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Yu F, Ma C, Jin X, Zhao H, Xiao J, Li L, Song S, Xie X, Yang S, Tang Y, Wang L, Zhang F. Mitochondrial disturbance related to increased caspase-1 of CD4 +T cells in HIV-1 infection. BMC Infect Dis 2024; 24:129. [PMID: 38267841 PMCID: PMC10809604 DOI: 10.1186/s12879-023-08485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/26/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In HIV-1 infection, more than 95% of CD4+T cells die of caspase-1 mediated pyroptosis. What governs the increased susceptibility of CD4+T cells to pyroptosis is poorly understood. METHODS Blood samples were obtained from 31 untreated HIV-infected patients (UNT), 29 antiretroviral therapy treated HIV-infected patients (ART), and 21 healthy control donors (HD). Plasma levels of IL-18 and IL-1β, caspase-1 expression, mitochondrial mass (MM) and mitochondrial fusion/fisson genes of CD4+T subsets were measured. RESULTS A significantly higher IL-18 level in plasma and MM level of CD4+T cells were found in HIV-infected patients (UNT and ART) compared to HD, and the MMhigh phenotype was manifested, related to increased caspase-1 expression. Moreover, the increased MM was more pronounced in the early differentiated and inactivated CD4+T cells. However, higher MM was not intrinsically linked to T cell differentiation disorder or excessive activation of the CD4+T cells. Mechanistically, the increased MM was significantly correlated with an elevated level of expression of the mitochondrial fusion gene mitofusin1. CONCLUSION An increase in MM was associated with heightened sensitivity of CD4+T cells to pyroptosis, even in early differentiated and inactivated CD4+T cells, in patients with HIV-1 infection, regardless of whether patients were on antiretroviral therapy or not. These new revelations have uncovered a previously unappreciated challenge to immune reconstitution with antiretroviral therapy.
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Affiliation(s)
- Fengting Yu
- Medical School, University of Chinese Academy of Sciences, Beijing, 101400, China
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Chengjie Ma
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Xia Jin
- Human Viral Diseases and Vaccine Translation Research Unit, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Hongxin Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Jiang Xiao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Shujing Song
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Xie
- Department of Infectious Diseases, Peking University Ditan Teaching, Hospital, Beijing, China
| | - Siyuan Yang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Yunxia Tang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Linghang Wang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China.
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China.
| | - Fujie Zhang
- Medical School, University of Chinese Academy of Sciences, Beijing, 101400, China.
- Beijing Ditan Hospital, Capital Medical University, Beijing, China.
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China.
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Saloner R, Sun-Suslow N, Morgan EE, Lobo J, Cherner M, Ellis RJ, Heaton RK, Grant I, Letendre SL, Iudicello JE. Plasma biomarkers of vascular dysfunction uniquely relate to a vascular-risk profile of neurocognitive deficits in virally-suppressed adults with HIV. Brain Behav Immun Health 2022; 26:100560. [DOI: 10.1016/j.bbih.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
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Rafikov R, Rischard F, Vasilyev M, Varghese MV, Yuan JXJ, Desai AA, Garcia JGN, Rafikova O. Cytokine profiling in pulmonary arterial hypertension: the role of redox homeostasis and sex. Transl Res 2022; 247:1-18. [PMID: 35405322 PMCID: PMC10062382 DOI: 10.1016/j.trsl.2022.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a fatal disease with a well-established sexual dimorphism. Activated inflammatory response and altered redox homeostasis, both known to manifest in a sex-specific manner, are implicated in the pathogenic mechanisms involved in PAH development. This study aimed to evaluate the impact of sex and plasma redox status on circulating cytokine profiles. Plasma oxidation-reduction potential (ORP), as a substitute measure of redox status, was analyzed in male and female Group 1 PAH and healthy subjects. The profiles of 27 circulating cytokines were compared in 2 PAH groups exhibiting the highest and lowest quartile for plasma ORP, correlated with clinical parameters, and used to predict patient survival. The analysis of the PAH groups with the highest and lowest ORP revealed a correlation between elevated cytokine levels and increased oxidative stress in females. In contrast, in males, cytokine expressions were increased in the lower oxidative environment (except for IL-1b). Correlations of the increased cytokine expressions with PAH severity were highly sex-dependent and corresponded to the increase in PAH severity in males and less severe PAH in females. Machine learning algorithms trained on the combined cytokine and redox profiles allowed the prediction of PAH mortality with 80% accuracy. We conclude that the profile of circulating cytokines in PAH patients is redox- and sex-dependent, suggesting the vital need to stratify the patient cohort subjected to anti-inflammatory therapies. Combined cytokine and/or redox profiling showed promising value for predicting the patients' survival.
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Affiliation(s)
- Ruslan Rafikov
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Franz Rischard
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Mikhail Vasilyev
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Mathews V Varghese
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Jason X-J Yuan
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Ankit A Desai
- Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Joe G N Garcia
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Olga Rafikova
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.
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Zahr NM, Pohl KM, Kwong AJ, Sullivan EV, Pfefferbaum A. Preliminary Evidence for a Relationship between Elevated Plasma TNFα and Smaller Subcortical White Matter Volume in HCV Infection Irrespective of HIV or AUD Comorbidity. Int J Mol Sci 2021; 22:ijms22094953. [PMID: 34067023 PMCID: PMC8124321 DOI: 10.3390/ijms22094953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023] Open
Abstract
Classical inflammation in response to bacterial, parasitic, or viral infections such as HIV includes local recruitment of neutrophils and macrophages and the production of proinflammatory cytokines and chemokines. Proposed biomarkers of organ integrity in Alcohol Use Disorders (AUD) include elevations in peripheral plasma levels of proinflammatory proteins. In testing this proposal, previous work included a group of human immunodeficiency virus (HIV)-infected individuals as positive controls and identified elevations in the soluble proteins TNFα and IP10; these cytokines were only elevated in AUD individuals seropositive for hepatitis C infection (HCV). The current observational, cross-sectional study evaluated whether higher levels of these proinflammatory cytokines would be associated with compromised brain integrity. Soluble protein levels were quantified in 86 healthy controls, 132 individuals with AUD, 54 individuals seropositive for HIV, and 49 individuals with AUD and HIV. Among the patient groups, HCV was present in 24 of the individuals with AUD, 13 individuals with HIV, and 20 of the individuals in the comorbid AUD and HIV group. Soluble protein levels were correlated to regional brain volumes as quantified with structural magnetic resonance imaging (MRI). In addition to higher levels of TNFα and IP10 in the 2 HIV groups and the HCV-seropositive AUD group, this study identified lower levels of IL1β in the 3 patient groups relative to the control group. Only TNFα, however, showed a relationship with brain integrity: in HCV or HIV infection, higher peripheral levels of TNFα correlated with smaller subcortical white matter volume. These preliminary results highlight the privileged status of TNFα on brain integrity in the context of infection.
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Affiliation(s)
- Natalie M. Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (K.M.P.); (A.P.)
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA;
- Correspondence: ; Tel.: +1-650-859-5243
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (K.M.P.); (A.P.)
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA;
| | - Allison J. Kwong
- Gastroenterology and Hepatology Medicine, Stanford University School of Medicine, Stanford, CA 94350, USA;
| | | | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (K.M.P.); (A.P.)
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA;
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Waldrop D, Irwin C, Nicholson WC, Lee CA, Webel A, Fazeli PL, Vance DE. The Intersection of Cognitive Ability and HIV: A Review of the State of the Nursing Science. J Assoc Nurses AIDS Care 2021; 32:306-321. [PMID: 33449578 PMCID: PMC8091162 DOI: 10.1097/jnc.0000000000000232] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Neurocognitive problems have been endemic to the HIV epidemic since its beginning. Four decades later, these problems persist, but currently, they are attributed to HIV-induced inflammation, the long-term effects of combination antiretroviral therapy, lifestyle (i.e., physical activity, drug use), psychiatric, and age-associated comorbidities (i.e., heart disease, hypertension). In many cases, persons living with HIV (PLWH) may develop cognitive problems as a function of accelerated or accentuated normal aging and lifestyle rather than HIV itself. Nonetheless, such cognitive impairments can interfere with HIV care, including medication adherence and attending clinic appointments. With more than half of PLWH 50 years and older, and 30%-50% of all PLWH meeting the criteria for HIV-associated neurocognitive disorder, those aging with HIV may be more vulnerable to developing cognitive problems. This state of the science article provides an overview of current issues and provides implications for practice, policy, and research to promote successful cognitive functioning in PLWH.
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Affiliation(s)
- Drenna Waldrop
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Crista Irwin
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - W. Chance Nicholson
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cheryl A. Lee
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison Webel
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E. Vance
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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6
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Choi H, Dey AK, Sharma G, Bhoite R, Burkholder G, Fedson S, Jneid H. Etiology and pathophysiology of heart failure in people with HIV. Heart Fail Rev 2021; 26:497-505. [PMID: 33619685 DOI: 10.1007/s10741-020-10048-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/25/2022]
Abstract
HIV-associated cardiomyopathy is a well-established sequela in people infected with HIV (PHIV). Despite significant advances in HIV management through the use of highly active anti-retroviral therapy (HAART), PHIV on HAART continue to have elevated risk of cardiomyopathy and heart failure, even when accounting for known cardiovascular risk factors. This review article will explore the proposed mechanisms by which chronic HIV infection induces cardiomyopathy and heart failure in the setting of HAART. Evaluation, work-up, and management of cardiomyopathy in PHIV will also be briefly discussed. The advent of HAART has altered the pathophysiology HIV-associated cardiomyopathy from a rapidly progressive cardiomyopathy, often with pericardial involvement, into a chronic process involving inflammation and persistent immune dysregulation. With the significant decrease in AIDS-related deaths, the prevalence of cardiomyopathy and the mortality associated with heart failure in PHIV have increased. Multiple immune-related and inflammatory mechanisms have been proposed, which may provide insight into evaluation and management of cardiomyopathy in PHIV.
