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Chow K, Wooten D, Annepally S, Burke L, Edi R, Morris SR. Impact of (recurrent) bacterial vaginosis on quality of life and the need for accessible alternative treatments. BMC Womens Health 2023; 23:112. [PMID: 36934289 PMCID: PMC10024842 DOI: 10.1186/s12905-023-02236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is one of the most common vaginal dysbiosis in women aged 15-44 years old. METHODS We administered a cross-sectional, single timepoint survey to women ages 18 years or older and who have had bacterial vaginosis (BV). Women completed an anonymous online survey evaluating the impact of BV on their quality of life, how effective different types of treatments were and the amount of self-diagnosed vs. provider diagnosed BV episodes they had. RESULTS 62 participants completed the anonymous online survey. With a self-reported median number of BV episodes in the past year was 4 (IQR 1-7). Among these women 69.8% reported BV had a negative impact on their sexual health, 67.7% on their physical health, 74.6% on their mental health. More than half of the respondents had used probiotics with oral Lactobacillus sp. (53.2%), mainly by oral route, and over a third had used vaginal boric acid (37.1%). Most women were unaware of Lactobacillus crispatus. Lactobacillus probiotics were more likely to be tried by women who were negatively impacted by BV for overall quality of life (p = 0.033), sexual health (p = 0.002), and mental health (p = 0.006) while boric acid use was more likely to be used by women who were negatively impacted by BV for their sexual health (p = 0.008). CONCLUSIONS BV is associated with negative quality of life and the women most impacted are seeking alternative treatments such as probiotics (Lactobacillus) and boric acid. There needs to be improvements in BV treatment that include alternative therapy options that have demonstrated efficacy with standardized composition, formulation and dosage.
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Affiliation(s)
- Karen Chow
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Darcy Wooten
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Sindhuja Annepally
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Leah Burke
- Department of Medicine, University of California San Diego, San Diego, CA, USA.
| | - Rina Edi
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Sheldon R Morris
- Department of Medicine, University of California San Diego, San Diego, CA, USA
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2
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Storholm ED, Huang W, Ogunbajo A, Horvath KJ, Reback CJ, Blumenthal J, Moore DJ, Flynn RP, Bolan RK, Corado KC, Morris SR. Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California. AIDS Behav 2023; 27:745-759. [PMID: 36053404 PMCID: PMC9908815 DOI: 10.1007/s10461-022-03807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Gender-based violence (GBV) against transgender and nonbinary (TGNB) persons is a pervasive public health issue. GBV has been linked to mental health problems such as depression and posttraumatic stress disorder (PTSD), as well has risk for HIV seroconversion and HIV treatment nonadherence. However, the impact of GBV on HIV pre-exposure prophylaxis (PrEP) use among TGNB persons has yet to be investigated. In the current study we assessed longitudinal PrEP persistence data from dried blood spots (DBS) collected from 172 racially and ethnically diverse TGNB participants during a 48-week PrEP demonstration project in Southern California from June 2017 to September 2020. Participants were categorized into three levels of PrEP uptake and persistence based on their PrEP levels at the start and end of the study: low-low, high-low, and high-high. Individual-, social-, and structural-level variables were then entered into multinomial logistic regression models to predict levels of PrEP uptake and persistence based on hypotheses informed by syndemic and minority stress theories. The models demonstrated that experience of GBV predicted significantly lower odds of PrEP uptake and persistence and greater PTSD symptoms predicted significantly greater odds of early PrEP discontinuation. Higher levels of coping skills, already being on PrEP at baseline, and being in a steady relationship were associated with greater odds of PrEP uptake and persistence. Implications for future GBV research, advocacy, interventions, and much needed structural changes focused on improving the health and safety of TGNB individuals are discussed.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Adedotun Ogunbajo
- RAND Corporation, Santa Monica, CA, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cathy J Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - David J Moore
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | | | | | | | - Sheldon R Morris
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
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Hassan A, Agustin HGS, Burke L, Kofron R, Corado K, Bolan R, Landovitz RJ, Dubé MP, Morris SR. Low incidence and prevalence of hepatitis C in two cohorts of HIV pre-exposure prophylaxis adherence interventions in men who have sex with men in Southern California. J Viral Hepat 2022; 29:529-535. [PMID: 35357767 PMCID: PMC9908082 DOI: 10.1111/jvh.13678] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) has been associated with incident hepatitis C virus (HCV) infection in men who have sex with men (MSM) due to decreased condom use. We examined rates of HCV among MSM and transgender women at high-risk of HIV on PrEP in Southern California using data from two trials (NCT01761643 and NCT01781806). Five of 599 participants (0.84%, 95% CI, 0.27-1.93) had HCV antibodies detected at entry. Factors associated with HCV seropositivity included being older (p = .002) and lower education level (p < .001). HCV-positive participants had no reported cases of sexually transmitted infection (rectal, urethral or pharyngeal gonorrhoea and/or chlamydia) at entry while HCV-negative participants had a prevalence of 18% (95% CI, 15%-21%). There were no significant differences in substance use and sexual risk behaviour between HCV-positive and HCV-negative participants 1-3 months prior to entry. Among early PrEP adopters, incident HCV did not occur despite ongoing condomless intercourse. Screening intervals for HCV in MSM on PrEP should be led by a risk behaviour assessment.
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Affiliation(s)
- Adiba Hassan
- Department of Medicine, University of California, San Diego, CA, USA,Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, CA, USA * research was conducted at Department of Medicine, University of California, San Diego, CA, USA
| | | | - Leah Burke
- Department of Medicine, University of California, San Diego, CA, USA
| | - Ryan Kofron
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Katya Corado
- Division of HIV Medicine, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | - Michael P Dubé
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sheldon R Morris
- Department of Medicine, University of California, San Diego, CA, USA
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Elko EA, Nelson GA, Mead HL, Kelley EJ, Carvalho ST, Sarbo NG, Harms CE, Le Verche V, Cardoso AA, Ely JL, Boyle AS, Piña A, Henson SN, Rahee F, Keim PS, Celona KR, Yi J, Settles EW, Bota DA, Yu GC, Morris SR, Zaia JA, Ladner JT, Altin JA. COVID-19 vaccination elicits an evolving, cross-reactive antibody response to epitopes conserved with endemic coronavirus spike proteins. Cell Rep 2022; 40:111022. [PMID: 35753310 PMCID: PMC9188999 DOI: 10.1016/j.celrep.2022.111022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 12/01/2021] [Revised: 04/22/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has triggered the first widespread vaccination campaign against a coronavirus. Many vaccinated subjects are previously naive to SARS-CoV-2; however, almost all have previously encountered other coronaviruses (CoVs), and the role of this immunity in shaping the vaccine response remains uncharacterized. Here, we use longitudinal samples and highly multiplexed serology to identify mRNA-1273 vaccine-induced antibody responses against a range of CoV Spike epitopes, in both phylogenetically conserved and non-conserved regions. Whereas reactivity to SARS-CoV-2 epitopes shows a delayed but progressive increase following vaccination, we observe distinct kinetics for the endemic CoV homologs at conserved sites in Spike S2: these become detectable sooner and decay at later time points. Using homolog-specific antibody depletion and alanine-substitution experiments, we show that these distinct trajectories reflect an evolving cross-reactive response that can distinguish rare, polymorphic residues within these epitopes. Our results reveal mechanisms for the formation of antibodies with broad reactivity against CoVs.
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Affiliation(s)
- Evan A Elko
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Georgia A Nelson
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Heather L Mead
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Erin J Kelley
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Sophia T Carvalho
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Nathan G Sarbo
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Caroline E Harms
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Virginia Le Verche
- Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Angelo A Cardoso
- Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Jennifer L Ely
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Annalee S Boyle
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Alejandra Piña
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Sierra N Henson
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Fatima Rahee
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA
| | - Paul S Keim
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Kimberly R Celona
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Jinhee Yi
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Erik W Settles
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Daniela A Bota
- Alpha Stem Cell Clinic, University of California at Irvine, Irvine, CA, USA
| | | | - Sheldon R Morris
- Alpha Stem Cell Clinic, University of California at San Diego, La Jolla, CA, USA
| | - John A Zaia
- Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Jason T Ladner
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - John A Altin
- The Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA.
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Armstrong E, Hemmerling A, Miller S, Burke KE, Newmann SJ, Morris SR, Reno H, Huibner S, Kulikova M, Nagelkerke N, Coburn B, Cohen CR, Kaul R. Sustained effect of LACTIN-V (Lactobacillus crispatus CTV-05) on genital immunology following standard bacterial vaginosis treatment: results from a randomised, placebo-controlled trial. The Lancet Microbe 2022; 3:e435-e442. [PMID: 35659905 PMCID: PMC9188188 DOI: 10.1016/s2666-5247(22)00043-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Bacterial vaginosis might increase HIV risk by eliciting genital inflammation and epithelial barrier disruption, whereas vaginal Lactobacillus crispatus is associated with immune quiescence and HIV protection. We investigated the effect of a live biotherapeutic containing L crispatus CTV-05 (LACTIN-V) on genital immunology and key vaginal bacteria. Methods This substudy included women aged 18–45 years who participated in the randomised, placebo-controlled, phase 2b trial of LACTIN-V to reduce bacterial vaginosis recurrence, conducted at four universities and hospitals in the USA. Women with negative results for sexually transmitted infection, pregnancy, and urinary tract infection were provided a 5-day course of vaginal metronidazole 0·75% gel. Those who met at least three of four clinical Amsel criteria for bacterial vaginosis and had a Nugent score of 4–10 from Gram staining were eligible. Participants in the LACTIN-V trial were randomly assigned (2:1) to receive either LACTIN-V or placebo, applied vaginally once per day for 5 days during the first week and then twice per week for 10 more weeks. Follow-up visits occurred 4, 8, 12, and 24 weeks after enrolment. Soluble immune factors and the absolute abundance of bacterial taxa were assayed by mutliplex ELISA and quantitative PCR. The primary outcomes were vaginal levels of IL-1α and soluble E-cadherin at 24 weeks (ie, 13 weeks after treatment cessation). Findings Between Feb 21, 2020 and March 18, 2021, we characterised genital immune parameters and the vaginal microbiota in a subset of 66 highly adherent participants who were randomly selected, with no exclusion criteria, from those who had attended all study follow-up visits (n=166) in the larger LACTIN-V clinical trial (n=288). 32 (48%) participants received LACTIN-V and 34 (52%) received placebo. LACTIN-V treatment was significantly associated with lower concentrations of the proinflammatory cytokine IL-1α (β coefficient 0·310, SE 0·149; p=0·042) and soluble E-cadherin (0·429, 0·199; p=0·035), a biomarker of epithelial barrier disruption. Interpretation Vaginal administration of LACTIN-V following standard bacterial vaginosis therapy resulted in a sustained reduction in genital inflammation and a biomarker of epithelial integrity. The potential of LACTIN-V to reduce HIV susceptibility merits further investigation. Funding Canadian Institutes of Health Research and the National Institutes of Health National Institute of Allergy and Infectious Diseases.
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6
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Bristow CC, Hassan A, Moore DJ, Dubé MP, Corado K, Chow K, Ellorin E, Blumenthal J, Morris SR. Sexually transmitted infections among participants in an HIV PrEP adherence trial. Int J STD AIDS 2022; 33:397-403. [PMID: 35239448 DOI: 10.1177/09564624211053428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND HIV PrEP effectiveness is highly dependent on adherence. High STI incidence has been reported among PrEP users. We assessed the relationship between STI incidence (CT, NG, and syphilis) and PrEP adherence. METHODS We performed a subanalysis of a controlled, open-label, two-arm, randomized clinical demonstration project of a text-message based adherence intervention. Participants had 48 weeks of follow-up and had STI testing every 12 or 24 weeks. PrEP adherence was measured at week 48 using intracellular tenofovir-diphosphate drug concentrations. We calculated incidence rate ratios for STIs among those adherent as compared with those not adherent to PrEP. RESULTS Of the 381 assessed for CT, NG and syphilis at one or more follow-up visits, there were 16 cases of syphilis or 5.0 per 100 person years (95% CI: 2.6, 7.5); 63 cases of NG or 26.3 per 100 person years (95% CI: 19.8, 32.8); and 81 cases of CT or 36.3 per 100 person years (95% CI: 28.4, 44.2). We found no association between adequate PrEP adherence and STI incidence (aIRR: 0.97 95% CI: 0.67, 1.40). CONCLUSIONS We found that the incidence of STIs was not significantly different between those adherent to PrEP and those non-adherent. Further research is needed to assess how PrEP use may impact STIs over time.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA
| | - Adiba Hassan
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA.,Department of Epidemiology, Fielding School of Public Health, 25808University of California Los Angeles, CA, USA
| | - David J Moore
- Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA
| | - Michael P Dubé
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katya Corado
- 117316Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Karen Chow
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA
| | - Eric Ellorin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA
| | - Jill Blumenthal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA
| | - Sheldon R Morris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 12220University of California San Diego, La Jolla, CA, USA
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7
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Armstrong E, Hemmerling A, Miller S, Burke KE, Newmann SJ, Morris SR, Reno H, Huibner S, Kulikova M, Liu R, Crawford ED, Castañeda GR, Nagelkerke N, Coburn B, Cohen CR, Kaul R. Metronidazole treatment rapidly reduces genital inflammation through effects on bacterial vaginosis-associated bacteria rather than lactobacilli. J Clin Invest 2022; 132:152930. [PMID: 35113809 PMCID: PMC8920324 DOI: 10.1172/jci152930] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Received: 07/06/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) causes genital inflammation and increases HIV risk, while a vaginal microbiota dominated by Lactobacillus species is associated with immune quiescence and relative HIV protection. BV treatment reduces genital inflammation, but it is unclear whether this is driven by a decrease in BV-associated bacteria or an increase in Lactobacillus. METHODS To evaluate the short-term impact of standard BV treatment on genital immunology and the vaginal microbiota, vaginal swabs were collected immediately before and after metronidazole treatment for BV and analyzed with multiplex ELISA, metagenomic sequencing, and quantitative polymerase chain reaction. RESULTS Topical metronidazole treatment rapidly reduced vaginal levels of proinflammatory cytokines, chemokines, and soluble immune markers of epithelial barrier disruption. Although the vaginal microbiota shifted to dominance by L. iners or L. jensenii, this proportional shift was primarily driven by a 2-4 log10 fold reduction in BV-associated bacteria absolute abundance; BV treatment induced no change in the absolute abundance of L. crispatus or L. iners, and only minor (<1 log10 fold) increases in L. gasseri and L. jensenii that were not independently associated with reduced inflammation in multivariable models. CONCLUSION The genital immune benefits that are associated with Lactobacillus dominance following BV treatment were not directly attributable to an absolute increase in lactobacilli, but rather to the loss of BV-associated bacteria.TRAIL REGISTRATION. Participants were recruited as part of a randomized controlled trial (NCT02766023) from 2016 to 2020. FUNDING Canadian Institutes of Health Research (PJT-156123) and the National Institute of Allergy and Infectious Diseases (HHSN2722013000141 and HHSN27200007).
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Affiliation(s)
| | - Anke Hemmerling
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, United States of America
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Kerianne E Burke
- Ruth M. Rothstein CORE Centre, Stroger Hospital of Cook County Health, Chicago, United States of America
| | - Sara J Newmann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, United States of America
| | - Sheldon R Morris
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, United States of America
| | - Hilary Reno
- Department of Medicine, Washington University, St. Louis, United States of America
| | - Sanja Huibner
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Maria Kulikova
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Rachel Liu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Emily D Crawford
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, United States of America
| | - Gloria R Castañeda
- Infectious Diseases, Chan Zuckerberg Biohub, San Francisco, United States of America
| | - Nico Nagelkerke
- Centre for Global Health Research, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Bryan Coburn
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, United States of America
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
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8
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Elko EA, Nelson GA, Mead HL, Kelley EJ, Verche VL, Cardoso AA, Ely JL, Boyle AS, Piña A, Henson SN, Rahee F, Keim PS, Celona KR, Yi J, Settles EW, Yu GC, Morris SR, Zaia JA, Ladner JT, Altin JA. COVID-19 vaccination recruits and matures cross-reactive antibodies to conserved epitopes in endemic coronavirus Spike proteins.. [PMID: 35118479 PMCID: PMC8811912 DOI: 10.1101/2022.01.24.22269542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has triggered the first widespread vaccination campaign against a coronavirus. Most vaccinated subjects are naïve to SARS-CoV-2, however almost all have previously encountered other coronaviruses (CoVs) and the role of this immunity in shaping the vaccine response remains uncharacterized. Here we use longitudinal samples and highly-multiplexed serology to identify mRNA-1273 vaccine-induced antibody responses against a range of CoV Spike epitopes and in both phylogenetically conserved and non-conserved regions. Whereas reactivity to SARS-CoV-2 epitopes showed a delayed but progressive increase following vaccination, we observed distinct kinetics for the endemic CoV homologs at two conserved sites in Spike S2: these became detectable sooner, and decayed at later timepoints. Using homolog-specific depletion and alanine-substitution experiments, we show that these distinctly-evolving specificities result from cross-reactive antibodies as they mature against rare, polymorphic residues within these epitopes. Our results reveal mechanisms for the formation of antibodies with broad reactivity against CoVs.
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9
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Klausner JD, Bristow CC, Soge OO, Shahkolahi A, Waymer T, Bolan RK, Philip SS, Asbel LE, Taylor SN, Mena LA, Goldstein DA, Powell JA, Wierzbicki MR, Morris SR. Resistance-Guided Treatment of Gonorrhea: A Prospective Clinical Study. Clin Infect Dis 2021; 73:298-303. [PMID: 32766725 PMCID: PMC8282307 DOI: 10.1093/cid/ciaa596] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Novel treatment strategies to slow the continued emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae are urgently needed. A molecular assay that predicts in vitro ciprofloxacin susceptibility is now available but has not been systematically studied in human infections. METHODS Using a genotypic polymerase chain reaction assay to determine the status of the N. gonorrhoeae gyrase subunit A serine 91 codon, we conducted a multisite prospective clinical study of the efficacy of a single oral dose of ciprofloxacin 500 mg in patients with culture-positive gonorrhea. Follow-up specimens for culture were collected to determine microbiological cure 5-10 days post-treatment. RESULTS Of the 106 subjects possessing culture-positive infections with wild-type gyrA serine N. gonorrhoeae genotype, the efficacy of single-dose oral ciprofloxacin treatment in the per-protocol population was 100% (95% 1-sided confidence interval, 97.5-100%). CONCLUSIONS Resistance-guided treatment of N. gonorrhoeae infections with single-dose oral ciprofloxacin was highly efficacious. The widespread introduction and scale-up of gyrA serine 91 genotyping in N. gonorrhoeae infections could have substantial medical and public health benefits in settings where the majority of gonococcal infections are ciprofloxacin susceptible. CLINICAL TRIALS REGISTRATION NCT02961751.
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Affiliation(s)
- Jeffrey D Klausner
- Departments of Medicine and Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Claire C Bristow
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Olusegun O Soge
- Neisseria Reference Laboratory, University of Washington, Seattle, Washington, USA
| | | | - Toni Waymer
- Social Scientific Systems, Silver Spring, Maryland, USA
| | | | - Susan S Philip
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Lenore E Asbel
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Stephanie N Taylor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Leandro A Mena
- University of Mississippi Medical Center, Oxford, Mississippi, USA
| | | | | | | | - Sheldon R Morris
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
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10
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Morris SR, Bristow CC, Wierzbicki MR, Sarno M, Asbel L, French A, Gaydos CA, Hazan L, Mena L, Madhivanan P, Philip S, Schwartz S, Brown C, Styers D, Waymer T, Klausner JD. Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study. Lancet Infect Dis 2021; 21:668-676. [PMID: 33242473 PMCID: PMC9884536 DOI: 10.1016/s1473-3099(20)30734-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device. METHODS Women aged 14 years and older who presented consecutively to ten clinical sites across seven US states were enrolled for a cross-sectional, single-visit study. Patients who consented to participate, and who had not used any exclusionary products in the genital area in the previous 48 h, provided self-collected vaginal swabs for testing with the investigational device. Untrained operators received the specimens and ran the device using the guide provided. Specimens had to be run within 2 h of collection to be considered valid. For comparison, patient-infected status was derived by testing clinician-collected vaginal specimens with the Hologic Aptima Combo 2 Assay and Aptima Trichomonas vaginalis Assay, as well as the BD ProbeTec CT/GC Qx Amplified DNA Assay and BD ProbeTec Trichomonas vaginalis Qx Assay. If the results of those assays did not match, the BD MAX CT/GC/TV was used as a tiebreaker. The primary outcomes were the sensitivity and specificity of the investigational device for the detection of C trachomatis, N gonorrhoeae, and T vaginalis compared with patient-infected status. FINDINGS Between Feb 25, 2019, and Jan 6, 2020, 1585 participants aged between 14 years and 80 years (mean 34·8 [SD 14·2]) were enrolled. 1555 participants had tests run with the investigational device, of whom 1532 (98·5%) had a valid result on either the first or repeat test. Among the patients with evaluable results (including a determinate patient-infected status), the device had a sensitivity of 97·6% (95% CI 93·2-99·2) and specificity of 98·3% (97·5-98·9) for C trachomatis (n=1457), sensitivity of 97·4% (86·5-99·5) and specificity of 99·4% (98·9-99·7) for N gonorrhoeae (n=1468), and sensitivity of 99·2% (95·5-99·9) and specificity of 96·9% (95·8-97·7) for T vaginalis (n=1449). INTERPRETATION This innovative, rapid, easy-to-use, single-use, point-of-care device to detect C trachomatis, N gonorrhoeae, and T vaginalis infections showed excellent sensitivity and specificity, and could represent an important advance in the development of rapid diagnostics for sexually transmitted infections and other infectious diseases. FUNDING Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Sheldon R Morris
- Department of Medicine, University of California San Diego, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA.
| | - Claire C Bristow
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Mark Sarno
- Vision Clinical Research, San Marcos, CA, USA
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Audrey French
- Ruth M Rothstein CORE Center-Cook County Health, Chicago, IL, USA
| | | | | | - Leandro Mena
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Susan Philip
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | | | | | - Toni Waymer
- Social & Scientific Systems, Silver Spring, MD, USA
| | - Jeffrey D Klausner
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
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11
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Abstract
Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis infections are a public health concern and cost the United States' healthcare system 16 billion dollars annually. By minimizing barriers to testing, an increased number of infections can be detected and treated. A home-based point-of-care (POC) sexually transmitted infection (STI) test may reduce personal, structural, social and system-level barriers to STI testing. This study assesses patient preferences and acceptance of home-based POC STI testing. We performed a cross-sectional, single-visit study of women aged 18 years and older at a single site. Women completed an anonymous online survey evaluating interest in POC STI testing, comfort in self-collecting vaginal swabs and participant reaction to a positive STI result. 138 participants completed the anonymous online survey. The survey results indicate high acceptability with self-collection of samples and home POC STI testing. A majority of participants were interested or very interested in a home POC STI device-especially amongst women with a past history of a STI. If receiving a positive test result, participants indicated they would want to have someone to discuss their results with, most preferring to speak with their primary care provider. Women on lower incomes were less comfortable and less interested with home testing. Women are likely to be receptive to home POC STI testing. Adapting to home-based testing will require engagement of primary care providers for management and surveillance of STIs.
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Affiliation(s)
- Karen Chow
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Rina Edi
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Geneen Gin
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Sheldon R Morris
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
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Wynn A, Bristow CC, Cristillo AD, Murphy SM, van den Broek N, Muzny C, Kallapur S, Cohen C, Ingalls RR, Wiesenfeld H, Litch JA, Morris SR, Klausner JD. Sexually Transmitted Infections in Pregnancy and Reproductive Health: Proceedings of the STAR Sexually Transmitted Infection Clinical Trial Group Programmatic Meeting. Sex Transm Dis 2020; 47:5-11. [PMID: 31658242 PMCID: PMC10731617 DOI: 10.1097/olq.0000000000001075] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 11/27/2022]
Abstract
The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on Sexually Transmitted Infections (STIs) in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, nonprofit, and industry discussed the burden of STIs during pregnancy; the impact of STIs on adverse pregnancy and birth outcomes; interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) alternative treatments and therapies for use during pregnancy are needed; (ii) further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) more research to determine whether STI tests function equally well in pregnant as nonpregnant women is needed; (iv) development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) policies should be implemented that create standard screening and treatment practices globally; (vi) federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).
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Affiliation(s)
- Adriane Wynn
- * Division of Infectious Diseases & Global Public Health, University of California San Diego School of Medicine, San Diego, CA
| | - Claire C. Bristow
- * Division of Infectious Diseases & Global Public Health, University of California San Diego School of Medicine, San Diego, CA
| | | | | | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Christina Muzny
- Division of Infectious Diseases, Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL
| | - Suhas Kallapur
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Craig Cohen
- Division of Infectious Diseases, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Robin R. Ingalls
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, CA
| | - Harold Wiesenfeld
- Division of Infectious Diseases, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, Division of Infectious Diseases, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - James A. Litch
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburg, Pittsburg, PA
| | - Sheldon R. Morris
- * Division of Infectious Diseases & Global Public Health, University of California San Diego School of Medicine, San Diego, CA
| | - Jeffrey D. Klausner
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
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Chaillon A, Nakazawa M, Anderson C, Christensen-Quick A, Ellis RJ, Franklin D, Morris SR, Gianella S. Effect of Cannabis Use on Human Immunodeficiency Virus DNA During Suppressive Antiretroviral Therapy. Clin Infect Dis 2020; 70:140-143. [PMID: 31074488 PMCID: PMC6912153 DOI: 10.1093/cid/ciz387] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Cannabis use is frequent among people living with human immunodeficiency virus (HIV) and is associated with reduced systemic inflammation. We observed a faster HIV DNA decay during antiretroviral therapy among cannabis users, compared to those with no drug use. No cannabis effect was observed on cellular HIV RNA transcription.
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Affiliation(s)
- Antoine Chaillon
- The Division of Infectious Diseases and Global Public Health, San Diego, La Jolla
| | - Masato Nakazawa
- The Division of Infectious Diseases and Global Public Health, San Diego, La Jolla
| | - Christy Anderson
- The Division of Infectious Diseases and Global Public Health, San Diego, La Jolla
| | | | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Donald Franklin
- Department of Neurosciences, University of California, San Diego, La Jolla
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Sheldon R Morris
- The Division of Infectious Diseases and Global Public Health, San Diego, La Jolla
| | - Sara Gianella
- The Division of Infectious Diseases and Global Public Health, San Diego, La Jolla
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Hassan A, Wertheim JO, Blumenthal JS, Ellorin E, Dube MP, Corado K, Moore DJ, Morris SR. Characteristics of a cohort of high-risk men who have sex with men on pre-exposure prophylaxis reporting transgender sexual partners. Medicine (Baltimore) 2019; 98:e18232. [PMID: 31852085 PMCID: PMC6922495 DOI: 10.1097/md.0000000000018232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.
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Affiliation(s)
- Adiba Hassan
- Department of Medicine, University of California, San Diego
| | | | | | - Eric Ellorin
- Department of Medicine, University of California, San Diego
| | - Michael P. Dube
- Department of Medicine, University of Southern California, Los Angeles
| | - Katya Corado
- Division of HIV Medicine, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
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15
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Moore DJ, Jain S, Dubé MP, Daar ES, Sun X, Young J, Corado K, Ellorin E, Milam J, Collins D, Blumenthal J, Best BM, Anderson P, Haubrich R, Morris SR. Randomized Controlled Trial of Daily Text Messages to Support Adherence to Preexposure Prophylaxis in Individuals at Risk for Human Immunodeficiency Virus: The TAPIR Study. Clin Infect Dis 2019; 66:1566-1572. [PMID: 29228144 DOI: 10.1093/cid/cix1055] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022] Open
Abstract
Background Adherence is critical for efficacy of tenofovir disoproxil fumarate/emtricitabine (FTC) as preexposure prophylaxis (PrEP). Methods Between February 2013 and February 2016, 398 men who have sex with men and transgender women were randomized 1:1 to receive individualized texting for adherence building (iTAB) or standard care (SoC) for 48 weeks. The primary endpoint was dried blood spot (DBS) tenofovir diphosphate (TFV-DP) concentrations at both week 12 and the last on-drug visit of >719 fmol/punch (ie, adequate adherence). Secondary outcomes included DBS TFV-DP concentrations of >1246 fmol/punch (ie, near-perfect adherence) and plasma FTC >350 ng/mL (consistent with dosing within the past 24 hours). Results Concentrations >719 fmol/punch of TFV-DP were found in 88.6% of participants at week 12 and 82.5% at week 48. For the primary endpoint, the study arms did not differ (72.0% in iTAB and 69.2% in SoC; P > .05). For the secondary composite endpoint of >1246 fmol/punch the iTAB arm was superior to SoC (33.5% vs 24.8%; P = .06), reaching statistical significance when adjusting for age (odds ratio, 1.56 [95% confidence interval, 1.00-2.42]; P < .05). At week 48, iTAB was superior to SoC for near-perfect adherence (51.0% vs 37.4%; P = .02). At week 12, iTAB was superior to SoC for dosing in past 24 hours by plasma FTC (47.5% vs 33.3%; P = .007), but not at weeks 24, 36, and 48 (all P > .05). Conclusions Automated text messaging is a low-burden tool that improves durability of near-perfect PrEP adherence. Clinical Trials Registration NCT01761643.
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Affiliation(s)
| | | | - Michael P Dubé
- University of Southern California, Keck School of Medicine, Los Angeles
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center; Long Beach, California
| | | | | | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center; Long Beach, California
| | | | - Joel Milam
- University of Southern California, Keck School of Medicine, Los Angeles
| | - Deborah Collins
- Long Beach Department of Health and Human Services, Long Beach, California
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16
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Weiss JM, Csoszi T, Maglakelidze M, Hoyer RJ, Beck JT, Domine Gomez M, Lowczak A, Aljumaily R, Rocha Lima CM, Boccia RV, Hanna W, Nikolinakos P, Chiu VK, Owonikoko TK, Schuster SR, Hussein MA, Richards DA, Sawrycki P, Bulat I, Hamm JT, Hart LL, Adler S, Antal JM, Lai AY, Sorrentino JA, Yang Z, Malik RK, Morris SR, Roberts PJ, Dragnev KH. Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial. Ann Oncol 2019; 30:1613-1621. [PMID: 31504118 PMCID: PMC6857609 DOI: 10.1093/annonc/mdz278] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity. PATIENTS AND METHODS This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy. RESULTS A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107). CONCLUSION Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits. CLINICAL TRAIL NUMBER NCT02499770.
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Affiliation(s)
- J M Weiss
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, USA
| | - T Csoszi
- Oncology, Hetenyi Geza Korhaz, Onkologiai Kozpont, Szolnok, Hungary
| | - M Maglakelidze
- Department of Oncology, Research Institute of Clinical Medicine, Tbilisi, Georgia, USA
| | - R J Hoyer
- Department of Oncology, Memorial Hospital, University of Colorado Health, Colorado Springs, USA
| | - J T Beck
- Department of Medical Oncology and Hematology, Highlands Oncology Group, Fayetteville, USA
| | - M Domine Gomez
- Department of Oncology, University Hospital Fundacion Jimenez Diaz, IIS-FJD, Madrid, Spain
| | - A Lowczak
- Department of Pulmonology, Faculty of Health and Science, University of Warmia and Mazury in Olsztyn, Poland
| | - R Aljumaily
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, USA
| | - C M Rocha Lima
- Gibbs Cancer Center and Research Institute, Spartanburg, USA
| | - R V Boccia
- Center for Cancer and Blood Disorders, Bethesda, USA
| | - W Hanna
- Hematology/Oncology, University of Tennessee Medical Center, Knoxville, USA
| | - P Nikolinakos
- University Cancer & Blood Center, LLC, Athens, Greece
| | - V K Chiu
- Department of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - T K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
| | | | - M A Hussein
- Department of Oncology, Florida Cancer Specialists, Leesburg, USA
| | - D A Richards
- Department of Oncology, US Oncology Research, Tyler, USA
| | - P Sawrycki
- Department of Cancer Chemotherapy, Provincial Hospital, Toruń, Poland
| | - I Bulat
- ARENSIA Oncology Unit, Institute of Oncology, Chisinau, Moldova
| | - J T Hamm
- Department of Medical Oncology, Norton Health Care, Louisville, USA
| | - L L Hart
- Drug Development Program, Floridia Cancer Specialists, Fort Myers, USA
| | - S Adler
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J M Antal
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - A Y Lai
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J A Sorrentino
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - Z Yang
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - R K Malik
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - S R Morris
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - P J Roberts
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - K H Dragnev
- Department of Hematology/Oncology, Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, Lebanon, USA.
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Debnath A, Reed SL, Morris SR. Predictors of Failure from Primary Therapy for Giardiasis in San Diego: A Single Institution Retrospective Review. Pathogens 2019; 8:pathogens8040165. [PMID: 31569735 PMCID: PMC6963537 DOI: 10.3390/pathogens8040165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 01/06/2023] Open
Abstract
This study aimed to determine the presence of giardiasis among HIV patients in San Diego, the rate of failure of metronidazole treatment, and factors associated with treatment failure. We used a 7 year retrospective single-center case series of HIV-infected individuals with giardiasis at University of California San Diego Medical Center. Data were analyzed for the changes in the hematological, biochemical, and immunologic results at pre- and at-diagnosis levels. We also compared the changes at the diagnosis level among patients who were treated successfully and those who experienced treatment failure as defined by retreatment with a second course of antibiotics. In 29 Giardia lamblia-infected HIV patients, following diagnosis of G. lamblia, there was a non-significant decrement in cluster of differentiation 4 (CD4), but a statistically significant increase in the number of white blood cell (WBC). Other indices did not differ between pre- and at-diagnosis levels. Twenty patients (69%) were treated with a single course of metronidazole or tinidazole and seven patients (24.1%) were treated with more than one course of metronidazole. These seven patients had statistically significant higher hemoglobin at the time of diagnosis, but further studies are required to confirm if this is a consistent finding and if this can predict failure from primary therapy.
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Affiliation(s)
- Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA.
| | - Sharon L Reed
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA.
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA.
| | - Sheldon R Morris
- Departments of Medicine and Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA 92103, USA.
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Pasipanodya EC, Jain S, Sun X, Blumenthal J, Ellorin E, Corado K, Dube MP, Daar ES, Morris SR, Moore DJ. Trajectories and Predictors of Longitudinal Preexposure Prophylaxis Adherence Among Men Who Have Sex With Men. J Infect Dis 2019; 218:1551-1559. [PMID: 30295803 DOI: 10.1093/infdis/jiy368] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background Adherence is necessary for efficacy of preexposure prophylaxis (PrEP), and text-messaging methods are promising tools for both adherence assessment and support. Although PrEP adherence is variable, little research has examined patterns of variability or factors associated with longitudinal use. Methods In the context of a randomized controlled trial of text-messaging versus standard of care for PrEP adherence, 181 men who have sex with men received once-daily tenofovir disoproxil fumarate/emtricitabine and daily adherence texts for 48 weeks. Growth mixture modeling (GMM) was used to identify subgroups of individuals with similar trajectories of text-reported adherence. Between-group differences in pharmacologic measures of adherence (ie, tenofovir diphosphate and emtricitabine triphosphate levels), as well as predictors and study-end attitudes associated with group membership, were examined. Results GMM identified 4 trajectories of text-reported adherence. Classes with higher text-reported adherence had higher drug concentrations. Younger age and minority race were associated with lower adherence, and individuals in classes with lower adherence had greater baseline levels of depression, substance use concerns, and sexual risk. Differences in study satisfaction were also associated with adherence. Conclusions This study supports the use of text-reported PrEP adherence. Identifying factors associated with less-than-optimal adherence may aid clinicians in anticipating at-risk patients requiring augmented intervention. Clinical trials registration NCT01761643.
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Affiliation(s)
| | - Sonia Jain
- Department of Family and Public Health, University of California-San Diego
| | - Xiaoying Sun
- Department of Family and Public Health, University of California-San Diego
| | - Jill Blumenthal
- Department of Family and Public Health, University of California-San Diego
| | - Eric Ellorin
- Department of Family and Public Health, University of California-San Diego
| | - Katya Corado
- Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance
| | - Michael P Dube
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Eric S Daar
- Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance
| | - Sheldon R Morris
- Department of Family and Public Health, University of California-San Diego
| | - David J Moore
- Department of Psychiatry, University of California-San Diego
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Bristow CC, Morris SR, Little SJ, Mehta SR, Klausner JD. Meta-analysis of the Cepheid Xpert ® CT/NG assay for extragenital detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Sex Health 2019; 16:314-319. [PMID: 31296280 PMCID: PMC6954977 DOI: 10.1071/sh18079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 03/07/2019] [Indexed: 11/23/2022]
Abstract
Background Most studies evaluating extragenital testing performance for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) detection by the Xpert® CT/NG show high per cent agreement with comparison assays; however, the precision around positive per cent agreement is low and thus the values that have been reported are not highly informative. Therefore, a systematic review was conducted and data from five studies were combined to better assess positive per cent agreement. METHODS The literature indexed on PubMed.gov was searched. Included studies were those that were an evaluation of the Xpert CT/NG assay with rectal and/or pharyngeal specimen types compared with another nucleic acid amplification test (NAAT), the Aptima transcription mediated amplification assay. A full Bayesian method was used for bivariate fixed-effect meta-analysis of positive and negative per cent agreement and pooled estimates (and 95% confidence intervals (CI)) were presented for each. RESULTS The pooled positive and negative per cent agreement for detection of CT in rectal specimens was 89.72% (95% CI: 84.97%, 93.64%) and 99.23% (95% CI: 98.74%, 99.60%), and in pharyngeal specimens, they were 89.96% (95% CI: 66.38%, 99.72%) and 99.62% (95% CI: 98.95%, 99.95%) respectively. For NG detection in rectal specimens, the pooled positive and negative per cent agreement was 92.75% (95% CI: 87.91%, 96.46%) and 99.75% (95% CI: 99.46%, 99.93%), and in pharyngeal specimens, they were 92.51% (95% CI: 85.84%, 97.18%) and 98.56% (95% CI: 97.69%, 99.23%) respectively. CONCLUSIONS It was found that the Xpert CT/NG assay performed similarly to the Aptima transcription mediated amplification assay for the detection of CT and NG in extragenital specimens. The Xpert assay has the benefit of providing faster results at the point-of-care, thus reducing the turnaround time for results, potentially enabling same-day treatment.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA; and Corresponding author.
| | - Sheldon R Morris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; and Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
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Hoenigl M, Hassan A, Moore DJ, Anderson PL, Corado K, Dubé MP, Ellorin EE, Blumenthal J, Morris SR. Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2019; 81:166-174. [PMID: 30865175 PMCID: PMC6522282 DOI: 10.1097/qai.0000000000002003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Efficacy of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men is well documented in randomized trials. After trial completion, participants are challenged with acquiring PrEP on their own and remaining adherent. METHODS This was a follow-up study of the TAPIR randomized controlled multicenter PrEP trial. Participants were contacted after their last TAPIR visit (ie, after study-provided PrEP was discontinued) to attend observational posttrial visits 24 and 48 weeks later. Adherence during TAPIR and posttrial visits was estimated by dried blood spot intracellular tenofovir diphosphate levels (adequate adherence defined as tenofovir diphosphate levels >719 fmol/punch). Binary logistic regression analysis assessed predictors of completing posttrial visits and PrEP adherence among participants completing ≥1 visit. RESULTS Of 395 TAPIR participants who were on PrEP as part of the TAPIR trial for a median of 597 days (range 3-757 days), 122 (31%) completed ≥1 posttrial visit (57% of University of California San Diego participants completed posttrial visits, whereas this was 13% or lower for other study sites). Among participants who completed ≥1 posttrial visit, 57% had adequate adherence posttrial. Significant predictors of adequate adherence posttrial were less problematic substance use, higher risk behavior, and adequate adherence in year 1 of TAPIR. CONCLUSION More than half of PrEP users followed after trial completion had successfully acquired PrEP and showed adequate adherence. Additional adherence monitoring and intervention measures may be needed for those with low PrEP adherence and problematic substance use during the first year of trial.
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Affiliation(s)
- Martin Hoenigl
- University of California San Diego (UCSD), San Diego, California, United States
| | - Adiba Hassan
- University of California San Diego (UCSD), San Diego, California, United States
| | - David J. Moore
- University of California San Diego (UCSD), San Diego, California, United States
| | - Peter L. Anderson
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Michael P. Dubé
- Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Eric E. Ellorin
- University of California San Diego (UCSD), San Diego, California, United States
| | - Jill Blumenthal
- University of California San Diego (UCSD), San Diego, California, United States
| | - Sheldon R. Morris
- University of California San Diego (UCSD), San Diego, California, United States
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21
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Hoenigl M, Morgan E, Franklin D, Anderson PL, Pasipanodya E, Dawson M, Hanashiro M, Ellorin EE, Blumenthal J, Heaton R, Moore DJ, Morris SR. Self-initiated continuation of and adherence to HIV pre-exposure prophylaxis (PrEP) after PrEP demonstration project roll-off in men who have sex with men: associations with risky decision making, impulsivity/disinhibition, and sensation seeking. J Neurovirol 2019; 25:324-330. [PMID: 30617849 PMCID: PMC6612450 DOI: 10.1007/s13365-018-0716-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/03/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022]
Abstract
The objective of this study was to examine differences in the levels of risky decision making and other frontal system behavior constructs in relation to self-initiated continuance of HIV pre-exposure prophylaxis (PrEP) and PrEP adherence outcomes among men who have sex with men (MSM) following completion of a clinical PrEP trial. At the last PrEP trial visit, study provided PrEP was discontinued and participants were navigated to the community for PrEP continuation. In this cross-sectional analysis, 84/187 (45%) MSM who completed a prospective observational post-PrEP trial follow-up visit at the University of California San Diego were included. PrEP adherence was measured using dried blood spot tenofovir diphosphate (TFV-DP) levels. Risky decision making was assessed using the Iowa Gambling Task (IGT) and the Balloon Analogue Risk Task (BART), while impulsivity/disinhibition, sensation seeking, and substance use were assessed via standardized self-report questionnaires. A total of 58/84 (69%) of MSM who completed the 12-month post-study visit continued PrEP. Of those, n = 46 (79%) reached TFV-DP levels associated with adequate adherence. Individuals who elected to continue PrEP 12 months post-trial had riskier decision making on BART, but less impulsivity/disinhibition compared to individuals who did not continue PrEP. Neither risky decision making nor impulsivity/disinhibition/sensation seeking nor substance use correlated with PrEP adherence. Our findings suggest that those with risky decision making may have greater insight into their HIV risks, and therefore be more likely to continue to use PrEP. However, elevated impulsivity/disinhibition, indicative of greater neurobehavioral alterations, was negatively associated with PrEP continuance and is a potential target for future interventions to help people link to PrEP.
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Affiliation(s)
- Martin Hoenigl
- University of California San Diego (UCSD), San Diego, CA, USA.
- Medical University of Graz, Graz, Austria.
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA.
| | - Erin Morgan
- University of California San Diego (UCSD), San Diego, CA, USA
| | - Donald Franklin
- University of California San Diego (UCSD), San Diego, CA, USA
| | | | | | - Matthew Dawson
- University of California San Diego (UCSD), San Diego, CA, USA
| | | | - Eric E Ellorin
- University of California San Diego (UCSD), San Diego, CA, USA
| | - Jill Blumenthal
- University of California San Diego (UCSD), San Diego, CA, USA
| | - Robert Heaton
- University of California San Diego (UCSD), San Diego, CA, USA
| | - David J Moore
- University of California San Diego (UCSD), San Diego, CA, USA
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Blumenthal J, Moore DJ, Jain S, Sun X, Ellorin E, Corado K, Hoenigl M, Dube M, Haubrich R, Morris SR. Recent HIV Risk Behavior and Partnership Type Predict HIV Pre-Exposure Prophylaxis Adherence in Men Who Have Sex with Men. AIDS Patient Care STDS 2019; 33:220-226. [PMID: 31067122 PMCID: PMC6531901 DOI: 10.1089/apc.2018.0289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men (MSM) reporting higher HIV risk behavior over time are often more adherent to pre-exposure prophylaxis (PrEP), but it is unclear if recent risk behavior and partnership type affect long-term PrEP adherence. HIV-negative MSM and transgender women completing the 48-week randomized study TAPIR (Daily Text Messages to Support Adherence to PrEP in At-Risk for HIV Individuals) were included. At baseline and weeks 24 and 48, a modified Calculated Risk (mCalcR) Score estimated the likelihood of HIV seroconversion over 1 year based on reported condomless anal sex acts in the last month and current sexually transmitted infection. mCalcR scores were categorized as low, moderate, and high/very high risk. Partnership type was classified as no partner/single HIV-negative partner (no/single-), single HIV-positive partner (single+), or multiple partners of any serostatus (multi) in the past 3 months. PrEP adherence was measured by intracellular tenofovir-diphosphate (TFV-DP) levels. Among 313 individuals, there was no difference in mCalcR category from baseline to week 48. There was a significant change in partnership type, with no/single partnerships increasing from 0.5% to 9%. Participants with moderate and high/very risk had higher TFV-DP levels than the low-risk group. No/single participants had lower TFV-DP levels than those reporting single+ or multi. Although there was a shift toward lower-risk partnerships, HIV risk category remained stable over time. Individuals with riskier behaviors and partnerships had higher PrEP drug levels, suggesting continued motivation for and adherence to PrEP.
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Affiliation(s)
- Jill Blumenthal
- Department of Medicine, University of California San Diego, La Jolla, California
| | - David J. Moore
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Sonia Jain
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Xiaoying Sun
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Eric Ellorin
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Katya Corado
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Michael Dube
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Richard Haubrich
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Sheldon R. Morris
- Department of Medicine, University of California San Diego, La Jolla, California
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23
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Ragonnet-Cronin M, Hu YW, Morris SR, Sheng Z, Poortinga K, Wertheim JO. HIV transmission networks among transgender women in Los Angeles County, CA, USA: a phylogenetic analysis of surveillance data. Lancet HIV 2019; 6:e164-e172. [PMID: 30765313 PMCID: PMC6887514 DOI: 10.1016/s2352-3018(18)30359-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 06/06/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Transgender women are among the groups at highest risk for HIV infection, with a prevalence of 27·7% in the USA; and despite this known high risk, undiagnosed infection is common in this population. We set out to identify transgender women and their partners in a molecular transmission network to prioritise public health activities. METHODS Since 2006, HIV protease and reverse transcriptase gene (pol) sequences from drug resistance testing have been reported to the Los Angeles County Department of Public Health and linked to demographic data, gender, and HIV transmission risk factor data for each case in the enhanced HIV/AIDS Reporting System. We reconstructed a molecular transmission network by use of HIV-TRAnsmission Cluster Engine (with a pairwise genetic distance threshold of 0·015 substitutions per site) from the earliest pol sequences from 22 398 unique individuals, including 412 (2%) self-identified transgender women. We examined the possible predictors of clustering with multivariate logistic regression. We characterised the genetically linked partners of transgender women and calculated assortativity (the tendency for people to link to other people with the same attributes) for each transmission risk group. FINDINGS 8133 (36·3%) of 22 398 individuals clustered in the network across 1722 molecular transmission clusters. Transgender women who indicated a sexual risk factor clustered at the highest frequency in the network, with 147 (43%) of 345 being linked to at least one other person (adjusted odds ratio [aOR] 2·0, p=0·0002). Transgender women were assortative in the network (assortativity 0·06, p<0·001), indicating that they tended to link to other transgender women. Transgender women were more likely than expected to link to other transgender women (OR 4·65, p<0·001) and cisgender men who did not identify as men who have sex with men (MSM; OR 1·53, p<0·001). Transgender women were less likely than expected to link to MSM (OR 0·75, p<0·001), despite the high prevalence of HIV among MSM. Transgender women were distributed across 126 clusters, and cisgender individuals linked to one transgender woman were 9·2 times more likely to link to a second transgender woman than other individuals in the surveillance database. Reconstruction of the transmission network is limited by sample availability, but sequences were available for more than 40% of diagnoses. INTERPRETATION Clustering of transgender women and the observed tendency for linkage with cisgender men who did not identify as MSM, shows the potential to use molecular epidemiology both to identify clusters that are likely to include undiagnosed transgender women with HIV and to improve the targeting of public health prevention and treatment services to transgender women. FUNDING California HIV and AIDS Research Program and National Institutes of Health-National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Manon Ragonnet-Cronin
- Department of Medicine, University of California, San Diego, CA, USA; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Yunyin W Hu
- Division of HIV and STD Programs, Department of Public Health, Los Angeles, CA, USA
| | - Sheldon R Morris
- Department of Medicine, University of California, San Diego, CA, USA
| | - Zhijuan Sheng
- Division of HIV and STD Programs, Department of Public Health, Los Angeles, CA, USA
| | - Kathleen Poortinga
- Division of HIV and STD Programs, Department of Public Health, Los Angeles, CA, USA
| | - Joel O Wertheim
- Department of Medicine, University of California, San Diego, CA, USA
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Cristillo AD, Bristow CC, Torrone E, Dillon JA, Kirkcaldy RD, Dong H, Grad YH, Nicholas RA, Rice PA, Lawrence K, Oldach D, Shafer WM, Zhou P, Wi TE, Morris SR, Klausner JD. Antimicrobial Resistance in Neisseria gonorrhoeae: Proceedings of the STAR Sexually Transmitted Infection-Clinical Trial Group Programmatic Meeting. Sex Transm Dis 2019; 46:e18-e25. [PMID: 30363025 PMCID: PMC6370498 DOI: 10.1097/olq.0000000000000929] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
The goal of the Sexually Transmitted Infection Clinical Trial Group's Antimicrobial Resistance (AMR) in Neisseria gonorrhoeae (NG) meeting was to assemble experts from academia, government, nonprofit and industry to discuss the current state of research, gaps and challenges in research and technology and priorities and new directions to address the continued emergence of multidrug-resistant NG infections. Topics discussed at the meeting, which will be the focus of this article, include AMR NG global surveillance initiatives, the use of whole genome sequencing and bioinformatics to understand mutations associated with AMR, mechanisms of AMR, and novel antibiotics, vaccines and other methods to treat AMR NG. Key points highlighted during the meeting include: (i) US and International surveillance programs to understand AMR in NG; (ii) the US National Strategy for combating antimicrobial-resistant bacteria; (iii) surveillance needs, challenges, and novel technologies; (iv) plasmid-mediated and chromosomally mediated mechanisms of AMR in NG; (v) novel therapeutic (eg, sialic acid analogs, factor H [FH]/Fc fusion molecule, monoclonal antibodies, topoisomerase inhibitors, fluoroketolides, LpxC inhibitors) and preventative (eg, peptide mimic) strategies to combat infection. The way forward will require renewed political will, new funding initiatives, and collaborations across academic and commercial research and public health programs.
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Affiliation(s)
- Anthony D. Cristillo
- From the Department of Clinical Research and Bioscience Social & Scientific Systems, Inc., Silver Spring, MD
| | - Claire C. Bristow
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA
| | - Elizabeth Torrone
- Division of STD Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Jo-Anne Dillon
- Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Robert D. Kirkcaldy
- Division of STD Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Huan Dong
- Charles R. Drew University of Medicine and Sciences, Los Angeles, CA
- David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Robert A. Nicholas
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Peter A. Rice
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | | | | | - William Maurice Shafer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta
- Veterans Affairs Medical Center, Decatur, GA
| | - Pei Zhou
- Department of Biochemistry, Duke University Medical Center, Durham, NC; and
| | - Teodora E. Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; and
| | - Sheldon R. Morris
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA
| | - Jeffrey D. Klausner
- Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA
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25
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O'Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Cheung E, Han HS, Daniel BR, Vojnovic Z, Vasev N, Ling M, Richards DA, Wilks ST, Milenkovic D, Sorrentino JA, Roberts PJ, Bomar M, Yang Z, Antal JM, Malik RK, Morris SR, Tan A. Abstract PD1-01: Trilaciclib (T), a CDK4/6 inhibitor, dosed with gemcitabine (G), carboplatin (C) in metastatic triple negative breast cancer (mTNBC) patients: Preliminary phase 2 results. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd1-01] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
Abstract
Background: Cytotoxic chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPCs) results in acute toxicities consisting of multi-lineage myelosuppression, and late onset toxicities consisting of progressive bone marrow suppression with increased incidence of therapy-related myeloid neoplasms. T is an IV CDK4/6 inhibitor in development to preserve HSPC and immune system function during cytotoxic chemotherapy (myelopreservation). Proof of concept for myelopreservation with T was observed in a randomized, placebo-controlled Phase 2 trial in small-cell lung cancer patients receiving 1st-line chemotherapy. This trial in mTNBC patients (NCT02978716) was designed to explore the utility of T in combination with GC.
Methods: This Phase 2, randomized, open-label study enrolled patients in the US and EU with mTNBC who had received 0-2 prior systemic cytotoxic therapies in the locally recurrent or metastatic setting and had no symptomatic brain metastases. Patients were randomized (1:1:1) to GC alone (Group 1) or T plus GC (Group 2) using a standard schedule (D1, 8 every 21 days) or to an alternative schedule (T on D1, 2, 8 and 9 with GC on D2 and 9 every 21 days; Group 3). On those days when both T and GC were scheduled, T was administered iv prior to GC infusion. Prophylactic growth factors were not administered in cycle 1; otherwise supportive care was allowed as needed. Primary objectives were safety and tolerability; tumor response was evaluated using RECIST v1.1 and PFS and OS were assessed. Myelopreservation endpoints reflecting the potential effects of T on multiple cellular lineages include occurrence of Grade 4 neutropenia (primary), RBC and platelet transfusions (primary), and lymphocyte counts with immune profiling (secondary and exploratory). A signature of CDK4/6 independence developed from preclinical data will be used to evaluate archival tumor tissue samples and data analysis is ongoing.
Results: 95 patients were dosed; median age 57 years (range 32,86), ECOG PS 0 (53%) or 1 (47%), 25% had liver metastases at baseline, and approximately 50% had received no systemic therapy in the recurrent/metastatic setting. Fifty-five patients remain on treatment. Disease progression was the most common reason for drug discontinuation (22/40; 55%). Overall the most common (≥ 25%) TEAEs were anemia (47%), nausea (35%), fatigue (34%), neutropenia (32%), platelet count decreased (25%), and vomiting (25%). The most frequent (≥ 15%) Grade 3 or 4 TEAEs were hematologic toxicities, i.e. neutropenia (28%), anemia (21%), neutrophil count decreased (21%) and thrombocytopenia (16%). These were also the most frequent drug-related TEAEs observed. Tumor efficacy data are being evaluated.
Conclusions: This trial, assessing the myelopreservation effects of T when combined with GC in patients with mTNBC, has completed enrollment. Myelopreservation data, immune profiling, as well as ORR and preliminary PFS results will be presented by study arm at the meeting.
Citation Format: O'Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Cheung E, Han HS, Daniel BR, Vojnovic Z, Vasev N, Ling M, Richards DA, Wilks ST, Milenkovic D, Sorrentino JA, Roberts PJ, Bomar M, Yang Z, Antal JM, Malik RK, Morris SR, Tan A. Trilaciclib (T), a CDK4/6 inhibitor, dosed with gemcitabine (G), carboplatin (C) in metastatic triple negative breast cancer (mTNBC) patients: Preliminary phase 2 results [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD1-01.
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Affiliation(s)
- J O'Shaughnessy
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - GS Wright
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - AR Thummala
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - MA Danso
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - L Popovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - TJ Pluard
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - E Cheung
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - HS Han
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - BR Daniel
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - Z Vojnovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - N Vasev
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - M Ling
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - DA Richards
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - ST Wilks
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - D Milenkovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - JA Sorrentino
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - PJ Roberts
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - M Bomar
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - Z Yang
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - JM Antal
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - RK Malik
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - SR Morris
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - A Tan
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
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Milam J, Jain S, Dubé MP, Daar ES, Sun X, Corado K, Ellorin E, Blumenthal J, Haubrich R, Moore DJ, Morris SR. Sexual Risk Compensation in a Pre-exposure Prophylaxis Demonstration Study Among Individuals at Risk of HIV. J Acquir Immune Defic Syndr 2019; 80:e9-e13. [PMID: 30334877 PMCID: PMC6289757 DOI: 10.1097/qai.0000000000001885] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A public health concern regarding HIV pre-exposure prophylaxis (PrEP) is sexual risk compensation (ie, increased unsafe sex among PrEP users that may undermine prevention efforts). METHODS This demonstration study (NCT#01761643; initiated in 2013) included 398 men who have sex with men who initiated PrEP and were followed over 48 weeks at 4 sites in Southern California. Wilcoxon signed-rank tests compared previous 30-day number of sex partners and condomless insertive anal sex and receptive anal sex (CIAS and CRAS, respectively) acts at weeks 4, 12, 24, 36, and 48 to baseline. At 2 sites, PrEP users were also compared with a lagged, comparison group of 99 men who have sex with men who did not receive PrEP over 24 weeks using linear regression models, adjusting for age, race/ethnicity, education, and respective baseline scores. Logistic regression compared week 24 sexually transmitted infection (STI) rates. RESULTS Over 48 weeks in the PrEP group, there were significant decreases in the number of unknown HIV status sex partners and increases in CRAS at all study visits; there was no consistent change in number of HIV+ sex partners or CIAS. Among participants at 2 sites, there were no significant differences between PrEP and non-PrEP users in change in number of partners, CIAS, CRAS, or STI rates at week 24. CONCLUSIONS Among early adopters of PrEP, there is some evidence for sexual risk compensation. Results support current guidelines of regular STI screening and behavioral risk reduction and adherence counseling with the provision of PrEP.
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Affiliation(s)
- Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Sonia Jain
- University of California, San Diego, San Diego, CA
| | - Michael P Dubé
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- Long Beach Department of Health and Human Services, Long Beach, CA
- University of Colorado Denver, Denver, CO
| | - Xiaoying Sun
- University of California, San Diego, San Diego, CA
| | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Eric Ellorin
- University of California, San Diego, San Diego, CA
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27
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Dubé MP, Park SY, Ross H, Love TMT, Morris SR, Lee HY. Daily HIV pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate-emtricitabine reduced Streptococcus and increased Erysipelotrichaceae in rectal microbiota. Sci Rep 2018; 8:15212. [PMID: 30315206 PMCID: PMC6185988 DOI: 10.1038/s41598-018-33524-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/25/2018] [Indexed: 12/25/2022] Open
Abstract
Daily PrEP is highly effective at preventing HIV-1 acquisition, but risks of long-term tenofovir disoproxil fumarate plus emtricitabine (TDF-FTC) include renal decline and bone mineral density decrease in addition to initial gastrointestinal side effects. We investigated the impact of TDF-FTC on the enteric microbiome using rectal swabs collected from healthy MSM before PrEP initiation and after 48 to 72 weeks of adherent PrEP use. The V4 region of the 16S ribosomal RNA gene sequencing showed that Streptococcus was significantly reduced from 12.0% to 1.2% (p = 0.036) and Erysipelotrichaceae family was significantly increased from 0.79% to 3.3% (p = 0.028) after 48–72 weeks of daily PrEP. Catenibacterium mitsuokai, Holdemanella biformis and Turicibacter sanguinis were increased within the Erysipelotrichaceae family and Streptococcus agalactiae, Streptococcus oralis, Streptococcus mitis were reduced. These changes were not associated with host factors including PrEP duration, age, race, tenofovir diphosphate blood level, any drug use and drug abuse, suggesting that the observed microbiome shifts were likely induced by daily PrEP use. Long-term PrEP resulted in increases of Catenibacterium mitsuokai and Holdemanella biformis, which have been associated with gut microbiome dysbiosis. Our observations can aid in characterizing PrEP’s side effects, which is likely to improve PrEP adherence, and thus HIV-1 prevention.
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Affiliation(s)
- Michael P Dubé
- Department of Medicine and Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sung Yong Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Heather Ross
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tanzy M T Love
- Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Sheldon R Morris
- University of California San Diego Antiviral Research Center, San Diego, CA, USA
| | - Ha Youn Lee
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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28
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Hassan A, Blumenthal JS, Dube MP, Ellorin E, Corado K, Moore DJ, Morris SR. Effect of rectal douching/enema on rectal gonorrhoea and chlamydia among a cohort of men who have sex with men on HIV pre-exposure prophylaxis. Sex Transm Infect 2018; 94:508-514. [PMID: 29907624 DOI: 10.1136/sextrans-2017-053484] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 11/29/2017] [Revised: 04/14/2018] [Accepted: 05/13/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Rectal douching/enema (RD) is a common practice among men who have sex with men (MSM) in preparation for sex. RD can break down the rectal mucosal barrier and potentially affect the rectal microbiome. The objective of this study was to understand if RD is associated with acquiring rectal infections (RI) with rectal gonorrhoea (NG) and/or chlamydia (CT). METHODS From 2013 to 2015, 395 adult HIV-uninfected MSM were enrolled in a randomised controlled study for pre-exposure prophylaxis (PrEP) adherence with routine sexual risk survey and testing. Using data from this cohort, baseline differences by RI were assessed using Pearson's χ² and Wilcoxon-Mann-Whitney test. Association between RD and RI was modelled using multivariable logistic regression adjusted for potential confounders (sexual behaviour, substance use and age) selected a priori. Effect modification by number of male partners and sensitivity analysis to rule out reverse causality were also conducted. RESULTS Of 395 participants, 261 (66%) performed RD and 133 (33%) had at least one NG/CT RI over 48 weeks. Number of condomless anal receptive sex (med: 4, p<0.001), male partners (med:6, p<0.001) and substance use (any of methamphetamine/hallucinogens/dissociative/poppers) (p<0.001) were associated with increased odds of RI. Controlling for potential confounders, odds of prevalent RI were 3.59 (p<0.001, 95% CI 1.90 to 6.78) and incident RI 3.87 (p=0.001, 95% CI 1.78 to 8.39) when douching weekly or more compared with not douching. MSM with more than six male partners had 5.34 (p=0.002, 95% CI 1.87 to 15.31) increased odds of RI when douching weekly or more compared with not douching. CONCLUSION Rectal hygiene with RD is a common practice (66%) among HIV-uninfected MSM on PrEP in this study, which increases the odds of acquiring rectal NG and/or CT independent of sexual risk behaviour, substance use and other factors. This suggests interventional approaches targeting rectal hygiene products and practices could reduce sexually transmitted infections.
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Affiliation(s)
- Adiba Hassan
- Antiviral Research Center, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jill S Blumenthal
- Antiviral Research Center, University of California San Diego School of Medicine, San Diego, California, USA
| | - Michael P Dube
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Eric Ellorin
- Antiviral Research Center, University of California San Diego School of Medicine, San Diego, California, USA
| | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Division of HIV Medicine, Torrance, California, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Sheldon R Morris
- Antiviral Research Center, University of California San Diego School of Medicine, San Diego, California, USA
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29
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Morris SR, Zhao M, Smith DM, Vargas MV, Little SJ, Gianella S. Longitudinal Viral Dynamics in Semen During Early HIV Infection. Clin Infect Dis 2017; 64:428-434. [PMID: 28174909 PMCID: PMC5849030 DOI: 10.1093/cid/ciw784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/18/2016] [Indexed: 12/30/2022] Open
Abstract
Background Multiple viruses coinfect the male genital tract, influencing each other’s replication and perhaps affecting human immunodeficiency virus (HIV) pathogenesis and disease progression. Methods This study included 453 longitudinal seminal samples from 195 HIV-infected men from the San Diego Primary Infection Resource Consortium and 67 seminal samples from HIV-negative healthy controls. Seminal HIV RNA and DNA from 7 human herpesviruses (HHVs) were measured by real-time polymerase chain reaction. Longitudinal shedding rates were determined by Kaplan-Meier survival analysis. Predictors of viral shedding were determined using backwards selection in a multivariable generalized estimating equation model. Results HIV-infected participants presented significantly increased rates of seminal HHV shedding compared with HIV-uninfected controls. Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) were the most commonly detected HHV in semen of HIV-infected participants. Persistent shedding was more common for CMV and EBV when compared to other HHVs. With exception of HHV-7, HHV shedding was not significantly influenced by HIV RNA levels, CD4+ cell counts, or antiretroviral therapy. Presence of CMV, EBV, and herpes simplex virus (HSV) were independent predictors of genital HIV RNA shedding after adjusting for plasma HIV RNA and longitudinal measurements. Conclusions Seminal replication of multiple HHVs is common in our HIV primary infection cohort. Genital replication of CMV and EBV was the most common and was significantly associated with seminal HIV RNA shedding. Prevalence of HSV shedding was lower and mostly intermittent, but its association with seminal HIV RNA was the strongest. Understanding the complex viral milieu in semen is important for HIV transmission but might also play a role in HIV pathogenesis and disease progression.
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Affiliation(s)
| | | | - Davey M Smith
- University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, San Diego, California
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Osorio G, Hoenigl M, Quartarolo J, Barger K, Morris SR, Reed SL, Lee J, Little SJ. Evaluation of opt-out inpatient HIV screening at an urban teaching hospital. AIDS Care 2017; 29:1014-1018. [PMID: 28114789 DOI: 10.1080/09540121.2017.1282106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study evaluated opt-out inpatient HIV screening delivered by admitting physicians, and compared number of HIV tests and diagnoses to signs and symptoms-directed HIV testing (based on physician orders) in the emergency department (ED). The opt-out inpatient HIV screening program was conducted over a one year period in patients who were admitted to the 386-bed University of California San Diego (UCSD) teaching hospital. Numbers of HIV tests and diagnoses were compared to those observed among ED patients who underwent physician-directed HIV testing during the same time period. Survey data were collected from a convenience sample of patients and providers regarding the opt-out testing program. Among 8488 eligible inpatients, opt-out HIV testing was offered to 3017 (36%) patients, and rapid antibody testing was performed in 1389 (16.4%) inpatients, resulting in 6 (0.4% of all tests) newly identified HIV infections (5/6 were admitted through the ED). Among 27,893 ED patients, rapid antibody testing was performed in 88 (0.3%), with 7 (8.0% of all tests) new HIV infections identified. HIV diagnoses in the ED were more likely to be men who have sex with men (MSM) (p = 0.029) and tended to have AIDS-related opportunistic infections (p = 0.103) when compared to HIV diagnoses among inpatients. While 85% of the 150 physicians who completed the survey were aware of the HIV opt-out screening program, 44% of physicians felt that they did not have adequate time to consent patients for the program, and only 30% agreed that a physician is best-suited to consent patients. In conclusion, the yield of opt-out HIV rapid antibody screening in inpatients was comparable to the national HIV prevalence average. However, uptake of screening was markedly limited in this setting where opt-out screening was delivered by physicians during routine care, with limited time resources being the major barrier.
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Affiliation(s)
- Georgina Osorio
- a Division of Infectious Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , USA.,b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | - Martin Hoenigl
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.,c Division of Pulmonology, Department of Internal Medicine , Medical University of Graz , Graz , Austria.,d Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - Jennifer Quartarolo
- e Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | | | - Sheldon R Morris
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | - