1
|
Delfraissy JF. [French research organization on emerging infectious diseases: From REACTing to ANRS emerging infectious diseases]. Bull Acad Natl Med 2023; 207:287-294. [PMID: 36691475 PMCID: PMC9847693 DOI: 10.1016/j.banm.2022.11.017] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 01/19/2023]
Abstract
Emerging infectious diseases (EIDs) can be responsible for epidemics or even pandemics that disrupt societies and cause national and international crises. In our globalized world, anarchic urbanization, ecosystem disruptions (deforestation, creation of dams…), changes in crop and livestock farming conditions, the increasing availability of air transport, population displacement and climate change are all factors that favor the occurrence and spread of emerging or re-emerging pathogens such as SARS-Cov, MERS-CoV, Ebola, Zika, influenza, or more recently SARS-CoV-2 and Monkeypox. States, regional and international organizations, health and research agencies, non-governmental organizations and the pharmaceutical industry are today challenged by the repetition of these crises and their consequences on health, social, economic and political balances. For the past fifteen years, we have clearly been in a new regime of infectious emergence and re-emergence. This new regime calls for new responses, to meet in the urgency the challenges of emergency epidemic crises and to better respond to the issues of crisis management in a context of "One Health". Research is an essential pillar in the response to these epidemics with a double challenge: (i) to improve knowledge on the disease, its prevention, treatment, diagnosis, impact on society. and (ii) to prepare for and understand future emergencies, "anticipate". As epidemics have occurred over the last fifteen years, French research has been organized and has evolved to respond to these crises, from the genesis of REACTing in 2011, to the creation of the ANRS Emerging Infectious Diseases in 2021.
Collapse
|
2
|
Chatenoud L, Dugas B, Beaurain G, Touam M, Drüeke T, Galanaud P, Bach JF, Delfraissy JF. Interleukin-2 production and targeting in hemodialyzed patients. Contrib Nephrol 2015; 59:10-6. [PMID: 3502084 DOI: 10.1159/000414610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
3
|
Sutherland KA, Ghosn J, Gregson J, Mbisa JL, Chaix ML, Cohen Codar I, Delfraissy JF, Delaugerre C, Gupta RK. HIV-1 subtype influences susceptibility and response to monotherapy with the protease inhibitor lopinavir/ritonavir. J Antimicrob Chemother 2014; 70:243-8. [PMID: 25228587 PMCID: PMC4267506 DOI: 10.1093/jac/dku365] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE PI susceptibility results from a complex interplay between protease and Gag proteins, with Gag showing wide variation across HIV-1 subtypes. We explored the impact of pre-treatment susceptibility on the outcome of lopinavir/ritonavir monotherapy. METHODS Treatment-naive individuals who experienced lopinavir/ritonavir monotherapy failure from the MONARK study were matched (by subtype, viral load and baseline CD4 count) with those who achieved virological response ('successes'). Successes were defined by viral load <400 copies/mL after week 24 and <50 copies/mL from week 48 to week 96. Full-length Gag-protease was amplified from patient samples for in vitro phenotypic susceptibility testing, with susceptibility expressed as fold change (FC) relative to a subtype B reference strain. RESULTS Baseline lopinavir susceptibility was lower in viral failures compared with viral successes, but the differences were not statistically significant (median lopinavir susceptibility: 4.4 versus 8.5, respectively, P = 0.17). Among CRF02_AG/G patients, there was a significant difference in lopinavir susceptibility between the two groups (7.1 versus 10.4, P = 0.047), while in subtype B the difference was not significant (2.7 versus 3.4, P = 0.13). Subtype CRF02_AG/G viruses had a median lopinavir FC of 8.7 compared with 3.1 for subtype B (P = 0.001). CONCLUSIONS We report an association between reduced PI susceptibility (using full-length Gag-protease sequences) at baseline and subsequent virological failure on lopinavir/ritonavir monotherapy in antiretroviral-naive patients harbouring subtype CRF02_AG/G viruses. We speculate that this may be important in the context of suboptimal adherence in determining viral failure.
Collapse
Affiliation(s)
- K A Sutherland
- Virus Reference Department, Public Health England, London, UK Department of Infection, University College London, London, UK
| | - J Ghosn
- Université Paris Descartes, EA 7327, Faculté de Médecine site Necker, Paris, France APHP, UF de thérapeutique en Immuno Infectiologie, CHU Hotel Dieu, Paris, France
| | - J Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - J L Mbisa
- Virus Reference Department, Public Health England, London, UK
| | - M L Chaix
- Université Paris Descartes, EA 7327, Faculté de Médecine site Necker, Paris, France
| | | | - J F Delfraissy
- AP-HP, Department of Internal Medicine, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - C Delaugerre
- Virology, U941 INSERM Paris Diderot University, St Louis Hospital-APHP, Paris, France
| | - R K Gupta
- Department of Infection, University College London, London, UK
| |
Collapse
|
4
|
Barennes H, Guillet S, Limsreng S, Him S, Nouhin J, Hak C, Srun C, Viretto G, Ouk V, Delfraissy JF, Ségéral O. Virological failure and HIV-1 drug resistance mutations among naive and antiretroviral pre-treated patients entering the ESTHER program of Calmette Hospital in Cambodia. PLoS One 2014; 9:e105736. [PMID: 25166019 PMCID: PMC4148321 DOI: 10.1371/journal.pone.0105736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction In resource limited settings, patients entering an antiretroviral therapy (ART) program comprise ART naive and ART pre-treated patients who may show differential virological outcomes. Methods This retrospective study, conducted in 2010–2012 in the HIV clinic of Calmette Hospital located in Phnom Penh (Cambodia) assessed virological failure (VF) rates and patterns of drug resistance of naive and pre-treated patients. Naive and ART pre-treated patients were included when a Viral Load (VL) was performed during the first year of ART for naive subjects or at the first consultation for pre-treated individuals. Patients showing Virological failure (VF) (>1,000 copies/ml) underwent HIV DR genotyping testing. Interpretation of drug resistance mutations was done according to 2013 version 23 ANRS algorithms. Results On a total of 209 patients, 164 (78.4%) were naive and 45 (21.5%) were ART pre-treated. Their median initial CD4 counts were 74 cells/mm3 (IQR: 30–194) and 279 cells/mm3 (IQR: 103–455) (p<0.001), respectively. Twenty seven patients (12.9%) exhibited VF (95% CI: 8.6–18.2%), including 10 naive (10/164, 6.0%) and 17 pre-treated (17/45, 37.8%) patients (p<0.001). Among these viremic patients, twenty-two (81.4%) were sequenced in reverse transcriptase and protease coding regions. Overall, 19 (86.3%) harbored ≥1 drug resistance mutations (DRMs) whereas 3 (all belonging to pre-treated patients) harbored wild-types viruses. The most frequent DRMs were M184V (86.3%), K103N (45.5%) and thymidine analog mutations (TAMs) (40.9%). Two (13.3%) pre-treated patients harbored viruses that showed a multi-nucleos(t)ide resistance including Q151M, K65R, E33A/D, E44A/D mutations. Conclusion In Cambodia, VF rates were low for naive patients but the emergence of DRMs to NNRTI and 3TC occurred relatively quickly in this subgroup. In pre-treated patients, VF rates were much higher and TAMs were relatively common. HIV genotypic assays before ART initiation and for ART pre-treated patients infection should be considered as well.
Collapse
Affiliation(s)
- Hubert Barennes
- Agence Nationale de Recherche sur le VIH et les Hepatites (ANRS), Phnom Penh, Cambodia
- ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, Bordeaux, France
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
- * E-mail:
| | - Stéphanie Guillet
- Agence Nationale de Recherche sur le VIH et les Hepatites (ANRS), Phnom Penh, Cambodia
- Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Sovanvatey Him
- Hospital Calmette, Phnom Penh, Cambodia
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Janin Nouhin
- HIV/Hepatitis Unit, Pasteur Institute, Phnom Penh, Cambodia
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Chanroeurn Hak
- Hospital Calmette, Phnom Penh, Cambodia
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | | | - Gerald Viretto
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Vara Ouk
- Hospital Calmette, Phnom Penh, Cambodia
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Jean Francois Delfraissy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| | - Olivier Ségéral
- Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
- Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER), Phnom Penh, Cambodia
| |
Collapse
|
5
|
Michot JM, Gubavu C, Fourn E, Maigne G, Teicher E, Angoulvant A, Blanche S, Lortholary O, Coilly A, Duclos-Vallée JC, Sebagh M, Guettier C, Aumont C, Delfraissy JF, Lambotte O. Very prolonged liposomal amphotericin B use leading to a lysosomal storage disease. Int J Antimicrob Agents 2014; 43:566-9. [PMID: 24787480 DOI: 10.1016/j.ijantimicag.2014.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 01/04/2014] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 11/26/2022]
Abstract
Amphotericin B is a powerful polyene antifungal drug used for treating systemic fungal infections and is usually administered for a short period. Side effects after prolonged use are unknown in humans. Here we report the case of a 28-year-old man suffering from chronic granulomatous disease (CGD), treated for invasive cerebral aspergillosis with liposomal amphotericin B (L-AmB) for a very long time (8 consecutive years). We describe the efficacy and safety of this treatment in the long term. Aspergillosis was kept under control as long as L-AmB therapy was maintained, but relapsed when the dose was reduced. No overt renal toxicity was noted. The patient gradually developed hepatosplenomegaly and pancytopenia. Abnormalities of bone marrow were similar to the sea-blue histiocyte syndrome. Liver biopsy showed images of nodular regenerative hyperplasia related to CGD as well as a histiocytic storage disease. We discuss the very prolonged use of L-AmB leading to the development of a lysosomal storage disease.
