- University of Minnesota, Minneapolis, Minnesota
| | | | | | - Caryn Morse
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina
| | | | | | | | | | | | - Steven Deeks
- University of California San Francisco, San Francisco, California
| | | | | | | | | |
Collapse
|
31
|
Jespersen NA, Axelsen F, Dollerup J, Nørgaard M, Larsen CS. The burden of non-communicable diseases and mortality in people living with HIV (PLHIV) in the pre-, early- and late-HAART era. HIV Med 2021; 22:478-490. [PMID: 33645000 PMCID: PMC8247855 DOI: 10.1111/hiv.13077] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
Objectives To estimate the burden of non‐communicable diseases (NCDs) and mortality among PLHIV in the pre‐, early‐ and late‐HAART (highly active antiretroviral therapy) era. Methods We conducted a cohort study using population‐based Danish medical registries including all adult HIV‐infected residents of the Central Denmark Region during 1985–2017. For each HIV patient, we selected 10 comparisons from the background population matched by age, sex and municipality of residence. Based on hospital‐related diagnoses we estimated the prevalence and incidence of specific NCD at diagnosis and at 5 and 10 years. Results We identified 1043 PLHIV and 10 430 matched comparisons. PLHIV had lower socioeconomic status and more were born outside western Europe. At HIV diagnosis, 21.9% of PHLIV vs. 18.2% of non‐HIV individuals had at least one NCD, increasing to 42.2% vs. 25.9% after 10 years. PLHIV had higher prevalence and cumulative incidence of alcohol abuse, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, mental disorders, renal and liver disease, but no increased risk of diabetes mellitus. Only PLHIV in the age groups 41–50 and > 51 years had an increased incidence of osteoporosis. From the pre‐ to the late‐HAART era, 10‐year mortality among PLHIV decreased from 45.5% to 9.4% but continued at more than twice that of uninfected comparisons. However, in the late‐HAART era, the mortality of PLHIV who were alive 2 years after HIV diagnosis was approaching that of comparisons. Conclusions Even in the late‐HAART era, PLHIV have an excess mortality, which may be attributable to several NCDs being more prevalent among PLHIV. The prevalence rates of ischaemic heart disease, diabetes, osteoporosis and renal disease tend to increase over calendar time. Therefore, improvement of survival and quality of life of PLHIV neets strategies to reduce the risk of developing NCDs, including avoiding toxic antiretroviral therapy and lifestyle changes.
Collapse
Affiliation(s)
- N A Jespersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - F Axelsen
- Gilead Sciences Denmark, Copenhagen S, Denmark
| | - J Dollerup
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - C S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
32
|
HIV Infection and Related Mental Disorders. Brain Sci 2021; 11:brainsci11020248. [PMID: 33671125 PMCID: PMC7922767 DOI: 10.3390/brainsci11020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.
Collapse
|
33
|
Drechsler H, Ayers C, Cutrell J, Arasaratnam R, Bedimo R. Consistent use of lipid lowering therapy in HIV infection is associated with low mortality. BMC Infect Dis 2021; 21:150. [PMID: 33546621 PMCID: PMC7866454 DOI: 10.1186/s12879-021-05787-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In people living with HIV (PLWH), statins may be disproportionately effective but remain underutilized. A large prospective trial in patients with low to moderate cardiovascular (ASCVD) risk will reveal whether they should be considered in all PLWH. But its effect size may not apply to real-world PLWH with higher ASCVD and mortality risk. Also, the clinical role of non-statin lipid-lowering therapy (LLT) and LLT adherence in this population is unknown. METHODS Comparative multi-level marginal structural model for all-cause mortality examining four time-updated exposure levels to LLT, antihypertensives, and aspirin in a virtual cohort of older PLWH. Incident coronary, cerebrovascular, and overall ASCVD events, serious infections, and new cancer diagnoses served as explanatory outcomes. RESULTS In 23,276 HIV-infected US-veterans who were followed for a median of 5.2 years after virologic suppression overall mortality was 33/1000 patient years: > 3 times higher than in the US population. Use of antihypertensives or aspirin was associated with increased mortality. Past LLT use (> 1 year ago) had no effect on mortality. LLT exposure in the past year was associated with a reduced hazard ratio (HR) of death: 0.59, 95% confidence interval (CI) 0.51-0.69, p < 0.0001 for statin containing LLT and 0.71 (CI: 0.54-0.93), p = 0.03 for statin-free LLT. For consistent LLT use (> 11/12 past months) the HR of death was 0.48 (CI: 0.35-0.66) for statin-only LLT, 0.34 (CI: 0.23-0.52) for combination LLT, and 0.27 (CI: 0.15-0.48) for statin-free LLT (p < 0.0001 for all). The ASCVD risk in these patients was reduced in similar fashion. Use of statin containing LLT was also associated with reduced infection and cancer risk. Multiple contrasting subgroup analyses yielded comparable results. Confounding is unlikely to be a major contributor to our findings. CONCLUSIONS In PLWH, ongoing LLT use may lead to substantially lower mortality, but consistent long-term adherence may be required to reduce ASCVD risk. Consistent non-statin LLT may be highly effective and should be studied prospectively.
Collapse
Affiliation(s)
- Henning Drechsler
- VA North Texas Health Care System, Dallas, TX, USA.