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Affiliation(s)
- Harry Choi
- Section of Inflammation and Cardiometabolic Diseases, National Institute of Health, Bethesda, MD, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Institute of Health, Bethesda, MD, USA
| | - Gaurav Sharma
- Division of Medicine, University of South Alabama, Mobile, AL, USA
| | - Rahul Bhoite
- Division of Medicine, MedStar Union Memorial Hospital and Good Samaritan Hospital, Baltimore, MD, USA
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA
| | - Savitri Fedson
- Section of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Hospital, Houston, TX, 77030, USA
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Hospital, Houston, TX, 77030, USA.
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Hove-Skovsgaard M, Zhao Y, Tingstedt JL, Hartling HJ, Thudium RF, Benfield T, Afzal S, Nordestgaard B, Ullum H, Gerstoft J, Mocroft A, Nielsen SD. Impact of Age and HIV Status on Immune Activation, Senescence and Apoptosis. Front Immunol 2020; 11:583569. [PMID: 33117394 PMCID: PMC7561401 DOI: 10.3389/fimmu.2020.583569] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Residual immune dysfunctions, resembling those that occur during normal aging, may persist even in well-treated people with HIV (PWH), and accelerated aging has been proposed. We aimed to determine if HIV infection is an independent risk factor for T-cell immune dysfunctions including increased immune activation, senescence and apoptosis. Moreover, in PWH we aimed to identify the associations between age and immune activation, senescence and apoptosis. Materials and Methods We included 780 PWH with suppressed viral replication (<50 copies/mL) and absence of hepatitis B and hepatitis C co-infection and 65 uninfected controls from the Copenhagen Co-morbidity in HIV Infection (COCOMO) Study. Flow cytometry was used to determine T-cell activation (CD38+HLA-DR+), senescence (CD28-CD57+), and apoptosis (CD28-CD95+). T-cell subsets are reported as proportions of CD4+ and CD8+ T-cells. We defined an elevated proportion of a given T-cell subset as above the 75th percentile. Regression models were used to determine the association between HIV status and T-cell subset and in PWH to determine the association between age or HIV-specific risk factors and T-cell subsets. Furthermore, an interaction between HIV status and age on T-cell subsets was investigated with an interaction term in models including both PWH and controls. Models were adjusted for age, sex, BMI, and smoking status. Results In adjusted models a positive HIV status was associated with elevated proportions of CD8+ activated (p = 0.009), CD4+ senescent (p = 0.004), CD4+ apoptotic (p = 0.002), and CD8+ apoptotic (p = 0.003) T-cells. In PWH a 10-year increase in age was associated with higher proportions of CD4+ and CD8+ senescent (p = 0.001 and p < 0.001) and CD4+ and CD8+ apoptotic T-cells (p < 0.001 and p < 0.001). However, no interaction between HIV status and age was found. Furthermore, in PWH a CD4+/CD8+ ratio < 1 was associated with elevated proportions of T-cell activation, senescence, and apoptosis. Discussion We found evidence of residual T-cell immune dysfunction in well-treated PWH without HBV or HCV co-infection, and age was associated with T-cell senescence and apoptosis. Our data supports that HIV infection has similar effects as aging on T-cell subsets. However, since no interaction between HIV status and age was found on these parameters, we found no evidence to support accelerated immunological aging in PWH.
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Affiliation(s)
- Malene Hove-Skovsgaard
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yanan Zhao
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans Jakob Hartling
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rebekka Faber Thudium
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shoaib Afzal
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Børge Nordestgaard
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, United Kingdom
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Cogswell A, Ferguson N, Barker E. Presence of Inflammatory Group I and III Innate Lymphoid Cells in the Colon of Simian Immunodeficiency Virus-Infected Rhesus Macaques. J Virol 2020; 94:e01914-19. [PMID: 32051277 PMCID: PMC7163113 DOI: 10.1128/jvi.01914-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic, low-grade, systemic, and mucosal inflammation correlates with increased morbidity and poor clinical outcomes among patients living with human immunodeficiency virus (HIV). These long-term complications are linked to the disruption of gastrointestinal (GI) tract epithelial barrier integrity and subsequent microbial translocation. However, the mechanisms responsible for these downstream effects of infection are unknown. Here, we demonstrate that during the disruption of the GI tract and increased microbial translocation, we find inflammatory cytokines (e.g., interferon gamma [IFN-γ] and tumor necrosis factor alpha [TNF-α]) produced by innate lymphoid cells (ILCs) located in the colon secondary to simian immunodeficiency virus (SIV) infection. To do this, we used viably cryopreserved colon cells from SIV-infected and uninfected rhesus macaque monkeys and determined the make-up of the ILC subpopulations and the cytokines they expressed constitutively. Our studies revealed that the interleukin-22 (IL-22)/IL-17-producing ILCS was not altered during SIV infection. However, the percentage of IFN-γ+ ILCs in infected colons was 5- to 10-fold higher than that in uninfected colons. ILCs from infected tissue that produced IFN-γ also expressed TNF-α and IL-22. The coexpression of inflammatory cytokines with IL-22 is linked to the ability of ILCs to coexpress T-bet and RORγT/Ahr. The expression of IFN-γ/TNF-α by ILCs and NK cells combined likely triggers a pathway that contributes to chronic mucosal inflammation, GI barrier breakdown, and microbial translocation within the context of SIV/HIV infection.IMPORTANCE There is a slow yet significant uptick in systemic inflammation secondary to HIV infection that has long-term consequences for the infected host. The systemic inflammation most likely occurs as a consequence of the disruption of the gut epithelial barrier, leading to the translocation of gut microbial products. This disruption may result from mucosal inflammation. Here, we show in an animal model of HIV that chronic SIV-infected gut contains innate lymphoid cells producing inflammatory cytokines.
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Affiliation(s)
- Andrew Cogswell
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois, USA
| | - Natasha Ferguson
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward Barker
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois, USA
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9
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Absence of peripapillary retinal nerve-fiber-layer thinning in combined antiretroviral therapy-treated, well-sustained aviremic persons living with HIV. PLoS One 2020; 15:e0229977. [PMID: 32155200 PMCID: PMC7064175 DOI: 10.1371/journal.pone.0229977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/18/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare peripapillary retinal nerve-fiber–layer (pRNFL) thickness, total retina macular volume, and ganglion-cell-layer (GCL) macular volume and thickness between persons living with HIV (PLHIVs) with well-controlled infections and good immune recovery, and sex- and age-matched HIV-uninfected controls (HUCs). Methods This prospective cross-sectional study (www.clinicaltrials.gov identifier: NCT02003989) included 56 PLHIVs, infected for ≥10 [median 20.2] years and with sustained plasma HIV-load suppression on combined antiretroviral therapy (cART) for ≥5 years, and 56 matched HUCs. Participants underwent spectral-domain optical coherence tomography (SD-OCT) with thorough ophthalmological examinations and brain magnetic resonance imaging (MRI). Their overall and quadrant pRNFL thicknesses, total macular volumes, and GCL macular volumes and thicknesses were compared. Cerebral small-vessel diseases (CSVD) complied with STRIVE criteria. Results Median [interquartile range, IQR] ages of PLHIVs and HUCs, respectively, were 52 [46–60] and 52 [44–60] years. Median [IQR] PLHIVs’ nadir CD4+ T-cell count and current CD4/CD8 T-cell ratio were 249/μL [158–350] and 0.95 [0.67–1.10], respectively; HIV-seropositivity duration was 20.2 [15.9–24.5] years; cART duration was 16.8 [12.6–18.6] years; and aviremia duration was 11.4 [7.8–13.6] years. No significant between-group pRNFL thickness, total macular volume, macular GCL-volume and -thickness differences were found. MRI-detected CSVD in 21 (38%) PLHIVs and 14 (25%) HUCs was associated with overall thinner pRNFLs, and smaller total retina and GCL macular volumes, independently of HIV status. Conclusions SD-OCT could not detect pRNFL thinning or macular GCL-volume reduction in well-sustained, aviremic, cART-treated PLHIVs who achieved good immune recovery. However, CSVD was associated with thinner pRNFLs and GCLs, independently of HIV status.