Collapse
Affiliation(s)
- J M Michot
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France; Université Paris Sud XI, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France.
| | - C Gubavu
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - E Fourn
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - G Maigne
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France; Université Paris Sud XI, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France
| | - E Teicher
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - A Angoulvant
- Université Paris Sud XI, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France; Assistance Publique - Hôpitaux de Paris, Service de Mycologie et Parasitologie, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - S Blanche
- Assistance Publique - Hôpitaux de Paris, Service d'Immuno-hématologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, 75014 Paris, France
| | - O Lortholary
- Université Paris Descartes, Assistance Publique - Hôpitaux de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, 75014 Paris, France; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, 75015 Paris, France
| | - A Coilly
- Assistance Publique - Hôpitaux de Paris, Centre hépato-biliaire, Hôpital Universitaire Paul Brousse, 94800 Villejuif, France
| | - J C Duclos-Vallée
- Assistance Publique - Hôpitaux de Paris, Centre hépato-biliaire, Hôpital Universitaire Paul Brousse, 94800 Villejuif, France
| | - M Sebagh
- Assistance Publique - Hôpitaux de Paris, Service d'anatomopathologie, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - C Guettier
- Assistance Publique - Hôpitaux de Paris, Service d'anatomopathologie, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - C Aumont
- Assistance Publique - Hôpitaux de Paris, Service d'hématologie biologique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France
| | - J F Delfraissy
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France; Université Paris Sud XI, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France
| | - O Lambotte
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre Cedex, France; Université Paris Sud XI, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France
| |
Collapse
|
6
|
Lévy Y, Sereti I, Tambussi G, Routy JP, Lelièvre JD, Delfraissy JF, Molina JM, Fischl M, Goujard C, Rodriguez B, Rouzioux C, Avettand-Fenoël V, Croughs T, Beq S, Morre M, Poulin JF, Sekaly RP, Thiebaut R, Lederman MM. Effects of recombinant human interleukin 7 on T-cell recovery and thymic output in HIV-infected patients receiving antiretroviral therapy: results of a phase I/IIa randomized, placebo-controlled, multicenter study. Clin Infect Dis 2012; 55:291-300. [PMID: 22550117 PMCID: PMC3381639 DOI: 10.1093/cid/cis383] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The immune deficiency of human immunodeficiency virus (HIV) infection is not fully corrected with ARV therapy. Interleukin-7 (IL-7) can boost CD4 T-cell counts, but optimal dosing and mechanisms of cellular increases need to be defined. METHODS We performed a randomized placebo-controlled dose escalation (10, 20 and 30 µg/kg) trial of 3 weekly doses of recombinant human IL-7 (rhIL-7) in ARV-treated HIV-infected persons with CD4 T-cell counts between 101 and 400 cells/µL and plasma HIV levels <50 copies/mL. Toxicity, activity and the impact of rhIL-7 on immune reconstitution were monitored. RESULTS Doses of rhIL-7 up to 20 µg/kg were well tolerated. CD4 increases of predominantly naive and central memory T cells were brisk (averaging 323 cells/µL at 12 weeks) and durable (up to 1 year). Increased cell cycling and transient increased bcl-2 expression were noted. Expanded cells did not have the characteristics of regulatory or activated T cells. Transient low-level HIV viremia was seen in 6 of 26 treated patients; modest increases in total levels of intracellular HIV DNA were proportional to CD4 T-cell expansions. IL-7 seemed to increase thymic output and tended to improve the T-cell receptor (TCR) repertoire in persons with low TCR diversity. CONCLUSIONS Three weekly doses of rhIL-7 at 20 µg/kg are well tolerated and lead to a dose-dependent CD4 T-cell increase and the broadening of TCR diversity in some subjects. These data suggest that this rhIL-7 dose could be advanced in future rhIL-7 clinical studies. CLINICAL TRIALS REGISTRATION NCT0047732.
Collapse
|
7
|
Guergnon J, Dalmasso C, Broet P, Meyer L, Westrop SJ, Imami N, Vicenzi E, Morsica G, Tinelli M, Zanone Poma B, Goujard C, Potard V, Gotch FM, Casoli C, Cossarizza A, Macciardi F, Debré P, Delfraissy JF, Galli M, Autran B, Costagliola D, Poli G, Theodorou I, Riva A. Single-nucleotide polymorphism-defined class I and class III major histocompatibility complex genetic subregions contribute to natural long-term nonprogression in HIV infection. J Infect Dis 2012; 205:718-24. [PMID: 22238471 DOI: 10.1093/infdis/jir833] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We performed a genome-wide association study comparing a cohort of 144 human immunodeficiency virus (HIV type 1-infected, untreated white long-term nonprogressors (LTNPs) with a cohort of 605 HIV-1-infected white seroconverters. Forty-seven single-nucleotide polymorphisms (SNPs), located from class I to class III major histocompatibility complex (MHC) subregions, show statistical association (false discovery rate, <0.05) with the LTNP condition, among which 5 reached genome-wide significance after Bonferonni correction. The MHC LTNP-associated SNPs are ordered in ≥4 linkage disequilibrium blocks; interestingly, an MHC class III linkage disequilibrium block (defined by the rs9368699 SNP) seems specific to the LTNP phenotype.
Collapse
|
8
|
Briot K, Kolta S, Flandre P, Boué F, Ngo Van P, Cohen-Codar I, Norton M, Delfraissy JF, Roux C. Prospective one-year bone loss in treatment-naïve HIV+ men and women on single or multiple drug HIV therapies. Bone 2011; 48:1133-9. [PMID: 21276883 DOI: 10.1016/j.bone.2011.01.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 01/16/2011] [Accepted: 01/19/2011] [Indexed: 01/06/2023]
Abstract
Antiretroviral therapy has decreased the rate of HIV-related mortality and extended the life span of HIV patients. Current guidelines recommend the use of a 3-drug regimen, such as two nucleoside reverse transcriptase inhibitors and a protease inhibitor, boosted by ritonavir. Osteoporosis can be associated with the HIV disease itself or with antiretroviral therapy. Many trials have been conducted employing a single drug regimen to simplify antiretroviral therapy but few studies assessed the effect of the single drug regimen on bone mineral density (BMD). The objectives of the study were to assess and compare the relative (%) changes in lumbar spine and hip BMD over 48 weeks in HIV patients treated with mono or triple antiretroviral regimens The study was conducted using data from a randomized trial (MONARK) conducted in 136 antiretroviral-naïve HIV patients (89 men and 47 women) comparing the antiviral efficacy of a single-drug protease inhibitor regimen of lopinavir/ritonavir (LPV/r) versus LPV/r in combination with zidovudine (ZDV) and lamivudine (3TC). Lumbar spine and total hip BMD were assessed in 100 patients by dual-energy X-ray absorptiometry at baseline and 48 weeks. 48 week-BMD data were available for 43 patients (mean age 37years) with a mean baseline lumbar spine Z-score of -0.1 in the LPV/r monotherapy group and for 25 patients (mean age 35.8years) with a mean baseline lumbar spine Z-score of -0.2 in the LPV/r+ZDV+3TC group. After 48weeks, lumbar spine BMD significantly decreased by 4.4% (-5.1% to -2.1%, P≤0.001) in the LPV/r group and by 4.0% (-5.0% to -1.7%, P≤0.0001) in the LPV/r+ZDV+3TC group. There was no significant difference in BMD changes between the two groups. These results suggest that bone loss is observed 48 weeks after the initiation of antiretroviral therapy, whether the patients receive a single- or triple-drug antiretroviral regimen.
Collapse
Affiliation(s)
- K Briot
- Paris-Descartes University, Medicine Faculty, Cochin Hospital, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Delfraissy JF, Moreno S, Sanz-Moreno J, Carosi G, Pokrovsky V, Lazzarin A, Pialoux G, Balogh A, Vandeloise E, Leleu G. O415 Efficacy and safety of 48-week maintenance with QD ATV vs ATV/r (both + 2NRTIs) in patients with VL <50 c/mL after induction with ATV/r + 2NRTIs: study AI424136. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-o42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
10
|
Laurichesse JJ, Persoz A, Theodorou I, Rouzioux C, Delfraissy JF, Meyer L. Improved virological response to highly active antiretroviral therapy in HIV-1-infected patients carrying the CCR5 ?32 deletion. HIV Med 2007; 8:213-9. [PMID: 17461848 DOI: 10.1111/j.1468-1293.2007.00455.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients heterozygous for the C-C chemokine receptor 5 (CCR5) Delta32 deletion spontaneously progress less rapidly to AIDS and death than do wild-type patients. We investigated whether the CCR5 Delta32 deletion has an impact on immunological, virological and clinical responses to highly active antiretroviral therapy (HAART) in HIV-1-infected patients. PATIENTS AND METHODS We included in the study 565 HIV-1-infected patients from the French HIV-1 infected cohort with documented date of seroconversion (SEROCO)/haemophiliacs HIV-1 infected (HEMOCO) cohorts, who started HAART after 1996. We investigated virological responses to HAART at 6 months (defined as a plasma HIV-1 RNA measurement below the threshold of detection or a 2 log HIV-1 RNA decrease) and at 12 months (defined as a plasma HIV-1 RNA measurement below the threshold of detection) and clinical response to HAART by Kaplan-Meier survival curves, with AIDS and death as outcomes. RESULTS The Delta32 heterozygous patients (n=83; 15%) had a better virological response to HAART than wild-type patients (73 vs 53% at 6 months, P=0.01; and 60 vs 44% at 12 months, P=0.01). This better virological response was still observed after adjustment for antiretroviral status (whether or not patients were naïve to antiretroviral therapy), year of HAART initiation, number of new antiretroviral drugs and baseline viral load. There was no statistical difference between heterozygous patients and wild-type patients in terms of survival and AIDS-free survival. CONCLUSIONS CCR5 Delta32 heterozygous patients were more likely to have a virological response to HAART than wild-type patients at 6 and 12 months. However, this virological response did not produce better immunological and clinical responses. The long-term impact of the Delta32 deletion on survival in HIV-1-infected treated patients should be investigated in a meta-analysis.
Collapse
Affiliation(s)
- J J Laurichesse
- INSERM, U569, Hôpital Bicêtre, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France.
| | | | | | | | | | | |
Collapse
|
11
|
Molina JM, Journot V, Furco A, Palmer P, Castro ND, Raffi F, Morlat P, May T, Rancinan C, Chêne G, Modaï J, Decazes JM, Molina JM, Madeleine I, Sombardier MN, Martinie M, Séréni D, Lascoux-Combes C, Michon C, Vinceneux P, Delfraissy JF, Goujard C, Peretti D, Rannou MT, Galanaud P, Boue F, Colson C, Rozenbaum W, Girard PM, Adda N, Saimot AG, Coulaud JP, Landman R, Matheron S, Hoen B, Derancourt C, Drobacheff C, Salard D, Laurent R, Estavoyer JM, Beylot J, Morlat P, Lacoste D, Bonarek M, Bonnet F, Bernard N, Nouts C, Trepo C, Cotte L, Schlienger I, Rougier P, Carre C, Raffi F, Bonnet B, Allavena C, Esnault JL, Charonnat MF, Sicot M, Canton P, Burty C, Brel F, May T, Lecompte TD. Five-Year Follow up of Once-Daily Therapy with Emtricitabine, Didanosine and Efavirenz (Montana ANRS 091 Trial). Antivir Ther 2007. [DOI: 10.1177/135965350701200315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Once-daily combination therapy with emtricitabine, didanosine and efavirenz has been highly effective in clinical trials but its long-term efficacy and safety has not been previously reported. Methods This multicentre, single-arm, open-label trial enrolled 40 antiretroviral-naive HIV-1-infected patients who received a once-daily regimen of emtricitabine, didanosine and efavirenz. The objective was to assess the long-term effects of this combination on plasma HIV RNA levels, CD4+ T-cell counts, safety and tolerability. Results After 5 years, 73% and 68% of patients had plasma HIV RNA levels <400 and <50 copies/ml, respectively, in an intent-to-treat, missing-equals-failure analysis. Genotypic resistance on treatment emerged in six patients. There was a significant increase in CD4+ T-cell count of 294x106 cells/l. Only six patients discontinued study treatment, because of non-severe adverse events. Lipodystrophy was infrequent, and lipid and glucose profiles were favourable with a significant increase in high-density lipoprotein cholesterol. Conclusions A convenient once-daily regimen of emtricitabine, didanosine and efavirenz provided durable antiretroviral response and was well tolerated through 5 years of therapy.
