1
|
Louw S, Mayne ES, Jacobson BF, Mayne AL. Selected inflammatory and coagulation biomarkers pre-viral suppression in people with human immunodeficiency virus (HIV) infection without overt cardiovascular disease: Is there a need to redefine reference indices? Cytokine 2023; 165:156174. [PMID: 36996538 DOI: 10.1016/j.cyto.2023.156174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is prevalent in Africa and causes morbidity and mortality despite antiretroviral therapy (ART). Non-communicable complications of HIV infection include cardiovascular disease (CVD) with thromboses throughout the vascular tree. Ongoing inflammation and endothelial dysfunction in people living with HIV (PLWH) probably contribute significantly to HIV-related CVD. OBJECTIVES A systematic review was conducted to inform interpretation of 5 biomarkers commonly measured in PLWH namely interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-α), D-dimers, and soluble intracellular and vascular adhesion molecules-1 (sICAM-1 and sVCAM-1) to attempt to define a range for these values in ART naïve PLWH without overt CVD or additional comorbid diseases. METHODS A systematic search was conducted for all studies documenting the levels of the above biomarkers in ART naïve PLWH published on the PubMed database from 1994 to 2020. RESULTS The number of publications that reported medians above the assay values was: 4/15 for D-dimer; 0/5 for TNF-α, 8/16 for IL-6, 3/6 for sVCAM-1, and 4/5 for sICAM-1. CONCLUSION The clinical utility of biomarkers is reduced by the lack of standardisation of the measurement of these parameters, absence of normal reference indices and the lack of uniformity of study protocols in different research centres. This review supports the ongoing use of D-dimers to predict thrombotic and bleeding events in PLWH since the weighted averages across study assays suggest that the median levels do not exceed the reference range. The role of inflammatory cytokine monitoring and measurement of endothelial adhesion markers is less clear.
Collapse
Affiliation(s)
- Susan Louw
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand (Wits) and National Health Laboratory Service (NHLS), Office 3B20, Wits Medical School, 7 York Road, Parktown, Johannesburg 2196, South Arica.
| | - Elizabeth S Mayne
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Barry F Jacobson
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand (Wits) and National Health Laboratory Service (NHLS), Office 3B20, Wits Medical School, 7 York Road, Parktown, Johannesburg 2196, South Arica
| | - Anthony L Mayne
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, South Africa
| |
Collapse
|
2
|
Thrombotic thrombocytopenic purpura (TTP) in Human immunodeficiency virus (HIV) infected patients: New twists on an old disease. AIDS 2022; 36:1345-1354. [PMID: 35608117 DOI: 10.1097/qad.0000000000003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Investigate the presence of inflammation, endothelial dysfunction and complement activation in patients with HIV-associated thrombotic thrombocytopenic purpura (HIV-TTP) to support the hypothesis that these processes probably contribute to the development of this thrombotic microangiopathy. DESIGN A prospective, investigational cohort study of 35 consecutive patients diagnosed with HIV-associated TTP presenting to three academic, tertiary care hospitals in Johannesburg, South Africa over 2 years. METHODS The patients with HIV-TTP received therapeutic plasma therapy and supportive treatment. Demographic data, the results of routine investigations and patient outcomes were recorded. Peripheral blood samples were collected prior to and on completion of plasma therapy and the following additional parameters were assessed at both time points: activity of the von Willebrand factor (VWF) cleaving protease, a-disintegrin-and-metalloproteinase-with-thrombospondin-motifs 13 (ADAMTS-13) and the presence of ADAMTS-13 autoantibodies, levels of pro-inflammatory cytokines, interleukin-6 and tumour necrosis factor-alpha, and two endothelial cell adhesion molecules. Complement activation was assessed by sequential measurement of C3 and C4 as well as levels of the complement inhibitor, factor H. RESULTS The inflammatory and endothelial activation markers were significantly (P < 0.001) elevated in the cohort of patients prior to plasma therapy compared with levels on discharge. Complement was activated and normalized with therapy. The ADAMTS-13 levels were reduced with significant auto-antibodies to this protease at presentation. CONCLUSION Inflammation in HIV mediates endothelial damage and complement activation. This study proposes that these processes are probably contributory to the development of HIV-TTP, which can therefore be characterized in part as a complementopathy, resembling TTP-like syndrome.