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Ballegaard V, Pedersen KK, Brændstrup P, Kirkby N, Stryhn A, Ryder LP, Gerstoft J, Nielsen SD. Cytomegalovirus-specific CD8+ T-cell responses are associated with arterial blood pressure in people living with HIV. PLoS One 2020; 15:e0226182. [PMID: 31929537 PMCID: PMC6957152 DOI: 10.1371/journal.pone.0226182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD), and immunity against cytomegalovirus (CMV) may be a contributing factor. We hypothesized that enhanced T-cell responses against CMV and CMV-IgG antibody-levels are associated with higher arterial blood pressure in PLHIV. We assessed serum CMV-IgG, systolic- (SBP) and diastolic- (DBP) blood pressure, pulse pressure (PP), traditional risk factors, activated CD8+ T-cells (CD38+HLA-DR+), senescent CD8+ T-cells (CD28-CD57+) and interleukin-6 (IL-6) in 60 PLHIV and 31 HIV-uninfected controls matched on age, gender, education and comorbidity. In PLHIV, expression of interleukin-2, tumor necrosis factor-α and interferon-γ was measured by intracellular-cytokine-staining after stimulation of T-cells with CMV-pp65 and CMV-gB. Associations between CMV-specific immune responses and hypertension, SBP, DBP or PP were assessed by multivariate logistic and linear regression models adjusted for appropriate confounders. The median age of PLHIV was 47 years and 90% were male. Prevalence of hypertension in PLHIV was 37% compared to 55% of HIV-uninfected controls. CMV-specific CD8+ T-cell responses were independently associated with higher PP (CMV-pp65; β = 2.29, p = 0.001, CMV-gB; β = 2.42, p = 0.001) in PLHIV. No significant differences were found with regard to individual measures of SBP and DBP. A possible weak association was found between CMV-IgG and hypertension (β = 1.33, p = 0.049) after adjustment for age, smoking and LDL-cholesterol. HIV-related factors, IL-6, CD8+ T-cell activation or CD8+ T-cell senescence did not mediate the associations, and no associations were found between CMV-specific CD4+ T-cell responses and blood pressure in PLHIV. In conclusion, increased arterial blood pressure in PLHIV may be affected by heightened CMV-specific CD8+ T-cell responses.
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Affiliation(s)
- Vibe Ballegaard
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Karin Kaereby Pedersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Peter Brændstrup
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Herlev University Hospital, Herlev, Denmark
| | - Nikolai Kirkby
- Department of Medical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anette Stryhn
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lars P Ryder
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Butler J, Greene SJ, Shah SH, Shah SJ, Anstrom KJ, Kim RJ, Kalogeropoulos AP, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Scherzer R, Hsue PY, Braunwald E. Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail 2019; 26:371-380. [PMID: 31682908 DOI: 10.1016/j.cardfail.2019.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/14/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear. METHODS AND RESULTS The Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD-). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD- patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01). CONCLUSIONS In this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Svati H Shah
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | - Raymond J Kim
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - Eric J Velazquez
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Rebecca Scherzer
- Department of Medicine, University of California San Francisco and San Francisco Department of Veterans Administration, San Francisco, California
| | - Priscilla Y Hsue
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Eugene Braunwald
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Cytomegalovirus-Specific CD4+ T-cell Responses and CMV-IgG Levels Are Associated With Neurocognitive Impairment in People Living With HIV. J Acquir Immune Defic Syndr 2019; 79:117-125. [PMID: 29781883 DOI: 10.1097/qai.0000000000001753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mechanisms leading to neurocognitive impairment (NCI) in people living with HIV (PLWHIV) on stable combination antiretroviral therapy (cART) remain unknown. We investigated the association between immunity against cytomegalovirus (CMV), HIV-specific variables, and NCI in PLWHIV on stable cART and with low comorbidity. METHODS Fifty-two PLWHIV on stable cART and 31 HIV-uninfected controls matched on age, sex, education, and comorbidity were tested with a neurocognitive test battery, and CMV-immunoglobulin G (CMV-IgG) levels were measured. In PLWHIV, CMV-specific (CMV-pp65 and CMV-gB) CD4 and CD8 T-cell responses were measured using intracellular cytokine staining and flow cytometry. NCI was defined as a global deficit scale score (GDS score) ≥0.5. GDS scores and domain-specific scores defined severity of NCI. Logistic and linear multivariable regression analyses were used. RESULTS NCI was detected in 30.8% of PLWHIV, and HIV was associated with an adjusted odds ratio (aOR) of 5.18 [95% confidence interval (CI): 1.15 to 23.41, P = 0.033] for NCI. In PLWHIV, higher CMV-specific CD4 T-cell responses increased the probability of NCI with an aOR of 1.68 (95% CI: 1.10 to 2.57) for CMV-pp65 or an aOR of 3.73 (95% CI: 1.61 to 16.98) for CMV-gB, respectively. Similar associations were not found with CMV-IgG or CMV-specific CD8 T cells, but when assessing severity of NCI, higher CMV-IgG (per 100 U/mL) was associated with worse GDS scores (β = 0.08) (0.01-0.16), P = 0.044), specifically in the domain of speed of information processing (β = 0.20 (0.04-0.36, P = 0.019). CONCLUSIONS PLWHIV had increased risk of NCI. Excess risk may be associated with CMV-specific CD4 T-cell responses and CMV-IgG. Larger longitudinal studies investigating the impact of immunity against CMV on risk of NCI are warranted.
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Savvoulidis P, Butler J, Kalogeropoulos A. Cardiomyopathy and Heart Failure in Patients With HIV Infection. Can J Cardiol 2018; 35:299-309. [PMID: 30621958 DOI: 10.1016/j.cjca.2018.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022] Open
Abstract
With the advent and widespread use of antiretroviral therapy (ART), the epidemiology of cardiomyopathy and heart failure (HF) associated with HIV infection is changing. Near-normal life expectancy in contemporary HIV-infected populations has been associated with prolonged exposure to increased cardiometabolic burden and chronic immune activation and systemic inflammation. Therefore, the pre-ART phenotype of HIV-associated cardiomyopathy with overt left ventricular systolic dysfunction and poor prognosis has been replaced over time by cardiomyopathy with a more insidious course, more frequent ischemic background, and highly prevalent left ventricular diastolic dysfunction. Patients with HIV are more prone to development of coronary artery disease and development of HF after myocardial infarction. The role of ongoing immune activation and systemic inflammation, despite highly active ART (HAART), appears to be central in this process. The role of HAART toxicity is controversial, as HAART itself appears to be protective for the development of HF, but recent data suggest that protease inhibitors might adversely affect the course of HIV-associated HF. Because of these unique features, the optimal therapeutic approach for HIV-associated cardiomyopathy remains unknown. The current therapeutic approaches are an extrapolation from noninfected populations. Importantly, the significance of the highly prevalent diastolic abnormalities among HIV-infected patients is not known. Therefore, further research is needed to identify its prognostic implications. Considering the prevalence of structural and functional cardiac abnormalities in HIV-infected persons and the lack of evidence on how to best screen and treat these patients, systematic research on this topic is a public health priority.
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Affiliation(s)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Andreas Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.
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Colston E, Grasela D, Gardiner D, Bucy RP, Vakkalagadda B, Korman AJ, Lowy I. An open-label, multiple ascending dose study of the anti-CTLA-4 antibody ipilimumab in viremic HIV patients. PLoS One 2018; 13:e0198158. [PMID: 29879143 PMCID: PMC5991705 DOI: 10.1371/journal.pone.0198158] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022] Open
Abstract
Expression of cytotoxic T-lymphocyte antigen 4 (CTLA-4), a negative regulator of T-cell function, is increased in chronic HIV-1 infection. It was hypothesized that CTLA-4 blockade may enhance immune response to HIV-1 and result in better control of viremia. This open-label, multiple ascending dose study (NCT03407105)-the first to examine ipilimumab in participants with HIV-1 infection-assessed the safety, tolerability, and pharmacokinetics of ipilimumab, as well as whether ipilimumab enhanced immune response to HIV-1 and improved control of viremia. Twenty-four participants received 2 or 4 doses of ipilimumab (0.1, 1, 3, or 5 mg/kg) every 28 days. No serious adverse events (AEs) or dose-limiting toxicities were reported; one participant discontinued ipilimumab for an AE of grade 2 facial palsy. Twenty participants (83.3%) had ≥1 AE; all but 1 were grade 1 or 2. Eight participants (33.3%) had potentially immune-related AEs (7 had grade 1 diarrhea not requiring corticosteroids; 1 who had diarrhea also had transient antinuclear antibody positivity; 1 had grade 2 facial palsy requiring corticosteroids). Two participants (8.3%), one each in the 0.1- and 1-mg/kg dose groups, had a decrease from baseline HIV-1 RNA of 0.85 and 1.36 log10 copies/mL. Fourteen participants (58.3%) had an increase from baseline HIV-1 RNA (mean, 0.87 log10 copies/mL; range, 0.59-1.29). Of these 14 participants, all but 1 were in the higher ipilimumab dose groups (3 or 5 mg/kg). No pattern was noted regarding change from baseline in CD4 or CD8 T cells; ex vivo assessments of immune response were precluded because of inadequate cell viability. Serum concentration data for ipilimumab showed biphasic disposition, with steady state reached by dose 3. Ipilimumab treatment was well tolerated and was associated with variations in HIV-1 RNA in excess of expected repeat measures in most participants, but these were not related to combination antiretroviral therapy status or CD4 counts. The mechanism(s) underlying the increased variation in HIV-1 RNA is unclear and needs further study.
