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Garbey M, Lesport Q, Girma H, Öztosen G, Abu-Rub M, Guidon AC, Juel V, Nowak R, Soliven B, Aban I, Kaminski HJ. Application of Digital Tools and Artificial Intelligence to the Myasthenia Gravis Core Examination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.19.24310691. [PMID: 39072011 PMCID: PMC11275678 DOI: 10.1101/2024.07.19.24310691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Advances in video image analysis and artificial intelligence provide the opportunity to transform the approach to patient evaluation through objective digital evaluation. Objectives We assessed ability to quantitate Zoom video recordings of a standardized neurological examination the myasthenia gravis core examination (MG-CE), which had been designed for telemedicine evaluations. Methods We used Zoom (Zoom Video Communications) videos of patients with myasthenia gravis undergoing the MG-CE. Computer vision in combination with artificial intelligence methods were used to build algorithms to analyze videos with a focus on eye or body motions. For the assessment of examinations involving vocalization, signal processing methods were developed, including natural language processing. A series of algorithms were built that could automatically compute the metrics of the MG-CE. Results Fifty-one patients with MG with videos recorded twice on separate days and 15 control subjects were assessed once. We were successful in quantitating lid, eye, and arm positions and as well as well as develop respiratory metrics using breath counts. Cheek puff exercise was found to be of limited value for quantitation. Technical limitations included variations in illumination, bandwidth, and recording being done on the examiner side, not the patient. Conclusions Several aspects of the MG-CE can be quantitated to produce continuous measures via standard Zoom video recordings. Further development of the technology offer the ability for trained, non-physician, health care providers to perform precise examination of patients with MG outside the clinic, including for clinical trials. Plain Language Summary Advances in video image analysis and artificial intelligence provide the opportunity to transform the approach to patient evaluation. Here, we asked whether video recordings of the typical telemedicine examination for the patient with myasthenia gravis be used to quantitate examination findings? Despite recordings not made for purpose, we were able to develop and apply computer vision and artificial intelligence to Zoom recorded videos to successfully quantitate eye muscle, facial muscle, and limb fatigue. The analysis also pointed out limitations of human assessments of bulbar and respiratory assessments. The neuromuscular examination can be enhanced by advance technologies, which have the promise to improve clinical trial outcome measures as well as standard care.
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Fan L, Hu Y, Li R, Ding J, Liu Y, Yu S, Hu M, Su R, Li Y, Yu A, Xie D, Zhao Q, Ma P. Enhanced immune reconstitution with albuvirtide in HIV-infected immunological non-responders. Front Cell Infect Microbiol 2024; 14:1397743. [PMID: 38975330 PMCID: PMC11227255 DOI: 10.3389/fcimb.2024.1397743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/24/2024] [Indexed: 07/09/2024] Open
Abstract
Background Incomplete immune recovery in people living with HIV/AIDS (PLWHA) remains an important clinical challenge with the lack of an effective strategy currently available to restore their T-cell immune response. This study aimed to evaluate the effect of Albuvirtide (ABT) on immune recovery in immunological non-responders (INRs) and attempted to explore potential mechanisms of ABT on the functionality of immune cells. Methods In this prospective, open-label, controlled clinical study, participants with incomplete immune reconstitution (continuous ART over 5 years and CD4+T lymphocyte absolute count of <500 cells/µl or ART for 2-5 years and CD4+T cell count of <200 cells/µl with undetectable viral load) were received intensive treatment with ABT or maintained on the original ART regimen at a ratio of 1:1. Immune response and safety were examined within 24 weeks. In the cytological study, T subsets, cell apoptosis and cell autophagy were analyzed using immunofluorescence staining and flow cytometry from 25 blood specimens. Results Both groups (n=25 each) were comparable in age, gender, and ART duration. At week 12, CD4+T cell count increased significantly in the intensive ABT group compared with control group (the change from baseline in CD4+T cell count: 45 vs. -5 cells/µL, p<0.001). After ABT discontinuation, CD4+T cell counts remained significantly higher in the intensive ABT group at week 24 (55 vs. -5 cells/µL, p=0.012). In laboratory analysis, naïve CD4+ T cell amounts were lowest among participants with unsatisfactory immune response (uIR) to ABT (p=0.001). The proportion of caspase 3+CD45RA+CD31+CD4+ T cells was significantly lower in participants with satisfactory immune response (sIR) to ABT (p<0.05). Conclusion Significant CD4+T cell count increase suggests ABT enhances immune function in INRs which may be attributed to its antiviral properties as well as its ability to increase thymic cell output and decrease cell apoptosis.
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Affiliation(s)
- Lina Fan
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Yue Hu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Tianjin Institute of Hepatology, Tianjin Second People’s Hospital, Tianjin, China
| | - Rui Li
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Jiaqi Ding
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Yuantao Liu
- Medical Affairs Department, Frontier Biotechnologies Inc, Nanjing, Jiangsu, China
| | - Shuchang Yu
- Medical Affairs Department, Frontier Biotechnologies Inc, Nanjing, Jiangsu, China
| | - Min Hu
- Medical Affairs Department, Frontier Biotechnologies Inc, Nanjing, Jiangsu, China
| | - Rui Su
- Tianjin Institute of Hepatology, Tianjin Second People’s Hospital, Tianjin, China
| | - Yangyang Li
- Department of Pathology, Tianjin Second People's Hospital, Tianjin, China
| | - AiPing Yu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Dong Xie
- Medical Affairs Department, Frontier Biotechnologies Inc, Nanjing, Jiangsu, China
| | - Qingxia Zhao
- Department of Infectious Diseases, Henan Infectious Diseases Hospital, Zhengzhou, Henan, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Tianjin Association of STD/AIDS Prevention and Control, Tianjin, China
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Guedes MCS, Carvalho-Silva WHV, Andrade-Santos JL, Brelaz-de-Castro MCA, Souto FO, Montenegro LML, Guimarães RL. HIV-Induced Thymic Insufficiency and Aging-Related Immunosenescence on Immune Reconstitution in ART-Treated Patients. Vaccines (Basel) 2024; 12:612. [PMID: 38932341 PMCID: PMC11209262 DOI: 10.3390/vaccines12060612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 06/28/2024] Open
Abstract
The mechanisms underlying unsatisfactory immune reconstitution in HIV-1 positive patients under ART have not been fully elucidated, even after years of investigation. Thus, this study aimed to assess the correlation between age and thymic production profile, and its influence on inadequate immunological recovery. Here, 44 ART-treated patients with undetectable plasma HIV-1 load (<40 copies/mL) were classified as 31 immunological responders (IR) and 13 immunological non-responders (INR), according to their CD4+ T-cell count after 18 months of ART. The thymic function was assessed by identifying recent thymic emigrants (RTEs) CD4+ T cells (CD4+/CD45RA+CD31+) in PBMCs using flow cytometry. Clinical data were also analyzed from medical records. The INR group showed a higher age at ART initiation (41 ± 3.0) compared to the IR (33.7 ± 2.1) group (p = 0.041). Evaluating RTE CD4+ T-cells, we observed a lower percentage in the INR group (19.5 ± 6.3) compared to the IR group (29.9 ± 11.5) (p = 0.012). There was a strong negative correlation between age at ART initiation and RTE CD4+ T-cells in INRs (r = -0.784, p = 0.004). Our study has highlighted the thymic insufficiency and aging-related immunosenescence with unsatisfactory immunological recovery during ART in HIV-1 positive patients.