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA.
| | - Colby Ayers
- VA North Texas Health Care System, Dallas, TX, USA
| | | | - Reuben Arasaratnam
- VA North Texas Health Care System, Dallas, TX, USA
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA
| | - Roger Bedimo
- VA North Texas Health Care System, Dallas, TX, USA
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA
| |
Collapse
|
34
|
Pahwa S, Deeks S, Zou S, Tomitch N, Miller-Novak L, Caler E, Justice A, Sacktor N, Gabuzda D, Hunt PW, Brown T, Kurth A, Baral S, Mugavero M, Mayer KH, Mendenhall E, Detels R, Mutabazi V. NIH Workshop on HIV-Associated Comorbidities, Coinfections, and Complications: Summary and Recommendation for Future Research. J Acquir Immune Defic Syndr 2021; 86:11-18. [PMID: 33306561 PMCID: PMC7982002 DOI: 10.1097/qai.0000000000002528] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND With potent antiretroviral therapy and simplified regimens, people living with HIV (PWH) are achieving near-normal lifespans but not necessarily a normal health span or healthy aging. PWH have a higher than expected risk of developing a number of non-AIDS comorbidities, coinfections, and complications (CCC), often against a background of stigma, poverty, and isolation. SETTING To gain a better understanding of research needs for HIV-associated CCC, the NIH convened a 2-day workshop (HIV-associated CCC, or HIV ACTION). METHODS A cross-institute NIH planning committee identified 6 key research areas: epidemiology and population research, pathogenesis and basic science research, clinical research, implementation science research, syndemics research and international research in low and middle income countries. Investigators were selected to lead working groups (WGs) to assess the state-of-the-art and identify 3-5 priority areas in each field before the workshop. A 2-day program at the NIH was developed which included presentations by invited experts and WG members. RESULTS Over 400 participants attended the workshop. After general and individual WG discussions, the most pressing gaps, questions, or proposed action items were identified. Priority lists of pressing research issues were presented by cochairs of each WG. A detailed report is posted at the NHLBI website. This article reports the streamlined priority list and a summary of WG discussions to inform investigators of current priorities in the field. CONCLUSION Collaborative efforts of many disciplines are needed to improve the health and wellbeing of PWH. Several common themes emerged across WG representing potential priorities for investigators and recommendations for the NIH.
Collapse
Affiliation(s)
- Savita Pahwa
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Shimian Zou
- National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD
| | | | - Leia Miller-Novak
- National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, MD
| | - Elisabet Caler
- National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD
| | - Amy Justice
- Yale University School of Medicine, New Haven, CT
| | - Ned Sacktor
- Johns Hopkins University, School of Medicine, Baltimore, MD
| | | | | | - Todd Brown
- Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Ann Kurth
- Yale University, School of Nursing, Orange, CT
| | - Stefan Baral
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | | | - Kenneth H. Mayer
- Harvard University, Medical School and Fenway Health, Boston, MA
| | | | | | | |
Collapse
|
35
|
Hove-Skovsgaard M, Abildgaard J, Gelpi M, Gaardbo JC, Kolte L, Ullum H, Trøseid M, Lindegaard B, Nielsen SD. No evidence of a synergistic effect of HIV infection and diabetes mellitus type 2 on fat distribution, plasma adiponectin or inflammatory markers. BMC Infect Dis 2020; 20:882. [PMID: 33238950 PMCID: PMC7687725 DOI: 10.1186/s12879-020-05594-3] [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] [Received: 10/15/2019] [Accepted: 11/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Altered fat distribution and chronic inflammation are found in both persons living with HIV (PLWH) and persons with diabetes mellitus type 2 (DM2) and are known risk factors for cardiovascular diseases (CVD). We aimed to investigate if a synergistic effect of HIV infection and DM2 was found on fat distribution and inflammation. Methods A cross-sectional study was performed including PLWH with HIV RNA < 200 copies/mL (18 with DM2 (HIV + DM2+), 18 without DM2 (HIV + DM2-)) and controls (19 with DM2 (controls with DM2) and 25 without DM2 (healthy controls). We measured fat distribution using dual-energy X-ray absorptiometry scan. Plasma concentrations of adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alfa (TNF- α) and soluble CD14 (sCD14) was measured using snap-frozen plasma. Results HIV + DM2+ and HIV + DM2- had comparable trunk/limb fat ratio. In contrast, HIV + DM2+ had a higher trunk/ limb fat ratio than controls with DM2 and healthy controls (p = 0.013 and p < 0.001, respectively). However, HIV + DM2+ and controls with DM2 had comparable amount of trunk fat mass (kg) (p = 0.254). A lower concentration of plasma adiponectin and higher concentration of IL-6 was found in HIV + DM2+ than in HIV + DM2-(p = 0.037 and p = 0.039) and in healthy controls (p = 0.001 and p = 0.012). In contrast, plasma adiponectin and IL-6 concentrations were comparable in HIV + DM2+ and controls with DM2 (p = 0.345 and p = 0.825). Concentration of sCD14 was comparable in HIV + DM2+ and HIV + DM2–(p = 0.850), but elevated in HIV + DM2+ compared to controls with DM2 (p < 0.001) and healthy controls (p = 0.007). No statistical interactions were found between HIV infection and DM2 for any of the depending variables. Conclusion A synergistic effect of HIV and DM2 was not found for any of the outcomes. However, HIV + DM2+ had features related to both HIV infection and DM2 with a high trunk/limb ratio, high trunk fat mass, low concentration of plasma adiponectin and elevated concentrations of IL-6 and sCD14. This could contribute to elevated risk of CVD.
Collapse
Affiliation(s)
- Malene Hove-Skovsgaard
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Julie Abildgaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Julie Christine Gaardbo
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lilian Kolte
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marius Trøseid
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Lindegaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| |
Collapse
|
36
|
Fidel PL, Moyes D, Samaranayake L, Hagensee ME. Interplay between oral immunity in HIV and the microbiome. Oral Dis 2020; 26 Suppl 1:59-68. [PMID: 32862522 DOI: 10.1111/odi.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This Basic Science Workshop addressed the oral microbiome. At the 7th World Workshop on Oral Health & Disease in HIV/AIDS in India in 2014, some aspects of the human microbiome were discussed, and research questions formulated. Since that time, there have been major advances in technology, which have stimulated a number of publications on many aspects of the human microbiome, including the oral cavity. This workshop aimed to summarize current understanding of the "normal" microbiome of the oral cavity compared to that during HIV infection, and how oral immune factors and other clinical variables alter or control the oral microbiome. An important question is whether successful treatment with anti-retroviral therapy, which leads to a significant drop in viral loads and immune reconstitution, is associated with any change or recovery of the oral microbiome. Additionally, the workshop addressed the issue of which parameters are most appropriate/correct to evaluate the oral microbiome and how clinically relevant are shifts/changes in the oral microbiome. The workshop evaluated current knowledge in five research areas related to five basic questions and identified further topics where further research is required.
