1
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Dubé K, Barr E, Philbin M, Perez-Brumer A, Minalga B, Peterson B, Averitt D, Picou B, Martel K, Chung C, Mejía M, Cameron M, Graham G, Dee L, Diallo DD, Gordon E, Korolkova A, Dyer T, Auerbach JD, Scully E, Dong KL, Gianella S. Increasing the meaningful involvement of women in HIV cure-related research: a qualitative interview study in the United States. HIV Res Clin Pract 2023; 24:2246717. [PMID: 37608645 PMCID: PMC10454980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Cisgender women represent over half of people living with HIV globally. However, current research efforts toward a cure for HIV focus predominantly on cisgender men. The under-representation of women in HIV cure clinical studies is particularly problematic given data suggesting that sex-dependent phenotypes limit scientific discovery. OBJECTIVE We aimed to generate considerations to increase the meaningful involvement of women in HIV cure-related research. MATERIALS AND METHODS We conducted in-depth interviews with biomedical researchers and community members to better understand factors that could increase the meaningful involvement of women in HIV cure clinical trials. Participants were affiliated with academia, industry, community advisory boards, and community-based organizations, and were identified using listings from the AIDS Clinical Trials Group and the Martin Delaney Collaboratories. We used conventional content analysis to analyze the qualitative data. RESULTS We recruited 27 participants, of whom 11 were biomedical researchers and 16 were community members. Participants included 25 cisgender women, 1 transgender woman, and 1 cisgender man. Key considerations emerged, including the need to ensure that HIV cure studies reflect HIV epidemiologic trends and having accurate representation by sex and gender in HIV cure research. To increase the meaningful involvement of women, recommendations included instituting intentional enrollment goals, frequent and mandatory reporting on enrollment, and incentives for sites to enroll women. Additional themes included the need for agency and self-determination, attention to lived experiences, trauma and healing, and adequate support for women (e.g. logistical, psychosocial, mental, emotional, and physical). Participants noted that women would be willing to participate in HIV cure trials, related procedures (e.g. biopsies), and analytical treatment interruptions. They also expressed a desired for women-centered and holistic clinical trial designs that account for intersectionality. CONCLUSIONS Our empirical inquiry extends recent calls to action to increase diversity of people involved in HIV cure research. Redressing the under-inclusion of women in HIV cure research is an urgent imperative. The entire field must mobilize and reform to achieve this goal. Meaningfully involving women across the gender spectrum in HIV cure research is needed to ensure that interventions are safe, effective, scalable, and acceptable for all people with HIV.
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Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
- University of North Carolina (UNC) Gillings School of Global Public Health, Department of Health Policy and Management, 135 Dauer Drive, Chapel Hill, NC, 27599-7411, USA
| | - Elizabeth Barr
- National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH), 6707 Democracy Boulevard, Suite 400, Bethesda, MD, 20817, USA
| | - Morgan Philbin
- Center for Vulnerable Populations, Department of Medicine, University of California San Francisco (UCSF), 2789 25 Street, Suite 350, San Francisco, CA, 94110, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, Ontario, M5T 3M7, Canada
| | - Brian Minalga
- Office of HIV/AIDS Network Coordination (HANC), Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
| | - Beth Peterson
- Wistar Institute and BEAT-HIV Delaney Collaboratory Towards an HIV-1 Cure, 3601 Spruce Street, Philadelphia, PA, 19104, USA
| | - Dawn Averitt
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Bridgette Picou
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Krista Martel
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Cecilia Chung
- Transgender Law Center, PO Box 70976, Oakland, CA, 94612-0976, USA
| | - María Mejía
- The Well Project Community Advisory Board (CAB), Nationwide, USA
| | - Martha Cameron
- International Community of Women Living with HIV (ICW), North America
| | - Gail Graham
- University of Maryland PATIENTS Program, 20 North Pine Sreet, Maryland, MD, 21201, USA
| | - Lynda Dee
- AIDS Action Baltimore, 14 East Street, Baltimore, MD, 21202, USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, 995 Potrero Avenue, San Francisco, CA, 94110, USA
| | | | - Ebony Gordon
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, 995 Potrero Avenue, San Francisco, CA, 94110, USA
- San Francisco AIDS Foundation (SFAF), 1035 Market Street, 4 Floor, San Francisco, CA, 94103, USA
| | - Anastasia Korolkova
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
| | - Typhanye Dyer
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD, 20742-2611, USA
| | - Judith D. Auerbach
- Division of Prevention Science, Department of Medicine, UCSF, 550 16 Street, 3 Floor, San Francisco, CA, 94158, USA
| | - Eileen Scully
- Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA
| | - Krista L. Dong
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Ragon Institute of MGH, MIT and Harvard, 400 Technology Square, Cambridge, MA, 02139-3583, USA
- Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MD, 02114, USA
| | - Sara Gianella
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
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2
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Gianella S, Rawlings SA, Dobrowolski C, Nakazawa M, Chaillon A, Strain M, Layman L, Caballero G, Scully E, Scott B, Pacis C, Weber KM, Landay A, Anderson C, Karn J. Sex Differences in Human Immunodeficiency Virus Persistence and Reservoir Size During Aging. Clin Infect Dis 2022; 75:73-80. [PMID: 34612493 PMCID: PMC9402699 DOI: 10.1093/cid/ciab873] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sex differences in human immunodeficiency virus (HIV) reservoir dynamics remain underexplored. METHODS Longitudinal samples from virally suppressed midlife women (n = 59, median age 45 years) and age-matched men (n = 31) were analyzed retrospectively. At each time point, we measured sex hormones (by means of enzyme-linked immunosorbent assay) and cellular HIV DNA and RNA (by means of digital droplet polymerase chain reaction). Number of inducible HIV RNA+ cells, which provides an upper estimate of the replication-competent reservoir, was quantified longitudinally in a different subset of 14 women, across well-defined reproductive stages. Mixed-effects models included normalized reservoir outcomes and sex, time since antiretroviral therapy (ART) initiation, and the sex-by-time interaction as predictors. RESULTS At ART initiation, women and men had median (interquartile range [IQR]) CD4+ T-cell counts of 204/μL (83-306/μL) versus 238/μL (120-284/μL), respectively; median ages of 45 (42-48) versus 47 (43-51) years; and median follow-up times of 79.2/μL (60.5-121.1/μL) versus 66.2/μL (43.2-80.6/μL) months. We observed a significant decline of total HIV DNA over time in both men and women (P < .01). However, the rates of change differed significantly between the sexes (P < .01), with women having a significantly slower rate of decline than men, more pronounced with age. By contrast, the levels of inducible HIV RNA increased incrementally over time in women during reproductive aging (P < .01). CONCLUSIONS In contrast to men, in whom the HIV reservoir steadily declines with aging, the HIV reservoir in women is more dynamic. Total HIV DNA (including intact and defective genomes) declines more slowly in women than in men, while the inducible HIV RNA+ reservoir, which is highly enriched in replication-competent virus, increases in women after menopause.
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Affiliation(s)
- Sara Gianella
- University of California San Diego, La Jolla, California, USA
| | | | - Curtis Dobrowolski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, Georgia, USA
| | - Masato Nakazawa
- University of California San Diego, La Jolla, California, USA
| | | | - Matthew Strain
- University of California San Diego, La Jolla, California, USA
| | - Laura Layman
- University of California San Diego, La Jolla, California, USA
| | - Gemma Caballero
- University of California San Diego, La Jolla, California, USA
| | | | - Brianna Scott
- University of California San Diego, La Jolla, California, USA
| | - Caitleen Pacis
- University of California San Diego, La Jolla, California, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine/Cook County Health, Chicago, Illinois, USA
| | - Alan Landay
- Rush University Medical Center, Chicago, Illinois, USAand
| | | | - Jonathan Karn
- Case Western Reserve University, Cleveland, Ohio, USA
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3
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Prodger JL, Capoferri AA, Yu K, Lai J, Reynolds SJ, Kasule J, Kityamuweesi T, Buule P, Serwadda D, Kwon KJ, Schlusser K, Martens C, Scully E, Choi YH, Redd AD, Quinn TC. Reduced HIV-1 latent reservoir outgrowth and distinct immune correlates among women in Rakai, Uganda. JCI Insight 2020; 5:139287. [PMID: 32544096 DOI: 10.1172/jci.insight.139287] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/03/2020] [Indexed: 01/22/2023] Open
Abstract
HIV-1 infection remains incurable owing to the persistence of a viral reservoir that harbors integrated provirus within host cellular DNA. Increasing evidence links sex-based differences in HIV-1 immune responses and pathogenesis; however, little is known about differences in HIV-1 infection persistence. Here, we quantified persistent HIV-1 infection in 90 adults on suppressive antiretroviral therapy in Rakai, Uganda (57 female patients). Total HIV-1 DNA was quantified by PCR, and replication-competent provirus by quantitative viral outgrowth assay (QVOA). Immune phenotyping of T cell subsets and plasma biomarkers was also performed. We found that whereas both sexes had similar total HIV DNA levels, female patients had significantly fewer resting CD4+ T cells harboring replication-competent virus, as measured by viral outgrowth in the QVOA. Factors associated with viral outgrowth differed by sex; notably, frequency of programmed cell death 1 (PD1+) CD4+ T cells correlated with reservoir size in male but not female patients. The sex-based differences in HIV-1 persistence observed in this cohort warrant additional research, especially given the widespread use of the QVOA to assess reservoir size and current explorations of PD1 agonists in cure protocols. Efforts should be made to power future cure studies to assess outcomes in both male and female patients.