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Affiliation(s)
- Elizabeth Colston
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, New Jersey, United States of America
- * E-mail:
| | - Dennis Grasela
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, New Jersey, United States of America
| | - David Gardiner
- Infectious Diseases Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - R. Pat Bucy
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Blisse Vakkalagadda
- Clinical Pharmacology and Pharmacometrics, Bristol-Myers Squibb, Hopewell, New Jersey, United States of America
| | - Alan J. Korman
- Biologics Discovery California, Bristol-Myers Squibb, Redwood City, California, United States of America
| | - Israel Lowy
- Translational Science and Clinical Oncology, Regeneron Pharmaceuticals, Tarrytown, New York, United States of America
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15
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Butler J, Kalogeropoulos AP, Anstrom KJ, Hsue PY, Kim RJ, Scherzer R, Shah SJ, Shah SH, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Braunwald E. Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study. J Card Fail 2018; 24:255-265. [PMID: 29482027 PMCID: PMC5880702 DOI: 10.1016/j.cardfail.2018.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 12/28/2022]
Abstract
Antiretroviral therapy (ART) has been associated with a shift in the epidemiology of human immunodeficiency virus (HIV)-associated cardiomyopathy from a phenotype of primarily left ventricular (LV) systolic dysfunction to LV diastolic dysfunction (DD). Patients with HIV receiving ART have higher rates of DD compared with age-matched control subjects and develop DD at a younger age. However, little is known about the natural history and pathogenesis of DD in virally suppressed HIV-infected patients. Current evidence suggests that immune processes modulate the risk for cardiac involvement in HIV-infected persons. Ongoing inflammation appears to have myocardial effects, and accelerated myocardial fibrosis appears to be a key mediator of HIV-induced DD. The Characterizing Heart Function on Antiretroviral Therapy (CHART) study aims to systematically investigate determinants, mechanisms, and consequences of DD in HIV-infected patients. We will compare ART-treated virally suppressed HIV-infected individuals with and without DD and HIV- individuals with DD regarding (1) systemic inflammation, myocardial stress, and subclinical myocardial necrosis as indicated by circulating biomarkers; (2) immune system activation as indicated by cell surface receptors; (3) myocardial fibrosis according to cardiac magnetic resonance examination; (4) markers of fibrosis and remodeling, oxidative stress, and hypercoagulability; (5) left atrial function according to echocardiographic examination; (6) myocardial stress and subclinical necrosis as indicated by circulating biomarkers; (7) proteomic and metabolic profiles; and (8) phenotype signatures derived from clinical, biomarker, and imaging data.
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Affiliation(s)
- Javed Butler
- Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York.
| | | | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Priscilla Y Hsue
- Cardiology Division, Department of Medicine, University of California, San Francisco, California
| | - Raymond J Kim
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Rebecca Scherzer
- UCSF Department of Medicine and San Francisco Department of Veterans Administration, San Francisco, California
| | - Sanjiv J Shah
- Cardiology Division, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Svati H Shah
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Eric J Velazquez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Adrian F Hernandez
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National, Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eugene Braunwald
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ballegaard V, Brændstrup P, Pedersen KK, Kirkby N, Stryhn A, Ryder LP, Gerstoft J, Nielsen SD. Cytomegalovirus-specific T-cells are associated with immune senescence, but not with systemic inflammation, in people living with HIV. Sci Rep 2018; 8:3778. [PMID: 29491459 PMCID: PMC5830877 DOI: 10.1038/s41598-018-21347-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/02/2018] [Indexed: 12/29/2022] Open
Abstract
In people living with HIV (PLWHIV), coinfection with cytomegalovirus (CMV) has been associated with inflammation, immunological ageing, and increased risk of severe non-AIDS related comorbidity. The effect of CMV-specific immune responses on systemic inflammation, immune activation and T-cell senescence was evaluated in 53 PLWHIV treated with combination antiretroviral therapy (cART). Activated-, terminally differentiated-, naïve-, and senescent T-cells were assessed by flow cytometry, and plasma levels of CMV IgG, interleukin-6, tumor necrosis factor-α, high-sensitivity C-reactive protein and soluble-CD14 were measured. In PLWHIV, expression of interleukin-2, tumor necrosis factor-α and interferon-γ was measured by intracellular-cytokine-staining after stimulation of T-cells with CMV-pp65, CMV-IE1, and CMV-gB. Increased CMV-specific T-cell responses were associated with a higher ratio of terminally differentiated/naïve CD8+ T-cells and with increased proportions of senescent CD8+ T-cells, but not with systemic inflammation or sCD14. Increased CMV-specific CD4+ T-cell responses were associated with increased proportions of activated CD8+ T-cells. In PLWHIV with expansion of CMV-specific T-cells or increased T-cell senescence, CMV-specific polyfunctionality was maintained. That the magnitude of the CMV-specific T-cell response was associated with a senescent immune phenotype, suggests that a dysregulated immune response against CMV may contribute to the immunological ageing often described in PLWHIV despite stable cART.
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Affiliation(s)
- Vibe Ballegaard
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Peter Brændstrup
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Herlev University Hospital, Herlev, Denmark
| | - Karin Kaereby Pedersen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Medical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anette Stryhn
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lars P Ryder
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
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Zahr NM. Peripheral TNFα elevations in abstinent alcoholics are associated with hepatitis C infection. PLoS One 2018; 13:e0191586. [PMID: 29408932 PMCID: PMC5800541 DOI: 10.1371/journal.pone.0191586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/08/2018] [Indexed: 12/31/2022] Open
Abstract
Substantial evidence supports the view that inflammatory processes contribute to brain alterations in HIV infection. Mechanisms recently proposed to underlie neuropathology in Alcohol Use Disorder (AUD) include elevations in peripheral cytokines that sensitize the brain to the damaging effects of alcohol. This study included 4 groups: healthy controls, individuals with AUD (abstinent from alcohol at examination), those infected with HIV, and those comorbid for HIV and AUD. The aim was to determine whether inflammatory cytokines are elevated in AUD as they are in HIV infection. Cytokines showing group differences included interferon gamma-induced protein 10 (IP-10) and tumor necrosis factor α (TNFα). Follow-up t-tests revealed that TNFα and IP-10 were higher in AUD than controls but only in AUD patients who were seropositive for Hepatitis C virus (HCV). Specificity of TNFα and IP-10 elevations to HCV infection status was provided by correlations between cytokine levels and HCV viral load and indices of liver integrity including albumin/globulin ratio, fibrosis scores, and AST/platelet count ratio. Because TNFα levels were mediated by HCV infection, this study provides no evidence for elevations in peripheral cytokines in "uncomplicated", abstinent alcoholics, independent of liver disease or HCV infection. Nonetheless, these results corroborate evidence for elevations in IP-10 and TNFα in HIV and for IP-10 levels in HIV+HCV co-infection.
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Affiliation(s)
- Natalie M. Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
- Neuroscience Department, SRI International, Menlo Park, CA, United States of America
- * E-mail:
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MicroRNA-210, MicroRNA-331, and MicroRNA-7 Are Differentially Regulated in Treated HIV-1-Infected Individuals and Are Associated With Markers of Systemic Inflammation. J Acquir Immune Defic Syndr 2017; 74:e104-e113. [PMID: 27749601 DOI: 10.1097/qai.0000000000001191] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Inflammation may contribute to an increased risk of cardiovascular disease (CVD) in HIV-1 infection. MicroRNAs (miRNAs) are involved in the regulation of inflammation. In treated HIV-1-infected individuals, we aimed to identify differentially expressed miRNAs with known roles in inflammation and CVD risk and to investigate associations between these and systemic inflammation. METHODS In a screening cohort including 14 HIV-1-infected individuals and 9 uninfected controls, microarray profiling was performed using peripheral blood mononuclear cells (PBMCs). Differentially regulated miRNAs previously related to inflammation and CVD were validated using real-time quantitative reverse-transcription polymerase chain reaction in 26 HIV-1-infected individuals and 20 uninfected controls. Validated miRNAs were measured in PBMCs, CD4 and CD8 T cells. Interleukin-6, tumor necrosis factor-alpha, high-sensitivity C-reactive protein, lipopolysaccharide (LPS), cytomegalovirus immunoglobulin G, lipids, and fasting glucose were measured, and associations with validated miRNAs were assessed with multiple linear regression analysis. RESULTS Upregulation of miR-210, miR-7, and miR-331 was found in PBMCs from HIV-1-infected individuals when compared with those from uninfected controls (P < 0.005). In contrast, miR-210 and miR-331 were downregulated in CD8 T cells. In multivariate analysis, miR-210 in CD8 T cells was negatively associated with LPS (P = 0.023) and triglycerides (P = 0.003) but positively associated with tumor necrosis factor-alpha (P = 0.004). MiR-7 in PBMC was positively associated with interleukin-6 (P = 0.025) and fasting glucose (P = 0.005), whereas miR-331 was negatively associated with LPS (P = 0.006). In PBMCs from HIV-1-infected individuals with low cytomegalovirus immunoglobulin G, miR-7, miR-29a, miR-221, and miR-222 were downregulated. CONCLUSION In 2 independent cohorts, miR-210, miR-7, and miR-331 were differentially regulated in treated HIV-1-infected individuals and associated with markers of systemic inflammation.
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Okafor CN, Kelso NE, Bryant V, Burrell LE, Míguez MJ, Gongvatana A, Tashima KT, de la Monte S, Cook RL, Cohen RA. Body mass index, inflammatory biomarkers and neurocognitive impairment in HIV-infected persons. PSYCHOL HEALTH MED 2017; 22:289-302. [PMID: 27319430 PMCID: PMC5173436 DOI: 10.1080/13548506.2016.1199887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To determine the relationships among body mass index (BMI), and HIV-associated neurocognitive impairment and the potential mediating effects of inflammatory cytokines. Among the HIV-infected individuals (N = 90) included in this study, obesity was associated with slower processing speed (β = -.229, standard error (SE) = 2.15, p = .033), compared to participants with a normal BMI, after controlling for psychosocial and HIV clinical factors. Serum concentrations of the interleukin-16 (IL-16) cytokine were significantly associated with slowed processing speed (β = -.235, SE = 1.62, p = .033) but did not mediate the relationship between obesity and processing speed These findings suggest that obesity may contribute to cognitive processing speed deficits in HIV-infected adults. Elevated concentrations of IL-16 are also associated with slowing, though the results suggest that obesity and IL-16 may exert independent effects.