Collapse
Affiliation(s)
- Jean-Michel Molina
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Department of Infectious Diseases and University of Paris 7, France
| | - Valérie Journot
- INSERM, U593, France; Université Victor Segalen Bordeaux 2, ISPED, France
| | - André Furco
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Department of Infectious Diseases and University of Paris 7, France
| | - Pierre Palmer
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Laboratory of Virology, France
| | - Nathalie De Castro
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Department of Infectious Diseases and University of Paris 7, France
| | - François Raffi
- CHU Nantes, Hotel Dieu, Department of Infectious Diseases, France
| | - Philippe Morlat
- CHU Bordeaux, Hôpital Saint-André, Department of Internal Medicine, France
| | - Thierry May
- CHU Nancy, Hôpital de Brabois, Department of Infectious Diseases, France
| | - Corinne Rancinan
- INSERM, U593, France; Université Victor Segalen Bordeaux 2, ISPED, France
| | - Geneviève Chêne
- INSERM, U593, France; Université Victor Segalen Bordeaux 2, ISPED, France
| | | | | | | | | | | | | | | | | | | | | | | | - C Goujard
- Hôpital de Bicêtre, Le Kremlin Bicêtre
| | - D Peretti
- Hôpital de Bicêtre, Le Kremlin Bicêtre
| | - MT Rannou
- Hôpital de Bicêtre, Le Kremlin Bicêtre
| | | | - F Boue
- Hôpital A Béclère, Clamart
| | | | | | | | - N Adda
- Hôpital Rothschild, Paris
| | - AG Saimot
- Hôpital Bichat-Claude Bernard, Paris
| | | | - R Landman
- Hôpital Bichat-Claude Bernard, Paris
| | | | - B Hoen
- Hôpital Saint-Jacques, Besançon
| | | | | | | | | | | | | | | | | | | | | | | | - C Nouts
- Hôpital Saint-André, Bordeaux
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Delfraissy JF. [National research center for AIDS and viral hepatitis: a novel and dynamic research facility]. Med Trop (Mars) 2006; 66:335-7. [PMID: 16999040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- J F Delfraissy
- l'Agence nationale de recherches sur le sida et les hépatites virales, Paris, France.
| |
Collapse
|
13
|
Desenclos JC, Delfraissy JF. [Viral hepatitis B and C: an object of public health research]. Rev Epidemiol Sante Publique 2006; 54 Spec No 1:1S1-1S3. [PMID: 17073124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
|
14
|
Delfraissy JF. [New therapeutic strategies. Many of the trails have not yet been validated]. Med Mal Infect 2006; 36 Suppl 2:S224-30. [PMID: 17076001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- J F Delfraissy
- Service de médecine interne, hôpital Bicêtre, AP-HP, 78 rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| |
Collapse
|
15
|
Abstract
The autoantibodies secreted by B lymphocytes have recently been shown to play an important role in autoimmune disease. B lymphocyte depletion by rituximab, a monoclonal anti-CD20 antibody, has been introduced for the treatment of several autoimmune disorders. Few reports have underlined its potential use for the treatment of systemic lupus erythematosus (SLE). We report here the occurrence of extracapillary glomerulonephritis associated with a thrombotic event shortly after rituximab treatment for a lupus flare-up in a patient with anticardiolipin antibodies. This observation suggests that rituximab alone may be insufficient to control severe SLE with glomerulonephritis and should therefore be used with caution in patients with this condition.
Collapse
Affiliation(s)
- O Lambotte
- Department of Internal Medicine, CHU Bicêtre AP-HP, Le Kremlin Bicêtre, France.
| | | | | | | | | | | |
Collapse
|
16
|
Delfraissy JF. [HIV management in 2005]. Presse Med 2005; 34:1S5-6. [PMID: 16025660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
|
17
|
Costagliola D, Potard V, Duvivier C, Pradier C, Dupont C, Salmon D, Duval X, Billaud E, Boué F, Costagliola D, Duval X, Duvivier C, Enel P, Fournier S, Gasnault J, Gaud C, Gilquin J, Grabar S, Khuong MA, Lang JM, Mary-Krause M, Matheron S, Meyohas MC, Pialoux G, Poizot-Martin I, Pradier C, Rouveix E, Salmon-Ceron D, Sobel A, Tattevin P, Tissot-Dupont H, Yasdanpanah Y, Aronica E, Tirard-Fleury V, Tortay I, Abgrall S, Costagliola D, Grabar S, Guiguet M, Lanoy E, Leneman H, Lièvre L, Mary-Krause M, Potard V, Saidi S, Matheron S, Vildé JL, Leport C, Yeni P, Bouvet E, Gaudebout C, Crickx B, Picard-Dahan C, Weiss L, Tisne-Dessus D, Tarnier-Cochin GH, Sicard D, Salmon D, Gilquin J, Auperin I, Viard JP, Roudière L, Boué F, Fior R, Delfraissy JF, Goujard C, Lesprit P, Jung C, Meyohas MC, Meynard JL, Picard O, Desplanque N, Cadranel J, Mayaud C, Pialoux JF, Rozenbaum W, Bricaire F, Katlama C, Herson S, Simon A, Decazes JM, Molina JM, Clauvel JF, Gerard L, Widal GHLF, Sellier P, Diemer M, Dupont C, Berthé H, Saïag P, Mortier E, Chandemerle C, de Truchis P, Bentata M, Honoré P, Tassi S, Jeantils V, Mechali D, Taverne B, Laurichesse H, Gourdon F, Lucht JF, Fresard A, de Dijon C, de Belfort CH, Faller JP, Eglinger P, Bazin C, Verdon R, de Grenoble C, de Lyon C, Peyramond D, Boibieux A, Touraine JL, Livrozet JM, Trepo C, Cotte L, Ravaux I, Tissot-Dupont H, Delmont JP, Moreau J, Gastaut JA, Poizot-Martin I, Soubeyrand J, Retornaz F, Blanc PA, Allegre T, Galinier A, Ruiz JM, d'Arles CH, d'Avignon CH, Lepeu G, Granet-Brunello P, Pelissier L, Esterni JP, de Martigues CH, Nezri M, Cohen-Valensi R, Laffeuillade A, Chadapaud S, de Nîmes JRCHG, May T, Rabaud C, Raffi F, Billaud E, Pradier C, Pugliese P, Michelet C, Arvieux C, Caron F, Borsa-Lebas F, Lang JM, Rey D, de Mulhouse PFCH, Massip P, Cuzin L, Arlet-Suau E, Legrand MFT, Rangueil CHU, de Tourcoing CH, Yasdanpanah Y, Sobesky M, Pradinaud R, Gaud C, Contant M. Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals. Antivir Ther 2005. [DOI: 10.1177/135965350501000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs). Design Cohort study. Setting: French Hospital Database on HIV. Patients Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml. Main outcome measures Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline. Results The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk. Conclusions The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.
Collapse
Affiliation(s)
| | | | - Valérie Potard
- INSERM U720, Université Pierre et Marie Curie, Paris, France
| | - Claudine Duvivier
- INSERM U720, Université Pierre et Marie Curie, Paris, France
- CHU Pitié-Salpétrière, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Yeni
- Hôpital Bichat-Claude Bernard
| | | | | | | | | | - L Weiss
- Hôpital Européen Georges Pompidou
| | | | | | - D Sicard
- Hôpital Européen Georges Pompidou
| | - D Salmon
- Hôpital Européen Georges Pompidou
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Harmouche H, Le Bras P, Bignani O, Delfraissy JF, Goujard C. [Acute renal failure, Fanconi syndrome and insipidus diabetes in a HIV-infected patient treated with Tenofovir]. Rev Med Interne 2005; 26:522-3. [PMID: 15936484 DOI: 10.1016/j.revmed.2005.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 01/19/2005] [Indexed: 11/25/2022]
|
19
|
Lascaux AS, Hemery F, Goujard C, Lesprit P, Delfraissy JF, Sobel A, Lepage E, Lévy Y. Beneficial effect of highly active antiretroviral therapy on the prognosis of AIDS-related systemic non-Hodgkin lymphomas. AIDS Res Hum Retroviruses 2005; 21:214-20. [PMID: 15795527 DOI: 10.1089/aid.2005.21.214] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The influence of HAART on the survival of patients with AIDS-related lymphoma (ARL) was evaluated. A retrospective analysis of 73 HIV-1-infected patients with proven ARL diagnosed between 1992 and 2000 was conducted. Patients received uniformly the same chemotherapy regimen according to CD4 cell counts at NHL diagnosis:, patients with CD4 cells below or above 100 cells x 10(6)/liter received CHOP or ACVBP regimens, respectively. Event-free survival (EFS) and survival were estimated by the Kaplan-Meir method and a Cox model was used to evaluate the effect of different variables on survival. At diagnosis of ARL, the median age was 37 years and 22 patients (30%) had prior AIDS-defining events. Median CD4 cell count was 99 x 10(6)/liter. The median follow-up was 60 months. Ann Arbor stage 3-4 was noted in 60 patients (82%) and bone marrow or meningeal involvement was present in 13 (17%) and 12 (16%) patients, respectively. Two groups were identified: group 1 (n = 38) included patients who had never received HAART and group 2 (n = 35) included those who received HAART either before the diagnosis or following ARL. There was no statistical significant differences in lymphoma extensive stage, presence of B symptoms, meningeal involvement, CD4 cell count at diagnosis, prior AIDS events, or chemotherapy regimens between the two groups. Median survival (MS) of the whole cohort of patients was 8 months. Estimated EFS was significantly higher (30 months) in group 2 compared to group 1 (6.1 months) (p = 0.03). In the multivariate Cox model HAART has an independent significant effect on EFS (p = 0.0085). No influence on outcome was found for other variables except for prior AIDS and bone marrow involvement. HAART has significantly improved the survival and EFS in patients with ARL, independently of chemotherapy regimen.