Collapse
Affiliation(s)
- Paul L Fidel
- LSU Health School of Dentistry, New Orleans, LA, USA
| | - David Moyes
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | | | | |
Collapse
|
37
|
Gelpi M, Vestad B, Hansen SH, Holm K, Drivsholm N, Goetz A, Kirkby NS, Lindegaard B, Lebech AM, Hoel H, Michelsen AE, Ueland T, Gerstoft J, Lundgren J, Hov JR, Nielsen SD, Trøseid M. Impact of Human Immunodeficiency Virus-Related Gut Microbiota Alterations on Metabolic Comorbid Conditions. Clin Infect Dis 2020; 71:e359-e367. [PMID: 31894240 DOI: 10.1093/cid/ciz1235] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to identify a human immunodeficiency virus (HIV)-related microbiota signature, independent of sexual preferences and demographic confounders, in order to assess a possible impact of the microbiome on metabolic comorbid conditions. METHODS Bacterial 16S ribosomal RNA analyses were performed on stool samples from 405 HIV-infected and 111 uninfected participants of the Copenhagen Comorbidity in HIV Infection (COCOMO) study. Individuals were stratified according to sexual behavior (men who have sex with men [MSM] vs non-MSM). RESULTS After excluding MSM-associated microbiota traits and adjusting for confounders, we identified an HIV-related microbiota signature, consisting of lower biodiversity, increased relative abundance of the bacterial clades Gammaproteobacteria and Desulfovibrionaceae and decrease in several Clostridia. This microbiota profile was associated with a 2-fold excess risk of metabolic syndrome, driven by increase in Desulfovibrionaceae and decrease in Clostridia (Butyrivibrio, Coprococcus 2, Lachnospiraceae UCG-001 and CAG-56). This association was accentuated (5-fold excess risk) in individuals with previous severe immunodeficiency, which also modified the association between HIV-related microbiota signature and visceral adipose tissue (VAT) area (P for interaction = .01). Accordingly, HIV-related microbiota was associated with 30-cm2 larger VAT in individuals with history of severe immunodeficiency, but not in those without. CONCLUSION The HIV-related microbiota was associated with increased risk of metabolic syndrome and VAT accumulation, particularly in individuals with previous severe immunodeficiency, driven by increased Desulfovibrionaceae and lower abundance of several Clostridia. Our findings suggest a potential interplay between HIV-related microbiota, immune dysfunction and metabolic comorbid conditions. Interventions targeting the gut microbiome may be warranted to reduce cardiovascular risk, particularly in individuals with previous immunodeficiency.
Collapse
Affiliation(s)
- Marco Gelpi
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Beate Vestad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Simen Hyll Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristian Holm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ninna Drivsholm
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra Goetz
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Nicolai Søren Kirkby
- Department of Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Center for inflammation and Metabolism, Rigshospitalet, København, Denmark
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hedda Hoel
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Medical Department, Lovisenberg Hospital, Oslo, Norway
| | - Annika E Michelsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jan Gerstoft
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Johannes Roksund Hov
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marius Trøseid
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo, Norway
| |
Collapse
|
38
|
Antiretroviral Therapy Concentrations Differ in Gut vs. Lymph Node Tissues and Are Associated With HIV Viral Transcription by a Novel RT-ddPCR Assay. J Acquir Immune Defic Syndr 2020; 83:530-537. [PMID: 32168200 DOI: 10.1097/qai.0000000000002287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most HIV-infected cells during antiretroviral therapy (ART) persist in lymphoid tissues. Studies disagree on whether suboptimal tissue ART concentrations contribute to ongoing HIV replication during viral suppression. METHODS We performed a cross-sectional study in virally-suppressed HIV+ participants measuring lymphoid tissue ART [darunavir (DRV), atazanavir (ATV), and raltegravir (RAL)] concentrations by LC-MS/MS assay. Tissue and plasma ART concentrations were used to estimate TPRs and drug-specific tissue:inhibitory concentration ratios (TICs). HIV DNA and sequentially produced HIV RNA transcripts were quantified from rectal biopsies using droplet digital PCR (ddPCR) assays. RESULTS Tissue samples were collected in duplicate from 19 participants: 38 rectal, 8 ileal (4 RAL, 2 DRV, 2 ATV), and 6 lymph node (4 RAL, 2 DRV) samples. Overall, median TICs were higher for RAL than DRV or ATV (both P = 0.006). Median TICs were lower in lymph nodes vs. ileum (0.49 vs. 143, P = 0.028) or rectum (33, P = 0.019), and all ART levels were below target concentrations. Higher rectal TICs were associated with lower HIV RNA transcripts (read-through, long LTR, and Nef, P all < 0.026) and a lower long LTR RNA/long LTR DNA ratio (P = 0.021). CONCLUSIONS We observed higher tissue ART concentrations in ileum and rectum compared with lymph nodes. We observed higher HIV transcription in participants with lower rectal ART concentrations. These findings add to the limited data supporting the idea that viral transcription may be influenced by ART concentrations in lymphoid tissues. Further exploration of tissue pharmacokinetics is needed in future HIV eradication strategies.