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Affiliation(s)
- Jessica L Prodger
- Department of Microbiology and Immunology and.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adam A Capoferri
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine Yu
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jun Lai
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.,Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | - Paul Buule
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda.,Makerere University, Kampala, Uganda
| | - Kyungyoon J Kwon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine Schlusser
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Craig Martens
- Genomic Unit, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, Montana, USA
| | - Eileen Scully
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew D Redd
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Thomas C Quinn
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
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4
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Dubé K, Hosey L, Starr K, Barr L, Evans D, Hoffman E, Campbell DM, Simoni J, Sugarman J, Sauceda J, Brown B, Diepstra KL, Godfrey C, Kuritzkes DR, Wohl DA, Gandhi R, Scully E. Participant Perspectives in an HIV Cure-Related Trial Conducted Exclusively in Women in the United States: Results from AIDS Clinical Trials Group 5366. AIDS Res Hum Retroviruses 2020; 36:268-282. [PMID: 32160755 DOI: 10.1089/aid.2019.0284] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Women remain underrepresented in HIV research. The AIDS Clinical Trials Group (ACTG) 5366 study was the first HIV cure-related trial conducted exclusively in women. Our multidisciplinary team integrated participant-centered reports into the ACTG 5366 protocol to elicit their perspectives. We nested mixed-methods surveys at the enrollment and final study visits to assess ACTG 5366 participants' perceptions and experiences. Of 31 participants enrolled in the ACTG 5366, 29 study agreed to complete the entry questionnaire and 27 completed the exit survey. The majority of study participants were nonwhite. We identified societal and personal motivators for participation, understanding of risks and benefits, and minor misconceptions among some trial participants. Stigma was pervasive for several women who joined the study, and served as a motivator for study participation. Reimbursements to defray costs of study participation were reported to facilitate involvement in the trial by about one-third of participants. Almost all respondents reported positive experiences participating in the ACTG 5366 trial. The ACTG 5366 study showed that it is possible to recruit and retain women in HIV cure-related research and to embed participant-centered outcomes at strategic time points during the study. The findings could help in the design, implementation, recruitment, and retention of women in HIV cure-related research and highlight the value of assessing psychosocial factors in HIV cure-related research participation.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Lara Hosey
- Social and Scientific Systems (S-3), Silver Spring, Maryland
| | - Kate Starr
- ACTG Community Scientific Sub-Committee, Columbus, Ohio and Baltimore, Maryland
| | - Liz Barr
- ACTG Community Scientific Sub-Committee, Columbus, Ohio and Baltimore, Maryland
- Department of Gender, Women's and Sexuality Studies, University of Maryland Baltimore County (UMBC), Baltimore, Maryland
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), New York City, New York
| | - Erin Hoffman
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jane Simoni
- Department of Global Health and University of Washington, Seattle, Washington
- Department of Psychology, University of Washington, Seattle, Washington
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California
| | - Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Catherine Godfrey
- HIV Research Branch, National Institute of Allergies and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, Maryland
| | | | - David A. Wohl
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rajesh Gandhi
- Massachusetts General Hospital, Boston, Massachusetts
| | - Eileen Scully
- John Hopkins University School of Medicine, Baltimore, Maryland
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5
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Dobrowolski C, Karn J, Scully E, Weber K, Landay A. Women undergoing reproductive aging show increased reservoir sizes associated with removal of hormonal control of HIV-1 latency by oestrogen. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Paximadis M, Perez Patrigeon S, Rajasuriar R, Tatoud R, Scully E, Arbuthnot P. Hepatitis B and HIV-1 2019 IAS Cure Forum: lessons and benefits from interdisciplinary research. J Virus Erad 2019; 5:234-244. [PMID: 31754448 PMCID: PMC6844409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Paximadis
- Centre for HIV and STIs, Cell Biology,
National Institute for Communicable Diseases and University of the Witwatersrand,
Johannesburg,
South Africa
| | - S Perez Patrigeon
- Division of Infectious Diseases,
Queen's University,
Kingston,
Ontario,
Canada
| | - R Rajasuriar
- Department of Medicine, Faculty of Medicine, University of Malaya and the Centre of Excellence for Research in AIDS (CERiA),
University of Malaya,
Malaysia
| | - R Tatoud
- International AIDS Society,
Geneva,
Switzerland,Corresponding author: Roger Tadoud
Avenue de France 23,