Collapse
Affiliation(s)
- A S Lascaux
- Service d'Immunologie Clinique, Hôpital Henri Mondor, 94010 Créteil, France.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Raguin G, Chêne G, Morand-Joubert L, Taburet AM, Droz C, Le Tiec C, Clavel F, Girard PM, Rozenbaum W, Naït-Ighil L, Nguyen TH, Slama L, Girard PM, Molina JM, Sereni D, Colin de Verdière N, Lascoux-Combes C, Pintado C, Ponscarme D, Prevoteau de Clary F, Tourneur M, Bentata M, Guillevin L, Launay O, Mansouri R, Rouges F, Kazatchkine M, Aouba A, Azizi M, Fiessinger JN, Le Houssine P, Sicard D, Bernasconi C, Salmon D, Silbermann B, Cassuto JP, Ceppi C, Poiree D, Raguin G, Merad M, Delfraissy JF, Goujard C, Quertainmont Y, Perronne C, de Truchis P, Dupont B, Bresson JL, Calatroni I, Raffi F, Esnault JL, Leautez S. Salvage Therapy with Amprenavir, Lopinavir and Ritonavir 200 Mg/D or 400 Mg/D in HIV-Infected Patients in Virological Failure. Antivir Ther 2004. [DOI: 10.1177/135965350400900407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To compare the antiviral efficacy of a salvage therapy combining lopinavir and amprenavir with 200 mg/d or 400 mg/d ritonavir, together with nucleoside reverse transcriptase inhibitors, over a 26-week period in HIV-infected patients in whom multiple anti-retroviral regimens had failed. Design Phase IIb, randomized, open-label, multicentre trial. Patients were eligible if they had <500 CD4+ cells/mm3 and >4 log10 copies/ml HIV-RNA after treatment with at least two protease inhibitors (PIs) and one non-nucleoside reverse transcriptase inhibitor. Results At baseline ( n=37), the median CD4+ cell count was 207/mm3 and the median plasma HIV-1 RNA level was 4.7 log10 copies/ml; the median number of PI mutations was seven and the median decrease in phenotypic susceptibility to lopinavir and amprenavir was 9.7 and 2.6, respectively. The mean number of antiretrovirals received prior to randomization was 7.7. The fall in the median HIV-1 RNA level at week 26 was -1.4 log10 copies/ml in the 200 mg/d ritonavir group and -2.5 log10 copies/ml in the 400 mg/d group ( P=0.02). Viral load fell below 50 copies/ml in 32% and 61% of patients, respectively ( P=0.07). After adjustment for the ritonavir dose, a smaller number of PI mutations was the only baseline characteristic associated with a better virological response at week 26. Amprenavir concentrations were significantly lower in presence of lopinavir. The lopinavir inhibitory quotient at week 6 correlated weakly with the change in the HIV-RNA level at week 26. Conclusion Combination of amprenavir, lopinavir and 400 mg/d ritonavir shows significant virological efficacy without increased toxicity in HIV-infected patients in whom multiple antiretroviral regimens have failed.
Collapse
Affiliation(s)
| | - Gilles Raguin
- Service de Maladies Infectieuses, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Departement de Medecine, Hôpital Croix-St-Simon, Paris, France
| | - Geneviève Chêne
- Inserm U593, Université Victor Segalen Bordeaux 2, Bordeaux, France
| | | | | | - Cécile Droz
- Inserm U593, Université Victor Segalen Bordeaux 2, Bordeaux, France
| | - Clotilde Le Tiec
- Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - François Clavel
- Inserm U552, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Marie Girard
- Service de Maladies Infectieuses, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Aouba
- Hôpital Européen Georges Pompidou, Paris
| | - M Azizi
- Hôpital Européen Georges Pompidou, Paris
| | | | | | | | | | | | | | | | | | | | - G Raguin
- Hôpital de la Croix Saint Simon Paris
| | - M Merad
- Hôpital de la Croix Saint Simon Paris
| | | | - C Goujard
- Hôpital de Bicêtre Le Kremlin-Bicêtre
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Matheron S, Descamps D, Boué F, Livrozet JM, Lafeuillade A, Aquilina C, Troisvallets D, Goetschel A, Brun-Vezinet F, Mamet JP, Thiaux C, Allegre T, Bataille P, Bazin C, Bentata M, Bergmann JF, Beytout J, Bicart-See A, Bodard L, Brottier-Mancini E, Caron F, Cassuto JP, Chousterman M, Counillon E, Delfraissy JF, Dellamonica P, Doll J, Faller JP, Gallais H, Garre M, Gastaut JA, Gilquin J, Herson S, Hoen B, Jarousse B, Katlama C, Lacoste D, Lange JM, Lecomte I, Lepeu G, Lucht F, Malkin JE, Massip P, Mechali D, Molina JM, Mouton Y, Pathe JP, Peyramond D, Philibert P, Plaisance N, Polomenie P, Remy G, Rispal P, Roue R, de Saint Martin L, Sereni D, Sicard D, Sobel A, Stahl JP, Trepo C, De Truchis P, Vermersch A, Welker Y, Izopet J, Vabret A, Peytavin. G. Triple Nucleoside Combination Zidovudine/Lamivudine/Abacavir versus Zidovudine/Lamivudine/Nelfinavir as First-Line Therapy in HIV-1-Infected Adults: A Randomized Trial. Antivir Ther 2003. [DOI: 10.1177/135965350300800211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To compare the efficacy and safety of a triple nucleoside combination to a protease inhibitor-containing triple regimen as first-line antiretroviral therapy (ART) in HIV-1-infected patients. Design Open-label study in HIV-1-infected ART-naive adults, randomized to receive either Combivir® (lamivudine 150 mg/zidovudine 300 mg twice daily) + abacavir (300 mg twice daily), or Combivir® + nelfinavir (750 mg every 8 h) for 48 weeks. Plasma HIV-1 RNA, CD4 cell count and adverse events were assessed at baseline and weeks 4, 8, 16, 24, 32, 40 and 48. Results 195 subjects (131 men, 64 women), median age 34 years, were randomized: 98 received combivir/abacavir and 97 combivir/nelfinavir. Baseline median plasma HIV-1 RNA was 4.2 log10 copies/ml [Interquartile range (IQR): 3.7-4.5.2] and 4.1 log10 copies/ml (IQR: 3.8–4.6), respectively. Baseline median CD4 cell count was 387 cells/mm3 (IQR: 194–501) and 449 cells/mm3 (IQR: 334–605), respectively. Nine patients (3 vs 6, respectively) did not start treatment or did not have any available efficacy data. At week 48, using the intent to treat analysis (switch/missing equals failure), plasma HIV-1 RNA was <50 copies/ml in 54/95 (57%) and 53/91 (58%) of subjects, respectively. Median CD4 increase was +110 and +120 cells/mm3, respectively. Possible hypersensitivity reactions to abacavir were reported in four subjects (4%). Conclusion The triple nucleoside combination combivir/abacavir is well tolerated as a first-line ART regimen in HIV-1-infected adults, with comparable antiviral activity to a nelfinavir-containing regimen at week 48.
Collapse
|
22
|
Affiliation(s)
- J F Delfraissy
- Service de médecine interne, CHU de Bicêtre 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| |
Collapse
|
23
|
Cunningham CK, Chaix ML, Rekacewicz C, Britto P, Rouzioux C, Gelber RD, Dorenbaum A, Delfraissy JF, Bazin B, Mofenson L, Sullivan JL. Development of resistance mutations in women receiving standard antiretroviral therapy who received intrapartum nevirapine to prevent perinatal human immunodeficiency virus type 1 transmission: a substudy of pediatric AIDS clinical trials group protocol 316. J Infect Dis 2002; 186:181-8. [PMID: 12134253 DOI: 10.1086/341300] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2001] [Revised: 03/20/2002] [Indexed: 11/03/2022] Open
Abstract
Pediatric AIDS Clinical Trials Group protocol 316 was an international, multicenter, placebo-controlled trial comparing single-dose oral nevirapine (200 mg to mother and 2 mg/kg to infant) with placebo in human immunodeficiency virus (HIV)-infected pregnant women receiving standard antiretroviral therapy. This substudy evaluated the emergence of nevirapine-resistance mutations at 6 weeks postpartum in a subgroup of participants. Maternal risk factors for the emergence of nevirapine-resistance mutations were evaluated. Mutations associated with nevirapine resistance were detectable at delivery, prior to receipt of study drug, in 5 (2.3%) of 217 women. Fourteen (15%; 95% confidence interval, 8%-23%) of 95 women who received intrapartum nevirapine developed a nevirapine-resistance mutation 6 weeks postpartum. The most common mutation was K103N, which was present in 10 women. The risk for development of a new nevirapine-resistance mutation did not correlate with CD4 cell count or HIV-1 RNA load at delivery or with type of antepartum antiretroviral therapy. The risk of nevirapine resistance should be considered when determining the risks or benefits of intrapartum nevirapine in women receiving antepartum antiretroviral therapy.
Collapse
Affiliation(s)
- Coleen K Cunningham
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, Syracuse, NY 13210, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Dorenbaum A, Cunningham CK, Gelber RD, Culnane M, Mofenson L, Britto P, Rekacewicz C, Newell ML, Delfraissy JF, Cunningham-Schrader B, Mirochnick M, Sullivan JL. Two-dose intrapartum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission: a randomized trial. JAMA 2002; 288:189-98. [PMID: 12095383 DOI: 10.1001/jama.288.2.189] [Citation(s) in RCA: 275] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT A 2-dose intrapartum/newborn nevirapine regimen reduced perinatal human immunodeficiency virus (HIV) transmission in Ugandan women not receiving antenatal antiretroviral therapy (ART). However, it is unknown whether the addition of the 2-dose nevirapine regimen to standard ART would further reduce perinatal HIV transmission. OBJECTIVE To determine whether a 2-dose nevirapine regimen can decrease perinatal transmission of HIV in nonbreastfeeding women receiving standard ART. DESIGN AND SETTING International, blinded, placebo-controlled, phase 3 trial enrolling women between May 1997 and June 2000 at clinical sites providing care for HIV infection throughout the United States, Europe, Brazil, and the Bahamas. PARTICIPANTS A total of 1270 women received nevirapine (n = 642) or placebo (n = 628). Infants were followed up for 6 months to determine HIV-infection status, which was available for 1248 deliveries. INTERVENTION A 200-mg dose of oral nevirapine to women after onset of labor and a 2-mg/kg dose of oral nevirapine to newborns between 48 and 72 hours after birth. MAIN OUTCOME MEASURES Detection of HIV infection in infants and grade 3 and 4 toxic effects in women and newborns. RESULTS After review by the data and safety monitoring board, the trial was stopped early because the overall transmission rates were significantly lower than assumed for the study design. Antenatal ART included zidovudine alone in 23%; combinations without protease inhibitors in 36%; and combinations with protease inhibitors in 41%. Thirty-four percent of women had elective cesarean delivery. No significant safety concerns were identified for women or infants. Detection of HIV infection occurred in 9 (1.4%; 95% confidence interval [CI], 0.6%-2.7%) of 631 nevirapine group deliveries and 10 (1.6%; 95% CI, 0.8%-2.9%) of 617 placebo group deliveries. The 95% CI for the difference in transmission rate (-0.2) between the 2 study arms ranged from -1.5% in favor of nevirapine to 1.2% in favor of placebo (P =.82, Fisher exact test). The transmission rate was higher in women with lower baseline CD4 cell counts and higher delivery HIV RNA levels, but there was no significant difference between treatment arms in any subgroup. CONCLUSION Risk of perinatal HIV transmission was low and no benefit from additional intrapartum/newborn nevirapine was demonstrated when women received prenatal care and antenatal ART, and elective cesarean section was made available.