Collapse
|
3
|
Chawki S, Charreau I, Gabassi A, Carette D, Cua E, Cotte L, Pialoux G, Pintado C, Meyer L, Chaix ML, Delaugerre C, Molina JM. Inflammatory Markers During Early Treatment of Seroconverters in a Randomized Placebo-Controlled Trial of PrEP (ANRS-IPERGAY). Open Forum Infect Dis 2021; 8:ofab085. [PMID: 33796598 PMCID: PMC7990514 DOI: 10.1093/ofid/ofab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/19/2021] [Indexed: 11/15/2022] Open
Abstract
HIV-related inflammation is associated with poor outcomes. We describe inflammatory biomarkers in 17 participants in a pre-exposure prophylaxis trial who seroconverted with very early initiation of antiretroviral therapy. Inflammation peaked at the time of HIV infection and returned to baseline within 6-12 months. Starting antiretroviral therapy very early could help mitigate long-lasting HIV-related inflammation.
Collapse
Affiliation(s)
- Sylvain Chawki
- Department of Virology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Paris University, Paris, France
| | | | - Audrey Gabassi
- Department of Virology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Paris University, Paris, France
| | | | - Eric Cua
- Maladies Infectieuses, Hôpital L'Archet, Nice, France
| | - Laurent Cotte
- Maladies Infectieuses, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Gilles Pialoux
- Maladies Infectieuses, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Claire Pintado
- Maladies Infectieuses, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Marie-Laure Chaix
- Department of Virology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Paris University, Paris, France
| | - Constance Delaugerre
- Department of Virology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Paris University, Paris, France
| | - Jean-Michel Molina
- Maladies Infectieuses, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM U944, Paris University, Paris, France
| |
Collapse
|
4
|
Delagreverie HM, Bauduin C, De Castro N, Grinsztejn B, Chevrier M, Jouenne F, Mourah S, Kalidi I, Pilotto JH, Brites C, Tregnago Barcellos N, Amara A, Wittkop L, Molina JM, Delaugerre C. Impact of Raltegravir or Efavirenz on Cell-Associated Human Immunodeficiency Virus-1 (HIV-1) Deoxyribonucleic Acid and Systemic Inflammation in HIV-1/Tuberculosis Coinfected Adults Initiating Antiretroviral Therapy. Open Forum Infect Dis 2020; 7:ofz549. [PMID: 32083147 PMCID: PMC7019658 DOI: 10.1093/ofid/ofz549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background In view of the fast viremia decline obtained with integrase inhibitors, we studied the respective effects of initiating efavirenz (EFV) or raltegravir (RAL)-based antiretroviral therapy (ART) regimens on human immunodeficiency virus (HIV)-1 deoxyribonucleic acid (DNA) levels and inflammation biomarkers in the highly inflammatory setting of advanced HIV-1 disease with tuberculosis (TB) coinfection. Methods We followed cell-associated HIV-1 DNA, high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), soluble CD14 and D-Dimer levels for 48 weeks after ART initiation in the participants to the ANRS12-180 REFLATE-TB study. This phase II open-label randomized study included ART-naive people with HIV and TB treated with rifampicin to receive RAL 400 mg twice daily (RAL400), RAL 800 mg twice daily (RAL800) or EFV 600 mg QD with tenofovir and lamivudine. Results In 146 participants, the median (interquartile range [IQR]) week (W)0 HIV-1 DNA level was 4.7 (IQR, 4.3–5.1) log10 copies/106 CD4+, and the reduction by W48 was −0.8 log10 copies/106 CD4+ on EFV, −0.9 on RAL400, and −1.0 on RAL800 (P = .74). Baseline median (IQR) hsCRP, IL-6, sCD14, and D-Dimer levels were 6.9 (IQR, 3.3–15.6) mg/L, 7.3 (IQR, 3.5–12.3) pg/mL, 3221 (IQR, 2383–4130) ng/mL, and 975 (IQR, 535–1970) ng/mL. All biomarker levels decreased over the study: the overall W0–W48 mean (95% confidence interval) fold-change on ART was 0.37 (IQR, 0.28–0.48) for hsCRP, 0.42 (IQR, 0.35–0.51) for IL-6, 0.51 (IQR, 0.47–0.56) for sCD14, and 0.39 (IQR, 0.32–0.47) for D-Dimers. There were no differences in biomarker reduction across treatment arms. Conclusions In participants with HIV and TB, EFV, RAL400, or RAL800 effectively and equally reduced inflammation and HIV-1 DNA levels.
Collapse
Affiliation(s)
- Héloïse M Delagreverie
- Laboratoire de Virologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Université de Paris, Paris, France
| | - Claire Bauduin
- ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux University, Bordeaux, France
| | - Nathalie De Castro
- Maladies Infectieuses et Tropicales, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute-Fiocruz, STD/AIDS Clinical Research Laboratory, Rio de Janeiro, Brazil
| | - Marc Chevrier
- Laboratoire de Biochimie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanélie Jouenne
- Laboratoire de Pharmacologie, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samia Mourah
- Laboratoire de Pharmacologie, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Issa Kalidi
- Laboratoire d'Hématologie, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Carlos Brites
- Hospital Universitário Profesor Edgar Santos, Laboratório de Pesquisa em Doenças Infecciosas, Bahia, Brazil
| | | | - Ali Amara
- INSERM U944, Université de Paris, Paris, France
| | - Linda Wittkop
- ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux University, Bordeaux, France.,Pole de Santé Publique, Service d'Information Medicale, Bordeaux, France
| | - Jean-Michel Molina
- INSERM U944, Université de Paris, Paris, France.,Maladies Infectieuses et Tropicales, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Constance Delaugerre
- Laboratoire de Virologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Université de Paris, Paris, France
| |
Collapse
|
5
|
Prendergast AJ, Szubert AJ, Berejena C, Pimundu G, Pala P, Shonhai A, Musiime V, Bwakura-Dangarembizi M, Poulsom H, Hunter P, Musoke P, Kihembo M, Munderi P, Gibb DM, Spyer M, Walker AS, Klein N. Baseline Inflammatory Biomarkers Identify Subgroups of HIV-Infected African Children With Differing Responses to Antiretroviral Therapy. J Infect Dis 2016; 214:226-36. [PMID: 27190179 PMCID: PMC4918830 DOI: 10.1093/infdis/jiw148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying determinants of morbidity and mortality may help target future interventions for human immunodeficiency virus (HIV)-infected children. METHODS CD4(+) T-cell count, HIV viral load, and levels of biomarkers (C-reactive protein, tumor necrosis factor α [TNF-α], interleukin 6 [IL-6], and soluble CD14) and interleukin 7 were measured at antiretroviral therapy (ART) initiation in the ARROW trial (case-cohort design). Cases were individuals who died, had new or recurrent World Health Organization clinical stage 4 events, or had poor immunological response to ART. RESULTS There were 115 cases (54 died, 45 had World Health Organization clinical stage 4 events, and 49 had poor immunological response) and 485 controls. Before ART initiation, the median ages of cases and controls were 8.2 years (interquartile range [IQR], 4.4-11.4 years) and 5.8 years (IQR, 2.3-9.3 years), respectively, and the median percentages of lymphocytes expressing CD4 were 4% (IQR, 1%-9%) and 13% (IQR, 8%-18%), respectively. In multivariable logistic regression, cases had lower age-associated CD4(+) T-cell count ratio (calculated as the ratio of the subject's CD4(+) T-cell count to the count expected in healthy individuals of the same age; P < .0001) and higher IL-6 level (P = .002) than controls. Clustering biomarkers and age-associated CD4(+) and CD8(+) T-cell count ratios identified 4 groups of children. Group 1 had the highest frequency of cases (41% cases; 16% died) and profound immunosuppression; group 2 had similar mortality (23% cases; 15% died), but children were younger, with less profound immunosuppression and high levels of inflammatory biomarkers and malnutrition; group 3 comprised young children with moderate immunosuppression, high TNF-α levels, and high age-associated CD8(+) T-cell count ratios but lower frequencies of events (12% cases; 7% died); and group 4 comprised older children with low inflammatory biomarker levels, lower HIV viral loads, and good clinical outcomes (11% cases; 5% died). CONCLUSIONS While immunosuppression is the major determinant of poor outcomes during ART, baseline inflammation is an additional important factor, identifying a subgroup of young children with similar mortality. Antiinflammatory interventions may help improve outcomes.
Collapse
Affiliation(s)
- Andrew J Prendergast
- Queen Mary University of London MRC Clinical Trials Unit at University College London
| | | | | | | | - Pietro Pala
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Victor Musiime
- Joint Clinical Research Centre Makerere University College of Health Sciences
| | | | | | | | - Philippa Musoke
- Paediatric Infectious Diseases Clinic/Baylor-Uganda, Kampala
| | | | - Paula Munderi
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Diana M Gibb
- MRC Clinical Trials Unit at University College London
| | - Moira Spyer
- MRC Clinical Trials Unit at University College London
| | | | - Nigel Klein
- Institute of Child Health, London, United Kingdom
| |
Collapse
|