Collapse
|
39
|
Madut DB, Park LP, Yao J, Reddy EA, Njau B, Ostermann J, Whetten K, Thielman NM. Predictors of mortality in treatment experienced HIV-infected patients in northern Tanzania. PLoS One 2020; 15:e0240293. [PMID: 33031434 PMCID: PMC7544106 DOI: 10.1371/journal.pone.0240293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background While factors that drive early mortality among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in sub-Saharan Africa (SSA) have been described, less is known about the predictors of long-term mortality for those with ART experience. Methods PLWH and on ART attending two HIV treatment clinics in Moshi, Tanzania were enrolled from 2008 through 2009 and followed for 3.5 years. Demographic, psychosocial, and clinical information were collected at enrollment. Plasma HIV RNA measurements were collected annually. Cause of death was adjudicated by two independent reviewers based on verbal autopsy information and medical records. Bivariable and multivariable analyses were conducted using Cox proportional hazard models to identify predictors of mortality. Results The analysis included 403 participants. The median (IQR) age in years was 42 (36–48) and 277 (68.7%) participants were female. The proportion of participants virologically suppressed during the 4 collection time points was 88.5%, 94.7%, 91.5%, and 94.5%. During follow-up, 24 participants died; the overall mortality rate was 1.8 deaths per 100 person-years. Of the deaths, 14 (58.3%) were suspected to be HIV/AIDS related. Predictors of mortality (adjusted hazard ratio, 95% confidence interval) were male sex (2.63, 1.01–6.83), secondary or higher education (7.70, 3.02–19.60), receiving care at the regional referral hospital in comparison to the larger zonal referral hospital (6.33, 1.93–20.76), and moderate to severe depression symptoms (6.35, 1.69–23.87). Conclusions As ART coverage continues to expand in SSA, HIV programs should recognize the need for interventions to promote HIV care engagement for men and the integration of mental health screening and treatment with HIV care. Facility-level barriers may contribute to challenges faced by PLWH as they progress through the HIV care continuum, and further understanding of these barriers is needed. The association of higher educational attainment with mortality merits further investigation.
Collapse
Affiliation(s)
- Deng B. Madut
- Department of Medicine, Duke University, Durham, NC, United States of America
- * E-mail:
| | - Lawrence P. Park
- Department of Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Jia Yao
- Center for Health Policy and Inequalities Research, Durham, NC, United States of America
- Duke Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Elizabeth A. Reddy
- Division of Infectious Disease, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kathryn Whetten
- Duke Global Health Institute, Durham, NC, United States of America
- Center for Health Policy and Inequalities Research, Durham, NC, United States of America
- Duke Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Nathan M. Thielman
- Department of Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| |
Collapse
|
40
|
Peterson TE, Baker JV, Wong L, Rupert A, Ntusi NAB, Esmail H, Wilkinson R, Sereti I, Meintjes G, Ntsekhe M, Thienemann F. Elevated N-terminal prohormone of brain natriuretic peptide among persons living with HIV in a South African peri-urban township. ESC Heart Fail 2020; 7:3246-3251. [PMID: 32585776 PMCID: PMC7524119 DOI: 10.1002/ehf2.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/12/2020] [Accepted: 06/02/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Efforts to improve access to antiretroviral therapy (ART) have shifted morbidity and mortality among persons living with HIV (PLWH) from AIDS to non-communicable diseases, such as cardiovascular disease (CVD). However, contemporary data on CVD among PLWH in sub-Saharan Africa in the current ART era are lacking. The aim of this study was to assess the burden of cardiac stress among PLWH in South Africa via measurement of N-terminal prohormone of brain natriuretic peptide (NT-proBNP). METHODS AND RESULTS NT-proBNP was measured at baseline in 224 PLWH enrolled in a sub-study of a tuberculosis vaccine trial in Khayelitsha township near Cape Town, South Africa. Thresholds were applied at the assay's limit of detection (≥137 pg/mL) and a level indicative of symptomatic heart failure in the acute setting (>300 pg/mL). Mean (SD) age of participants was 39 (6) years, 86% were female, and 19% were hypertensive. Mean (SD) duration of HIV diagnosis was 8.3 (3.9) years and CD4 + count was 673 (267) with 79% prescribed ART for a duration of 5.6 (2.7) years. Thirty-one percent of participants had NT-proBNP > 300 pg/mL. Elevated vs. undetectable NT-proBNP level was associated with older age (P = 0.04), no ART (P = 0.03), and higher plasma tumour necrosis factor-α (P = 0.01). CONCLUSIONS Among South African PLWH largely free of known CVD and on ART with high CD4 + counts and few comorbidities, we observed a high proportion with elevated NT-proBNP levels, suggesting the burden of cardiac stress in this population may be high. This observation underscores the need for more in-depth research, including the current effect of HIV on heart failure risk among a growing ART-treated population in sub-Saharan Africa.