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Affiliation(s)
- Maria Carolina Santos Guedes
- Department of Genetics, Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (M.C.S.G.); (R.L.G.)
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (W.H.V.C.-S.); (J.L.A.-S.); (F.O.S.)
| | - Wlisses Henrique Veloso Carvalho-Silva
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (W.H.V.C.-S.); (J.L.A.-S.); (F.O.S.)
- Aggeu Magalhães Institute—Oswaldo Cruz Fundation (IAM/FIOCRUZ), Recife 50740-465, PE, Brazil;
| | - José Leandro Andrade-Santos
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (W.H.V.C.-S.); (J.L.A.-S.); (F.O.S.)
| | - Maria Carolina Accioly Brelaz-de-Castro
- Aggeu Magalhães Institute—Oswaldo Cruz Fundation (IAM/FIOCRUZ), Recife 50740-465, PE, Brazil;
- Vitória Academic Center (CAV), Federal University of Pernambuco—UFPE, Recife 55608-680, PE, Brazil
| | - Fabrício Oliveira Souto
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (W.H.V.C.-S.); (J.L.A.-S.); (F.O.S.)
- Agreste Academic Center (CAA), Federal University of Pernambuco—UFPE, Recife 55014-900, PE, Brazil
| | | | - Rafael Lima Guimarães
- Department of Genetics, Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (M.C.S.G.); (R.L.G.)
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco—UFPE, Recife 50670-901, PE, Brazil; (W.H.V.C.-S.); (J.L.A.-S.); (F.O.S.)
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Vos WAJW, Navas A, Meeder EMG, Blaauw MJT, Groenendijk AL, van Eekeren LE, Otten T, Vadaq N, Matzaraki V, van Cranenbroek B, Brinkman K, van Lunzen J, Joosten LAB, Netea MG, Blok WL, van der Ven AJAM, Koenen HJPM, Stalenhoef JE. HIV immunological non-responders are characterized by extensive immunosenescence and impaired lymphocyte cytokine production capacity. Front Immunol 2024; 15:1350065. [PMID: 38779686 PMCID: PMC11109418 DOI: 10.3389/fimmu.2024.1350065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Immunological non-responders (INR) are people living with HIV (PLHIV) who fail to fully restore CD4+ T-cell counts despite complete viral suppression with antiretroviral therapy (ART). INR are at higher risk for non-HIV related morbidity and mortality. Previous research suggest persistent qualitative defects. Methods The 2000HIV study (clinical trials NTC03994835) enrolled 1895 PLHIV, divided in a discovery and validation cohort. PLHIV with CD4 T-cell count <350 cells/mm3 after ≥2 years of suppressive ART were defined as INR and were compared to immunological responders (IR) with CD4 T-cell count >500 cells/mm3. Logistic and rank based regression were used to analyze clinical data, extensive innate and adaptive immunophenotyping, and ex vivo monocyte and lymphocyte cytokine production after stimulation with various stimuli. Results The discovery cohort consisted of 62 INR and 1224 IR, the validation cohort of 26 INR and 243 IR. INR were older, had more advanced HIV disease before starting ART and had more frequently a history of non-AIDS related malignancy. INR had lower absolute CD4+ T-cell numbers in all subsets. Activated (HLA-DR+, CD38+) and exhausted (PD1+) subpopulations were proportionally increased in CD4 T-cells. Monocyte and granulocyte immunophenotypes were comparable. INR lymphocytes produced less IL-22, IFN-γ, IL-10 and IL-17 to stimuli. In contrast, monocyte cytokine production did not differ. The proportions of CD4+CD38+HLA-DR+ and CD4+PD1+ subpopulations showed an inversed correlation to lymphocyte cytokine production. Conclusions INR compared to IR have hyperactivated and exhausted CD4+ T-cells in combination with lymphocyte functional impairment, while innate immune responses were comparable. Our data provide a rationale to consider the use of anti-PD1 therapy in INR.