1202 Geneva,
Switzerland
| | - E Scully
- Division of Infectious Diseases, Department of Internal Medicine,
Johns Hopkins University,
Baltimore,
MD,
USA
| | - P Arbuthnot
- Wits/SAMRC Antiviral Gene Therapy Research Unit, School of Pathology, Faculty of Health Science,
University of the Witwatersrand,
Johannesburg,
South Africa
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7
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Paximadis M, Perez Patrigeon S, Rajasuriar R, Tatoud R, Scully E, Arbuthnot P. Hepatitis B and HIV-1 2019 IAS Cure Forum: lessons and benefits from interdisciplinary research. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30027-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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8
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Karn J, Dobrowolski C, Valadkhan S, Wille P, Hoh R, Ghandi M, Deeks S, Scully E. Hormonal control of HIV-1 latency by estrogen imparts gender-specific restrictions on the latent reservoir. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Henrich TJ, Hobbs KS, Hanhauser E, Scully E, Hogan LE, Robles YP, Leadabrand KS, Marty FM, Palmer CD, Jost S, Körner C, Li JZ, Gandhi RT, Hamdan A, Abramson J, LaCasce AS, Kuritzkes DR. Human Immunodeficiency Virus Type 1 Persistence Following Systemic Chemotherapy for Malignancy. J Infect Dis 2017; 216:254-262. [PMID: 28838149 DOI: 10.1093/infdis/jix265] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Systemic chemotherapies for various malignancies have been shown to significantly, yet transiently, decrease numbers of CD4+ T lymphocytes, a major reservoir for human immunodeficiency virus type 1 (HIV-1) infection. However, little is known about the impact of cytoreductive chemotherapy on HIV-1 reservoir dynamics, persistence, and immune responses. Methods We investigated the changes in peripheral CD4+ T-cell-associated HIV-1 DNA and RNA levels, lymphocyte activation, viral population structure, and virus-specific immune responses in a longitudinal cohort of 15 HIV-1-infected individuals receiving systemic chemotherapy or subsequent autologous stem cell transplantation for treatment of hematological malignancies and solid tumors. Results Despite a transient reduction in CD4+ T cells capable of harboring HIV-1, a 1.7- and 3.3-fold increase in mean CD4+ T-cell-associated HIV-1 RNA and DNA, respectively, were observed months following completion of chemotherapy in individuals on antiretroviral therapy. We also observed changes in CD4+ T-cell population diversity and clonal viral sequence expansion during CD4+ T-cell reconstitution following chemotherapy cessation. Finally, HIV-1 DNA was preferentially, and in some cases exclusively, detected in cytomegalovirus (CMV)- and Epstein-Barr virus (EBV)-responsive CD4+ T cells following chemotherapy. Conclusions Expansion of HIV-infected CMV/EBV-specific CD4 + T cells may contribute to maintenance of the HIV DNA reservoir following chemotherapy.
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Affiliation(s)
- Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
| | - Kristen S Hobbs
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital
| | - Emily Hanhauser
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital
| | - Eileen Scully
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School.,Dana-Farber Cancer Institute, Boston
| | - Louise E Hogan
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
| | - Yvonne P Robles
- Division of Infectious Diseases, Brigham and Women's Hospital
| | | | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School.,Dana-Farber Cancer Institute, Boston
| | - Christine D Palmer
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge
| | - Stephanie Jost
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge.,Beth Israel Deaconess Medical Center
| | - Christian Körner
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
| | - Rajesh T Gandhi
- Harvard Medical School.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge.,Massachusetts General Hospital, Boston
| | - Ayad Hamdan
- Harvard Medical School.,Beth Israel Deaconess Medical Center
| | - Jeremy Abramson
- Harvard Medical School.,Massachusetts General Hospital, Boston
| | - Ann S LaCasce
- Harvard Medical School.,Dana-Farber Cancer Institute, Boston
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
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10
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Abstract
Natural killer (NK) cells play a critical role in viral immunity. In the setting of HIV infection, epidemiologic and functional evidence support a role for NK cells in both protection from new infection and in viral control. Specifically, NK cells directly mediate immune pressure leading to virus evolution, and NK cell receptor genotypic profiles, clonal repertoires, and functional capacity have all been implicated in virus containment. In addition, indirect NK cell-mediated antibody-dependent cellular cytotoxicity has been linked to vaccine-induced protective immunity against HIV infection. With recent advances in our understanding of NK cell deficiency, development, memory-like responses, and editing of the adaptive immune system, the opportunities to direct and exploit NK cell antiviral immunity to target HIV have exponentially grown. In this review, we seek to highlight the intersections between discoveries in basic NK cell biology and the challenges of HIV chronic infection, vaccine development, and cure/eradication strategies.
