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Cervino L, Raybould J, Fulco P. Resolution of possible acquired protein S deficiency after viral suppression in HIV infection. BMJ Case Rep 2021; 14:e244983. [PMID: 34794977 PMCID: PMC8603259 DOI: 10.1136/bcr-2021-244983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 12/17/2022] Open
Abstract
Current literature suggests an increased risk of venous thromboembolism (VTE) in people living with HIV (PLWH) with poorly controlled viraemia and immunodeficiency. VTE treatment guidelines do not specifically address anticoagulation management in PLWH. We report a case of a 33-year-old woman diagnosed with an unprovoked pulmonary embolism (PE) and deemed protein S deficient. Three years later, she was diagnosed with AIDS. Antiretroviral therapy (ART) was promptly initiated with viral suppression and immune reconstitution within 12 months. Eight years after her initial PE, the patient self-discontinued warfarin. Multiple repeat protein S values were normal. ART without anticoagulation has continued for 3 years with no thrombotic events. This case describes a patient with VTE presumably secondary to undiagnosed HIV with possible consequent acquired protein S deficiency. Additional research is needed to understand the characteristics of PLWH with VTE who may warrant long-term anticoagulation as opposed to shorter courses.
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Affiliation(s)
- Leigh Cervino
- Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jillian Raybould
- Department of Internal Medicine/Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia Fulco
- Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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Wei L, Li H, Lv X, Zheng C, Li G, Yang Z, Chen L, Han X, Zou H, Gao Y, Cheng J, Wang H, Zhao J. Impact of HIV-1 CRF55_01B infection on the evolution of CD4 count and plasma HIV RNA load in men who have sex with men prior to antiretroviral therapy. Retrovirology 2021; 18:22. [PMID: 34399785 PMCID: PMC8365277 DOI: 10.1186/s12977-021-00567-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/05/2021] [Indexed: 03/16/2023] Open
Abstract
Background CRF55_01B is a newly identified HIV-1 circulating recombinant form originated from MSM in China. However, its impact on the disease progression and transmission risk has not been investigated. This study aimed to determine the impact of CRF55_01B infection on viral dynamics and immunological status so as to provide scientific evidence for further control and prevention effort on CRF55_01B. Linear mixed effect models were applied to evaluate CD4 cell count decline and viral load increase by subtype. Results Of the 3418 blood samples, 1446 (42.3%) were CRF07_BC, 1169 (34.2%) CRF01_AE, 467 (13.7%) CRF55_01B, 249 (7.3%) type B, and 87 (2.5%) other subtypes (CRF_08BC, CRF_01B, C). CRF55_01B had become the third predominant strain since 2012 in Shenzhen, China. CRF55_01B-infected MSM showed lower median of CD4 count than CRF07_BC-infected MSM (349.5 [IQR, 250.2–474.8] vs. 370.0 [IQR, 278.0–501.0], P < 0.05). CRF55_01B infection was associated with slower loss of CD4 count than CRF01_AE (13.6 vs. 23.3 [cells/µl]¹/²/year, P < 0.05)among MSM with initial CD4 count of 200–350 cells/µl. On the other hand, those infected with CRF55_01B showed higher median plasma HIV RNA load (5.4 [IQR, 5.0–5.9]) than both CRF01_AE (5.3 [IQR, 4.8–5.7], P < 0.05) and CRF07_BC (5.0 log10 [IQR, 4.5–5.5], P < 0.001) at the initiation of antiretroviral therapy. Furthermore, the annual increasing rate of viral load for CRF55_01B infection was significantly higher than that of CRF07_BC (2.0 vs. 0.7 log10 copies/ml/year, P < 0.01). Conclusions The relatively lower CD4 count and faster increase of plasma HIV RNA load of CRF55_01B-infected MSM without antiretroviral therapy suggest that CRF55_01B may lead to longer asymptomatic phase and higher risk of HIV transmission. Strengthened surveillance, tailored prevention strategies and interventions, and in-depth research focusing on CRF55_01B are urgently needed to forestall potential epidemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12977-021-00567-z.