Collapse
Affiliation(s)
- Tess E. Peterson
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Jason V. Baker
- Infectious DiseasesHennepin Healthcare Research InstituteMinneapolisMNUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - Lye‐Yeng Wong
- Department of SurgeryOregon Health Sciences UniversityPortlandORUSA
| | - Adam Rupert
- Leidos Biomedical Research IncFrederick National Laboratory for Cancer ResearchFrederickMDUSA
| | | | - Hanif Esmail
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
- MRC Clinical Trials UnitUniversity College LondonLondonUK
- Institute for Global HealthUniversity College LondonLondonUK
| | - Robert Wilkinson
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Department of Infectious DiseaseImperial College LondonLondonUK
- Francis Crick InstituteLondonUK
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institutes of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMDUSA
| | - Graeme Meintjes
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Mpiko Ntsekhe
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Friedrich Thienemann
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Department of MedicineUniversity Hospital ZurichZurichSwitzerland
| |
Collapse
|
41
|
Hove-Skovsgaard M, Zhao Y, Tingstedt JL, Hartling HJ, Thudium RF, Benfield T, Afzal S, Nordestgaard B, Ullum H, Gerstoft J, Mocroft A, Nielsen SD. Impact of Age and HIV Status on Immune Activation, Senescence and Apoptosis. Front Immunol 2020; 11:583569. [PMID: 33117394 PMCID: PMC7561401 DOI: 10.3389/fimmu.2020.583569] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Residual immune dysfunctions, resembling those that occur during normal aging, may persist even in well-treated people with HIV (PWH), and accelerated aging has been proposed. We aimed to determine if HIV infection is an independent risk factor for T-cell immune dysfunctions including increased immune activation, senescence and apoptosis. Moreover, in PWH we aimed to identify the associations between age and immune activation, senescence and apoptosis. Materials and Methods We included 780 PWH with suppressed viral replication (<50 copies/mL) and absence of hepatitis B and hepatitis C co-infection and 65 uninfected controls from the Copenhagen Co-morbidity in HIV Infection (COCOMO) Study. Flow cytometry was used to determine T-cell activation (CD38+HLA-DR+), senescence (CD28-CD57+), and apoptosis (CD28-CD95+). T-cell subsets are reported as proportions of CD4+ and CD8+ T-cells. We defined an elevated proportion of a given T-cell subset as above the 75th percentile. Regression models were used to determine the association between HIV status and T-cell subset and in PWH to determine the association between age or HIV-specific risk factors and T-cell subsets. Furthermore, an interaction between HIV status and age on T-cell subsets was investigated with an interaction term in models including both PWH and controls. Models were adjusted for age, sex, BMI, and smoking status. Results In adjusted models a positive HIV status was associated with elevated proportions of CD8+ activated (p = 0.009), CD4+ senescent (p = 0.004), CD4+ apoptotic (p = 0.002), and CD8+ apoptotic (p = 0.003) T-cells. In PWH a 10-year increase in age was associated with higher proportions of CD4+ and CD8+ senescent (p = 0.001 and p < 0.001) and CD4+ and CD8+ apoptotic T-cells (p < 0.001 and p < 0.001). However, no interaction between HIV status and age was found. Furthermore, in PWH a CD4+/CD8+ ratio < 1 was associated with elevated proportions of T-cell activation, senescence, and apoptosis. Discussion We found evidence of residual T-cell immune dysfunction in well-treated PWH without HBV or HCV co-infection, and age was associated with T-cell senescence and apoptosis. Our data supports that HIV infection has similar effects as aging on T-cell subsets. However, since no interaction between HIV status and age was found on these parameters, we found no evidence to support accelerated immunological aging in PWH.
Collapse
Affiliation(s)
- Malene Hove-Skovsgaard
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yanan Zhao
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans Jakob Hartling
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rebekka Faber Thudium
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shoaib Afzal
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Børge Nordestgaard
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, United Kingdom
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
42
|
Sil S, Niu F, Chivero ET, Singh S, Periyasamy P, Buch S. Role of Inflammasomes in HIV-1 and Drug Abuse Mediated Neuroinflammaging. Cells 2020; 9:cells9081857. [PMID: 32784383 PMCID: PMC7464640 DOI: 10.3390/cells9081857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
Despite the effectiveness of combined antiretroviral therapy (cART) in suppressing virus replication, chronic inflammation remains one of the cardinal features intersecting HIV-1, cART, drug abuse, and likely contributes to the accelerated neurocognitive decline and aging in people living with HIV-1 (PLWH) that abuse drugs. It is also estimated that ~30–60% of PLWH on cART develop cognitive deficits associated with HIV-1-associated neurocognitive disorders (HAND), with symptomatology ranging from asymptomatic to mild, neurocognitive impairments. Adding further complexity to HAND is the comorbidity of drug abuse in PLWH involving activated immune responses and the release of neurotoxins, which, in turn, mediate neuroinflammation. Premature or accelerated aging is another feature of drug abusing PLWH on cART regimes. Emerging studies implicate the role of HIV-1/HIV-1 proteins, cART, and abused drugs in altering the inflammasome signaling in the central nervous system (CNS) cells. It is thus likely that exposure of these cells to HIV-1/HIV-1 proteins, cART, and/or abused drugs could have synergistic/additive effects on the activation of inflammasomes, in turn, leading to exacerbated neuroinflammation, ultimately resulting in premature aging referred to as “inflammaging” In this review, we summarize the current knowledge of inflammasome activation, neuroinflammation, and aging in central nervous system (CNS) cells such as microglia, astrocytes, and neurons in the context of HIV-1 and drug abuse.
Collapse
Affiliation(s)
| | | | | | | | | | - Shilpa Buch
- Correspondence: (P.P.); (S.B.); Tel.: +1-402-559-3165 (S.B.)
| |
Collapse
|
43
|
Zuniga JA, García AA, Lee J, Park J. Retention in care in aging adults with a dual diagnosis of HIV infection and type 2 diabetes mellitus: a longitudinal retrospective cross-sectional study. AIDS Res Ther 2020; 17:29. [PMID: 32471484 PMCID: PMC7260810 DOI: 10.1186/s12981-020-00286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the measures of retention in care (RIC) in persons living with HIV (PLWH) and type 2 diabetes mellitus (T2DM) by age group (younger vs. older adults). METHODS This was a longitudinal retrospective cross-sectional study that used secondary data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We examined RIC in 798 adult PLWH + T2DM who visited a CNICS clinic at least once in 2015. Six measures of RIC were examined: missed visits [measured as a continuous variable (total number of missed visits) and dichotomous variable (0 = never missed, 1 = missed)], visit adherence, 6-month visit gap, 4-month visit constancy, and the Health and Resources Services Administration HIV/AIDS Bureau's RIC measure. We calculated Spearman correlation coefficients and conducted logistic regression and multi-group path analysis. RESULTS Most RIC measures were significantly correlated (p < 0.05) with one another; only 4-month visit constancy was not correlated with other measures. Except for the number of missed visits in older adult PLWH + T2DM, we found no significant relationships between RIC measures and CD4 cell count using logistic regression. However, multi-group path analysis demonstrated significant positive relationships between most RIC measures and CD4 cell count in both age groups. In younger adults living with HIV (YALWH) + T2DM, HbA1c level, but not CD4 count, was significantly associated with most RIC measures. CONCLUSIONS RIC is related to disease control (CD4 cell count and HbA1c level) in PLWH + T2DM and notably, HbA1c level was only significantly affected in YALWH + T2DM. A future study is needed to find more accurate reasons for the fact that only HbA1c level had significant relationships in YALWH + T2DM. The findings from this study provide guidance in measuring RIC in PLWH who have comorbidities.