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Affiliation(s)
- Wilhelm A. J. W. Vos
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | - Adriana Navas
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elise M. G. Meeder
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, Netherlands
- Cognition and Behavior, Donders Institute for Brain, Radboud University, Nijmegen, Netherlands
| | - Marc J. T. Blaauw
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine and Infectious Diseases, Elizabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands
| | - Albert L. Groenendijk
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine, ErasmusMC, Erasmus University, Rotterdam, Netherlands
- Department of Medical Microbiology and Infectious diseases, ErasmusMC, Erasmus University, Rotterdam, Netherlands
| | - Louise E. van Eekeren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Twan Otten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine and Infectious Diseases, Elizabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands
| | - Nadira Vadaq
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Vasiliki Matzaraki
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bram van Cranenbroek
- Department of Laboratory Medicine, Laboratory for Medical Immunology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kees Brinkman
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | - Jan van Lunzen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leo A. B. Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai G. Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Willem L. Blok
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | | | - Hans J. P. M. Koenen
- Department of Laboratory Medicine, Laboratory for Medical Immunology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Janneke E. Stalenhoef
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
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5
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Zhang Y, Ji J, Xie K, Cai M, Wang R, Zhang X, Chen X, Zhang Y, Wu H, Wang W, Li Z, Zhang T. Pathological proliferation: a potential mechanism for poor CD4 + T cell recovery in people living with HIV. Front Cell Infect Microbiol 2024; 14:1344778. [PMID: 38601742 PMCID: PMC11004319 DOI: 10.3389/fcimb.2024.1344778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
Background People living with HIV (PLWH) fail to achieve normalization of CD4+ T cell counts and function, especially in immunological non-responders (INRs). The frequencies of Ki67+CD4+ T cells were inversely associated with CD4+ T cell counts in HIV infected patients. Early ART did not normalize CD4+ T cell proliferation. However, the features of the abnormal proliferation CD4+ T cell in INRs are far from known. Method PLWH were divided into INRs (n= 16) and immunological responders (IRs, n= 53) groups. Mass cytometry was applied to peripheral blood T cells to profile the immune cells and liquid chip technique was used to measure plasma levels of cytokines and chemokines. Correlation analyses were conducted to evaluate associations between the degree of CD4+ T cell proliferation and immune function. Results The percentage of Ki67+ CD4+ T cells were significant higher in INRs, and we defined these cells with significant higher level of Ki67, as over-proliferating cells. No significant difference of markers' expression (HLA-DR, CD38, CD57, PD-1, PD-L1, CD107a, perforin) was found between INRs and IRs. Compared with naïve CD4+ T cells in INRs, Ki67+ CD4+ T cells exhibited lower levels of CD57 and CD38. Whereas Ki67+ T cells exhibited higher levels of CD38 and CD57 and activation compared with differentiated mature central memory CD4+ T cells and effector memory CD4+ T cells. Ki67+ cells did not show higher levels of senescence and activation compared to certain Ki67- CD4+ central memory T cells in IRs. Furthermore, Ki67+ CD4+ Tcm cells exhibited positive correlations with pro-inflammatory cytokines. Conclusion We proposed and validated the hypothesis of "pathological proliferation" in INRs: excessive proliferation of CD4+ T cells in INRs may be accompanied by aberrant activation, senescence and loss of immune function. Eventually, such over-proliferating but poor-quality cells in INRs result in incomplete recovery of both CD4+ T cell counts and function. An intervention that enhancing the proliferative capacity or functional ability or both of CD4+ T cell in INRs might therefore be beneficial.
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Affiliation(s)
- Yang Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, China
| | - Jiahao Ji
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Kaidi Xie
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Miaotian Cai
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Beijing, China
| | - Xin Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xue Chen
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yulin Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, China
| | - Zhen Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Beijing, China
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Zhao H, Feng A, Luo D, Yuan T, Lin YF, Ling X, Zhong H, Li J, Li L, Zou H. Factors associated with immunological non-response after ART initiation: a retrospective observational cohort study. BMC Infect Dis 2024; 24:138. [PMID: 38287246 PMCID: PMC10823693 DOI: 10.1186/s12879-024-09021-9] [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: 07/18/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Among people living with HIV (PLHIV) on antiretroviral therapy (ART), the mortality of immunological non-responders (INRs) is higher than that of immunological responders (IRs). However, factors associated with immunological non-response following ART are not well documented. METHODS We obtained data for HIV patients from the National Free Antiretroviral Treatment Program database in China. Patients were grouped into IRs (CD4 cell count ≥ 350 cells/μl after 24 months' treatment), immunological incomplete responders (ICRs) (200-350 cells/μl) and INRs (< 200 cells/μl). Multivariable logistic regression was used to assess factors associated with immunological non-response. RESULTS A total of 3900 PLHIV were included, among whom 2309 (59.2%) were IRs, 1206 (30.9%) ICRs and 385 (9.9%) INRs. In multivariable analysis, immunological non-response was associated with being male (2.07, 1.39-3.09), older age [40-49 years (vs. 18-29 years): 2.05, 1.29-3.25; 50-59 years: 4.04, 2.33-7.00; ≥ 60 years: 5.51, 2.84-10.67], HBV co-infection (1.63, 1.14-2.34), HCV co-infection (2.01, 1.01-4.02), lower CD4 + T cell count [50-200 cells/μl (vs. 200-350 cells/μl): 40.20, 16.83-96.01; < 50 cells/μl: 215.67, 85.62-543.26] and lower CD4/CD8 ratio (2.93, 1.98-4.34) at baseline. Compared with patients treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens, those receiving protease inhibitors (PIs) based regimens were less likely to be INRs (0.47, 0.26-0.82). CONCLUSIONS We found a sizable immunological non-response rate among HIV-infected patients. Being male, older age, coinfection with HBV and HCV, lower CD4 + T cell count and lower CD4/CD8 ratio are risk factors of immunological non-response, whereas PIs-based regimens is a protective factor.
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Affiliation(s)
- Heping Zhao
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Anping Feng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Dan Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xuemei Ling
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huolin Zhong
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junbin Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China.
- School of Public Health, Southwest Medical University, Luzhou, China.
- Kirby Institute, University of New South Wales, Sydney, Australia.
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McLaughlin A, Lin N, Jiang W, Lodi S, Lioznov D, Patts G, Gnatienko N, Blokhina E, Bendiks S, Freiberg MS, Tindle HA, Krupitsky E, Hahn JA, Samet JH, So-Armah K. Association of Alcohol Consumption With CD4 Recovery After Antiretroviral Therapy Initiation in St. Petersburg, Russia. J Acquir Immune Defic Syndr 2023; 94:244-252. [PMID: 37850982 PMCID: PMC10593489 DOI: 10.1097/qai.0000000000003250] [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: 10/31/2022] [Accepted: 06/21/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Delayed CD4 recovery after initiating antiretroviral therapy (ART) is a novel potential mechanism by which alcohol consumption leads to increased morbidity and mortality in people with HIV. We hypothesized that alcohol consumption at ART initiation is associated with slower CD4 recovery. METHODS We retrospectively analyzed 2 pooled longitudinal alcohol/HIV cohorts (2014-2019) in St. Petersburg, Russia. Eligible participants initiated the first ART during parent studies; had alcohol consumption assessed by the blood biomarker, phosphatidylethanol (PEth), at the last research visit before ART initiation; and had ≥1 CD4 count measurement before and after initiating ART. Participants were stratified by low, moderate, and high PEth (<8, 8-80, and >80 ng/mL, respectively). We used random-effects piecewise linear regression models to estimate CD4 recovery, defined as CD4 count change per 30 days after ART initiation, by the alcohol group. RESULTS Of 60 eligible participants, median age was 34 years and 28% were female. The median pre-ART PEth in the low, moderate, and high PEth groups were <8, 23, and 232 ng/mL, respectively. After starting ART, the CD4 count increased by 13.60 cells/mm3/mo (95% CI: 0.33 to 26.87) with low PEth, 0.93 cells/mm3/mo (95% CI: -6.18 to 8.04) with moderate PEth, and 2.33 cells/mm3/mo (95% CI: -3.44 to 8.09) with high PEth. CONCLUSIONS Among Russians with HIV, we observed faster CD4 recovery after ART initiation in those with low alcohol consumption compared with those with moderate and high alcohol consumption, as assessed by PEth. This analysis provides further evidence for the possible value of alcohol reduction interventions for people with HIV who are initiating ART.