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Affiliation(s)
- Eileen Scully
- />Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, 400 Technology Square, Cambridge, MA 02139 USA
- />Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02130 USA
| | - Galit Alter
- />Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, 400 Technology Square, Cambridge, MA 02139 USA
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11
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Scully E, Lockhart A, Huang L, Robles Y, Becerril C, Romero-Tejeda M, Albrecht MA, Palmer CD, Bosch RJ, Altfeld M, Kuritzkes DR, Lin NH. Elevated Levels of Microbial Translocation Markers and CCL2 Among Older HIV-1-Infected Men. J Infect Dis 2015; 213:771-5. [PMID: 26494772 DOI: 10.1093/infdis/jiv501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/13/2015] [Indexed: 12/28/2022] Open
Abstract
The aging of the human immunodeficiency virus type 1 (HIV-1)-infected population obligates a focus on the interaction between aging, comorbid conditions, and HIV-1. We recruited a cohort of HIV-1-infected men aged ≤ 35 years or ≥ 50 years who were receiving fully suppressive antiretroviral therapy (ART). We analyzed plasma markers of inflammation; T-cell activation, exhaustion, proliferation; and innate cellular subsets and functional capacity. Levels of lipopolysaccharide and the plasma marker of chemokine (C-C motif) ligand 2 were significantly elevated in older HIV-infected men despite comparable cellular phenotypes. Compared with similarly age-stratified uninfected subjects, older HIV-1-infected adults were also more frequently in the upper quartile of soluble CD14 expression.
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Affiliation(s)
- Eileen Scully
- Ragon Institute of MGH, MIT, and Harvard, Cambridge Division of Infectious Diseases, Brigham and Women's Hospital
| | | | - Lisa Huang
- Division of Infectious Diseases, Massachusetts General Hospital
| | - Yvonne Robles
- Division of Infectious Diseases, Brigham and Women's Hospital
| | - Carlos Becerril
- Division of Infectious Diseases, Massachusetts General Hospital
| | | | - Mary A Albrecht
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | | | - Marcus Altfeld
- Ragon Institute of MGH, MIT, and Harvard, Cambridge Heinrich-Pette-Institut, Hamburg, Germany
| | | | - Nina H Lin
- Division of Infectious Diseases, Boston Medical Center, Boston University School of Medicine, Massachusetts
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12
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Bamberger DM, Pepito BS, Proia LA, Ostrosky-Zeichner L, Ashraf M, Marty F, Scully E, Wheat LJ. Cerebrospinal fluidCoccidioidesantigen testing in the diagnosis and management of central nervous system coccidioidomycosis. Mycoses 2015; 58:598-602. [DOI: 10.1111/myc.12366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Francisco Marty
- Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
| | - Eileen Scully
- Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
| | - L. Joseph Wheat
- MiraVista Diagnostics and MiraVista Technologies; Indianapolis IN USA
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Palmer C, Romero-Tejeda M, Scully E, Jost S, Seaman M, Goldenthal A, Piechocka-Trocha A, Pereyra F, Walker B. HIV elite controllers have lower frequencies of CD14dimCD16+ inflammatory monocytes with greater CX3CR1-dependent tissue homing potential than viremic controllers (VIR9P.1138). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.215.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Without antiretroviral therapy, a small fraction of HIV-infected patients does not progress to AIDS. Such elite controllers (EC) or viremic controllers (VC) maintain undetectable or low levels of viremia, respectively. Generation of broadly neutralizing antibodies (bNAb) does not correlate with viral control, but might enhance antibody-dependent cellular phagocytosis by monocytes. Monocytes are classified into CD14+CD16-, CD14+CD16+ and CD14dimCD16+ monocytes. The latter show increased inflammatory responsiveness and are elevated during chronic HIV-1 infection. We measured markers of T cell activation and monocyte subset distribution and quantity, and investigated the relationship between these parameters and production of bNAb to identify markers for the development of bNAbs. We showed that VC display increased frequencies of CD38+ CD4+ and CD8+ T cells compared to EC. Our data also show that elevated frequencies of CD8+CD38+HLA-DR+ T cells and CD14dimCD16+ monocytes were associated with both viremic control status and production of bNAbs. bNAb production was also strongly associated with increased frequency of CD57+HLA-DR+ CD8+ T cells, as well as decreased expression of chemokine receptors CCR2 and CX3CR1 on CD14dimCD16+ monocytes in VC compared to EC. Further studies are required to establish the cause and effect of alterations in monocyte populations during HIV-1 infection and whether these could tip the scale towards viral control below detectable levels.