Collapse
|
25
|
Taoufik Y, de Goër de Herve MG, Giron-Michel J, Durali D, Cazes E, Tardieu M, Azzarone B, Delfraissy JF. Human microglial cells express a functional IL-12 receptor and produce IL-12 following IL-12 stimulation. Eur J Immunol 2001; 31:3228-39. [PMID: 11745339 DOI: 10.1002/1521-4141(200111)31:11<3228::aid-immu3228>3.0.co;2-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Microglial cells (MC) are IL-12 producers in the central nervous system. Here, we found that IL-12 receptor subunits beta1 and beta2 were both constitutively expressed, and up-regulated by IFN-gamma, in human primary MC. IL-12p70, after binding to its receptor, is internalized into vesicles that qualify as early endosomes as indicated by intracellular colocalization with transferrin. IL-12 induced tyrosine phosphorylation and nuclear translocation of STAT4. IL-12 signaling in human MC also involved members of the NFkappaB family. IL-12p70 and, more effectively, the combination of IL-12p70 and IFN-gamma, induced IL-12p40 mRNA expression and bioactive IL-12p70 production. Human MC, thus, express a functional IL-12 receptor and produce bioactive IL-12 following IL-12 stimulation.
Collapse
Affiliation(s)
- Y Taoufik
- INSERM E-0109, Faculté de Médecine Paris XI, Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Gougeon ML, Rouzioux C, Liberman I, Burgard M, Taoufik Y, Viard JP, Bouchenafa K, Capitant C, Delfraissy JF, Levy Y. Immunological and virological effects of long term IL-2 therapy in HIV-1-infected patients. AIDS 2001; 15:1729-31. [PMID: 11546950 DOI: 10.1097/00002030-200109070-00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the long-term outcome of 27 HIV-infected patients treated for over 3 years with IL-2 and binucleoside analogues. These patients experienced a sustained increase in CD4 cells and a decrease of proviral DNA with infrequent IL-2 cycles. In three cases, virus could not be isolated from activated peripheral cells. A high frequency of HIV-1-specific memory CD4 T cells was found in the patients studied. IL-2 maintains specific effector cells and reduces the pool of infected cells in patients, albeit treated only with binucleosides.
Collapse
Affiliation(s)
- M L Gougeon
- Département SIDA et Rétrovirus, Institut Pasteur, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gasnault J, Kousignian P, Kahraman M, Rahoiljaon J, Matheron S, Delfraissy JF, Taoufik Y. Cidofovir in AIDS-associated progressive multifocal leukoencephalopathy: a monocenter observational study with clinical and JC virus load monitoring. J Neurovirol 2001; 7:375-81. [PMID: 11517420 DOI: 10.1080/13550280152537274] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A monocenter observational study was conducted to determine the clinical and virological effects of cidofovir added to highly active anti-retroviral therapy (HAART) in AIDS-associated progressive multifocal leukoencephalopathy (PML). Exposure to other anti-viral drugs or late initiation of cidofovir were exclusion criteria. Of the 53 consecutive patients with virologically proven PML admitted at the NeuroAIDS Unit of Bicêtre Hospital between May 1996 and July 2000 and having received HAART with or without cidofovir, 46 met the inclusion criteria. Cidofovir was initiated in most cases on compassionate grounds. The 22 patients treated with HAART only (HAART group) were compared to the 24 patients treated with HAART and cidofovir (CDV group). Survival, neurological outcome assessed by the expanded disability status scale (EDSS), and monitoring of the JC virus (JCV) load in CSF were investigated prospectively. At baseline (date of initiation or intensification of HAART), both groups were similar regarding CD4 cell count, plasma HIV load, CSF JCV load, EDSS, and demographic features. Both groups had similar response to HAART in terms of plasma HIV load and CD4 cell count. At month 6, CSF-JCV load was below the detection level in 8 out of 24 (33%) patients from the CDV group and 7 out of 18 (39%) patients from the HAART group (P = 0.71). One-year cumulative probability of being alive was 62% in the CDV group and 53% in the HAART group (P = 0.72). However, an additional benefit with respect to survival was observed in patients who were given cidofovir after adjustment to the following baseline variables (CSF-JCV load, CD4 cell count, and EDSS). Despite the addition of cidofovir to HAART, no significant benefit had been observed in neurological outcome, particularly in patients with an early worsening.
Collapse
Affiliation(s)
- J Gasnault
- Neuro-AIDS Rehabilitation Unit, Department of Internal Medicine, INSERM E109, Faculté de Médecine Paris Sud, Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Soluble factors released by intra-cerebral activated cells are implicated in neuronal alterations during central nervous system inflammatory diseases. In this study, the role of the CD23 pathway in astrocyte activation and its participation in human immunodeficiency virus-1 (HIV-1)-induced neuropathology were evaluated. In human primary astrocytes, CD23 protein membrane expression was dose-dependently upregulated by gp120. It was also upregulated by gamma-interferon (gamma-IFN) and modulated by interleukin-1-beta (IL-1beta) whereas microglial cells in these stimulation conditions did not express CD23. Cell surface stimulation of CD23 expressed by astrocytes induced production of nitric oxide (NO) and IL-1beta which was inhibited by a specific inducible NO-synthase (iNOS) inhibitor (aminoguanidine), indicating the implication of this receptor in the astrocyte inflammatory reaction. On brain tissues from five out of five patients with HIV-1-related encephalitis, CD23 was expressed by astrocytes and by some microglial cells, whereas it was not detectable on brain tissue from five of five HIV-1-infected patients without central nervous system (CNS) disease or from two of two control subjects. In addition, CD23 antigen was co-localized with iNOS and nitrotyrosine on brain tissue from patients with HIV1-related encephalitis, suggesting that CD23 participates in iNOS activation of astrocytes in vivo. In conclusion, CD23 ligation is an alternative pathway in the induction of inflammatory product synthesis by astrocytes and participates in CNS inflammation.
Collapse
Affiliation(s)
- N Dugas
- Laboratoire Virus, Neurone et Immunité, Faculté de Médecine Paris Sud, 63 rue Gabriel Péri, 94276 Le Kremlin Bicêtre, France
| | | | | | | | | |
Collapse
|
29
|
Boufassa F, Dulioust A, Lascaux AS, Meyer L, Boué F, Delfraissy JF, Sobel A, Goujard C. Lipodystrophy in 685 HIV-1-treated patients: influence of antiretroviral treatment and immunovirological response. HIV Clin Trials 2001; 2:339-45. [PMID: 11590538 DOI: 10.1310/bre5-448n-wupu-jwvl] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To describe the clinical features in HIV-1-infected patients treated with protease inhibitors (PIs) or not, and to determine factors related to occurrence of lipodystrophy (LD). METHOD We performed a cross-sectional analysis of 685 treated HIV-1-infected patients that were routinely followed in 6 Paris hospital centers between January and May 1999. Demographic data, familial and personal vascular risk factors, history of antiretroviral treatment, HIV plasma viral load, CD4 cell count, and metabolic data were collected. Clinical examination was based on an assessment of changes in abdominal, dorso-cervical, and breast girth and wasting of the limbs, face, and skin as quoted by the clinician. RESULTS The mean age at inclusion in the study was 38 years; 29.5% were women. At study assessment, 77.5% of patients were PI-treated and 22.5% had never received a PI. LD was observed in 403 (58.8%) patients, of whom 340 were currently receiving a PI and 63 had never received a PI. More than half of the lipodystrophic patients had a mixed form (53.9%), while 25.3% were classified as exclusive lipoatrophic and 20.8% as exclusive hypertrophic. In multivariate analysis, older age, duration of antiretroviral treatment (ART), antiretroviral combinations including stavudine, antiretroviral combinations including a PI, AIDS status, and a low HIV RNA were independently associated with occurrence of LD. CONCLUSION LD is frequently observed in PI-treated patients, but it is also observed in patients receiving an ART regimen without PIs. Our study suggests different underlying mechanisms, because immunovirological response to treatment as well as certain therapies were linked to the occurrence of LD. This hypothesis would be best clarified in a large prospective cohort of naive patients.
Collapse
Affiliation(s)
- F Boufassa
- Department of Epidemiology, INSERM U292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Rozenbaum W, Katlama C, Massip P, Bentata M, Zucman D, Delfraissy JF, Trepo C, David F, Lanier ER, Vavro C, Mamet JP. Treatment intensification with abacavir in HIV-infected patients with at least 12 weeks previous lamivudine/zidovudine treatment. Antivir Ther 2001; 6:135-42. [PMID: 11491418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To demonstrate that lamivudine and zidovudine, given separately (lamivudine/zidovudine) or as a single combination tablet (Combivir), had equivalent efficacy. To evaluate the safety and antiretroviral activity of intensification with abacavir in patients treated with lamivudine/zidovudine for > or = 12 weeks. DESIGN A 12-week, equivalence study of lamivudine/ zidovudine versus Combivir. Patients who completed this study could enter a 48-week, intensification study of Combivir plus abacavir. METHODS In the equivalence study, treatment-naive patients were assessed for HIV-1 RNA, CD4 cell count and genotype. The same assessments plus phenotype were made in the intensification study. Serious adverse events were recorded in the equivalence study and all adverse events in the intensification study. RESULTS Lamivudine/zidovudine (n=40) and Combivir (n=35) gave equivalent reductions in plasma HIV-1 RNA levels at week 12. An identical proportion of patients (74%) in each treatment group harboured virus with the M184V mutation after 12 weeks. Fifty-two patients entered the intensification study and 44 completed 48 weeks of treatment. At the time of intensification with abacavir, all 35 patients with evaluable isolates harboured HIV-1 containing M184V. Addition of abacavir to Combivir led to further decreases in plasma HIV-1 RNA and increases in CD4 cell counts compared with the start of intensification (P<0.001 at week 48). After 48 weeks of triple therapy, multi-nucleoside resistance mutations at codons 69 and 151 were not detected in any patients. All treatment regimens were generally well tolerated. CONCLUSION Lamivudine/zidovudine and Combivir have equivalent antiretroviral activity over 12 weeks. Adding abacavir to Combivir can be a safe and effective therapeutic option for patients, including those harbouring virus with the M184V mutation.