Collapse
|
44
|
Touloumi G, Kalpourtzi N, Papastamopoulos V, Paparizos V, Adamis G, Antoniadou A, Chini M, Karakosta A, Makrilakis K, Gavana M, Vantarakis A, Psichogiou M, Metallidis S, Sipsas NV, Sambatakou H, Hadjichristodoulou C, Voulgari PV, Chrysos G, Gogos C, Chlouverakis G, Tripsianis G, Alamanos Y, Stergiou G. Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece. PLoS One 2020; 15:e0230730. [PMID: 32226048 PMCID: PMC7105103 DOI: 10.1371/journal.pone.0230730] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/06/2020] [Indexed: 12/24/2022] Open
Abstract
Background Although combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece. Settings Cross-sectional comparison of PLHIV (Athens-Multicenter-AIDS-Cohort-Study; AMACS) versus general population controls (National health examination survey; EMENO). Methods All HIV-infected adults with ≥1 measurement of interest (blood pressure, lipids, glucose, weight, height) between 2012–2014 and all EMENO participants (2014–2016) were included. Ten-year total CVD risk was estimated using the Framingham (FRS) or the Systematic Coronary Risk Evaluation (SCORE) equations. Results 5839 PLHIV (median age:41.6 years, 85.4% males) and 4820 controls (median age:48 years, 48.4% males) were included. Adjusting for age, sex and origin, PLHIV were more likely to be current smokers (adjusted OR:1.53 [95% CI:1.35–1.74]) and dyslipidemic (aOR:1.18; [1.04–1.34]), less likely to be obese (aOR:0.44 [0.38–0.52], with no differences in hypertension, diabetes or high (≥20%) FRS but with greater odds of high (≥5%) SCORE (aOR:1.55 [1.05–2.30]). Further adjustment for educational level, anti-HCV positivity and BMI showed higher prevalence of hypertension in PLHIV. Conclusions Despite the relative absence of obesity, PLHIV have higher prevalence of traditional CVD risk factors and higher risk of fatal CVD compared to general population. Regular screening and early management of CVD risk factors in PLHIV should be of high priority for CVD prevention.
Collapse
Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
- * E-mail:
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine & Infectious Diseases Unit, Evaggelismos General Hospital, Athens, Greece
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Syngros Hospital, Athens, Greece
| | - Georgios Adamis
- 1st Dept of Internal Medicine and Infectious Diseases, Gennimatas General Hospital, Athens, Greece
| | - Anastasia Antoniadou
- 4th Dept Of Internal Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Chini
- 3rd Dept Of Internal Medicine—Infectious Disease Unit, Red Cross General Hospital, Athens, Greece
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Makrilakis
- Hellenic Diabetes Association, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Magda Gavana
- Lab of Primary Health Care, General Medicine & Health Services Research, Medical Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mina Psichogiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Simeon Metallidis
- 1st Internal Medicine Department, Infectious Diseases Unit, Ahepa University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Infectious Diseases Unit, Department of Pathophysiology Laikon Athens General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Sambatakou
- 2nd Dept of Internal Medicine, HIV Unit, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Paraskevi V. Voulgari
- Department of Internal Medicine, Rheumatology Clinic, University of Ioannina, Ioannina, Greece
| | - George Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, Athens, Greece
| | - Charalambos Gogos
- Dept of Internal Medicine & Infectious Diseases, Patras University General Hospital, Patras, Greece
| | - Grigoris Chlouverakis
- Division of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
| | - Grigoris Tripsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - George Stergiou
- Hypertension Center, STRIDE-7, Third department of Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | | |
Collapse
|
45
|
Fernandez-Botran R, Vega AR, García Y, Tirumala CC, Srisailam P, Raghuram A, Peyrani P, Furmanek S, Tella MA, Ritzhentaler JD, Roman J, Ramírez JA. The elevated systemic cytokine levels in HIV patients are not associated with an elevated pulmonary cytokine environment. Cytokine 2020; 126:154874. [PMID: 31655458 PMCID: PMC6938540 DOI: 10.1016/j.cyto.2019.154874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND HIV-positive patients on anti-retroviral therapy (ART) are at higher risk of developing many non-AIDS related chronic diseases, including chronic obstructive pulmonary disease (COPD), compared to HIV-negative individuals. While the mechanisms are not clear, a persistent pro-inflammatory state appears to be a key contributing factor. The aims of this study were to investigate whether HIV-positive patients without COPD present evidence of potentially predisposing abnormal pulmonary cytokine/chemokine environment and to explore the relationship between pulmonary and systemic cytokine levels. METHODS This study included 39 HIV-seropositive and 34 HIV-seronegative subjects without COPD. All were subjected to outpatient bronchoscopy with bronchoalveolar lavage fluid (BALF) aspiration and blood sample collection. The levels of 21 cytokines and chemokines were measured in plasma and BALF using a bead-based multi-analyte assay. RESULTS In plasma, HIV-infected patients showed significantly increased circulating levels of pro-inflammatory (TNFα) and Th1-associated cytokines (IL-12p70) as well as several chemokines (CXCL11 and CX3CL1). However, no statistically significant differences were found in the numbers of cells, the concentrations of protein and urea as well as cytokine levels in the BALFs of HIV-positive patients when compared to controls. Correlation analysis indicated a potential modulatory effect of the BMI in HIV-seropositive individuals. CONCLUSIONS While our results are consistent with the existence of a systemic pro-inflammatory state in HIV-infected patients, they did not detect significant differences in cytokine levels and other inflammatory markers in the lungs of HIV-positive individuals when compared to HIV-negative controls.
