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Ferrari B, Da Silva AC, Liu KH, Saidakova EV, Korolevskaya LB, Shmagel KV, Shive C, Pacheco Sanchez G, Retuerto M, Sharma AA, Ghneim K, Noel-Romas L, Rodriguez B, Ghannoum MA, Hunt PP, Deeks SG, Burgener AD, Jones DP, Dobre MA, Marconi VC, Sekaly RP, Younes SA. Gut-derived bacterial toxins impair memory CD4+ T cell mitochondrial function in HIV-1 infection. J Clin Invest 2022; 132:e149571. [PMID: 35316209 PMCID: PMC9057623 DOI: 10.1172/jci149571] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
People living with HIV (PLWH) who are immune nonresponders (INRs) are at greater risk of comorbidity and mortality than are immune responders (IRs) who restore their CD4+ T cell count after antiretroviral therapy (ART). INRs have low CD4+ T cell counts (<350 c/μL), heightened systemic inflammation, and increased CD4+ T cell cycling (Ki67+). Here, we report the findings that memory CD4+ T cells and plasma samples of INRs from several cohorts are enriched in gut-derived bacterial solutes p-cresol sulfate (PCS) and indoxyl sulfate (IS) that both negatively correlated with CD4+ T cell counts. In vitro PCS or IS blocked CD4+ T cell proliferation, induced apoptosis, and diminished the expression of mitochondrial proteins. Electron microscopy imaging revealed perturbations of mitochondrial networks similar to those found in INRs following incubation of healthy memory CD4+ T cells with PCS. Using bacterial 16S rDNA, INR stool samples were found enriched in proteolytic bacterial genera that metabolize tyrosine and phenylalanine to produce PCS. We propose that toxic solutes from the gut bacterial flora may impair CD4+ T cell recovery during ART and may contribute to CD4+ T cell lymphopenia characteristic of INRs.
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Affiliation(s)
- Brian Ferrari
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Center for AIDS Research, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amanda Cabral Da Silva
- Department of Pathology, Pathology Advanced Translational Research (PATRU), School of Medicine and
| | - Ken H. Liu
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Evgeniya V. Saidakova
- Institute of Ecology and Genetics of Microorganisms, Perm Federal Research Center Ural Branch Russian Academy of Sciences, Perm, Russia
- Department of Microbiology and Immunology, Perm State University, Perm, Russia
| | - Larisa B. Korolevskaya
- Institute of Ecology and Genetics of Microorganisms, Perm Federal Research Center Ural Branch Russian Academy of Sciences, Perm, Russia
| | - Konstantin V. Shmagel
- Institute of Ecology and Genetics of Microorganisms, Perm Federal Research Center Ural Branch Russian Academy of Sciences, Perm, Russia
| | - Carey Shive
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Center for AIDS Research, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Gabriela Pacheco Sanchez
- Department of Pathology, Pathology Advanced Translational Research (PATRU), School of Medicine and
| | - Mauricio Retuerto
- Institute of Ecology and Genetics of Microorganisms, Perm Federal Research Center Ural Branch Russian Academy of Sciences, Perm, Russia
| | | | - Khader Ghneim
- Department of Microbiology and Immunology, Perm State University, Perm, Russia
| | - Laura Noel-Romas
- Integrated Microbiome Core, Department of Dermatology, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, Ohio, USA
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benigno Rodriguez
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Center for AIDS Research, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mahmoud A. Ghannoum
- Integrated Microbiome Core, Department of Dermatology, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Peter P. Hunt
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Steven G. Deeks
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Adam D. Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Obstetrics & Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dean P. Jones
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mirela A. Dobre