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Affiliation(s)
- Chukwuemeka N. Okafor
- Department of Epidemiology - College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America
| | - Natalie E. Kelso
- Department of Epidemiology - College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America
| | - Vaughn Bryant
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Room 3151, P.O. Box 100165, Gainesville, FL 32610, United States of America
| | - Larry E. Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Room 3151, P.O. Box 100165, Gainesville, FL 32610, United States of America
| | - Maria Jose Míguez
- School of Integrated Science and Humanity (SISH), Florida International University, 11200 SW 8 Street, Miami, Florida, 33199, United States of America
| | - Assawin Gongvatana
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States of America
| | - Karen T. Tashima
- Departments of Medicine and Pathology, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Suzanne de la Monte
- Departments of Medicine and Pathology, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Robert L. Cook
- Department of Epidemiology - College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America
| | - Ronald A. Cohen
- Center for Cognitive Aging and Memory, Institute on Aging, and the, Departments of Neurology, Psychiatry, and Aging and Geriatric Research, University of Florida, 2004 Mowry Road, PO Box 100107, Gainesville, FL 32611, United States of America
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20
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Shmagel KV, Saidakova EV, Shmagel NG, Korolevskaya LB, Chereshnev VA, Robinson J, Grivel JC, Douek DC, Margolis L, Anthony DD, Lederman MM. Systemic inflammation and liver damage in HIV/hepatitis C virus coinfection. HIV Med 2016; 17:581-9. [PMID: 27187749 DOI: 10.1111/hiv.12357] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Chronic hepatitis C virus (HCV) and HIV viral infections are characterized by systemic inflammation. Yet the relative levels, drivers and correlates of inflammation in these settings are not well defined. METHODS Seventy-nine HIV-infected patients who had been receiving antiretroviral therapy (ART) for more than 2 years and who had suppressed plasma HIV levels (< 50 HIV-1 RNA copies/mL) were included in the study. Two patient groups, HCV-positive/HIV-positive and HCV-negative/HIV-positive, and a control group comprised of healthy volunteers (n = 20) were examined. Markers of systemic inflammation [interleukin (IL)-6, interferon gamma-induced protein (IP)-10, soluble tumour necrosis factor receptor-I (sTNF-RI) and sTNF-RII], monocyte/macrophage activation [soluble CD163 (sCD163), soluble CD14 and neopterin], intestinal epithelial barrier loss [intestinal fatty acid binding protein (I-FABP) and lipopolysaccharide (LPS)] and coagulation (d-dimers) were analysed. CD4 naïve T cells and CD4 recent thymic emigrants (RTEs) were enumerated. RESULTS Plasma levels of IP-10, neopterin and sCD163 were higher in HCV/HIV coinfection than in HIV monoinfection and were positively correlated with indices of hepatic damage [aspartate aminotransferase (AST), alanine aminotransferase (ALT) and the AST to platelet ratio index (APRI)]. Levels of I-FABP were comparably increased in HIV monoinfection and HIV/HCV coinfection but LPS concentrations were highest in HCV/HIV coinfection, suggesting impaired hepatic clearance of LPS. Plasma HCV levels were not related to any inflammatory indices except sCD163. In coinfected subjects, a previously recognized relationship of CD4 naïve T-cell and RTE counts to hepatocellular injury was defined more mechanistically by an inverse relationship to sCD163. CONCLUSIONS Hepatocellular injury in HCV/HIV coinfection is linked to elevated levels of certain inflammatory cytokines and an apparent failure to clear systemically translocated microbial products. A related decrease in CD4 naïve T cells and RTEs also merits further exploration.
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Affiliation(s)
- K V Shmagel
- Institute of Ecology and Genetics of Microorganisms UB RAS, Perm, Russia.,Perm State University, Perm, Russia
| | - E V Saidakova
- Institute of Ecology and Genetics of Microorganisms UB RAS, Perm, Russia.,Perm State University, Perm, Russia
| | - N G Shmagel
- Perm State University, Perm, Russia.,Perm Regional Center for Protection against AIDS and Infectious Diseases, Perm, Russia
| | - L B Korolevskaya
- Institute of Ecology and Genetics of Microorganisms UB RAS, Perm, Russia.,Perm State University, Perm, Russia
| | - V A Chereshnev
- Institute of Ecology and Genetics of Microorganisms UB RAS, Perm, Russia.,Perm State University, Perm, Russia.,Institute of Immunology and Physiology UB RAS, Yekaterinburg, Russia
| | - J Robinson
- Case Western Reserve University, Cleveland, OH, USA
| | - J-C Grivel
- National Institute of Child Health and Development, Bethesda, MD, USA
| | - D C Douek
- Vaccine Research Center, National Institutes of Health, Bethesda, MD, USA
| | - L Margolis
- National Institute of Child Health and Development, Bethesda, MD, USA
| | - D D Anthony
- Case Western Reserve University, Cleveland, OH, USA
| | - M M Lederman
- Case Western Reserve University, Cleveland, OH, USA
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21
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Jespersen S, Pedersen KK, Anesten B, Zetterberg H, Fuchs D, Gisslén M, Hagberg L, Trøseid M, Nielsen SD. Soluble CD14 in cerebrospinal fluid is associated with markers of inflammation and axonal damage in untreated HIV-infected patients: a retrospective cross-sectional study. BMC Infect Dis 2016; 16:176. [PMID: 27103116 PMCID: PMC4839160 DOI: 10.1186/s12879-016-1510-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/13/2016] [Indexed: 12/13/2022] Open
Abstract
Background HIV-associated cognitive impairment has declined since the introduction of combination antiretroviral treatment (cART). However, milder forms of cognitive impairment persist. Inflammation in the cerebrospinal fluid (CSF) has been associated with cognitive impairment, and CSF neurofilament light chain protein (NFL) and CSF neopterin concentrations are increased in those patients. Microbial translocation in HIV infection has been suggested to contribute to chronic inflammation, and lipopolysaccharide (LPS) and soluble CD14 (sCD14) are markers of microbial translocation and the resulting monocyte activation, respectively. We hypothesised that microbial translocation contributes to inflammation and axonal damage in the central nervous system (CNS) in untreated HIV infection. Methods We analyzed paired samples of plasma and CSF from 62 HIV-infected, untreated patients without cognitive symptoms from Sahlgrenska University Hospital, Gothenburg, Sweden. Measurements of neopterin and NFL in CSF were available from previous studies. Plasma and CSF sCD14 was measured using ELISA (R&D, Minneapolis, MN), and plasma and CSF LPS was measured using LAL colorimetric assay (Lonza, Walkersville, MD, USA). Univariate and multivariate regression analyses were performed. Results LPS in plasma was associated with plasma sCD14 (r = 0.31, P = 0.015), and plasma sCD14 was associated with CSF sCD14 (r = 0.32, P = 0.012). Furthermore, CSF sCD14 was associated with NFL (r = 0.32, P = 0.031) and neopterin (r = 0.32, P = 0.012) in CSF. LPS was not detectable in CSF. In a multivariate regression model CSF sCD14 remained associated with NFL and neopterin after adjusting for age, CD4+ cell count, and HIV RNA in CSF. Conclusions In a group of untreated, HIV-infected patients LPS was associated with sCD14 in plasma, and plasma sCD14 was associated CSF sCD14. CSF sCD14 were associated with markers of CNS inflammation and axonal damage. This suggest that microbial translocation might be a driver of systemic and CNS inflammation. However, LPS was not detectable in the CSF, and since sCD14 is a marker of monocyte activation sCD14 may be increased due to other causes than microbial translocation. Further studies regarding cognitive impairment and biomarkers are warranted to fully understand causality.
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Affiliation(s)
- Sofie Jespersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK 2100, Copenhagen Ø, Denmark
| | - Karin Kæreby Pedersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK 2100, Copenhagen Ø, Denmark
| | - Birgitta Anesten
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Hagberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marius Trøseid
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK 2100, Copenhagen Ø, Denmark.
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Pre-cART Elevation of CRP and CD4+ T-Cell Immune Activation Associated With HIV Clinical Progression in a Multinational Case-Cohort Study. J Acquir Immune Defic Syndr 2015; 70:163-71. [PMID: 26017661 DOI: 10.1097/qai.0000000000000696] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the success of combination antiretroviral therapy (cART), a subset of HIV-infected patients who initiate cART develop early clinical progression to AIDS; therefore, some cART initiators are not fully benefitted by cART. Immune activation pre-cART may predict clinical progression in cART initiators. METHODS A case-cohort study (n = 470) within the multinational Prospective Evaluation of Antiretrovirals in Resource-Limited Settings clinical trial (1571 HIV treatment-naive adults who initiated cART; CD4 T-cell count <300 cells/mm; 9 countries) was conducted. A subcohort of 30 participants per country was randomly selected; additional cases were added from the main cohort. Cases [n = 236 (random subcohort 36; main cohort 200)] had clinical progression (incident WHO stage 3/4 event or death) within 96 weeks after cART initiation. Immune activation biomarkers were quantified pre-cART. Associations between biomarkers and clinical progression were examined using weighted multivariable Cox-proportional hazards models. RESULTS Median age was 35 years, 45% were women, 49% black, 31% Asian, and 9% white. Median CD4 T-cell count was 167 cells per cubic millimeter. In multivariate analysis, highest quartile C-reactive protein concentration [adjusted hazard ratio (aHR), 2.53; 95% confidence interval (CI): 1.02 to 6.28] and CD4 T-cell activation (aHR, 5.18; 95% CI: 1.09 to 24.47) were associated with primary outcomes, compared with lowest quartiles. sCD14 had a trend toward association with clinical failure (aHR, 2.24; 95% CI: 0.96 to 5.21). CONCLUSIONS Measuring C-reactive protein and CD4 T-cell activation may identify patients with CD4 T-cell counts <300 cells per cubic millimeter at risk for early clinical progression when initiating cART. Additional vigilance and symptom-based screening may be required in this subset of patients even after beginning cART.