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Affiliation(s)
- Angela McLaughlin
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Nina Lin
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Wenqing Jiang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dmitry Lioznov
- Department of Infectious Diseases and Epidemiology, First Pavlov State Medical University, St. Petersburg, Russia
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Natalia Gnatienko
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Elena Blokhina
- First Pavlov State Medical University, St. Petersburg, Russia
| | - Sally Bendiks
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Matthew S. Freiberg
- Department of Medicine, Vanderbilt University School of Medicine, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, St. Petersburg, Russia
- V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Judith A. Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey H. Samet
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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8
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Fan L, Li P, Yu A, Liu D, Wang Z, Wu Y, Zhang D, Zou M, Ma P. Prevalence of and prognosis for poor immunological recovery by virally suppressed and aged HIV-infected patients. Front Med (Lausanne) 2023; 10:1259871. [PMID: 37928477 PMCID: PMC10625403 DOI: 10.3389/fmed.2023.1259871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Background Antiretroviral therapy (ART) prolongs lifespan and decreases mortality of HIV infected patients. However, many patients do not achieve optimal immune reconstitution. The influence of non-optimal immune recovery on non-AIDS related diseases is not well defined in aged HIV-infected patients receiving ART. Methods A retrospective study was conducted at Tianjin Second People's Hospital, China to evaluate the association of an inadequate immunological response and non-AIDS diseases in HIV infected patients ≥60 years of age and virally suppressed for at least 2 years by ART. Results The study included patients (n = 666) who initiated ART between August 2009 and December 2020. The prevalence of patients with an inadequate immunological response was 29.6%. The percentage of non-AIDS diseases such as hypertension, cardiovascular disease (CVD), diabetes, tumor, and chronic kidney disease (CKD) was 32.9, 9.9, 31, 4.1, and 13%, respectively. In addition to baseline CD4+ T cell counts, CVD and tumor were associated with poor immune reconstitution in aged Chinese HIV-1 infected patients. The adjusted odds ratios (95% confidence interval) were AOR 2.45 (95% CI: 1.22-4.93) and 3.06 (95% CI: 1.09-8.56, p = 0.03). Inadequate immunological response was associated with greater mortality (AOR: 2.83, 95% CI: 1.42-5.67, p = 0.003) in this cohort. Conclusion These results tend to demonstrate appropriate drug selection at ART initiation and prevention of non-AIDS complications during ART decreased mortality of and an inadequate immunological response in aged HIV infected patients.
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Affiliation(s)
- Lina Fan
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Penghui Li
- Department of Surgery, Tianjin Second People's Hospital, Tianjin, China
| | - Aiping Yu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Dan Liu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Ziyu Wang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Yue Wu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Out-patient Department, Tianjin Second People's Hospital, Tianjin, China
| | - Defa Zhang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Out-patient Department, Tianjin Second People's Hospital, Tianjin, China
| | - Meiyin Zou
- Affiliated Infectious Disease Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Tianjin Association of STD/AIDS Prevention and Control, Tianjin, China
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9
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Saidakova EV, Korolevskaya LB, Shmagel NG, Vlasova VV, Shardina KY, Chereshnev VA, Shmagel KV. In HIV-Infected Immunological Non-Responders, Hepatitis C Virus Eradication Contributes to Incomplete Normalization of Systemic Inflammation Indexes, but Does Not Lead to Rapid CD4+ T-Cell Count Recovery. DOKL BIOCHEM BIOPHYS 2023; 512:274-278. [PMID: 38093130 DOI: 10.1134/s1607672923700448] [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: 04/20/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
In HIV-positive individuals taking antiretroviral therapy, coinfection with hepatitis C virus (HCV) increases systemic inflammation, which interferes with the CD4+ T-cells regeneration. This study evaluated the effect of HCV eradication on systemic inflammation and CD4+ T-cell regeneration in patients who gave poor response to antiretroviral therapy, the so-called "immunological non-responders" (INRs). HIV-infected patients who received a course of direct-acting antivirals for treating hepatitis C were examined. The control groups included HIV/HCV-coinfected INRs and relatively healthy volunteers. It was established for the first time that HCV eradication is not accompanied by a complete suppression of systemic inflammation, but improves the T-cell pool composition: in INRs, the blood CD4+/CD8+ T-lymphocyte ratio increases and approaches those of healthy individuals. Apparently, in INRs treated for hepatitis C, the immune system recovery takes time and may be incomplete.
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Affiliation(s)
- E V Saidakova
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia.
| | - L B Korolevskaya
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia
| | - N G Shmagel
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia
| | - V V Vlasova
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia
| | - K Yu Shardina
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia
| | - V A Chereshnev
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia
- Institute of Immunology and Physiology, Ural Branch, Russian Academy of Sciences, Yekaterinburg, Russia
| | - K V Shmagel
- Perm Federal Research Center, Ural Branch, Russian Academy of Sciences, Perm, Russia
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10
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Yan L, Xu K, Xiao Q, Tuo L, Luo T, Wang S, Yang R, Zhang F, Yang X. Cellular and molecular insights into incomplete immune recovery in HIV/AIDS patients. Front Immunol 2023; 14:1152951. [PMID: 37205108 PMCID: PMC10185893 DOI: 10.3389/fimmu.2023.1152951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Highly active antiretroviral therapy (ART) can effectively inhibit virus replication and restore immune function in most people living with human immunodeficiency virus (HIV). However, an important proportion of patients fail to achieve a satisfactory increase in CD4+ T cell counts. This state is called incomplete immune reconstitution or immunological nonresponse (INR). Patients with INR have an increased risk of clinical progression and higher rates of mortality. Despite widespread attention to INR, the precise mechanisms remain unclear. In this review, we will discuss the alterations in the quantity and quality of CD4+ T as well as multiple immunocytes, changes in soluble molecules and cytokines, and their relationship with INR, aimed to provide cellular and molecular insights into incomplete immune reconstitution.