Collapse
Affiliation(s)
- Rafael Fernandez-Botran
- Department of Pathology & Laboratory Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States.
| | - Andrea Reyes Vega
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Yasmany García
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Chanakya Charan Tirumala
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Praneet Srisailam
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Anupama Raghuram
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Paula Peyrani
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Stephen Furmanek
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Mahder Alem Tella
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Jeffrey D Ritzhentaler
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care and the Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, United States(1)
| | - Jesse Roman
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care and the Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, United States(1)
| | - Julio A Ramírez
- Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| |
Collapse
|
46
|
Ozemek C, Erlandson KM, Jankowski CM. Physical activity and exercise to improve cardiovascular health for adults living with HIV. Prog Cardiovasc Dis 2020; 63:178-183. [PMID: 32014512 DOI: 10.1016/j.pcad.2020.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022]
Abstract
Pharmacologic advancements in the treatment of human immunodeficiency virus (HIV) has extended the life expectancy of people living with HIV (PLWH). An unfortunate side effect of HIV treatment, however, is an increased prevalence of dyslipidemia, glycemic dysregulation and abnormal distribution of body fat (lipodystrophy). Consequently, the risk of developing cardiovascular disease (CVD) is significantly increased in PLWH and ultimately a major cause of mortality. Physical activity and exercise training are interventions that have effectively protected against the development of CVD and, in the presence of CVD, has help mitigate morbidity and mortality. Early concerns over potential immunosuppressive effects of exercise in PLWH have largely been dispelled and in some cases exercise has been shown to strengthen markers of immune function. Interventions with aerobic exercise, resistance exercise, and their combination, particularly at higher intensities, are showing promising health outcomes in PLWH. This review will summarize the key cardiovascular and metabolic effects of antiretroviral therapy; the effects of the types and intensities of exercise on cardiorespiratory fitness, cardiometabolic markers, and muscle strength; and provide recommendations on strategies to apply exercise interventions in clinical settings.
Collapse
Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Kristine M Erlandson
- School of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW This article describes the use of biomarkers in expanding our understanding of chronic non-AIDS comorbidities among persons living with HIV (PLWH) receiving antiretroviral therapy (ART). RECENT FINDINGS We review current evidence that biomarkers of chronic immune activation and inflammation associate with a broad spectrum of end-organ diseases in PLWH. We discuss how ART may impact inflammation associated with HIV infection and the degree to which inflammation persists despite effective suppression of viral replication in plasma. We then discuss the limitations of the current literature, which lacks evidence of causality and disproportionately involves a few protein biomarkers that are unable to disentangle complex and overlapping biological pathways. SUMMARY Premature end-organ disease among PLWH has been repeatedly associated with higher levels of blood biomarkers reflecting inflammation and immune activation, which, despite viral suppression and CD4 T-cell increases after ART treatment, remain elevated relative to uninfected persons. There remain important unanswered questions with implications for the development of anti-inflammatory treatment strategies aimed at mitigating excess risk for end-organ comorbidities among PLWH.
Collapse
|
48
|
Cutrell J, Jodlowski T, Bedimo R. The management of treatment-experienced HIV patients (including virologic failure and switches). Ther Adv Infect Dis 2020; 7:2049936120901395. [PMID: 32010443 PMCID: PMC6974747 DOI: 10.1177/2049936120901395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
Significant advances in the potency and tolerability of antiretroviral therapy (ART) have led to very high rates of virologic success for most who remain adherent to therapy. As a result, the life expectancy of people living with HIV (PLWH) has increased significantly. PLWH do, however, continue to experience a significantly higher risk of noninfectious comorbidities and chronic age-related complications, including cardiovascular disease and malignancies, which are now the biggest drivers of this excess morbidity and mortality. Therefore, in addition to virologic failure, the management of the treatment-experienced patient increasingly requires optimization of ART to enhance tolerability, avoid drug-drug interactions, and mitigate non-AIDS complications and comorbid conditions. This article will present principles of the management of virologic failure, poor immunologic recovery, and strategies for optimizing ART in the setting of virologic suppression.
Collapse
Affiliation(s)
- James Cutrell
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Tomasz Jodlowski
- Department of Pharmacy, VA North Texas Health Care System, Dallas, USA
| | - Roger Bedimo
- Department of Medicine, VA North Texas Health Care System and the University of Texas Southwestern Medical Center, 4500 South Lancaster Road, 111-D, Dallas, TX 75216, USA
| |
Collapse
|
49
|
Ballegaard V, Pedersen KK, Brændstrup P, Kirkby N, Stryhn A, Ryder LP, Gerstoft J, Nielsen SD. Cytomegalovirus-specific CD8+ T-cell responses are associated with arterial blood pressure in people living with HIV. PLoS One 2020; 15:e0226182. [PMID: 31929537 PMCID: PMC6957152 DOI: 10.1371/journal.pone.0226182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD), and immunity against cytomegalovirus (CMV) may be a contributing factor. We hypothesized that enhanced T-cell responses against CMV and CMV-IgG antibody-levels are associated with higher arterial blood pressure in PLHIV. We assessed serum CMV-IgG, systolic- (SBP) and diastolic- (DBP) blood pressure, pulse pressure (PP), traditional risk factors, activated CD8+ T-cells (CD38+HLA-DR+), senescent CD8+ T-cells (CD28-CD57+) and interleukin-6 (IL-6) in 60 PLHIV and 31 HIV-uninfected controls matched on age, gender, education and comorbidity. In PLHIV, expression of interleukin-2, tumor necrosis factor-α and interferon-γ was measured by intracellular-cytokine-staining after stimulation of T-cells with CMV-pp65 and CMV-gB. Associations between CMV-specific immune responses and hypertension, SBP, DBP or PP were assessed by multivariate logistic and linear regression models adjusted for appropriate confounders. The median age of PLHIV was 47 years and 90% were male. Prevalence of hypertension in PLHIV was 37% compared to 55% of HIV-uninfected controls. CMV-specific CD8+ T-cell responses were independently associated with higher PP (CMV-pp65; β = 2.29, p = 0.001, CMV-gB; β = 2.42, p = 0.001) in PLHIV. No significant differences were found with regard to individual measures of SBP and DBP. A possible weak association was found between CMV-IgG and hypertension (β = 1.33, p = 0.049) after adjustment for age, smoking and LDL-cholesterol. HIV-related factors, IL-6, CD8+ T-cell activation or CD8+ T-cell senescence did not mediate the associations, and no associations were found between CMV-specific CD4+ T-cell responses and blood pressure in PLHIV. In conclusion, increased arterial blood pressure in PLHIV may be affected by heightened CMV-specific CD8+ T-cell responses.
