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Caetano DG, Ribeiro-Alves M, Hottz ED, Vilela LM, Cardoso SW, Hoagland B, Grinsztejn B, Veloso VG, Morgado MG, Bozza PT, Guimarães ML, Côrtes FH. Increased biomarkers of cardiovascular risk in HIV-1 viremic controllers and low persistent inflammation in elite controllers and art-suppressed individuals. Sci Rep 2022; 12:6569. [PMID: 35449171 PMCID: PMC9023525 DOI: 10.1038/s41598-022-10330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
HIV controllers (HICs) are models of HIV functional cure, although some studies have shown persistent inflammation and increased rates of atherosclerosis in HICs. Since immune activation/inflammation contributes to the pathogenesis of cardiovascular diseases (CVD), we evaluated clinical data and inflammation markers in HIV-1 viremic controllers (VC), elite controllers (EC), and control groups (HIV positive individuals with virological suppression by antiretroviral therapy—cART; HIV negative individuals—HIVneg) to assess whether they presented elevated levels of inflammation markers also associated with CVD. We observed the highest frequencies of activated CD8+ T cells in VCs, while EC and cART groups presented similar but slightly altered frequencies of this marker when compared to the HIVneg group. Regarding platelet activation, both HICs groups presented higher expression of P-selectin in platelets when compared to control groups. Monocyte subset analyses revealed lower frequencies of classical monocytes and increased frequencies of non-classical and intermediate monocytes among cART individuals and in EC when compared to HIV negative individuals, but none of the differences were significant. For VC, however, significant decreases in frequencies of classical monocytes and increases in the frequency of intermediate monocytes were observed in comparison to HIV negative individuals. The frequency of monocytes expressing tissue factor was similar among the groups on all subsets. In terms of plasma markers, VC had higher levels of many inflammatory markers, while EC had higher levels of VCAM-1 and ICAM-1 compared to control groups. Our data showed that VCs display increased levels of inflammation markers that have been associated with CVD risk. Meanwhile, ECs show signals of lower but persistent inflammation, comparable to the cART group, indicating the potential benefits of alternative therapies to decrease inflammation in this group.
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Affiliation(s)
- Diogo Gama Caetano
- Laboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute - IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Marcelo Ribeiro-Alves
- Laboratory of Clinical Research in STD and AIDS, National Institute of Infectology Evandro Chagas - INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Eugênio Damaceno Hottz
- Laboratory of Immunothrombosis, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil.,Laboratory of Immunopharmacology, Oswaldo Cruz Institute - IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Larissa Melo Vilela
- Laboratory of Clinical Research in STD and AIDS, National Institute of Infectology Evandro Chagas - INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Sandra Wagner Cardoso
- Laboratory of Clinical Research in STD and AIDS, National Institute of Infectology Evandro Chagas - INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Laboratory of Clinical Research in STD and AIDS, National Institute of Infectology Evandro Chagas - INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Laboratory of Clinical Research in STD and AIDS, National Institute of Infectology Evandro Chagas - INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Laboratory of Clinical Research in STD and AIDS, National Institute of Infectology Evandro Chagas - INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Mariza Gonçalves Morgado
- Laboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute - IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Patrícia Torres Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute - IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Fernanda Heloise Côrtes
- Laboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute - IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
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Li Y, Mohammadi A, Li JZ. Challenges and Promise of Human Immunodeficiency Virus Remission. J Infect Dis 2021; 223:4-12. [PMID: 33586773 DOI: 10.1093/infdis/jiaa568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Antiretroviral therapy effectively controls human immunodeficiency virus (HIV) replication but it is unable to fully eradicate the HIV reservoir and treatment must be life-long. Progress toward a strategy for HIV remission will require overcoming key hurdles to fill gaps in our understanding of HIV persistence, but the identification of individuals who have attained sterilizing or functional HIV cure show that such a goal is achievable. In this review, we first outline challenges in targeting the HIV reservoir, including difficulties identifying HIV-infected cells, ongoing work elucidating the complex intracellular environment that contribute to HIV latency, and barriers to reactivating and clearing the HIV reservoir. We then review reported cases of HIV sterilizing cure and explore natural models of HIV remission and the promise that such HIV spontaneous and posttreatment controllers may hold in our search for a broadly-applicable strategy for the millions of patients living with HIV.