- Department of Medicine (Nephrology), Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Department of Global Health, and Department of Global Health, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Rafick-Pierre Sekaly
- Department of Pathology, Pathology Advanced Translational Research (PATRU), School of Medicine and
| | - Souheil-Antoine Younes
- Department of Pathology, Pathology Advanced Translational Research (PATRU), School of Medicine and
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Valdivia-Cerda V, Alvarez-Zavala M, Sánchez-Reyes K, Cabrera-Silva RI, Ruiz-Herrera VV, Loza-Salazar AD, Martínez-Ayala P, Vázquez-Limón JC, García-García G, Andrade-Villanueva JF, González-Hernández LA. Prevalence and risk factors of chronic kidney disease in an HIV positive Mexican cohort. BMC Nephrol 2021; 22:317. [PMID: 34556049 PMCID: PMC8461868 DOI: 10.1186/s12882-021-02526-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND HIV subjects have several kidney pathologies, like HIV-associated nephropathy or antiretroviral therapy injury, among others. The global prevalence of Chronic Kidney Disease (CKD) is 8-16%; however, in HIV subjects, the prevalence varies between geographic regions (2-38%). The aim was to determine the prevalence of CKD and identify the associated risk factors. METHODS A longitudinal descriptive study was carried out at the 'Hospital Civil de Guadalajara' Feb'18 - Jan'19. Basal clinical, demographic, opportunistic infections (OI), and laboratory data were obtained at months 0 and 3; inclusion criteria were ≥ 18 years old, naïve HIV + , urine albumin/creatinine ratio, serum creatinine & urine test, and signed informed consent. Descriptive and multiple logistic regression statistical analyses were made. RESULTS One hundred twenty subjects were included; 92.5% were male, 33 ± 9.5 years, 60% consumed tobacco, 73% alcohol, and 59% some type of drug. The CKD prevalence was 15.8%. CKD patients had a higher risk of hepatitis C virus coinfection, Relative Risk (RR):5.9; HCV infection, RR:4.3; ≥ 30 years old, RR:3.9; C clinical-stage, RR:3.5; CD4+ T cells count < 200 cells/μL, RR: 2.4; and HIV-1 viral load ≥ 100,000 cop/mL, RR: 2.7. CONCLUSIONS Our study showed a higher CKD prevalence in patients with HIV; higher CKD development with coinfections as Hepatitis C Virus and Mycobacterium tuberculosis. The identification and prompt management of CKD and coinfections should be considered to avoid the progression and to delay renal replacement therapy as long as possible.
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Affiliation(s)
- Verónica Valdivia-Cerda
- Servicio de Nefrología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico
| | - Monserrat Alvarez-Zavala
- Universidad de Guadalajara, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Centro Universitario de Ciencias de La Salud, Jalisco, México
| | - Karina Sánchez-Reyes
- Universidad de Guadalajara, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Centro Universitario de Ciencias de La Salud, Jalisco, México
| | - Rodolfo I Cabrera-Silva
- Universidad de Guadalajara, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Centro Universitario de Ciencias de La Salud, Jalisco, México
| | - Vida V Ruiz-Herrera
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Jalisco, Mexico
| | - Aldo D Loza-Salazar
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Jalisco, Mexico
| | - Pedro Martínez-Ayala
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Jalisco, Mexico
| | - Juan C Vázquez-Limón
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Jalisco, Mexico
| | - Guillermo García-García
- Servicio de Nefrología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico
| | - Jaime F Andrade-Villanueva
- Universidad de Guadalajara, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Centro Universitario de Ciencias de La Salud, Jalisco, México
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Jalisco, Mexico
| | - Luz A González-Hernández
- Universidad de Guadalajara, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Centro Universitario de Ciencias de La Salud, Jalisco, México.
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Jalisco, Mexico.