Collapse
Affiliation(s)
- W Rozenbaum
- Maladies Infectieuses Trĵpicales, Hĵpital Rothschild, Paris, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Boutet A, Salim H, Taoufik Y, Lledo PM, Vincent JD, Delfraissy JF, Tardieu M. Isolated human astrocytes are not susceptible to infection by M- and T-tropic HIV-1 strains despite functional expression of the chemokine receptors CCR5 and CXCR4. Glia 2001; 34:165-77. [PMID: 11329179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Within the brain, HIV-1 targets the microglia and astrocytes. Previous studies have reported that viral entry into astrocytes is independent of CD4, in contrast to microglia. We aimed to determine whether chemokine receptors play a role in mediating CD4-independent HIV-1 entry into astrocytes. We found that embryonic astrocytes and microglial cells express CCR5, CCR3, and CXCR4 transcripts. Intracellular calcium levels in astrocytes were found to increase following application of RANTES, MIP-1beta (CCR5-agonist), SDF-1alpha (CXCR4-agonist), but not eotaxin (CCR3-agonist). In microglial cells, eotaxin was also able to modulate internal calcium homeostasis. CD4 was not present at the cell surface of purified astrocytes but CD4 mRNA could be detected by RT-PCR. Neither HIV-1(9533) (R5 isolate) nor HIV-1(LAI) (X4 isolate) penetrated into purified astrocytes. In contrast, mixed CNS cell cultures were infected by HIV-1(9533) and this was inhibited by anti-CD4 mAb in 4/4 tested cultures and by anti-CCR5 mAb in 2/4. Thus, the HIV-1 R5 strain requires CD4 to penetrate into brain cells, suggesting that CCR5 cannot be used as the primary receptor for M-tropic HIV-1 strains in astrocytes. Moreover, inconstant inhibition of HIV-1 entry by anti-CCR5 mAb supports the existence of alternative coreceptors for penetration of M-tropic isolates into brain cells.
Collapse
MESH Headings
- AIDS Dementia Complex/metabolism
- AIDS Dementia Complex/physiopathology
- AIDS Dementia Complex/virology
- Astrocytes/cytology
- Astrocytes/metabolism
- Astrocytes/virology
- Brain/cytology
- Brain/metabolism
- Brain/virology
- CD4 Antigens/metabolism
- Calcium/metabolism
- Calcium Signaling/drug effects
- Calcium Signaling/physiology
- Cells, Cultured/cytology
- Cells, Cultured/metabolism
- Cells, Cultured/virology
- Chemokine CCL4
- Chemokine CCL5/pharmacology
- Chemokine CXCL12
- Chemokines, CXC/pharmacology
- Coculture Techniques
- Fetus
- HIV-1/metabolism
- HIV-1/pathogenicity
- Humans
- Immunohistochemistry
- Macrophage Inflammatory Proteins/pharmacology
- Macrophages/virology
- Microglia/cytology
- Microglia/metabolism
- Microglia/virology
- Neurons/cytology
- Neurons/metabolism
- Neurons/virology
- RNA, Messenger/metabolism
- Receptors, CCR3
- Receptors, CCR5/genetics
- Receptors, CCR5/metabolism
- Receptors, CXCR4/genetics
- Receptors, CXCR4/metabolism
- Receptors, Chemokine/genetics
- Receptors, Chemokine/metabolism
- T-Lymphocytes/virology
Collapse
Affiliation(s)
- A Boutet
- Laboratoire d'immunologie antivirale systémique et cérébrale, Inserm E 0109, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre Cedex, France.
| | | | | | | | | | | | | |
Collapse
|
32
|
Mandelbrot L, Landreau-Mascaro A, Rekacewicz C, Berrebi A, Bénifla JL, Burgard M, Lachassine E, Barret B, Chaix ML, Bongain A, Ciraru-Vigneron N, Crenn-Hébert C, Delfraissy JF, Rouzioux C, Mayaux MJ, Blanche S. Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1. JAMA 2001; 285:2083-93. [PMID: 11311097 DOI: 10.1001/jama.285.16.2083] [Citation(s) in RCA: 290] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Zidovudine reduces maternal-infant transmission of human immunodeficiency virus 1 (HIV-1) infection by two thirds. Combination antiretroviral therapies are potentially more effective prevention. OBJECTIVES To assess the safety of perinatal lamivudine-zidovudine therapy, especially in children, and its effects on viral load, acquisition of drug resistance, and maternal-infant transmission of HIV-1 in a nonbreastfeeding population. DESIGN AND SETTING The Agence Nationale de Recherches sur le SIDA (ANRS) 075 Study, an open-label, nonrandomized intervention trial conducted in the context of an ongoing observational cohort study in 48 sites in France. PATIENTS A total of 445 HIV-1-infected pregnant women were enrolled as the study cohort from February 1997 to September 1998; controls consisted of 899 pregnant women who had received zidovudine monotherapy in May 1994 to February 1997 as standard care. INTERVENTION The study cohort received lamivudine in addition to the standard Pediatric AIDS Clinical Trial Group 076 Study zidovudine prophylaxis regimen. Lamivudine was initiated in women at 32 weeks' gestation through delivery at 150 mg twice per day orally; children received lamivudine, 2 mg/kg twice per day for 6 weeks. MAIN OUTCOME MEASURES HIV-1 infection status and tolerance of therapy in children through age 18 months; maternal plasma HIV-1 RNA levels through 6 weeks after delivery. RESULTS The transmission rate in the study group was 1.6% (7/437; 95% confidence interval [CI], 0.7%-3.3%). In a multivariable analysis, transmission in the study group was 5-fold lower than in controls. In the study group, maternal plasma HIV-1 RNA level was less than 500 copies/mL at delivery in 74%; the median decrease was 1.24 (range, -1.63 to 3.40) log(10) copies/mL. The M184V lamivudine resistance mutation was detected at 6 weeks after delivery in specimens from 52 of 132 women. The most frequent serious adverse events in children were neutropenia and anemia, requiring blood transfusion in 9 children and premature treatment discontinuation in 19. Two uninfected children died at age 1 year from neurologic complications related to mitochondrial dysfunction. CONCLUSIONS Lamivudine-zidovudine may be effective in preventing maternal-infant HIV transmission. However, severe adverse effects and emergence of resistance to lamivudine occurred. Thus, the role of this combination therapy in this setting is as yet unclear, and further research involving a variety of strategies is needed to definitively ascertain its utility for preventing maternal-infant HIV transmission.
Collapse
Affiliation(s)
- L Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Cochin, 123 Boulevard de Port Royal, 75014 Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ngo-Giang-Huong N, Deveau C, Da Silva I, Pellegrin I, Venet A, Harzic M, Sinet M, Delfraissy JF, Meyer L, Goujard C, Rouzioux C. Proviral HIV-1 DNA in subjects followed since primary HIV-1 infection who suppress plasma viral load after one year of highly active antiretroviral therapy. AIDS 2001; 15:665-73. [PMID: 11371680 DOI: 10.1097/00002030-200104130-00001] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An assessment of the impact of one year potent antiretroviral treatment initiated during primary HIV infection on the cell-associated viral burden. DESIGN AND METHODS Proviral HIV-1 DNA was quantified in serial peripheral blood mononuclear cell (PBMC) samples from 19 patients enrolled in the French prospective PRIMO Cohort for whom plasma HIV RNA was suppressed to undetectable levels after one year of triple therapy; that is, plasma HIV-1 RNA was maintained below 200 copies/ml. Results were compared with those observed in 19 patients with chronic HIV-1 infection presenting the same degree of virus suppression after 12 months of treatment. RESULTS At study entry, PRIMO subjects presented heterogeneous levels of proviral HIV-1 DNA: 2-3.92 log10 copies/10(6) PBMC and plasma HIV RNA: 2.3-6.5 log10 copies/ml. One year of effective highly active antiretroviral therapy (HAART) resulted in a median diminution of proviral DNA of -0.78 log10/10(6) PBMC in PRIMO subjects. The median decline in chronic-phase patients was -0.32 for those who were pre-treated and -0.52 for those previously naive of treatment. CONCLUSION The decline in cell-associated HIV DNA observed throughout one year treatment indicated that HAART reduces the proviral HIV-DNA load more effectively when initiated during the primary rather than the chronic phase of HIV infection. These findings therefore tend to lend support to the early initiation of treatment. Nevertheless, heterogeneous baseline values observed for CD4 cell count, plasma HIV RNA and proviral HIV DNA in PRIMO subjects, raise the question of whether treatment should be delayed in some to spare early adverse effects of HAART.
Collapse
Affiliation(s)
- N Ngo-Giang-Huong
- Laboratoire de Virologie, CHU Necker-Enfants Malades, Paris, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Taoufik Y, Peguillet I, de Goër MG, Lambert M, Gubler B, Trylesinski A, Delfraissy JF, Lantz O. Effect of highly active antiretroviral therapy on expression of interleukin-10 and interleukin-12 in HIV-infected patients. J Acquir Immune Defic Syndr 2001; 26:303-4. [PMID: 11317069 DOI: 10.1097/00126334-200104010-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Y Taoufik
- Laboratoire d'Immunologie, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
de Goër de Herve MG, Delfraissy JF, Taoufik Y. FOLLOWING DIRECT CD40 ACTIVATION, HUMAN PRIMARY MICROGLIAL CELLS PRODUCE IL-12 p40 BUT NOT BIOACTIVE IL-12 p70. Cytokine 2001; 14:88-96. [PMID: 11356009 DOI: 10.1006/cyto.2000.0855] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is accumulating evidence that interleukin 12 (IL-12) is involved in the pathogenesis of multiple sclerosis. In the periphery, this cytokine is produced by antigen-presenting cells (APCs) following interaction with activated T cells. CD40 ligation plays a crucial role in this production. Microglial cells are thought to play a major role in antigen presentation in the central nervous system. In this work, we examined IL-12 production by human primary microglial cells after CD40 ligation. These cells expressed CD40 and MHC class II following interferon-gamma activation. IL-12 p40 mRNA and protein, but not bioactive IL-12 p70, were detected in response to direct CD40 activation. Microglial cells co-cultured with activated allogenic CD4+ T lymphocytes also produced IL-12 p40 but not IL-12 p70. This IL-12 p40 production was inhibited by anti-CD40 ligand. Altogether, these results suggest that CD40-CD40-ligand interaction provides a signal that triggers IL-12 p40 expression. However, other interaction(s) may be required during antigen presentation for bioactive heterodimeric IL-12 p70 to be produced by microglial cells.