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Affiliation(s)
- Yijia Li
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abbas Mohammadi
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Plaçais L, Boufassa F, Lécuroux C, Gardiennet E, Avettand-Fenoel V, Saez-Cirion A, Lambotte O, Noël N. Antiretroviral therapy for HIV controllers: Reasons for initiation and outcomes in the French ANRS-CO21 CODEX cohort. EClinicalMedicine 2021; 37:100963. [PMID: 34195579 PMCID: PMC8225698 DOI: 10.1016/j.eclinm.2021.100963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Less than 1% of Human Immunodeficiency Virus (HIV)-infected individuals are able to achieve spontaneous viral control without requiring antiretroviral therapy (ART). Whether these HIV controllers (HIC) are at risk of HIV-associated comorbidities and could benefit from ART is debated, but recent studies reported decreased T-cell activation upon ART initiation. We report the frequency of ART initiation, reasons to treat, treatment outcome on immunovirological parameters, and rate of side-effects and treatment discontinuation in the French cohort of HIC. METHODS Participants included in the French multicenter Agence Nationale de Recherche sur le SIDA et les Hépatites (ANRS) Cohorte des extremes (CODEX) cohort of HIC between July 6, 2007 and January 3, 2018 were prospectively followed. ART initiation, indication, discontinuation, non-Acquired ImmunoDeficiency Syndrome (AIDS)-defining events, side-effects, and immunovirological parameters were recorded. Undetectable HIC (u-HIC) were defined as participants with strictly undetectable viral loads based on routinely used assays throughout the follow-up and blipper HIC (b-HIC) as participants with possible detectable viral loads above the detection threshold during follow-up. FINDINGS Among 302 HIC followed for a median of 14.8 years [10.3-20.2], 90 (30%) received ART (7 u-HIC and 83 b-HIC). The main reasons for ART initiation were decreased CD4 T-cell counts (n = 36, 40%), loss of virological control (n = 13, 14%), and non-AIDS-defining events (n = 12, 13%). Sixteen (18%) participants experienced 17 grade 1-2 adverse events. In b-HIC, ART slightly increased the CD4/CD8 ratio (median +0.19, p < 0.0001) and decreased the frequency of circulating CD38+ HLA-DR.+ CD4 and CD8 lymphocytes (median -0.75%, p = 0.003, and -2%, p < 0.0001, respectively), but these changes were not observed for treated u-HIC. Thirteen (14%) participants discontinued ART (5 (38%) because of side-effects, and 10 remained HIC after treatment cessation (median follow-up: 305 days [235-728]). INTERPRETATION Only 30% of participants in this large cohort of HIC required ART during a median follow-up of 14.8 years. These results show that HIC status is very stable and vouch for a patient-centered treatment decision based on the individual benefit/risk balance.
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Affiliation(s)
- Léo Plaçais
- AP-HP, GHU Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin Bicêtre, 78, rue du Général Leclerc, 94275 CEDEX, France
- Inserm, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-Immunes ImVA, Université Paris-Saclay, UMR1184, Le Kremlin Bicêtre 94270, France
| | - Faroudy Boufassa
- CESP, Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, Inserm UMRS 1018, Villejuif, France
| | - Camille Lécuroux
- Inserm, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-Immunes ImVA, Université Paris-Saclay, UMR1184, Le Kremlin Bicêtre 94270, France
| | - Elise Gardiennet
- AP-HP, Laboratoire de Microbiologie Clinique, Hôpital Necker-Enfants Malades, Paris, France
- Faculté de Médecine, INSERM U1016, CNRS, UMR8104, Institut Cochin, Université de Paris, Paris, France
| | - Véronique Avettand-Fenoel
- AP-HP, Laboratoire de Microbiologie Clinique, Hôpital Necker-Enfants Malades, Paris, France
- Faculté de Médecine, INSERM U1016, CNRS, UMR8104, Institut Cochin, Université de Paris, Paris, France
| | - Asier Saez-Cirion
- Institut Pasteur, Unité HIV, Inflammation et Persistance, Paris, France
| | - Olivier Lambotte
- AP-HP, GHU Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin Bicêtre, 78, rue du Général Leclerc, 94275 CEDEX, France
- Inserm, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-Immunes ImVA, Université Paris-Saclay, UMR1184, Le Kremlin Bicêtre 94270, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Nicolas Noël
- AP-HP, GHU Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin Bicêtre, 78, rue du Général Leclerc, 94275 CEDEX, France
- Inserm, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-Immunes ImVA, Université Paris-Saclay, UMR1184, Le Kremlin Bicêtre 94270, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin Bicêtre, France
- Corresponding author at: AP-HP, GHU Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin Bicêtre, 78, rue du Général Leclerc, 94275 CEDEX, France.
