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Bénard A, Mercié P, Alioum A, Bonnet F, Lazaro E, Dupon M, Neau D, Dabis F, Chêne G. Bacterial pneumonia among HIV-infected patients: decreased risk after tobacco smoking cessation. ANRS CO3 Aquitaine Cohort, 2000-2007. PLoS One 2010; 5:e8896. [PMID: 20126646 PMCID: PMC2811185 DOI: 10.1371/journal.pone.0008896] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 12/31/2009] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bacterial pneumonia is still a substantial cause of morbidity and mortality in HIV-infected patients in the era of combination Antiretroviral Therapy. The benefit of tobacco withdrawal on the risk of bacterial pneumonia has not been quantified in such populations, exposed to other important risk factors such as HIV-related immunodeficiency. Our objective was to estimate the effect of tobacco smoking withdrawal on the risk of bacterial pneumonia among HIV-infected individuals. METHODOLOGY/PRINCIPAL FINDINGS Patients of the ANRS CO3 Aquitaine Cohort with >or= two visits during 2000-2007 and without bacterial pneumonia at the first visit were included. Former smokers were patients who stopped smoking since >or= one year. We used Cox proportional hazards models adjusted on CD4+ lymphocytes (CD4), gender, age, HIV transmission category, antiretroviral therapy, cotrimoxazole prophylaxis, statin treatment, viral load and previous AIDS diagnosis. 135 cases of bacterial pneumonia were reported in 3336 patients, yielding an incidence of 12 per thousand patient-years. The adjusted hazard of bacterial pneumonia was lower in former smokers (Hazard Ratio (HR): 0.48; P = 0.02) and never smokers (HR: 0.50; P = 0.01) compared to current smokers. It was higher in patients with <200 CD4 cells/microL and in those with 200 to 349 CD4 cells/microL (HR: 2.98 and 1.98, respectively; both P<0.01), but not in those with 350 to 499 CD4 cells/microL (HR: 0.93; P = 0.79), compared to those with >or=500 CD4 cells/microL. The interaction between CD4 cell count and tobacco smoking status was not statistically significant. CONCLUSIONS/SIGNIFICANCE Smoking cessation dramatically reduces the risk of bacterial pneumonia, whatever the level of immunodeficiency. Smoking cessation interventions should become a key element of the clinical management of HIV-infected individuals.
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Heath L, Fox A, McClure J, Diem K, van 't Wout AB, Zhao H, Park DR, Schouten JT, Twigg HL, Corey L, Mullins JI, Mittler JE. Evidence for limited genetic compartmentalization of HIV-1 between lung and blood. PLoS One 2009; 4:e6949. [PMID: 19759830 PMCID: PMC2736399 DOI: 10.1371/journal.pone.0006949] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/29/2009] [Indexed: 01/04/2023] Open
Abstract
Background HIV-1 is frequently detected in the lungs of infected individuals and is likely important in the development of pulmonary opportunistic infections. The unique environment of the lung, rich in alveolar macrophages and with specialized local immune responses, may contribute to differential evolution or selection of HIV-1. Methodology and Findings We characterized HIV-1 in the lung in relation to contemporaneous viral populations in the blood. The C2-V5 region of HIV-1 env was sequenced from paired lung (induced sputum or bronchoalveolar lavage) and blood (plasma RNA and proviral DNA from sorted or unsorted PBMC) from 18 subjects. Compartmentalization between tissue pairs was assessed using 5 established tree or distance-based methods, including permutation tests to determine statistical significance. We found statistical evidence of compartmentalization between lung and blood in 10/18 subjects, although lung and blood sequences were intermingled on phylogenetic trees in all subjects. The subject showing the greatest compartmentalization contained many nearly identical sequences in BAL sample, suggesting clonal expansion may contribute to reduced viral diversity in the lung in some cases. However, HIV-1 sequences in lung were not more homogeneous overall, nor were we able to find a lung-specific genotype associated with macrophage tropism in V3. In all four subjects in whom predicted X4 genotypes were found in blood, predicted X4 genotypes were also found in lung. Conclusions Our results support a picture of continuous migration of HIV-1 between circulating blood and lung tissue, with perhaps a very limited degree of localized evolution or clonal replication.