Collapse
Affiliation(s)
- M G de Goër de Herve
- Laboratoire Virus, Neurone et Immunité and Laboratoire d'Immunologie, Université Paris XI and CHU de Bicêtre, Bicêtre, France
| | | | | |
Collapse
|
36
|
Pruvost A, Becher F, Bardouille P, Guerrero C, Creminon C, Delfraissy JF, Goujard C, Grassi J, Benech H. Direct determination of phosphorylated intracellular anabolites of stavudine (d4T) by liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom 2001; 15:1401-1408. [PMID: 11507751 DOI: 10.1002/rcm.384] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The objective was to develop and validate a routine assay for active intracellular anabolites of stavudine (d4T), a nucleoside reverse transcriptase inhibitor in human PBMC, applicable to pharmacokinetic studies and treatment monitoring. This was achieved using liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS), which theoretically allies optimum sensitivity, specificity and high sample throughput. After cellular lysis in a Tris/methanol buffer, the extract spiked with 2[H(8)]-ATP (internal standard) is directly injected into the LC/MS/MS system. Phosphorylated metabolites of d4T as well as deoxythymidine-triphosphate, the competitor on the reverse transcriptase, are separated from d4T on a reverse-phase microbore column with ion pairing. The detection is performed in the multiple reaction monitoring (MRM) mode after drug ionisation in negative mode electrospray. The limit of quantitation for d4T-TP was 138 fmol per 7 mL blood (9.8 fmol per 10(6) cells) and CV% for repeatability and intermediate precision were lower than 15%. Stability of compounds was checked before and during the process of isolation of PBMC. Cellular samples from several d4T-treated patients were successfully analysed using this method and d4T-triphosphate and deoxythymidine triphosphate were recovered. In conclusion, we have developed and validated a routine LC/MS/MS method that allows the simultaneous determination of mono-, di- and triphosphorylated anabolites of d4T in PBMC as well as the natural corresponding triphosphate in one analysis. For the first time, the chain terminator ratio (d4T-TP/dT-TP) could be directly measured. This method can be used simply and routinely on more than 35 samples per day. Extension to other nucleoside analogues is under development.
Collapse
Affiliation(s)
- A Pruvost
- CEA, Pharmacology and Immunology Unit, DSV/DRM, CEA/Saclay, 91191 Gif-sur-Yvette cedex, France
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Katlama C, Pellegrin JL, Lacoste D, Aquilina C, Raffi F, Pialoux G, Vittecoq D, Raguin G, Lantz O, Mouroux M, Calvez V, Trylesinski A, Montestruc F, Dohin E, Goehrs JM, Delfraissy JF. MIKADO: a multicentre, open-label pilot study to evaluate the antiretroviral activity and safety of saquinavir with stavudine and zalcitabine. HIV Med 2001; 2:20-6. [PMID: 11737372 DOI: 10.1046/j.1468-1293.2001.00046.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since eradication of HIV is unlikely, long-term management of the disease necessitates careful evaluation of the combinations of currently available drugs to determine the most potent and useful rational sequencing of regimens. OBJECTIVE To determine the antiretroviral efficacy and tolerability of saquinavir soft gelatin capsule (SQV-SGC) plus zalcitabine (ddC) and stavudine (d4T), as first-line treatment in HIV-infected patients. DESIGN Multicentre, open-label, non-comparative study. PATIENTS AND METHODS Thirty-five asymptomatic, HIV-infected adults with no prior antiretroviral treatment, a CD4 count > or =250 cells/microL and baseline > or = 5000 HIV RNA copies/mL were included in the study. Patients received SQV-SGC 1200 mg three times a day (tid), ddC 0.75 mg tid and d4T 30 or 40 mg twice a day (bid) for 24 weeks. Plasma HIV RNA, CD4 and CD8 cell counts, HIV reverse transcriptase and protease resistance genotypes, SQV plasma concentration and tolerability were evaluated. RESULTS At baseline, median HIV RNA (interquartile range) was 4.99 (4.81-5.48) log10 copies/mL, and median CD4 count was 370 (318-504) cells/microL (n = 35). At week 24, the median decrease in HIV RNA was 3.05 (2.19-3.68) log10 copies/mL. A viral load below the level of quantification (200 copies/mL and 20 copies/mL) was achieved in 63% and 34% of patients, respectively (intent-to-treat analysis). The only mutations detected were L90M substitutions in two patients. At week 24, the median CD4 count increased (P < 0.0001), and CD8 cell counts decreased (P < 0.0001), relative to baseline. In total, there were five cases of peripheral neuropathy (14%). Mean triglyceride and cholesterol levels remained within normal ranges. CONCLUSIONS Triple therapy with SQV-SGC plus ddC and d4T is a reasonably well tolerated regimen that markedly and rapidly reduces viral load with immunological improvement. This combination is an effective additional therapeutic option, with an efficacy that compares favourably to other triple regimens used in HIV treatment.
Collapse
Affiliation(s)
- C Katlama
- Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Guérin S, Meyer L, Theodorou I, Boufassa F, Magierowska M, Goujard C, Rouzioux C, Debré P, Delfraissy JF. CCR5 delta32 deletion and response to highly active antiretroviral therapy in HIV-1-infected patients. AIDS 2000; 14:2788-90. [PMID: 11125899 DOI: 10.1097/00002030-200012010-00020] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Guérin
- INSERM U292, Department of Epidemiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Saada M, Le Chenadec J, Berrebi A, Bongain A, Delfraissy JF, Mayaux MJ, Meyer L. Pregnancy and progression to AIDS: results of the French prospective cohorts. SEROGEST and SEROCO Study Groups. AIDS 2000; 14:2355-60. [PMID: 11089624 DOI: 10.1097/00002030-200010200-00017] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether pregnancy accelerates HIV-1 disease progression. METHOD In two large French SEROCO and SEROGEST prospective cohorts of HIV infected patients, the progression to AIDS in 365 women with a known date of HIV-1 seroconversion was examined by comparing those who delivered after HIV infection (n = 241) with those who did not become pregnant while HIV-infected (n = 124). RESULTS The crude relative risk of developing AIDS associated with pregnancy was 0.7 [95% confidence interval (CI), 0.4-1.2]. Adjustment for age at seroconversion, the CD4+ cell percentage at entry, and the method used to date seroconversion did not modify the results (adjusted relative risk, 0.7; 95% CI 0.4-1.2). CONCLUSIONS No deleterious effect of pregnancy on progression from seroconversion to AIDS was found. This result has important implications for the counselling of HIV-infected women of child-bearing age.
Collapse
Affiliation(s)
- M Saada
- Service d'Epidémiologie and INSERM U292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
40
|
Mouroux M, Yvon-Groussin A, Peytavin G, Delaugerre C, Legrand M, Bossi P, Do B, Trylesinski A, Diquet B, Dohin E, Delfraissy JF, Katlama C, Calvez V. Early virological failure in naive human immunodeficiency virus patients receiving saquinavir (soft gel capsule)-stavudine-zalcitabine (MIKADO trial) is not associated with mutations conferring viral resistance. J Clin Microbiol 2000; 38:2726-30. [PMID: 10878071 PMCID: PMC87009 DOI: 10.1128/jcm.38.7.2726-2730.2000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The MIKADO trial was designed to evaluate the efficacy of stavudine-zalcitabine-saquinavir (soft gel capsule) [d4T-ddC-SQV(SGC)] in 36 naive patients (-3.3 log(10) units at week 24 [W24]). Among the 29 patients remaining on d4T-ddC-SQV(SGC) until W24, 10 harbored a virological failure (viral load of >200 copies/ml at W24) (group 1). To determine the reasons for therapeutic failure, genotypic and phenotypic resistance test results and SQV concentrations in plasma were analyzed and compared to those in successfully treated patients (viral load of <200 copies/ml at W24) (group 2). Reverse transcriptase and protease genotypic analyses in group 1 revealed the acquisition of only one SQV-associated mutation (L90M) in only two patients. There was no significant increase in the 50 or 90% inhibitory concentration of SQV in patients with or without the L90M mutation. However, the fact that two patients developed an L90M mutation only 4 weeks after relapse points to the need for genotypic resistance testing in the context of an initial failure of the antiretroviral regimen. At W24, the median SQV concentration in group 1 (71 ng/ml) was significantly lower than in group 2 (475 ng/ml), and the plasma SQV concentration was correlated with the viral load at W24 (r = -0.5; P<0.05) and with the drop in viral load between day 0 and W24 (r = -0.5; P<0.01). These results and the fact that the plasma SQV concentrations in the two groups prior to relapse (W12) were not significantly different strongly suggest that the early failure of this combination is not due to viral resistance but to a lack of compliance, pharmacological variability, and drug interactions or a combination of these factors.
Collapse
Affiliation(s)
- M Mouroux
- Department of Virology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- J F Delfraissy
- Hôpital de Bicêtre, 78, rue de Général Leclerc, 94270 Le Kremlin Bicêtre, Paris, France
| |
Collapse
|
42
|
Taoufik Y, Delfraissy JF, Gasnault J. Highly active antiretroviral therapy does not improve survival of patients with high JC virus load in the cerebrospinal fluid at progressive multifocal leukoencephalopathy diagnosis. AIDS 2000; 14:758-9. [PMID: 10807206 DOI: 10.1097/00002030-200004140-00022] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
|
44
|
Faure S, Meyer L, Costagliola D, Vaneensberghe C, Genin E, Autran B, Delfraissy JF, McDermott DH, Murphy PM, Debré P, Théodorou I, Combadière C. Rapid progression to AIDS in HIV+ individuals with a structural variant of the chemokine receptor CX3CR1. Science 2000; 287:2274-7. [PMID: 10731151 DOI: 10.1126/science.287.5461.2274] [Citation(s) in RCA: 221] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Human immunodeficiency virus (HIV) enters cells in vitro via CD4 and a coreceptor. Which of 15 known coreceptors are important in vivo is poorly defined but may be inferred from disease-modifying mutations, as for CCR5. Here two single nucleotide polymorphisms are described in Caucasians in CX3CR1, an HIV coreceptor and leukocyte chemotactic/adhesion receptor for the chemokine fractalkine. HIV-infected patients homozygous for CX3CR1-I249 M280, a variant haplotype affecting two amino acids (isoleucine-249 and methionine-280), progressed to AIDS more rapidly than those with other haplotypes. Functional CX3CR1 analysis showed that fractalkine binding is reduced among patients homozygous for this particular haplotype. Thus, CX3CR1-I249 M280 is a recessive genetic risk factor in HIV/AIDS.