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Affiliation(s)
| | | | - Eileen Scully
- 1Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | | | | | | | | | | | - Bruce Walker
- 1Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
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Claiborne D, Prince J, Scully E, Kopycinski J, Macharia G, Nganou-Makamdop K, Tang J, Goepfert P, Yu T, Lakhi S, Kilembe W, Douek D, Gilmour J, Price M, Altfeld M, Allen S, Hunter E. Protective HLA Alleles Reduce Markers of Gut Damage and Microbial Translocation and Preserve the Cellular Immune Response during Acute HIV-1 Infection. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5063.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Eileen Scully
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States
| | | | | | | | - Jianming Tang
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul Goepfert
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tianwei Yu
- Emory University, Atlanta, GA, United States
| | | | | | | | | | - Matthew Price
- IAVI, London, United Kingdom
- UCSF, Epidemiology & Biostatistics, San Francisco, CA, United States
| | - Marcus Altfeld
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Susan Allen
- Emory University, Atlanta, GA, United States
- ZEHRP, Lusaka, Zambia
| | - Eric Hunter
- Emory University, Atlanta, GA, United States
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Prince JL, Claiborne DT, Macharia G, Micci L, Lawson B, Scully E, Kopycinski J, Vanderford T, Tang J, Yu T, Lakhi S, Kilembe W, Silvestri G, Goepfert P, Price MA, Altfeld M, Paiardini M, Gilmour J, Allen S, Hunter E. HIV Replicative Capacity of Transmitted Viruses Is Associated with Early Immune Activation, Exhaustion and Establishment of the Viral Reservoir. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5100.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Gladys Macharia
- International AIDS Vaccine Initiative (IAVI), London, United Kingdom
| | - Luca Micci
- Emory University, Atlanta, GA, United States
| | | | - Eileen Scully
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, United States
| | | | | | - Jianming Tang
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tianwei Yu
- Emory University, Atlanta, GA, United States
| | - Shabir Lakhi
- Zambia Emory HIV Research Project, Lusaka, Zambia
| | | | | | - Paul Goepfert
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew A. Price
- International AIDS Vaccine Initiative (IAVI), London, United Kingdom
- UCSF, San Francisco, CA, United States
| | - Marcus Altfeld
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | | | - Jill Gilmour
- International AIDS Vaccine Initiative (IAVI), London, United Kingdom
| | - Susan Allen
- Emory University, Atlanta, GA, United States
- Zambia Emory HIV Research Project, Lusaka, Zambia
| | - Eric Hunter
- Emory University, Atlanta, GA, United States
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Sax PE, Komarow L, Finkelman MA, Grant PM, Andersen J, Scully E, Powderly WG, Zolopa AR. Blood (1->3)-beta-D-glucan as a diagnostic test for HIV-related Pneumocystis jirovecii pneumonia. Clin Infect Dis 2011; 53:197-202. [PMID: 21690628 DOI: 10.1093/cid/cir335] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED (See the editorial commentary by Morris and Masur, on pages 203-204.) BACKGROUND Improved noninvasive diagnostic tests for Pneumocystis jirovecii pneumonia (PCP) are needed. We evaluated the test characteristics of plasma (1 → 3)-β-D-glucan (β-glucan) for HIV-related PCP among a large group of patients presenting with diverse opportunistic infections (OIs). METHODS The study population included all 282 participants in AIDS Clinical Trials Group A5164, a study of early versus deferred antiretroviral therapy in conjunction with initial therapy of acute OIs. Baseline plasma samples were assayed for β-glucan, with standard assay reference values defining ≥ 80 pg/mL as positive. Before this analysis, diagnosis of PCP was independently adjudicated by 2 study investigators after reviewing reports from study sites. RESULTS A total of 252 persons had a β-glucan result that could be analyzed, 173 (69%) of whom had received a diagnosis of PCP. Median β-glucan with PCP was 408 pg/mL (interquartile range [IQR], 209-500 pg/mL), compared with 37 pg/mL (IQR, 31-235 pg/mL) without PCP (P < .001). The sensitivity of β-glucan dichotomized at 80 pg/mL for the diagnosis of PCP was 92% (95% confidence interval [CI], 87%-96%), and the specificity was 65% (95% CI, 53%-75%); positive and negative predictive values were 85% (95% CI, 79%-90%) and 80% (95% CI, 68%-89%) respectively, based on the study prevalence of 69% of patients with PCP. Rates of abnormal lactate dehyrogenase levels did not differ significantly between those with and without PCP. CONCLUSIONS Blood (1 → 3)-β-D-glucan is strongly correlated with HIV-related PCP. In some clinical centers, this may be a more sensitive test than the induced sputum examination and could reduce the need for both bronchoscopy and empirical therapy of PCP.