Collapse
Affiliation(s)
- Vibe Ballegaard
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Karin Kaereby Pedersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Peter Brændstrup
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Herlev University Hospital, Herlev, Denmark
| | - Nikolai Kirkby
- Department of Medical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anette Stryhn
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lars P Ryder
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
50
|
Zaidan SM, Leyre L, Bunet R, Larouche-Anctil E, Turcotte I, Sylla M, Chamberland A, Chartrand-Lefebvre C, Ancuta P, Routy JP, Baril JG, Trottier B, MacPherson P, Trottier S, Harris M, Walmsley S, Conway B, Wong A, Thomas R, Kaplan RC, Landay AL, Durand M, Chomont N, Tremblay C, El-Far M. Upregulation of IL-32 Isoforms in Virologically Suppressed HIV-Infected Individuals: Potential Role in Persistent Inflammation and Transcription From Stable HIV-1 Reservoirs. J Acquir Immune Defic Syndr 2019; 82:503-513. [PMID: 31714430 PMCID: PMC6857723 DOI: 10.1097/qai.0000000000002185] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Human IL-32 is a polyfunctional cytokine that was initially reported to inhibit HIV-1 infection. However, recent data suggest that IL-32 may enhance HIV-1 replication by activating the HIV-1 primary targets, CD4 T-cells. Indeed, IL-32 is expressed in multiple isoforms, some of which are proinflammatory, whereas others are anti-inflammatory. SETTING AND METHODS Here, we aimed to determine the relative expression of IL-32 isoforms and to test their inflammatory nature and potential to induce HIV-1 production in latently infected cells from virologically suppressed HIV-infected individuals. IL-32 and other cytokines were quantified from plasma and supernatant of CD4 T-cells by ELISA. Transcripts of IL-32 isoforms were quantified by qRT-PCR in peripheral blood mononuclear cells. The impact of recombinant human IL-32 isoforms on HIV-1 transcription was assessed in CD4 T-cells from HIV-1cART individuals by qRT-PCR. RESULTS All IL-32 isoforms were significantly upregulated in HIV-1cART compared to HIV individuals with IL-32β representing the dominantly expressed isoform, mainly in T-cells and NK-cells. At the functional level, although IL-32γ induced typical proinflammatory cytokines (IL-6 and IFN-γ) in TCR-activated CD4 T-cells, IL-32α showed an anti-inflammatory profile by inducing IL-10 but not IL-6 or IFN-γ. However, IL-32β showed a dual phenotype by inducing both pro- and anti-inflammatory cytokines. Interestingly, consistent with its highly pro-inflammatory nature, IL-32γ, but not IL-32α or IL-32β, induced HIV-1 production in latently infected CD4 T-cells isolated from combined antiretroviral therapy-treated individuals. CONCLUSIONS Our data report on the differential expression of IL-32 isoforms and highlight the potential role of IL-32, particularly the γ isoform, in fueling persistent inflammation and transcription of viral reservoir in HIV-1 infection.
Collapse
Affiliation(s)
- Sarah M. Zaidan
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Louise Leyre
- Départment de microbiologie, infectiologie et immunologie, Faculty of Medicine, Université de Montréal, Montreal,QC, Canada
| | - Rémi Bunet
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | | | - Isabelle Turcotte
- Départment de microbiologie, infectiologie et immunologie, Faculty of Medicine, Université de Montréal, Montreal,QC, Canada
| | - Mohamed Sylla
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Annie Chamberland
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | | | - Petronela Ancuta
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Départment de microbiologie, infectiologie et immunologie, Faculty of Medicine, Université de Montréal, Montreal,QC, Canada
| | - Jean-Pierre Routy
- McGill University Health Centre Research Institute, Montréal, QC, Canada
| | - Jean-Guy Baril
- Centre de médecine urbaine du Quartier latin, Montréal, QC, Canada
| | - Benoit Trottier
- Centre de médecine urbaine du Quartier latin, Montréal, QC, Canada
| | | | - Sylvie Trottier
- Centre Hospitalier de l’Université Laval, Quebec, QC, Canada
| | - Marianne Harris
- AIDS Research Program, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Sharon Walmsley
- Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Brian Conway
- Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | | | | | | | | | - Madeleine Durand
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Départment de microbiologie, infectiologie et immunologie, Faculty of Medicine, Université de Montréal, Montreal,QC, Canada
| | - Cécile Tremblay
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Départment de microbiologie, infectiologie et immunologie, Faculty of Medicine, Université de Montréal, Montreal,QC, Canada
| | - Mohamed El-Far
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| |
Collapse
|