Collapse
MESH Headings
- Acquired Immunodeficiency Syndrome/genetics
- Acquired Immunodeficiency Syndrome/physiopathology
- Acquired Immunodeficiency Syndrome/virology
- CX3C Chemokine Receptor 1
- Case-Control Studies
- Chemokine CX3CL1
- Chemokines, CX3C
- Chemokines, CXC/metabolism
- Chromosomes, Human, Pair 3
- Cohort Studies
- Disease Progression
- Genetic Variation
- Genotype
- HIV/physiology
- HIV Infections/genetics
- HIV Infections/physiopathology
- HIV Infections/virology
- Haplotypes
- Homozygote
- Humans
- Leukocytes, Mononuclear/metabolism
- Linkage Disequilibrium
- Membrane Proteins/metabolism
- Mutation
- Polymorphism, Restriction Fragment Length
- Polymorphism, Single Nucleotide
- Polymorphism, Single-Stranded Conformational
- Receptors, Cytokine/genetics
- Receptors, Cytokine/physiology
- Receptors, HIV/genetics
- Receptors, HIV/physiology
- Survival Analysis
- White People/genetics
Collapse
Affiliation(s)
- S Faure
- Laboratoire d'Immunologie Cellulaire et Tissulaire, Centre National de la Recherche Scientifique UMR 7627, Hôpital Pitié-Salpétrière, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Dugas N, Dereuddre-Bosquet N, Goujard C, Dormont D, Tardieu M, Delfraissy JF. Role of nitric oxide in the promoting effect of HIV type 1 infection and of gp120 envelope glycoprotein on interleukin 4-induced IgE production by normal human mononuclear cells. AIDS Res Hum Retroviruses 2000; 16:251-8. [PMID: 10710213 DOI: 10.1089/088922200309340] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Increased levels of serum IgE have been described in HIV-1 infection; however, mechanisms implicated in this immunoglobulin production remain unknown. In this study, we demonstrate that in vitro infection of human peripheral blood mononuclear cells (PBMCs) by HIV-1 monocytotropic (Ba-L) or lymphocytotropic (LAI) strains promotes IL-4-induced IgE production, indicating that the HIV-1 infectious process may participate in the IgE production observed in vivo. The effect of membrane glycoproteins (gp160, gp120, and gp41) was also evaluated. It was found that gp120 specifically potentiates in a dose-dependent manner IL-4-induced IgE production and does not affect IL-4-induced IgG, IgA, or IgM production. In these experiments, gp160 was also found to upregulate IL-4-induced IgE production, whereas gp41 was ineffective. This effect of gp120, gp160, and HIV-1 infection on IgE synthesis was not observed in the absence of IL-4. In the presence of IL-4, the inducing effect of gp120 appeared to be indirect because gp120 did not modify purified B lymphocyte IgE production after IL-4 and anti-CD40 monoclonal antibody stimulation. As HIV-1 infection is associated with alterations of PBMC redox metabolism, the role of nitric oxide (NO) in this IgE production by human PBMCs was evaluated. In the presence of a specific inhibitor of NO synthase pathways (L-NAME), IgE production induced by IL-4 and gp120 was abolished. Taken together, these data indicate that HIV-1 envelope glycoprotein gp120 (and gp160) specifically enhances IL-4-induced IgE production by normal human PBMCs, probably through the regulation of the nitric oxide pathway.
Collapse
Affiliation(s)
- N Dugas
- Laboratorie Virus, Neurone, et Immunité, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France.
| | | | | | | | | | | |
Collapse
|
46
|
Lambotte O, Taoufik Y, de Goër MG, Wallon C, Goujard C, Delfraissy JF. Detection of infectious HIV in circulating monocytes from patients on prolonged highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2000; 23:114-9. [PMID: 10737425 DOI: 10.1097/00126334-200002010-00002] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The existence of a reservoir of resting CD4+ T cells harboring latent replication-competent HIV has been demonstrated in patients on prolonged highly active antiretroviral therapy (HAART). Latently infected tissue macrophages may constitute a second HIV reservoir. The pool of these cells may be maintained by incoming infected monocytes from blood and/or by in situ viral replication. In this study, the presence of infectious HIV was investigated in highly purified monocytes from 5 patients receiving HAART with undetectable plasma viral load for up to 16 months. HIV was detected in freshly isolated monocytes and recovered following Staphylococcus aureus Cowan strain 1 (SAC) or lipopolysaccharide (LPS) activation. No new drug resistance-associated mutation was found in monocyte-associated HIV. These results demonstrate the long-term persistence of infectious virus in cells of the monocyte-macrophage lineage in patients receiving HAART. These cells are capable of releasing infectious virus under appropriate stimulations.
Collapse
Affiliation(s)
- O Lambotte
- Laboratory of Virus Neuron and Immunity, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | | | | | | | | |
Collapse
|
47
|
Hubert JB, Burgard M, Dussaix E, Tamalet C, Deveau C, Le Chenadec J, Chaix ML, Marchadier E, Vildé JL, Delfraissy JF, Meyer L. Natural history of serum HIV-1 RNA levels in 330 patients with a known date of infection. The SEROCO Study Group. AIDS 2000; 14:123-31. [PMID: 10708282 DOI: 10.1097/00002030-200001280-00007] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the spontaneous course, before the introduction of highly active antiretroviral therapy (HAART), of HIV-1 RNA during the AIDS-free period of the disease. To assess the predictive value of changes in HIV-1 RNA levels. DESIGN A total of 330 patients with a known date of infection followed in the SEROCO cohort. METHODS HIV-1 RNA levels (threshold, 200 copies/ml) were evaluated from 2243 frozen sera obtained from enrolment until the onset of AIDS or until February 1996. Lowess curves were used to describe the variations of viraemia during follow-up. A Cox regression model was used to assess the predictive value of early and updated CD4 cell count and viral load. RESULTS In addition to a lower early viral load, patients who remained AIDS-free had, on average, a longer period of viral load decrease after infection (36 versus 18 months), followed by a slower viral load increase compared with those who progressed to AIDS. A true plateau-phase after the seroconversion period, lasting approximately 4 years, was identified only in patients who remained AIDS-free for at least 90 months. In multivariate analysis, both early viral load and later changes were significant predictors of progression to AIDS. A decrease in the CD4 cell count to less than 200 cells/microl and the onset of a group B condition remained significant predictors of progression. CONCLUSION Our study extends to the early post-seroconversion phase the prognostic value of extracellular HIV-1 RNA levels. Moreover, our data suggest that, in most HIV-infected individuals, a progressive loss of control of viral replication arises during the early years of HIV-1 infection.
Collapse
Affiliation(s)
- J B Hubert
- Department of Epidemiology, INSERM U292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Dalod M, Dupuis M, Deschemin JC, Goujard C, Deveau C, Meyer L, Ngo N, Rouzioux C, Guillet JG, Delfraissy JF, Sinet M, Venet A. Weak anti-HIV CD8(+) T-cell effector activity in HIV primary infection. J Clin Invest 1999; 104:1431-9. [PMID: 10562305 PMCID: PMC409838 DOI: 10.1172/jci7162] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
HIV-specific CD8(+) T cells play a major role in the control of virus during HIV primary infection (PI) but do not completely prevent viral replication. We used IFN-gamma enzyme-linked immunospot assay and intracellular staining to characterize the ex vivo CD8(+) T-cell responses to a large variety of HIV epitopic peptides in 24 subjects with early HIV PI. We observed HIV-specific responses in 71% of subjects. Gag and Nef peptides were more frequently recognized than Env and Pol peptides. The number of peptides recognized was low (median 2, range 0-6). In contrast, a much broader response was observed in 30 asymptomatic subjects with chronic infection: all were responders with a median of 5 peptides recognized (range 1-13). The frequency of HIV-specific CD8(+) T cells among PBMC for a given peptide was of the same order of magnitude in both groups. The proportion of HIV-specific CD8(+)CD28(-) terminally differentiated T cells was much lower in PI than at the chronic stage of infection. The weakness of the immune response during HIV PI could partially account for the failure to control HIV. These findings have potential importance for defining immunotherapeutic strategies and establishing the goals for effective vaccination.
Collapse
Affiliation(s)
- M Dalod
- Laboratoire d'Immunologie des Pathologies Infectieuses et Tumorales, Unité Institut National de la Santé et de la Recherche Médicale (INSERM) 445, Institut Cochin de Génétique Moléculaire, Université René Descartes, 75014 Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Teglas JP, N'Go N, Burgard M, Mayaux MJ, Rouzioux C, Blanche S, Delfraissy JF, Misrahi M. CCR2B-64I chemokine receptor allele and mother-to-child HIV-1 transmission or disease progression in children. French pediatric HIV infection study group. J Acquir Immune Defic Syndr 1999; 22:267-71. [PMID: 10770347 DOI: 10.1097/00126334-199911010-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The beneficial role of a variant of the chemokine receptor CCR2B (CCR2B-641) in the evolution of HIV-1 infection in adults is still controversial. Furthermore, no studies have been performed in HIV-1-infected children. A multicenter and prospective study of 745 infants born to HIV-1-seropositive mothers was performed. The CCR2B-641 allele was studied in 525 non-African children among whom 523 had been previously genotyped for the CCR5delta32 allele and 220 African children. Of the 745 total, 376 children were infected and 369 were uninfected. In the complete population studied, the children homozygous for the CCR2B-64I allele and the heterozygous children were found distributed equally in the infected (respectively, 1.6% and 21%) and uninfected (respectively, 1.9% and 26.3%) groups (p < .22). Among 376 infected children, the incidence of stage C symptoms (U.S. Centers for Disease Control and Prevention [CDC] classification) or the progression of severe immune deficiency (CD4 <15%, CDC stage 3) was not significantly different in heterozygous infected children or children homozygous for the normal allele (p < .17 and p < .75, respectively). The same lack of protective effect was obtained when a separate analysis was performed in the non-African and African HIV-1-infected children.
Collapse
Affiliation(s)
- J P Teglas
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 292, Public Health, Epidemiology, and Human Reproduction, France
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Labetoulle M, Goujard C, Frau E, Rogier H, Niessen F, Furlan V, Lantz O, Lecointe D, Delfraissy JF, Offret H. Cytomegalovirus retinitis in advanced HIV-infected patients treated with protease inhibitors: incidence and outcome over 2 years. J Acquir Immune Defic Syndr 1999; 22:228-34. [PMID: 10770342 DOI: 10.1097/00126334-199911010-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We prospectively studied the incidence of cytomegalovirus (CMV) retinitis in 93 patients treated with highly active antiretroviral therapy (HAART) containing a protease inhibitor (PI), during a median follow-up period of 24 months. The median initial CD4+ count was 22 cells/microl (range, 1-311 cells/microl), and the median plasma HIV viral load was 5.1 log10 copies/ml (range, 2.4-6.4 log10 copies/ml). The fundus was examined monthly in patients with a history of CMV retinitis or an initial CD4+ count <50 cells/microl and every 3 months in the other patients. Of patients with previously controlled CMV retinitis, 1 of 7 relapsed. In addition, 6 of 59 patients with a CD4+ count <50 cells/microl and no history of CMV retinitis before starting PI therapy developed CMV retinitis. Of them, 3 had at least one relapse during follow-up. CD4+ counts were <40 cells/microl at the time of primary or recurrent CMV retinitis, except in two cases (147 cells/microl and 203 cells/microl). In conclusion, the incidence of CMV retinitis was 0.091 per patient-year among study subjects with advanced HIV infection who were receiving HAART (95% confidence interval [CI], 0.037-0.145). The time to progression of CMV retinitis (mean, 215 days; 95% CI, 113-317 days) was longer than reported before widespread use of PIs.
Collapse
Affiliation(s)
- M Labetoulle
- Department of Ophthalmology, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|