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Affiliation(s)
- Liting Yan
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Xingxiang Yang, ; Fujie Zhang, ; Liting Yan,
| | - Kaiju Xu
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Qing Xiao
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Beijing, China
| | - Lin Tuo
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Tingting Luo
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Shuqiang Wang
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Renguo Yang
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Fujie Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Beijing, China
- *Correspondence: Xingxiang Yang, ; Fujie Zhang, ; Liting Yan,
| | - Xingxiang Yang
- Department of Infectious Disease, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Xingxiang Yang, ; Fujie Zhang, ; Liting Yan,
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11
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Xiao Q, Han J, Yu F, Yan L, Li Q, Lao X, Zhao H, Zhang F. Elucidating the Gene Signatures and Immune Cell Types in HIV-Infected Immunological Non-Responders by Bioinformatics Analyses. Int J Gen Med 2022; 15:8491-8507. [PMID: 36514742 PMCID: PMC9741855 DOI: 10.2147/ijgm.s390642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Numerous studies have reported on the pathogenesis of poor immune reconstitution (PIR) after antiretroviral treatment in human immunodeficiency virus (HIV) patients. However, fewer studies focused on both immune-related genes (IRGs) and immune cells, and the correlation between IRGs and immune cells was evaluated via bioinformatics analyses. Methods Gene expression profiling of GSE143742 from the Gene Expression Omnibus (GEO) database was analyzed to get differentially expressed immune-related genes (DEIRGs). The enrichment analysis and protein-protein interaction (PPI) networks of DEIRGs were established. The relative fractions of 22 immune cell types were detected using the "CIBERSORT". The correlation analysis between DEIRGs and immune cells was constructed to discover the potential IRGs associated with immune cells. A logistic regression diagnostic model was built, and a receiver operating characteristic (ROC) curve was performed to evaluate the model's diagnostic efficacy. The CMap database was used to find molecules with therapeutic potential. RT-qPCR was used to verify the expression of the hub DEIRGs. Results We identified eight types of significantly changed immune cells and five hub IRGs in INRs. The DEIRGs were mainly enriched in lymphocyte activation, receptor-ligand activity, and T cell receptor signaling pathway. The correlation analysis showed that the expression of TNF, CXCR4 and TFRC correlate with CD8 cells, resting mast cells, activated NK cells, and naïve CD4 cells in INRs. Meanwhile, TFRC and IL7R relate to activated NK cells and resting memory CD4 cells respectively in IRs. A diagnostic model was constructed using multiple logistic regression and nine small molecules were identified as possible drugs. Conclusion In this study, we suggested that the process of PIR might be related to TNF, CXCR4, TFRC, CD48, and IL7R. And these IRGs play roles in regulating immune-competent cells. And our constructed diagnostic model has excellent effectiveness. Moreover, some small-molecule drugs are screened to alleviate PIR.
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Affiliation(s)
- Qing Xiao
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China
| | - Junyan Han
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Beijing, People’s Republic of China,National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China,Beijing Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China,Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fengting Yu
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China,Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Beijing, People’s Republic of China
| | - Liting Yan
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China
| | - Qun Li
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaojie Lao
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China
| | - Hongxin Zhao
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China
| | - Fujie Zhang
- Department of Infectious Diseases, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, People’s Republic of China,Clinical Center for HIV/AIDS, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Fujie Zhang, Beijing, Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China, Tel +86 10 84322581, Email
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12
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Low Dehydroepiandrosterone (DHEA) Level Is Associated with Poor Immunologic Response among People Living with HIV/AIDS. J Clin Med 2022; 11:jcm11206077. [PMID: 36294397 PMCID: PMC9605475 DOI: 10.3390/jcm11206077] [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: 08/15/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Dehydroepiandrosterone (DHEA) is an adrenal steroid converted to potent androgens. This study aimed to discover the association between serum DHEA levels and immunologic response in people with HIV/AIDS (PLWHA). We enrolled patients aged ≥ 18 years who were treated with combination antiretroviral therapy (cART). We measured CD4+ and CD8+ T-cell counts, HIV-RNA titres, and serum DHEA levels. We assigned each patient to a good- or poor-responder group depending on their CD4+ T-cell counts at study enrolment. Participants with CD4+ T-cell counts > 200/µL were assigned to the good-responder group, whilst those with CD4+ T-cell counts < 200/µL were assigned to the poor-responder group. The participants were followed up for 2 years. The poor-responder group showed lower CD4+ T-cell counts and higher HIV PCR titres at their initial HIV diagnosis and in their 2-year follow-up data. Serum DHEA level was lower in the poor-responder group. Multivariable logistic analysis showed that BMI, initial CD4+ T-cell counts, and serum DHEA level were clinical factors associated with poor immunologic responsiveness to cART in PLWHA. Therefore, DHEA may be used as an indicator of the immunological recovery of PLWHA.
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13
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Sisteré-Oró M, Andrade N, Wortmann DD, Du J, Garcia-Giralt N, González-Cao M, Güerri-Fernández R, Meyerhans A. Anti-SARS-COV-2 specific immunity in HIV immunological non-responders after mRNA-based COVID-19 vaccination. Front Immunol 2022; 13:994173. [PMID: 36091014 PMCID: PMC9459333 DOI: 10.3389/fimmu.2022.994173] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 02/05/2023] Open
Abstract
Individuals infected with the human immunodeficiency virus type 1 (HIV-1) belong to the group of people most vulnerable to SARS-CoV-2 infections and the associated disease COVID-19. Here we describe SARS-CoV-2-specific antibody and cellular immune responses in a small cohort of immunological non-responder HIV-1 patients (HIV-INRs) after receiving the COVID-19 mRNA-based BioNTech/Pfizer vaccine. Compared to the control group of vaccinated healthy individuals that all developed a virus-specific immune response, 5 of 10 vaccinated HIV-1 patients showed insufficient immune responses. The lack of response was not directly correlated with patients CD4 cell counts. Three of the five non-responders that agreed to receive a booster vaccination subsequently generated a virus-specific response. Thus, even HIV-INRs can be efficiently vaccinated against COVID-19 but may require a follow-up by virus-specific immune monitoring to guarantee clinical vaccine benefits.