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Zhao N, Zeng Z, Liang H, Wang F, Yang D, Xiao J, Chen M, Zhao H, Zhang F, Gao G. Estimation of renal function by three CKD-EPI equations in Chinese HIV/AIDS patients: A STROBE-compliant article. Medicine (Baltimore) 2021; 100:e26003. [PMID: 34087846 PMCID: PMC8183803 DOI: 10.1097/md.0000000000026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/01/2021] [Indexed: 01/04/2023] Open
Abstract
Assessing renal function accurately is important for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recommended three equations to calculate estimated glomerular filtration rate (eGFR). There is evidence that eGFR based on the combination of serum creatinine and cystatin C is the most accurate of the three equations. But there is limited data on the comparison of three CKD-EPI equations in Chinese HIV/AIDS patients. The aim of our study was to compare the three CKD-EPI equations in Chinese HIV/AIDS population and assess renal function.Cross-sectional, single center, prospective study.One hundred seventy two Chinese adult HIV/AIDS patients were enrolled, including 145 (84.3%) males and 27 (15.7%) females. Mean age was 40(±12) years old. Overall mean eGFR based on serum creatinine, cystatin C and the combination of the 2 markers was 112.6(±19.0) mL/min/1.73 m2, 92.0(±24.2)mL/min/1.73 m2, and 101.7(±21.8)mL/min/1.73 m2, respectively (P = .000). The eGFR calculated by serum creatinine alone is higher than eGFR calculated by combination of serum creatinine and cystatin C, and eGFR calculated by cystatin C individual is lower than eGFR calculated by combination of the 2 markers.Of the 3 CKD-EPI equations, the CKD-EPIscr-cys equation may have the most accuracy in evaluating renal function in Chinese HIV/AIDS patients while the CKD-EPIscr equation may overestimate renal function and the CKD-EPIcys equation may underestimate renal function.
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Affiliation(s)
| | | | | | - Fang Wang
- Clinical and Research Center of Infectious Diseases
| | - Di Yang
- Clinical and Research Center of Infectious Diseases
| | - Jiang Xiao
- Clinical and Research Center of Infectious Diseases
| | - Meiling Chen
- Department of Medical Records and Statistics, Beijing Ditan Hospital, Capital Medical University, China
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases
| | - Fujie Zhang
- Clinical and Research Center of Infectious Diseases
| | - Guiju Gao
- Clinical and Research Center of Infectious Diseases
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4
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Pontes PS, Ruffino-Netto A, Kusumota L, Costa CRB, Gir E, Reis RK. Factors associated to chronic kidney disease in people living with HIV/AIDS. Rev Lat Am Enfermagem 2020; 28:e3331. [PMID: 32696924 PMCID: PMC7365608 DOI: 10.1590/1518-8345.3553.3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/13/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE to analyze the factors associated to chronic kidney disease in people living with HIV (PLHIV). METHOD a paired case-control study (4 controls for each case) carried out in a specialized care service in the Southeastern of Brazil, by analyzing PLHIV medical records. The sample consisted of 85 participants, corresponding to 17 cases and 68 controls. Pearson's chi-square test (Χ2) and Fisher's exact test, logistic regression, Odds Ratio (OR), 95% Confidence Interval (CI) and p<0.05 were used. SPSS version 25.0 and R Core Team, 2018 version 3.5.1 were used. RESULTS the factors associated with chronic kidney disease identified in this study were the following: presence of Systemic Arterial Hypertension [OR=5.8, CI (95%)=1.84-18.42, p=0.001] and use of nephrotoxic anti-retrovirals in the previous therapeutic regimen [OR=3.3, CI (95%)=1.105-10.221, p=0.028]. On the other hand, age below 40 years old [OR: 0.122, CI (95%)=0.015-0.981, p=0.022] was identified as a protective factor. CONCLUSION the PLHIV under study have multi-factorial exposure associated with chronic kidney disease. However, knowing these factors helps to identify the existing risks and/or renal dysfunction, in addition to supporting the clinical decision of the health professionals who directly assist them.
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Affiliation(s)
- Priscila Silva Pontes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto,
SP, Brazil
| | - Antonio Ruffino-Netto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto,
Departamento de Medicinal Social, Ribeirão Preto, SP, Brazil
| | - Luciana Kusumota
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto,
SP, Brazil
| | - Christefany Régia Braz Costa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto,
SP, Brazil
| | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto,
SP, Brazil
| | - Renata Karina Reis
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto,
SP, Brazil
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