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Affiliation(s)
- Lan Wei
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hao Li
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xing Lv
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Chenli Zheng
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Guilian Li
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhengrong Yang
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lin Chen
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaoxu Han
- Key Laboratory of AIDS Immunology, Ministry of Health, Department of Laboratory Medicine, First Hospital of China Medical University, Shenyang, China
| | - Huachun Zou
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Jinquan Cheng
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hui Wang
- HKU-AIDS Institute Shenzhen Research Laboratory, Shenzhen Key Laboratory of Infection and Immunity, Guangdong Key Laboratory of Emerging Infectious Diseases, Third People's Hospital of Shenzhen, Shenzhen, China.
| | - Jin Zhao
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
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Masson JJR, Cherry CL, Murphy NM, Sada-Ovalle I, Hussain T, Palchaudhuri R, Martinson J, Landay AL, Billah B, Crowe SM, Palmer CS. Polymorphism rs1385129 Within Glut1 Gene SLC2A1 Is Linked to Poor CD4+ T Cell Recovery in Antiretroviral-Treated HIV+ Individuals. Front Immunol 2018; 9:900. [PMID: 29867928 PMCID: PMC5966582 DOI: 10.3389/fimmu.2018.00900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/11/2018] [Indexed: 01/14/2023] Open
Abstract
Untreated HIV infection is associated with progressive CD4+ T cell depletion, which is generally recovered with combination antiretroviral therapy (cART). However, a significant proportion of cART-treated individuals have poor CD4+ T cell reconstitution. We investigated associations between HIV disease progression and CD4+ T cell glucose transporter-1 (Glut1) expression. We also investigated the association between these variables and specific single nucleotide polymorphisms (SNPs) within the Glut1 regulatory gene AKT (rs1130214, rs2494732, rs1130233, and rs3730358) and in the Glut1-expressing gene SLC2A1 (rs1385129 and rs841853) and antisense RNA 1 region SLC2A1-AS1 (rs710218). High CD4+Glut1+ T cell percentage is associated with rapid CD4+ T cell decline in HIV-positive treatment-naïve individuals and poor T cell recovery in HIV-positive individuals on cART. Evidence suggests that poor CD4+ T cell recovery in treated HIV-positive individuals is linked to the homozygous genotype (GG) associated with SLC2A1 SNP rs1385129 when compared to those with a recessive allele (GA/AA) (odds ratio = 4.67; P = 0.04). Furthermore, poor response to therapy is less likely among Australian participants when compared against American participants (odds ratio: 0.12; P = 0.01) despite there being no difference in prevalence of a specific genotype for any of the SNPs analyzed between nationalities. Finally, CD4+Glut1+ T cell percentage is elevated among those with a homozygous dominant genotype for SNPs rs1385129 (GG) and rs710218 (AA) when compared to those with a recessive allele (GA/AA and AT/TT respectively) (P < 0.04). The heterozygous genotype associated with AKT SNP 1130214 (GT) had a higher CD4+Glut1+ T cell percentage when compared to the dominant homozygous genotype (GG) (P = 0.0068). The frequency of circulating CD4+Glut1+ T cells and the rs1385129 SLC2A1 SNP may predict the rate of HIV disease progression and CD4+ T cell recovery in untreated and treated infection, respectively.
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Affiliation(s)
- Jesse J R Masson
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia
| | - Catherine L Cherry
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicholas M Murphy
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,Preimplantation Genetic Diagnosis, Monash IVF, Melbourne, VIC, Australia
| | - Isabel Sada-Ovalle
- Unidad de Investigación Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Tabinda Hussain
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Riya Palchaudhuri
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia
| | - Jeffrey Martinson
- Department of Immunology-Microbiology, Rush University Medical Centre, Chicago, IL, United States
| | - Alan L Landay
- Department of Immunology-Microbiology, Rush University Medical Centre, Chicago, IL, United States
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
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Teklu AM, Delele K, Abraha M, Belayhun B, Gudina EK, Nega A. Exploratory Analysis of Time from HIV Diagnosis to ART Start, Factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia. Ethiop J Health Sci 2017; 27:17-28. [PMID: 28465650 PMCID: PMC5402800 DOI: 10.4314/ejhs.v27i1.3s] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors. METHODS This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression. RESULTS 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality. CONCLUSION AND RECOMMENDATION Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.
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Affiliation(s)
| | | | | | | | | | - Abiy Nega
- MERQ Consultancy Services, Addis Ababa, Ethiopia
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