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Affiliation(s)
- Paul E Sax
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
Psychosocial interventions (PSI), though recommended in the NICE guidelines for schizophrenia and bipolar affective disorder, are not routinely available to people with a serious mental illness in the UK. Education and training initiatives to equip mental health professionals with skills in PSI have grown over the last decade; yet the literature indicates serious problems in implementation of PSI in routine service provision. This paper examines on a local level the factors which support and limit the education and practice of PSI in one UK mental healthcare trust. It reports on a survey of trainees and their managers which aims to evaluate the impact of a PSI training programme and practice development strategy on staff, managers and service provision. The key findings are: a high rate of implementation of PSI by PSI-trained staff in the Trust; a strong association between PSI training and career progression for staff; and the support mechanisms which are most effective in the education and implementation of PSI. The paper concludes that certain measures and support mechanisms have facilitated the successful implementation of PSI with positive outcomes for staff and service provision. Further recommendations are made identifying measures which facilitate the implementation of PSI through an integrated education and practice development strategy owned by all stakeholders.
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Affiliation(s)
- J Sin
- Education & Practice Lead in Psychosocial Interventions, Berkshire Healthcare NHS Trust & Thames Valley University, Prospect House, Prospect Park Hospital, Berkshire, UK.
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Wang T, Gao Y, Scully E, Davis CT, Anderson JF, Welte T, Ledizet M, Koski R, Madri JA, Barrett A, Yin Z, Craft J, Fikrig E. Gamma delta T cells facilitate adaptive immunity against West Nile virus infection in mice. J Immunol 2006; 177:1825-32. [PMID: 16849493 DOI: 10.4049/jimmunol.177.3.1825] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
West Nile (WN) virus causes fatal meningoencephalitis in laboratory mice, and gammadelta T cells are involved in the protective immune response against viral challenge. We have now examined whether gammadelta T cells contribute to the development of adaptive immune responses that help control WN virus infection. Approximately 15% of TCRdelta(-/-) mice survived primary infection with WN virus compared with 80-85% of the wild-type mice. These mice were more susceptible to secondary challenge with WN virus than the wild-type mice that survived primary challenge with the virus. Depletion of gammadelta T cells in wild-type mice that survived the primary infection, however, does not affect host susceptibility during secondary challenge with WN virus. Furthermore, gammadelta T cells do not influence the development of Ab responses during primary and at the early stages of secondary infection with WN virus. Adoptive transfer of CD8(+) T cells from wild-type mice that survived primary infection with WN virus to naive mice afforded partial protection from lethal infection. In contrast, transfer of CD8(+) T cells from TCRdelta(-/-) mice that survived primary challenge with WN virus failed to alter infection in naive mice. This difference in survival correlated with the numeric and functional reduction of CD8 memory T cells in these mice. These data demonstrate that gammadelta T cells directly link innate and adaptive immunity during WN virus infection.
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MESH Headings
- Adoptive Transfer
- Animals
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/transplantation
- CD8-Positive T-Lymphocytes/virology
- Genetic Predisposition to Disease/genetics
- Immunity, Cellular/genetics
- Immunity, Innate/genetics
- Immunization, Secondary
- Immunoglobulin G/biosynthesis
- Immunoglobulin M/biosynthesis
- Immunologic Memory/genetics
- Lymphocyte Depletion
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Antigen, T-Cell, gamma-delta/deficiency
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/physiology
- Recurrence
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- T-Lymphocyte Subsets/virology
- West Nile Fever/genetics
- West Nile Fever/immunology
- West Nile virus/immunology
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Affiliation(s)
- Tian Wang
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80521, USA
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Wang T, Scully E, Yin Z, Kim JH, Wang S, Yan J, Mamula M, Anderson JF, Craft J, Fikrig E. IFN-gamma-producing gamma delta T cells help control murine West Nile virus infection. J Immunol 2003; 171:2524-31. [PMID: 12928402 DOI: 10.4049/jimmunol.171.5.2524] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
West Nile (WN) virus causes fatal meningoencephalitis in laboratory mice, thereby partially mimicking human disease. Using this model, we have demonstrated that mice deficient in gammadelta T cells are more susceptible to WN virus infection. TCRdelta(-/-) mice have elevated viral loads and greater dissemination of the pathogen to the CNS. In wild-type mice, gammadelta T cells expanded significantly during WN virus infection, produced IFN-gamma in ex vivo assays, and enhanced perforin expression by splenic T cells. Adoptive transfer of gammadelta T cells to TCRdelta(-/-) mice reduced the susceptibility of these mice to WN virus, and this effect was primarily due to IFN-gamma-producing gammadelta T cells. These data demonstrate a distinct role for gammadelta T cells in the control of and prevention of mortality from murine WN virus infection.