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23
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Lower Self-Reported Quality of Life in HIV-Infected Patients on cART and With Low Comorbidity Compared With Healthy Controls. J Acquir Immune Defic Syndr 2015; 70:16-22. [PMID: 26017659 DOI: 10.1097/qai.0000000000000697] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-reported quality of life (QoL) has previously been found to be impaired in patients living with HIV and associated with viral replication, degree of immunodeficiency, and comorbidity. We aimed at investigating QoL in a group of HIV-infected patients with suppressed viral replication and with low comorbidity, compared with healthy controls. We furthermore aimed to identify factors associated with QoL. DESIGN AND METHODS Cross-sectional study of 52 HIV-infected patients and 23 healthy controls matched on age, gender, education, and comorbidity. HIV-infected patients and healthy controls had previously been examined regarding cognitive, physical, metabolic, and immunological parameters. QoL was investigated using the Medical Outcomes Study HIV Health Survey (MOS-HIV). Linear multiple regression models were created to find factors associated with mental health summary score (MHS) and physical health summary score (PHS). RESULTS HIV-infected patients reported lower QoL compared with controls. In HIV-infected patients, female gender and depression score were associated with lower MHS. In controls, years of education, depression score, and cognitive test performance were associated with lower MHS. In HIV-infected patients, years of education, depression score, and body mass index were associated with lower PHS, whereas in controls, years of education and fitness level were associated with PHS. CONCLUSIONS Even well-treated HIV-infected patients with low level of comorbidity reported lower QoL compared with healthy controls. Especially, depression score and body mass index were associated with QoL in HIV-infected patients.
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Grauer OM, Reichelt D, Grüneberg U, Lohmann H, Schneider-Hohendorf T, Schulte-Mecklenbeck A, Gross CC, Meuth SG, Wiendl H, Husstedt IW. Neurocognitive decline in HIV patients is associated with ongoing T-cell activation in the cerebrospinal fluid. Ann Clin Transl Neurol 2015; 2:906-19. [PMID: 26401512 PMCID: PMC4574808 DOI: 10.1002/acn3.227] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 01/30/2023] Open
Abstract
Objective HIV-associated neurocognitive disorders (HAND) remain a challenge despite combination antiretroviral therapy (cART). Immune cell activation has been implicated to play a major role in the development of HAND. Methods In this study, we used multicolor flow cytometry on peripheral blood (PB) and cerebrospinal fluid (CSF) samples to determine the expression of HLA-DR and programmed death-1 (PD-1) on CD4+ and CD8+ T cells in patients with chronic HIV infection. Expression levels were correlated with HI virus load in PB and CSF, classification of HAND and severity of magnetic resonance imaging (MRI) signal abnormalities. Results In a cohort of 86 HIV patients we found that the grade of neurocognitive impairment and the severity of MRI signal abnormalities correlated with decreasing CD4/CD8-ratios and increased frequencies of HLA-DR expressing CD4+ and CD8+ T cells reaching the highest values in the CSF samples. Importantly, HLA-DR upregulation was still detectable in virologically suppressed HIV patients. Further, T-cell subpopulation analysis of 40 HIV patients showed a significant shift from naïve to effector memory (EM) T cells that was negatively correlated with the grade of neurocognitive impairment in the PB samples. Moreover, PD-1 was significantly increased on CD4+ memory T cells with highest levels on EM T cells in HIV patients with mild or severe neurocognitive alterations. Interpretation The CD4/CD8 ratio, the proportion of EM to naïve T cells and the immune activation profile of CD4+ and CD8+ T cells in PB and CSF might be useful parameters to monitor the efficacy of cART and to identify HIV patients at risk of further neurocognitive deterioration.
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Affiliation(s)
- Oliver M Grauer
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Doris Reichelt
- Department of Internal Medicine D, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Ute Grüneberg
- Department of Internal Medicine D, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Hubertus Lohmann
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Tilman Schneider-Hohendorf
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Catharina C Gross
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Ingo W Husstedt
- Department of Neurology, University Hospital of Muenster Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
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25
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Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection. AIDS 2015; 29:547-57. [PMID: 25587908 DOI: 10.1097/qad.0000000000000573] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study is to assess whether multivariate normative comparison (MNC) improves detection of HIV-1-associated neurocognitive disorder (HAND) as compared with Frascati and Gisslén criteria. METHODS One-hundred and three HIV-1-infected men with suppressed viremia on combination antiretroviral therapy (cART) for at least 12 months and 74 HIV-uninfected male controls (comparable regarding age, ethnicity, sexual orientation, premorbid intelligence and educational level), aged at least 45 years, underwent neuropsychological assessment covering six cognitive domains (fluency, attention, information processing speed, executive function, memory, and motor function). Frascati and Gisslén criteria were applied to detect HAND. Next, MNC was performed to compare the cognitive scores of each HIV-positive individual against the cognitive scores of the control group. RESULTS HIV-infected men showed significantly worse performance on the cognitive domains of attention, information processing speed and executive function compared with HIV-uninfected controls. HAND by Frascati criteria was highly prevalent in HIV-infected [48%; 95% confidence interval (95% CI) 38-58] but nearly equally so in HIV-uninfected men (36%; 95% CI 26-48), confirming the low specificity of this method. Applying Gisslén criteria, HAND-prevalence was reduced to 5% (95% CI 1-9) in HIV-infected men and to 1% (95% CI 1-3) among HIV-uninfected controls, indicating better specificity but reduced sensitivity. MNC identified cognitive impairment in 17% (95% CI 10-24) of HIV-infected men and in 5% (95% CI 0-10) of the control group (P = 0.02, one-tailed), showing an optimal balance between sensitivity and specificity. CONCLUSION Prevalence of cognitive impairment in HIV-1-infected men with suppressed viremia on cART estimated by MNC was much higher than that estimated by Gisslén criteria, while the false positive rate was greatly reduced compared with the Frascati criteria. VIDEO ABSTRACT :
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26
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Monocyte activation, but not microbial translocation, is independently associated with markers of endovascular dysfunction in HIV-infected patients receiving cART. J Acquir Immune Defic Syndr 2015; 67:370-4. [PMID: 25226210 DOI: 10.1097/qai.0000000000000339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Microbial translocation has been suggested as a driver of cardiovascular disease in HIV infection. We hypothesized that microbial translocation and the resulting monocyte activation would be associated with markers of endovascular dysfunction. METHODS In 60 HIV-infected patients on combination antiretroviral therapy, plasma levels of lipopolysaccharide, soluble CD14 (sCD14), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) were measured. RESULTS ADMA and SDMA were associated with sCD14 but not lipopolysaccharide. There was a significant increase in ADMA and SDMA through tertiles of sCD14, and both markers were associated with sCD14 in multivariate linear regression analyses. CONCLUSIONS Monocyte activation as measured by sCD14 is associated with endovascular dysfunction in HIV infection.
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d'Ettorre G, Ceccarelli G, Giustini N, Mastroianni CM, Silvestri G, Vullo V. Taming HIV-related inflammation with physical activity: a matter of timing. AIDS Res Hum Retroviruses 2014; 30:936-44. [PMID: 25055246 DOI: 10.1089/aid.2014.0069] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many sets of data indicate that HIV-infected individuals maintain a low level of chronic immune activation and inflammation even in the presence of effective antiretroviral therapy (ART). This residual immune activation seems to be associated with accelerated aging and an increased incidence of non-AIDS-defining illnesses. Several published studies suggest that physical activity is a beneficial nonpharmacological intervention to reduce chronic inflammation. However, currently available data on the potential benefits of regular physical exercises for HIV-infected individuals are limited. Nonetheless, increasing evidence suggests that the introduction of regular physical exercise in the clinical management of HIV-infected individuals may have a significant positive impact in reducing some of the long-term complications of both infection and ART. Based on a comprehensive review of the existing data, we propose that regular physical exercise should be further studied as a potential antiinflammatory, nonpharmacological approach to be used to treat HIV residual disease and non-AIDS-defining illnesses in ART-treated HIV-infected individuals.
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Affiliation(s)
- Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Istituto Pasteur-Fondazione Cenci Bolognetti, University of Rome “Sapienza,” Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Istituto Pasteur-Fondazione Cenci Bolognetti, University of Rome “Sapienza,” Rome, Italy
| | - Noemi Giustini
- Department of Public Health and Infectious Diseases, Istituto Pasteur-Fondazione Cenci Bolognetti, University of Rome “Sapienza,” Rome, Italy
| | - Claudio M. Mastroianni
- Department of Infectious Diseases, Istituto Pasteur-Fondazione Cenci Bolognetti, University of Rome “Sapienza,” Polo Pontino, Italy
| | - Guido Silvestri
- Department of Pathology, Emory University School of Medicine and Yerkes National Primate Research Center, Atlanta, Georgia
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Istituto Pasteur-Fondazione Cenci Bolognetti, University of Rome “Sapienza,” Rome, Italy
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28
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Arbeitman LE, O’Brien RC, Somarriba G, Messiah SE, Neri D, Scott GB, Miller TL. Body mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts. J Pediatr Gastroenterol Nutr 2014; 59:449-54. [PMID: 24709829 PMCID: PMC4524541 DOI: 10.1097/mpg.0000000000000394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV)-infected youth are healthier because of effective antiretroviral therapies. We compared anthropometric measurements and prevalence of overweight and obesity between perinatally HIV-infected youth, a local HIV-uninfected comparison group, and 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) data. In addition, we compared only African American HIV-infected youth with NHANES African Americans. METHODS Height, weight, body mass index (BMI), and waist circumference (WC) of HIV-infected youth, aged 10 to 19 years, were compared among groups. BMI percentiles were categorized as underweight (<5%), normal (5% to <85%), overweight (85% to <95%), and obese (≥ 95%). Clinical correlates were modeled as predictors of BMI and WC. RESULTS A total of 134 HIV-infected (including 103 African Americans) (mean age 16.5 years), 75 HIV-uninfected (mean age 14.2 years), and 3216 NHANES (including 771 NHANES African Americans) (mean age 15.0 years) youth were included in the analysis. Height and weight z scores of HIV-infected youth were lower than those of HIV-uninfected and NHANES (P ≤ 0.056) youth. BMI, WC, and BMI category were not statistically different between groups. In the HIV-infected African American group, BMI z score was lower (0.49 vs 0.76, P = 0.04) compared with NHANES African Americans. There were no significant predictors of BMI or WC for the HIV-infected group. CONCLUSIONS HIV-infected children have similar BMIs and WCs as uninfected children both locally and nationally and show similar high rates of obesity and overweight. When compared with a more racially similar African American national sample, HIV-infected children have a lower BMI, suggesting that there may be persistent anthropometric differences in HIV.
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Affiliation(s)
- Lori E. Arbeitman
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, United States
| | - Robert C. O’Brien
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gabriel Somarriba
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah E. Messiah
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Daniela Neri
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gwendolyn B. Scott
- Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tracie L. Miller
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, United States
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29
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Nissen SK, Højen JF, Andersen KLD, Kofod-Olsen E, Berg RK, Paludan SR, Østergaard L, Jakobsen MR, Tolstrup M, Mogensen TH. Innate DNA sensing is impaired in HIV patients and IFI16 expression correlates with chronic immune activation. Clin Exp Immunol 2014; 177:295-309. [PMID: 24593816 DOI: 10.1111/cei.12317] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 02/03/2023] Open
Abstract
The innate immune system has been recognized to play a role in the pathogenesis of HIV infection, both by stimulating protective activities and through a contribution to chronic immune activation, the development of immunodeficiency and progression to AIDS. A role for DNA sensors in HIV recognition has been suggested recently, and the aim of the present study was to describe the influence of HIV infection on expression and function of intracellular DNA sensing. Here we demonstrate impaired expression of interferon-stimulated genes in responses to DNA in peripheral blood monuclear cells from HIV-positive individuals, irrespective of whether patients receive anti-retroviral treatment. Furthermore, we show that expression levels of the DNA sensors interferon-inducible protein 16 (IFI16) and cyclic guanosine monophosphate-adenosine monophosphate synthase were increased in treatment-naive patients, and for IFI16 expression was correlated with high viral load and low CD4 cell count. Finally, our data demonstrate a correlation between IFI16 and CD38 expression, a marker of immune activation, in CD4(+) central and effector memory T cells, which may indicate that IFI16-mediated DNA sensing and signalling contributes to chronic immune activation. Altogether, the present study demonstrates abnormal expression and function of cytosolic DNA sensors in HIV patients, which may have implications for control of opportunistic infections, chronic immune activation and T cell death.
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Affiliation(s)
- S K Nissen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark
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Trøseid M, Manner IW, Pedersen KK, Haissman JM, Kvale D, Nielsen SD. Microbial translocation and cardiometabolic risk factors in HIV infection. AIDS Res Hum Retroviruses 2014; 30:514-22. [PMID: 24521167 DOI: 10.1089/aid.2013.0280] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The widespread access to antiretroviral treatment during the past decades has transformed HIV infection from a lethal disease to a chronic condition, in which the relative burden of non-AIDS-related chronic disorders such as cardiovascular disease, malignancy, renal, liver, and bone disease has increased. The adjusted relative risk for myocardial infarction is reported to be around 2-fold compared to that of the general population, which over time is likely to translate into increased absolute risk in an aging population. Thus, delineating potentially HIV-specific pathogenetic mechanisms is crucial in order to tailor novel strategies for prophylaxis and treatment. This review will focus on advances in the field that possibly link HIV-induced alterations of the gut mucosa and consequent microbial translocation to cardiometabolic risk factors in HIV infection. Recent work suggests that markers of microbial translocation are closely associated with several cardiovascular risk factors such as dyslipidemia, insulin resistance, hypertension, coagulation abnormalities, endothelial dysfunction, and carotid atherosclerosis. Future studies should investigate whether associations between microbial translocation and cardiovascular risk factors will translate into increased risk of acute events, and whether strategies to target gut microbiota and microbial translocation might reduce such a risk.
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Affiliation(s)
- Marius Trøseid
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway
| | | | - Karin K. Pedersen
- Viro-Immunology, Department of Infectious Diseases, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Judith M. Haissman
- Viro-Immunology, Department of Infectious Diseases, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Dag Kvale
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway
| | - Susanne D. Nielsen
- Viro-Immunology, Department of Infectious Diseases, Copenhagen University Rigshospitalet, Copenhagen, Denmark
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Steele AK, Lee EJ, Vestal B, Hecht D, Dong Z, Rapaport E, Koeppe J, Campbell TB, Wilson CC. Contribution of intestinal barrier damage, microbial translocation and HIV-1 infection status to an inflammaging signature. PLoS One 2014; 9:e97171. [PMID: 24819230 PMCID: PMC4018269 DOI: 10.1371/journal.pone.0097171] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Systemic inflammation is a characteristic of both HIV-1 infection and aging (“inflammaging”). Intestinal epithelial barrier damage (IEBD) and microbial translocation (MT) contribute to HIV-associated inflammation, but their impact on inflammaging remains unclear. Methods Plasma biomarkers for IEBD (iFABP), MT (LPS, sCD14), T-cell activation (sCD27), and inflammation (hsCRP, IL-6) were measured in 88 HIV-1 uninfected (HIVneg) and 83 treated, HIV-1-infected (HIVpos) adults from 20–100 years old. Results Age positively correlated with iFABP (r = 0.284, p = 0.008), sCD14 (r = 0.646, p = <0.0001) and LPS (r = 0.421, p = 0.0002) levels in HIVneg but not HIVpos subjects. Age also correlated with sCD27, hsCRP, and IL-6 levels regardless of HIV status. Middle-aged HIVpos subjects had elevated plasma biomarker levels similar to or greater than those of elderly HIVneg subjects with the exception of sCD14. Clustering analysis described an inflammaging phenotype (IP) based on iFABP, sCD14, sCD27, and hsCRP levels in HIVneg subjects over 60 years of age. The IP in HIVneg subjects was used to develop a classification model that was applied to HIVpos subjects to determine whether HIVpos subjects under 60 years of age were IP+. HIVpos IP+ subjects were similar in age to IP- subjects but had a greater risk of cardiovascular disease (CVD) based on Framingham risk score (p = 0.01). Conclusions We describe a novel IP that incorporates biomarkers of IEBD, MT, immune activation as well as inflammation. Application of this novel IP in HIV-infected subjects identified a group at higher risk of CVD.
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Affiliation(s)
- Amanda K. Steele
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Eric J. Lee
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Brian Vestal
- Colorado Biostatistics Consortium Research Consulting Laboratory, University of Colorado, Aurora, Colorado, United States of America
| | - Daniel Hecht
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Zachary Dong
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Eric Rapaport
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - John Koeppe
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Immunology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Thomas B. Campbell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Immunology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Cara C. Wilson
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Immunology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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Plasma lipopolysaccharide and triglycerides are independently associated and both markers correlate with the development of metabolic syndrome in HIV infection. J Acquir Immune Defic Syndr 2014; 65:e158-61. [PMID: 24577189 DOI: 10.1097/qai.0000000000000055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Genetic, transcriptomic, and epigenetic studies of HIV-associated neurocognitive disorder. J Acquir Immune Defic Syndr 2014; 65:481-503. [PMID: 24583618 DOI: 10.1097/qai.0000000000000069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Human Genome Project, coupled with rapidly evolving high-throughput technologies, has opened the possibility of identifying heretofore unknown biological processes underlying human disease. Because of the opaque nature of HIV-associated neurocognitive disorder (HAND) neuropathogenesis, the utility of such methods has gained notice among NeuroAIDS researchers. Furthermore, the merging of genetics with other research areas has also allowed for application of relatively nascent fields, such as neuroimaging genomics, and pharmacogenetics, to the context of HAND. In this review, we detail the development of genetic, transcriptomic, and epigenetic studies of HAND, beginning with early candidate gene association studies and culminating in current "omics" approaches that incorporate methods from systems biology to interpret data from multiple levels of biological functioning. Challenges with this line of investigation are discussed, including the difficulty of defining a valid phenotype for HAND. We propose that leveraging known associations between biology and pathology across multiple levels will lead to a more reliable and valid phenotype. We also discuss the difficulties of interpreting the massive and multitiered mountains of data produced by current high-throughput omics assays and explore the utility of systems biology approaches in this regard.
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Biomarkers and neurodevelopment in perinatally HIV-infected or exposed youth: a structural equation model analysis. AIDS 2014; 28:355-64. [PMID: 24670521 DOI: 10.1097/qad.0000000000000072] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the relationship between markers of vascular dysfunction and neurodevelopmental outcomes in perinatally HIV-infected (PHIV+) and perinatally HIV-exposed but uninfected (PHEU) youth. DESIGN Cross-sectional design within a prospective, 15-site US-based cohort study. METHODS Neurodevelopmental outcomes were evaluated in relation to nine selected vascular biomarkers in 342 youth (212 PHIV+, 130 PHEU). Serum levels were assessed for adiponectin, C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), soluble vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sE-selectin), monocyte chemoattractant protein (sMCP-1), intercellular adhesion molecule-1 (sICAM-1), and P-selectin (sP-selectin). The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was administered at entry, yielding a Full-Scale IQ score, and four index scores. Factor analysis was conducted to reduce the biomarkers to fewer factors with related biological roles. Structural equation models (SEMs) were used to measure associations between resulting factors and WISC-IV scores. RESULTS Mean participant age was 11.4 years, 54% were female, 70% black. The nine biomarkers were clustered into three factor groups: F1 (fibrinogen, CRP, and IL-6); F2 (sICAM-1 and sVCAM-1); and F3 (MCP-1, sP-selectin, and sE-selectin). Adiponectin showed little correlation with any factor. SEMs revealed significant negative association of F1 with WISC-IV processing speed score in the total cohort. This effect remained significant after adjusting for HIV status and other potential confounders. A similar association was observed when restricted to PHIV+ participants in both unadjusted and adjusted SEMs. CONCLUSION Aggregate measures of fibrinogen, CRP, and IL-6 may serve as a latent biomarker associated with relatively decreased processing speed in both PHIV+ and PHEU youth.
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Gavegnano C, Detorio M, Montero C, Bosque A, Planelles V, Schinazi RF. Ruxolitinib and tofacitinib are potent and selective inhibitors of HIV-1 replication and virus reactivation in vitro. Antimicrob Agents Chemother 2014; 58:1977-86. [PMID: 24419350 PMCID: PMC4023721 DOI: 10.1128/aac.02496-13] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/08/2014] [Indexed: 12/18/2022] Open
Abstract
The JAK-STAT pathway is activated in both macrophages and lymphocytes upon human immunodeficiency virus type 1 (HIV-1) infection and thus represents an attractive cellular target to achieve HIV suppression and reduced inflammation, which may impact virus sanctuaries. Ruxolitinib and tofacitinib are JAK1/2 inhibitors that are FDA approved for rheumatoid arthritis and myelofibrosis, respectively, but their therapeutic application for treatment of HIV infection was unexplored. Both drugs demonstrated submicromolar inhibition of infection with HIV-1, HIV-2, and a simian-human immunodeficiency virus, RT-SHIV, across primary human or rhesus macaque lymphocytes and macrophages, with no apparent significant cytotoxicity at 2 to 3 logs above the median effective antiviral concentration. Combination of tofacitinib and ruxolitinib increased the efficacy by 53- to 161-fold versus that observed for monotherapy, respectively, and each drug applied alone to primary human lymphocytes displayed similar efficacy against HIV-1 containing various polymerase substitutions. Both drugs inhibited virus replication in lymphocytes stimulated with phytohemagglutinin (PHA) plus interleukin-2 (IL-2), but not PHA alone, and inhibited reactivation of latent HIV-1 at low-micromolar concentrations across the J-Lat T cell latency model and in primary human central memory lymphocytes. Thus, targeted inhibition of JAK provided a selective, potent, and novel mechanism to inhibit HIV-1 replication in lymphocytes and macrophages, replication of drug-resistant HIV-1, and reactivation of latent HIV-1 and has the potential to reset the immunologic milieu in HIV-infected individuals.
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Affiliation(s)
- Christina Gavegnano
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Mervi Detorio
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Catherine Montero
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Alberto Bosque
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Vicente Planelles
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Raymond F. Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Veterans Affairs Medical Center, Decatur, Georgia, USA
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Microbial translocation in HIV infection is associated with dyslipidemia, insulin resistance, and risk of myocardial infarction. J Acquir Immune Defic Syndr 2014; 64:425-33. [PMID: 23797689 DOI: 10.1097/qai.0b013e31829f919d] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Microbial translocation has been suggested to be a driver of immune activation and inflammation. It is hypothesized that microbial translocation may be related to dyslipidemia, insulin resistance, and the risk of coronary heart disease in HIV-infected individuals. DESIGN Cross-sectional study of 60 HIV-infected patients on combination antiretroviral therapy with viral suppression >2 years and 31 healthy age-matched controls. METHODS Lipopolysaccharide (LPS) was analyzed by limulus amebocyte lysate colorimetric assay. Lipids, including cholesterol, low-density lipoprotein (LDL), and triglycerides, were measured. Glucose metabolism was determined using an oral glucose tolerance test. Body composition was determined using whole-body dual-energy x-ray absorptiometry scans and magnetic resonance imaging. The Framingham risk score was used to assess risk of cardiovascular disease and myocardial infarction. RESULTS HIV-infected patients had higher level of LPS compared with controls (64 pg/mL vs. 50 pg/mL, P = 0.002). Likewise, HIV-infected patients had higher triglycerides, LDL, and fasting insulin as well as evidence of lower insulin sensitivity compared with controls. Among HIV-infected patients, high LPS was associated with a higher level of triglycerides and LDL and with lower insulin sensitivity. Importantly, among HIV-infected patients, high LPS was associated with a higher Framingham risk score. CONCLUSIONS HIV-infected patients with suppressed viral replication had increased level of microbial translocation as measured by LPS. LPS was associated with cardiometabolic risk factors and increased Framingham risk score. Hence, the gastrointestinal mucosal barrier may be a potential therapeutic target to prevent dyslipidemia and future cardiovascular complications in HIV infection.
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Cassol E, Misra V, Morgello S, Gabuzda D. Applications and limitations of inflammatory biomarkers for studies on neurocognitive impairment in HIV infection. J Neuroimmune Pharmacol 2013; 8:1087-97. [PMID: 24259252 PMCID: PMC3889222 DOI: 10.1007/s11481-013-9512-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/23/2013] [Indexed: 12/31/2022]
Abstract
Despite reduced prevalence of severe forms of HIV-associated neurocognitive disorders (HAND) on current antiretroviral therapy (ART) regimens, milder forms of neurocognitive impairment (NCI) remain prevalent in HIV-infected populations. These mild forms of HAND consist of subtypes, probably reflecting distinct, though possibly overlapping, pathophysiological mechanisms. Factors associated with HAND in HIV patients with prolonged viral suppression on ART include older age, low nadir CD4, active HCV co-infection, and cardiovascular risk factors, but underlying mechanisms and their relationship to innate immune activation, chronic inflammation, and other features of systemic disease are poorly understood. In this article, we discuss applications and limitations of plasma inflammatory biomarkers for studies on HAND in HIV patients on ART and describe an analysis pipeline to reduce common sources of noise and increase likelihood of identifying relevant inflammatory biomarkers. Clinical covariates and comorbidities that influence inflammatory biomarkers, such as aging, obesity, metabolic abnormalities, HCV co-infection, and substance abuse, are also reviewed. As an example for using this analytic pipeline, we present an exploratory study of 22 plasma inflammatory biomarkers (IFN-α 2b and -γ, 16 cytokines/chemokines, sIL-2R, sCD14, HA, and YKL-40) in a cohort of HIV-infected individuals with advanced disease, frequent HCV co-infection, and viral suppression on ART. The identification of inflammatory biomarkers associated with HAND in HIV+ patients on ART may be useful to distinguish between HAND subtypes with distinct pathophysiology, and is important for achieving a systems-level understanding of the biology of these disorders, developing effective therapies, and evaluating therapeutic outcomes.
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Affiliation(s)
- Edana Cassol
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Vikas Misra
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | | | - Dana Gabuzda
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
- Dana Farber Cancer Institute, 450 Brookline Avenue CLS 1010, Boston, MA 02215 USA
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Levine AJ, Horvath S, Miller EN, Singer EJ, Shapshak P, Baldwin GC, Martínez-Maza O, Witt MD, Langfelder P. Transcriptome analysis of HIV-infected peripheral blood monocytes: gene transcripts and networks associated with neurocognitive functioning. J Neuroimmunol 2013; 265:96-105. [PMID: 24094461 DOI: 10.1016/j.jneuroim.2013.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/15/2013] [Accepted: 09/21/2013] [Indexed: 02/06/2023]
Abstract
UNLABELLED Immunologic dysfunction, mediated via monocyte activity, has been implicated in the development of HIV-associated neurocognitive disorder (HAND). We hypothesized that transcriptome changes in peripheral blood monocytes relate to neurocognitive functioning in HIV+ individuals, and that such alterations could be useful as biomarkers of worsening HAND. METHODS mRNA was isolated from the monocytes of 86 HIV+ adults and analyzed with the Illumina HT-12 v4 Expression BeadChip. Neurocognitive functioning, HAND diagnosis, and other clinical and virologic variables were determined. Data were analyzed using standard expression analysis and weighted gene co-expression network analysis (WGCNA). RESULTS Neurocognitive functioning was correlated with multiple gene transcripts in the standard expression analysis. WGCNA identified two nominally significant co-expression modules associated with neurocognitive functioning, which were enriched with genes involved in mitotic processes and translational elongation. CONCLUSIONS Multiple modified gene transcripts involved in inflammation, cytoprotection, and neurodegeneration were correlated with neurocognitive functioning. The associations were not strong enough to justify their use as biomarkers of HAND; however, the associations of two co-expression modules with neurocognitive functioning warrant further exploration.
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Affiliation(s)
- Andrew J Levine
- Department of Neurology, National Neurological AIDS Bank, David Geffen School of Medicine, University of California, Los Angeles, United States.
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