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Affiliation(s)
- Laura Heath
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
| | - Alan Fox
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Jan McClure
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
| | - Kurt Diem
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Angélique B. van 't Wout
- Department of Experimental Immunology, Center for Infection and Immunity Amsterdam (CINIMA) at the Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Hong Zhao
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
| | - David R. Park
- Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, United States of America
| | - Jeffrey T. Schouten
- General Surgery, University of Washington, Seattle, Washington, United States of America
| | - Homer L. Twigg
- Division of Pulmonary and Critical Care, Indiana University Medical Center, Indianapolis, Indiana, United States of America
| | - Lawrence Corey
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - James I. Mullins
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - John E. Mittler
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Twigg III H, Weiden M, Valentine F, Schnizlein‐Bick C, Bassett R, Zheng L, Wheat J, Day R, Rominger H, Collman R, Fox L, Brizz B, Dragavon J, Coombs R, Bucy R. Effect of Highly Active Antiretroviral Therapy on Viral Burden in the Lungs of HIV‐Infected Subjects. J Infect Dis 2008; 197:109-16. [DOI: 10.1086/523766] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Kay DG, Yue P, Hanna Z, Jothy S, Tremblay E, Jolicoeur P. Cardiac disease in transgenic mice expressing human immunodeficiency virus-1 nef in cells of the immune system. THE AMERICAN JOURNAL OF PATHOLOGY 2002; 161:321-35. [PMID: 12107117 PMCID: PMC1850688 DOI: 10.1016/s0002-9440(10)64184-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2002] [Indexed: 11/28/2022]
Abstract
We previously reported that a severe acquired immune deficiency syndrome-like disease develops in transgenic (Tg) mice expressing the human immunodeficiency virus-1 in its natural target cells: immature and mature CD4(+) T cells and cells of the macrophage/dendritic lineage. Here, we show that these mice also develop cardiac disease, characterized most prominently by a focal myocytolysis, occasionally by myocarditis and by deposition of endogenous immunoglobulin on cardiomyocytes. Microfil perfusion demonstrated widespread coronary arteriospasm and echocardiographic analysis revealed depressed cardiac function in Tg mice. A higher (but still modest) level of cardiomyocyte apoptosis was detected in Tg as compared to non-Tg hearts. Tg expression was detected in some of the infiltrating mononuclear cells, but not in cardiomyocytes or in cells of the heart vessels, suggesting a human immunodeficiency virus-1-induced disease process mediated by cells of the immune system. The similarity of the heart disease observed in these Tg mice to that observed in acquired immune deficiency syndrome patients suggests a common pathogenesis.
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Affiliation(s)
- Denis G Kay
- Laboratory of Molecular Biology, Clinical Research Institute of Montreal, Montreal, Quebec, Canada
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White NC, Agostini C, Israel-Biet D, Semenzato G, Clarke JR. The growth and the control of human immunodeficiency virus in the lung: implications for highly active antiretroviral therapy. Eur J Clin Invest 1999; 29:964-72. [PMID: 10583442 DOI: 10.1046/j.1365-2362.1999.00550.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, it has become apparent that the lung is an important niche for the proliferation of human immunodeficiency virus (HIV), which may have implications for highly active antiretroviral therapy (HAART). The lung itself is a major site for the opportunistic infections associated with the progression to acquired immune deficiency syndrome (AIDS), specifically Pneumocystis carinii, Myobacterium tuberculosis and pyogenic bacteria. These cases of active pulmonary complications are direct indicators of enhanced progression to AIDS-defining illness and increased morbidity and mortality. It is therefore essential that the interaction between the lung and HIV is fully understood. Recent research indicates the lung may be a major sanctuary for the virus, with distinct evolution and replication in contrast to other target organs for HIV. In this review, we will discuss the recent findings of HIV infection, evolution, host factors involved in the control of HIV within the lung and the impact this may have on current therapy.
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Affiliation(s)
- N C White
- St Mary's Hospital, Paddington, London, UK.
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Singh A, Besson G, Mobasher A, Collman RG. Patterns of chemokine receptor fusion cofactor utilization by human immunodeficiency virus type 1 variants from the lungs and blood. J Virol 1999; 73:6680-90. [PMID: 10400765 PMCID: PMC112752 DOI: 10.1128/jvi.73.8.6680-6690.1999] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) infection is highly compartmentalized, with distinct viral genotypes being found in the lungs, brain, and other organs compared with blood. CCR5 and CXCR4 are the principal HIV-1 coreceptors, and a number of other molecules support entry in vitro but their roles in vivo are uncertain. To address the relationship between tissue compartmentalization and the selective use of entry coreceptors, we generated functional env clones from primary isolates derived from the lungs and blood of three infected individuals and analyzed their use of the principal, secondary, orphan, and virus-encoded coreceptors for fusion. All Env proteins from lung viruses used CCR5 but not CXCR4, while those from blood viruses used CCR5 or CXCR4 or both. The orphan receptor APJ was widely used for fusion by Env proteins from both blood and lung viruses, but none used the cytomegalovirus-encoded receptor US28. Fusion mediated by the secondary coreceptors CCR2b, CCR3, CCR8, and CX3CR1 and orphan receptors GPR1, GPR15, and STRL33 was variable and heterogeneous, with relatively broad utilization by env clones from isolates of one subject but limited use by env clones from the other two subjects. However, there was no clear distinction between blood and lung viruses in secondary or orphan coreceptor fusion patterns. In contrast to fusion, none of the secondary or orphan receptors enabled efficient productive infection. These results confirm, at the level of cofactor utilization, previous observations that HIV-1 populations in the lungs and blood are biologically distinct and demonstrate diversity within lung-derived as well as blood-derived quasispecies. However, the heterogeneity in coreceptor utilization among clones from each isolate and the lack of clear distinction between lung- and blood-derived Env proteins argue against selective coreceptor utilization as a major determinant of compartmentalization.