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MESH Headings
- Adoptive Transfer
- Animals
- Blood/immunology
- Blood/virology
- Cell Division/genetics
- Cell Division/immunology
- Cells, Cultured
- Cytotoxicity, Immunologic/genetics
- Encephalitis, Viral/genetics
- Encephalitis, Viral/immunology
- Encephalitis, Viral/prevention & control
- Encephalitis, Viral/virology
- Female
- Genes, T-Cell Receptor beta/genetics
- Genes, T-Cell Receptor delta/genetics
- Genetic Predisposition to Disease
- Interferon-gamma/biosynthesis
- Interferon-gamma/physiology
- Lymphoid Tissue/immunology
- Lymphoid Tissue/virology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Antigen, T-Cell, alpha-beta/deficiency
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/deficiency
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/physiology
- Severity of Illness Index
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- T-Lymphocyte Subsets/pathology
- T-Lymphocyte Subsets/transplantation
- Viral Load
- West Nile Fever/genetics
- West Nile Fever/immunology
- West Nile Fever/prevention & control
- West Nile Fever/virology
- West Nile virus/immunology
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Affiliation(s)
- Tian Wang
- Department of Internal Medicine, Section of Rheumatology, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA
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20
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Abstract
Interferon (IFN)-gamma is necessary for tumor immunity, however, its initial cellular source is unknown. Because gammadelta T cells primarily produce this cytokine upon activation, we hypothesized that they would provide an important early source of IFN-gamma in tumor immunosurveillance. To address this hypothesis, we first demonstrated that gammadelta T cell-deficient mice had a significantly higher incidence of tumor development after challenge with a chemical carcinogen methylcholanthrene (MCA) or inoculation with the melanoma cell line B16. In wild-type mice, gammadelta T cells were recruited to the site of tumor as early as day 3 after inoculation, followed by alphabeta T cells at day 5. We then used bone marrow chimeras and fetal liver reconstitutions to create mice with an intact gammadelta T cell repertoire but one that was specifically deficient in the capacity to produce IFN-gamma. Such mice had a higher incidence of tumor development, induced either with MCA or by inoculation of B16 melanoma cells, compared with mice with IFN-gamma-competent gammadelta T cells. Moreover, genetic deficiency of gammadelta T cells resulted in impaired IFN-gamma production by tumor antigen-triggered alphabeta T cell upon immunization with tumor lysate. These results demonstrate that gammadelta T cells can play a necessary role in tumor immunity through provision of an early source of IFN-gamma that in turn may regulate the function of tumor-triggered alphabeta T cells.
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MESH Headings
- Animals
- Immunity, Cellular
- Interferon-gamma/immunology
- Interferon-gamma/metabolism
- Interleukin-12/immunology
- Interleukin-12/metabolism
- Lymphocyte Activation
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Neoplasm Transplantation
- Neoplasms, Experimental/immunology
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- T-Lymphocyte Subsets/immunology
- Transplantation Chimera
- Tumor Cells, Cultured
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Affiliation(s)
- Yunfei Gao
- Section of Rheumatology, Yale School of Medicine, 300 Cedar Street, CAB Building Room S517, New Haven, CT 06520, USA
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Abstract
Occupational therapy students and staff at McGill University organized an O.T. display for the McGill Open House. The theme of the display was Rehabilitation ′77. The focus was on helping the public to gain a clear understanding of occupational therapy. This was done by presenting as many aspects of O.T. as possible and by inviting the active participation of our visitors. The display was most successful. Our aim of enlightening the public was enjoyably accomplished and the end result was a positive experience for all involved.
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Silver AA, Hagin RA, DeVito E, Kreeger H, Scully E. A SEARCH battery for scanning kindergarten children for potential learning disability. J Am Acad Child Psychiatry 1976; 15:224-39. [PMID: 1262617 DOI: 10.1016/s0002-7138(09)61484-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Faulkner SH, Scully E, Carter EE. OPERATIONS ON ONE HUNDRED CASES OF CONVERGENT CONCOMITANT SQUINT. Br J Ophthalmol 1944; 28:403-7. [PMID: 18170035 DOI: 10.1136/bjo.28.8.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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