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McGettrick P, Mallon PWG, Sabin CA. Cardiovascular disease in HIV patients: recent advances in predicting and managing risk. Expert Rev Anti Infect Ther 2020; 18:677-688. [PMID: 32306781 DOI: 10.1080/14787210.2020.1757430] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is one of the leading causes of mortality in virally suppressed people living with HIV (PLWH) and with an aging population, is likely to become one of the leading challenges in maintaining good health outcomes in HIV infection. However, factors driving the risk of CVD in PLWH are multiple and may be different from those of the general population, raising challenges to predicting and managing CVD risk in this population. AREAS COVERED In this review, we examine the relevant data regarding CVD in HIV infection including CVD prevalence, pathogenesis, and other contributing factors. We review the data regarding CVD risk prediction in PLWH and summarize factors, both general and HIV specific, that may influence CVD risk in this population. And finally, we discuss appropriate management of CVD risk in PLWH and explore potential therapeutic pathways which may mitigate CVD risk in the future in this population. EXPERT OPINION Following a comprehensive review of CVD risk in PLWH, we give our opinion on the primary issues in risk prediction and management of CVD in HIV infected individuals and discuss the future direction of CVD management in this population.
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Affiliation(s)
- Padraig McGettrick
- Centre for Pathogen Host Research, UCD School of Medicine, University College Dublin , Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Pathogen Host Research, UCD School of Medicine, University College Dublin , Dublin, Ireland.,Department of Infectious Diseases, St. Vincent's University Hospital , Dublin, Ireland
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London , London, UK
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Noël N, Saez-Cirion A, Avettand-Fenoël V, Boufassa F, Lambotte O. HIV controllers: to treat or not to treat? Is that the right question? Lancet HIV 2019; 6:e878-e884. [PMID: 31624011 DOI: 10.1016/s2352-3018(19)30264-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
The term HIV controller refers to the small proportion of individuals infected with HIV who can spontaneously control viraemia to maintain very low viral loads. One major unresolved question is whether HIV controllers should receive antiretroviral therapy, given that international guidelines recommend treatment for all individuals who are infected with HIV. Differences in the definitions of a controller (in terms of the viral-load cutoff and the duration of viral control) and contrasting reports on CD4 T-cell decline, chronic immune activation, the cardiovascular risk, and loss of viral control in controllers have prevented the development of a consensus view.
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Affiliation(s)
- Nicolas Noël
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay aux Roses, France; Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Asier Saez-Cirion
- Institut Pasteur, Unité HIV, Inflammation et Persistance, Paris, France
| | - Véronique Avettand-Fenoël
- Assistance Publique-Hôpitaux de Paris, Laboratoire de Microbiologie clinique, CHU Necker-Enfants Malades, Paris, France; CNRS 8104, INSERM U1016, Université Paris Descartes, Paris, France
| | - Faroudy Boufassa
- INSERM CESP U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay aux Roses, France; Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, Le Kremlin Bicêtre, France.
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Etemad B, Esmaeilzadeh E, Li JZ. Learning From the Exceptions: HIV Remission in Post-treatment Controllers. Front Immunol 2019; 10:1749. [PMID: 31396237 PMCID: PMC6668499 DOI: 10.3389/fimmu.2019.01749] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 12/19/2022] Open
Abstract
Among the top priorities of the HIV field is the search for therapeutic interventions that can lead to sustained antiretroviral therapy (ART)-free HIV remission. Although the majority of HIV-infected persons will experience rapid viral rebound after ART interruption, there are rare individuals, termed post-treatment controllers (PTCs), who demonstrate sustained virologic suppression for months or years after treatment cessation. These individuals are considered an ideal example of durable HIV control, with direct implications for HIV cure research. However, understanding of the mechanisms behind the capacity of PTCs to control HIV remains incomplete. This is in part due to the scarcity of PTCs identified through any one research center or clinical trial, and in part because of the limited scope of studies that have been performed in these remarkable individuals. In this review, we summarize the results of both clinical and basic research studies of PTCs to date, explore key differences between PTCs and HIV spontaneous controllers, examine potential mechanisms of post-treatment control, and discuss unanswered questions and future research directions in this field.
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Affiliation(s)
| | | | - Jonathan Z. Li
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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