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MESH Headings
- Antigens, CD/metabolism
- Cell Line, Transformed
- Cloning, Molecular
- Genes, env
- Genetic Variation
- HIV Seropositivity/blood
- HIV Seropositivity/pathology
- HIV Seropositivity/virology
- HIV-1/genetics
- HIV-1/isolation & purification
- HIV-1/metabolism
- HIV-1/pathogenicity
- Humans
- Lung/pathology
- Lung/virology
- Receptors, CCR2
- Receptors, CCR3
- Receptors, CCR5/metabolism
- Receptors, CCR8
- Receptors, CXCR4/metabolism
- Receptors, CXCR6
- Receptors, Cell Surface/metabolism
- Receptors, Chemokine/metabolism
- Receptors, Cytokine/metabolism
- Receptors, G-Protein-Coupled
- Receptors, HIV/metabolism
- Receptors, Interleukin/metabolism
- Receptors, Interleukin-8A
- Receptors, Peptide/metabolism
- Receptors, Virus
- Saccharomyces cerevisiae Proteins
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Affiliation(s)
- A Singh
- Pulmonary and Critical Care Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6060, USA
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Hanna Z, Kay DG, Cool M, Jothy S, Rebai N, Jolicoeur P. Transgenic mice expressing human immunodeficiency virus type 1 in immune cells develop a severe AIDS-like disease. J Virol 1998; 72:121-32. [PMID: 9420207 PMCID: PMC109356 DOI: 10.1128/jvi.72.1.121-132.1998] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We have constructed transgenic (Tg) mice expressing the entire human immunodeficiency virus type 1 (HIV-1) coding sequences in cells targeted by HIV-1 infection in humans. These Tg mice developed a severe AIDS-like disease leading to early death (< 1 month). They developed muscle wasting, severe atrophy and fibrosis of lymphoid organs, tubulointerstitial nephritis, and lymphoid interstitial pneumonitis. In addition the expression of RANTES was increased in various tissues of these Tg mice relative to that in the normal controls. Disease appearance was correlated with the levels of transgene expression. The numerous pathologies observed in these mice are remarkably similar to those observed in human AIDS and, more specifically, in pediatric AIDS.
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Affiliation(s)
- Z Hanna
- Laboratory of Molecular Biology, Clinical Research Institute of Montreal, Quebec, Canada
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de Martino M, Veneruso G, Gabiano C, Frongia G, Tulisso S, Lombardi E, Tovo PA, Galli L, Vierucci A. Airway resistance and spirometry in children with perinatally acquired human immunodeficiency virus-type 1 infection. Pediatr Pulmonol 1997; 24:406-14. [PMID: 9448232 DOI: 10.1002/(sici)1099-0496(199712)24:6<406::aid-ppul5>3.0.co;2-e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Airway resistance was measured by the interrupter technique in 54 children [aged 63.8 months (range: 9.1-131.6 months)], with perinatal human immunodeficiency virus-type 1 (HIV-1) infection and in a control group of 315 gender, height, and race-matched healthy children. In addition, 14 HIV-infected children, aged 75-131 months, had spirometry performed. Resistance was significantly higher in infected children than in controls (0.84 +/- 0.3 vs 0.64 +/- 0.08 kPa x l(-1) x s; t = 9.991; P < 0.0001). Resistance decreased with age in controls (r = -0.95; P < 0.001), but not in infected children (r= -0.22; P = 0.105). Resistance did not correlate with mothers' intravenous drug addiction, perinatal data, T-cell subset numbers, treatment, clinical course, or presence of respiratory complications. Resistance was higher (t = 3.103; P < 0.003) in p24 antigen-positive than in negative children. Thirty-nine children underwent a second evaluation 12.3 months (range 11.1-14 months) after the first. Resistance was higher (t = 3.960; P < 0.0001) at the second evaluation compared to the first. Eight of 14 children had abnormal spirometric measurements. We conclude that perinatal HIV-1 infection is associated with increased airway resistance and often abnormal spirometry. The degree of abnormalities in resistance depends on the duration of the infection rather than on HIV-1-related respiratory complications.
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Affiliation(s)
- M de Martino
- Department of Medicine, University of Chieti, Italy
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Clarke JR, Israel-Biet D. Interactions between opportunistic micro-organisms and HIV in the lung. Thorax 1996; 51:875-77. [PMID: 8984694 PMCID: PMC472602 DOI: 10.1136/thx.51.9.875] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Affiliation(s)
- Alexandra I Smith
- Department of Respiratory MedicineRoyal North Shore HospitalSydneyNSW
| | - Peter C Pigott
- Department of Respiratory MedicineRoyal North Shore HospitalSydneyNSW
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