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Affiliation(s)
- Marta Sisteré-Oró
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Naina Andrade
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Diana D.J. Wortmann
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Juan Du
- Infectious Diseases Unit, Hospital del Mar, Institute of Medical Research (IMIM), Barcelona, Spain
| | - Natalia Garcia-Giralt
- Infectious Diseases Unit, Hospital del Mar, Institute of Medical Research (IMIM), Barcelona, Spain
| | - María González-Cao
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Robert Güerri-Fernández
- Infectious Diseases Unit, Hospital del Mar, Institute of Medical Research (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades infecciosas, CIBERINFEC Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Robert Güerri-Fernández, ; Andreas Meyerhans,
| | - Andreas Meyerhans
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- *Correspondence: Robert Güerri-Fernández, ; Andreas Meyerhans,
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14
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Analysis of the Influencing Factors of Immunological Nonresponders in Wuhan, China. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:5638396. [PMID: 35979516 PMCID: PMC9377976 DOI: 10.1155/2022/5638396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
Objective CD4+ cell recovery is hampered in some human immunodeficiency virus (HIV)-infected patients, despite a successful highly active antiretroviral therapy (HAART) with suppressed viral replication. We investigated the factors that might have hindered the CD4+ cell recovery in these patients. Methods In this retrospective study, we collected the data of all immune nonresponders (INRs) in Wuhan, China, until the end of 2020. A linear model was constructed based on the data from 220 patients with baseline and follow-up records. The response variables in this study were the CD4+ cell count increase. The predictor variables considered in this study were those factors likely to affect the CD4+ cell recovery. Results Our findings revealed that the plasma HIV-1 viral load of all patients was suppressed and 87.3% patients' CD4+ cells was increased after more than one year of the HAART treatment. In addition, their last follow-up showed a significant reduction in complications. In our results, the body mass index (BMI), number of months since HIV diagnosis to HAART start, and nonuse of co-trimoxazole were negatively correlated with the increase in CD4+ cells (P < 0.05). However, there were positive associations between serum creatinine levels and CD4+ cell recovery (P < 0.05). Further stratified analyses indicated that the associations between HAART replacement or creatinine usage and CD4+ cell growth were only observed in those participants with a BMI <18.5 (P < 0.05). Conclusions An early initiation of HAART and co-trimoxazole preventive therapy (CPT) can promote immune reconstitution. BMI and serum creatinine can serve as monitoring indicators of immune reconstitution prognosis after the HAART.
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15
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Abstract
OBJECTIVE Atherosclerosis is common in people with HIV (PWH). Peripheral artery disease (PAD) is the peripheral manifestation of atherosclerosis, but little is known about the incidence of PAD in PWH. Our objective was to determine the PAD incidence in PWH and to investigate potential risk factors. DESIGN Prospective longitudinal study on PWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) study cohort. METHODS We performed ankle-brachial index (ABI) measurements at study entry and at 2-year follow-up and included participants with normal ABI at study entry. We defined de novo PAD as ABI ≤0.9 at follow-up. Using Poisson regression adjusted for age, sex, and smoking, we investigated the role of traditional and HIV-related risk factors, including inflammatory markers. RESULTS Of 844 PWH followed for a median duration of 2.3 years, 30 (3.6%) developed de novo PAD. All cases were subclinical. Diabetes (relative risk [RR] = 4.90 [95% confidence interval [CI]: 1.99-12.1]), current CD4 count <350 cells/μl (2.66 [1.06-6.71]), longer duration of antiretroviral therapy (antiretroviral therapy [ART], 1.88 [1.06-3.33] per decade), and concentrations of high-sensitivity C-reactive protein (1.33 [1.08-1.63] per doubling) and interleukin-6 (1.38 [1.06-1.80] per doubling), were associated with de novo PAD. CONCLUSIONS PWH had a high incidence of de novo subclinical PAD. Diabetes, low current CD4 count, duration of ART, and inflammatory markers were associated with de novo PAD, indicating a possible role in PAD pathogenesis in PWH.
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16
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Su B, Kong D, Yang X, Zhang T, Kuang YQ. Mucosal-associated invariant T cells: a cryptic coordinator in HIV-infected immune reconstitution. J Med Virol 2022; 94:3043-3053. [PMID: 35243649 DOI: 10.1002/jmv.27696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 11/11/2022]
Abstract
Human immunodeficiency virus type 1 (HIV-1) infection causes considerable morbidity and mortality worldwide. Although antiretroviral therapy (ART) has largely transformed HIV infection from a fatal disease to a chronic condition, approximately 10%~40% of HIV-infected individuals who receive effective ART and sustain long-term viral suppression still cannot achieve optimal immune reconstitution. These patients are called immunological non-responders, a state associated with poor clinical prognosis. Mucosal-associated invariant T (MAIT) cells are an evolutionarily conserved unconventional T cell subset defined by expression of semi-invariant αβ T cell receptor (TCR), which recognizes metabolites derived from the riboflavin biosynthetic pathway presented on major histocompatibility complex (MHC)-related protein-1 (MR1). MAIT cells, which are considered to act as a bridge between innate and adaptive immunity, produce a wide range of cytokines and cytotoxic molecules upon activation through TCR-dependent and TCR-independent mechanisms, which is of major importance in defense against a variety of pathogens. In addition, MAIT cells are involved in autoimmune and immune-mediated diseases. The number of MAIT cells is dramatically and irreversibly decreased in the early stage of HIV infection and is not fully restored even after long-term suppressive ART. In light of the important role of MAIT cells in mucosal immunity and because microbial translocation is inversely associated with CD4+ T cell counts, we propose that MAIT cells participate in the maintenance of intestinal barrier integrity and microbial homeostasis, thus further affecting immune reconstitution in HIV-infected individuals. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.,Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Deshenyue Kong
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, 650032, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Xiaodong Yang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.,Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.,Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, 650032, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
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17
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Yeregui E, Masip J, Viladés C, Domingo P, Pacheco YM, Blanco J, Mallolas J, Alba V, Vargas M, García-Pardo G, Negredo E, Olona M, Vidal-González J, Peraire M, Martí A, Reverté L, Gómez-Bertomeu F, Leal M, Vidal F, Peraire J, Rull A. Adipokines as New Biomarkers of Immune Recovery: Apelin Receptor, RBP4 and ZAG Are Related to CD4+ T-Cell Reconstitution in PLHIV on Suppressive Antiretroviral Therapy. Int J Mol Sci 2022; 23:ijms23042202. [PMID: 35216318 PMCID: PMC8874604 DOI: 10.3390/ijms23042202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
A significant proportion of people living with HIV (PLHIV) who successfully achieve virological suppression fail to recover CD4+ T-cell counts. Since adipose tissue has been discovered as a key immune organ, this study aimed to assess the role of adipokines in the HIV immunodiscordant response. This is a multicenter prospective study including 221 PLHIV starting the first antiretroviral therapy (ART) and classified according to baseline CD4+ T-cell counts/µL (controls > 200 cells/µL and cases ≤ 200 cells/µL). Immune failure recovery was considered when cases did not reach more than 250 CD4+ T cells/µL at 144 weeks (immunological nonresponders, INR). Circulating adipokine concentrations were longitudinally measured using enzyme-linked immunosorbent assays. At baseline, apelin receptor (APLNR) and zinc-alpha-2-glycoprotein (ZAG) concentrations were significantly lower in INRs than in immunological responders (p = 0.043 and p = 0.034), and they remained lower during all ART follow-up visits (p = 0.044 and p = 0.028 for APLNR, p = 0.038 and p = 0.010 for ZAG, at 48 and 144 weeks, respectively). ZAG levels positively correlated with retinol-binding protein 4 (RBP4) levels (p < 0.01), and low circulating RBP4 concentrations were related to a low CD4+ T-cell gain (p = 0.018 and p = 0.039 at 48 and 144 weeks, respectively). Multiple regression adjusted for clinical variables and adipokine concentrations confirmed both low APLNR and RBP4 as independent predictors for CD4+ T cells at 144 weeks (p < 0.001). In conclusion, low APLNR and RBP4 concentrations were associated with poor immune recovery in treated PLHIV and could be considered predictive biomarkers of a discordant immunological response.
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Affiliation(s)
- Elena Yeregui
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Jenifer Masip
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Consuelo Viladés
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Yolanda M. Pacheco
- Laboratory of Immunology, Institute of Biomedicine of Seville, IBiS, 41013 Seville, Spain;
- UGC Clinical Laboratories, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - Julià Blanco
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- IrsiCaixa AIDS Research Institute, 08916 Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Badalona, Spain
- Infectious Diseases and Immunity, Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), 08500 Vic, Spain
| | - Josep Mallolas
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- HIV Unit and Infectious Diseases Service, Hospital Clinic-IDIBAPS, 08036 Barcelona, Spain
| | - Verónica Alba
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Montserrat Vargas
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Graciano García-Pardo
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Eugènia Negredo
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- Infectious Diseases and Immunity, Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), 08500 Vic, Spain
- Fundació de la Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Montserrat Olona
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | | | - Maria Peraire
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
| | - Anna Martí
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Laia Reverté
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Fréderic Gómez-Bertomeu
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Manuel Leal
- Internal Medicine Service, Hospital Viamed Santa Ángela de la Cruz, 41014 Seville, Spain;
| | - Francesc Vidal
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- Correspondence: (F.V.); (A.R.)
| | - Joaquim Peraire
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
| | - Anna Rull
- Infection and Immunity Research Group (INIM), Hospital Universitari de Tarragona Joan XXIII (HJ23), 43005 Tarragona, Spain; (E.Y.); (J.M.); (C.V.); (V.A.); (M.V.); (G.G.-P.); (M.O.); (A.M.); (L.R.); (F.G.-B.); (J.P.)
- Institut Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Infection and Immunity Research Group (INIM), Universitat Rovira i Virgili (URV), 43003 Tarragona, Spain;
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.B.); (J.M.); (E.N.)
- Correspondence: (F.V.); (A.R.)
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Rousseau RK, Walmsley SL, Lee T, Rosenes R, Reinhard RJ, Malazogu F, Benko E, Huibner S, Kovacs CM, Singer J, Kim CJ, Kaul R. A randomized, blinded, placebo-controlled trial of De Simone formulation probiotic during HIV-associated suboptimal CD4+ T cell recovery. J Acquir Immune Defic Syndr 2021; 89:199-207. [PMID: 34693932 DOI: 10.1097/qai.0000000000002840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether probiotic supplementation may reduce disease-linked systemic immune activation in people living with HIV with the immunologic non-responder (INR) phenotype. DESIGN Phase 2b, randomized, double-blind, placebo-controlled pilot trial. METHODS HIV-positive individuals with blood CD4+ T cell counts <350/mm3 despite viral suppression were randomized 2:1 to receive De Simone Formulation Probiotic (DSFP; "Visbiome" commercially) or placebo for 48 weeks; target enrolment was 36 patients. The primary endpoint was change in blood CD8+ T cell co-expression of HLA-DR and CD38 ("CD8 activation"). Secondary endpoints included biomarkers of inflammation, immune reconstitution, bacterial translocation, and gut permeability. Adjusted linear regression and linear mixed methods regression evaluated the differences between study arms from baseline to week 48. Study monitoring was done by the CIHR Canadian HIV Trials Network Data Safety Monitoring Committee. RESULTS Nineteen patients received DSFP, while 10 received placebo. One probiotic-arm patient withdrew early. Blood CD8 activation increased 0.82 percentage points (pp) in the probiotic arm (95% confidence interval [CI];-1.23,2.87;) and decreased by 2.06pp in the placebo arm (-4.81,0.70; between arms p=0.097). CD4+ T cell activation (%HLA-DR+) decreased in the placebo arm (-3.79pp [-7.32,-0.26]) but increased in the probiotic arm (1.64 [-0.98,4.26]; between arms p=0.018). No differences were observed in plasma or urine biomarkers of inflammation or microbial translocation. CONCLUSIONS Blood immune activation markers in INR individuals on effective ART were not reduced by supplementation with DSFP; CD4+ T cell activation may have been increased.
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Affiliation(s)
- Rodney K Rousseau
- University of Toronto, Departments of Immunology, Medicine, and Internal Medicine, Toronto, Canada University Health Network, Toronto General Hospital Immunodeficiency Clinic, Toronto, Canada Toronto General Hospital Research Institute, Toronto, Canada CIHR Canadian HIV Trials Network, Vancouver, Canada Centre for Health Evaluation & Outcomes Sciences, Vancouver, Canada Community Health Advocate and Consultant (Independent), Toronto, Canada Public/Global Health Consultant (Independent), San Francisco, USA Maple Leaf Medical Clinic, Toronto, Canada
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19
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Lu D, Zhang JB, Wang YX, Geng ST, Zhang Z, Xu Y, Li SY, Wang KH, Kuang YQ. Association between CD4 + T cell counts and gut microbiota and serum cytokines levels in HIV-infected immunological non-responders. BMC Infect Dis 2021; 21:742. [PMID: 34344350 PMCID: PMC8336095 DOI: 10.1186/s12879-021-06491-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023] Open
Abstract
Background CD4+ T cell counts in certain human immunodeficiency virus (HIV)-infected patients called immunological non-responders (INRs) could not return to a normal level even with sustained antiretroviral therapy (ART) because of persistent immune activation, which is associated with pro-inflammatory cytokines production and an altered intestinal microbiome profile. Changes in gut bacterial composition have been linked to low CD4+ T cell counts in HIV-infected individuals. However, the association between CD4+ T cell counts and gut microbiota community composition and cytokines levels in INRs (CD4+ T cell counts < 500 cells/μL) from Yunnan Province, China, has not been previously investigated.
Methods To address this issue, we carried out a cross-sectional study of 34 HIV-infected INRs. The patients were divided into CD4 count > 200 cells/μL group and CD4 count < 200 cells/μL group. The gut microbiota composition of each subject was analyzed by 16S rRNA gene sequencing. We also compared CD8+ T cell counts, pro-inflammatory cytokines levels, and nutritional status between the two groups. Results Compared to INRs with CD4 count > 200 cells/μL, those with CD4 count < 200 cells/μL had a lower CD4/CD8 ratio, lower nutritional status and higher serum levels of tumor necrosis factor (TNF)-α, interferon-γ-inducible protein (IP)-10 and interleukin (IL)-1α. Ruminococcaceae was less abundant in the CD4 count < 200 cells/μL group than in the CD4 count > 200 cells/μL group, and difference in alpha diversity was observed between the two groups. Moreover, CD4+ T cell counts were negatively associated with TNF-α and IL-1α levels and positively associated with the relative abundance of Ruminococcaceae. Conclusions Our study demonstrated that lower CD4+ T cell counts in INRs are associated with a reduced abundance of Ruminococcaceae in the gut and elevated serum pro-inflammatory cytokines levels. Thus, interventions targeting gut microbiota to increase CD4+ T cell counts are a potential strategy for promoting immune reconstitution in HIV-infected INRs. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06491-z.
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Affiliation(s)
- Danfeng Lu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Bo Zhang
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Yue-Xin Wang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shi-Tao Geng
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zunyue Zhang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu Xu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shao-You Li
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kun-Hua Wang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China. .,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China. .,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China.
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20
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Wang L, Zhang Z, Xu R, Wang X, Shu Z, Chen X, Wang S, Liu J, Li Y, Wang L, Zhang M, Yang W, Wang Y, Huang H, Tu B, Liang Z, Li L, Li J, Hou Y, Shi M, Wang FS. Human umbilical cord mesenchymal stem cell transfusion in immune non-responders with AIDS: a multicenter randomized controlled trial. Signal Transduct Target Ther 2021; 6:217. [PMID: 34103473 PMCID: PMC8187429 DOI: 10.1038/s41392-021-00607-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 02/07/2023] Open
Abstract
We examined the safety and efficacy of human umbilical cord mesenchymal stem cell (hUC-MSC) infusion for immune non-responder (INR) patients with chronic HIV-1 infection, who represent an unmet medical need even in the era of efficient antiretroviral therapy (ART). Seventy-two INR patients with HIV were enrolled in this phase II randomized, double-blinded, multicenter, placebo-controlled, dose-determination trial (NCT01213186) from May 2013 to March 2016. They were assigned to receive high-dose (1.5 × 106/kg body weight) or low-dose (0.5 × 106/kg body weight) hUC-MSC, or placebo. Their clinical and immunological parameters were monitored during the 96-week follow-up study. We found that hUC-MSC treatment was safe and well-tolerated. Compared with baseline, there was a statistical increase in CD4+ T counts in the high-dose (P < 0.001) and low-dose (P < 0.001) groups after 48-week treatment, but no change was observed in the control group. Kaplan-Meier analysis revealed a higher cumulative probability of achieving an immunological response in the low-dose group compared with the control group (95.8% vs. 70.8%, P = 0.004). However, no significant changes in CD4/CD8+ T counts and CD4/CD8 ratios were observed among the three groups. In summary, hUC-MSC treatment is safe. However, the therapeutic efficacy of hUC-MSC treatment to improve the immune reconstitution in INR patients still needs to be further investigated in a large cohort study.
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Affiliation(s)
- Lifeng Wang
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zheng Zhang
- Institute of Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Ruonan Xu
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xicheng Wang
- Yunnan Provincial Hospital of Infectious Diseases, Kunming, China
| | - Zhanjun Shu
- Xinjiang Uygur Autonomous Regional the Sixth People's Hospital, Urumqi, China
| | - Xiejie Chen
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Siyu Wang
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiaye Liu
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuanyuan Li
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Wang
- Yunnan Provincial Hospital of Infectious Diseases, Kunming, China
| | - Mi Zhang
- Yunnan Provincial Hospital of Infectious Diseases, Kunming, China
| | - Wei Yang
- Xinjiang Uygur Autonomous Regional the Sixth People's Hospital, Urumqi, China
| | - Ying Wang
- Xinjiang Uygur Autonomous Regional the Sixth People's Hospital, Urumqi, China
| | - Huihuang Huang
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bo Tu
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiwei Liang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jingxin Li
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuying Hou
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ming Shi
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fu-Sheng Wang
- Treatment and Research Center for Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
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Meissner EG, Chung D, Tsao B, Haas DW, Utay NS. IFNL4 Genotype Does Not Associate with CD4 T-Cell Recovery in People Living with Human Immunodeficiency Virus. AIDS Res Hum Retroviruses 2021; 37:184-188. [PMID: 33066718 PMCID: PMC8020497 DOI: 10.1089/aid.2020.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Immune non-responders (INRs) are people with HIV infection who fail to restore their CD4 T-cell counts in spite of prolonged virologic suppression, a condition associated with higher rates of all-cause mortality. The mechanisms of immune non-response are not entirely clear. We used existing clinical and genetic data from AIDS Clinical Trials Group clinical trials to ask whether an IFNL4 single-nucleotide polymorphism, shown to be associated with outcomes for other infectious diseases, correlated with immune non-response for HIV. Analysis of data from 426 participants with clearly defined CD4 T-cell recovery phenotypes, including 88 INRs with CD4 < 200 cells/mm3 after 2 years of suppressive antiretroviral therapy, did not identify an association of IFNL4 genotype with immune non-response. Thus, the IFNL4 genotype is unlikely to influence immunologic recovery.
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Affiliation(s)
- Eric G. Meissner
- Division of Infectious Diseases, Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dongjun Chung
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, USA
| | - Betty Tsao
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David W. Haas
- Departments of Medicine, Pharmacology, Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Division of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Netanya S. Utay
- Division of General Medicine, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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22
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Definition of Immunological Nonresponse to Antiretroviral Therapy: A Systematic Review: Erratum. J Acquir Immune Defic Syndr 2020; 83:e28. [DOI: 10.1097/qai.0000000000002312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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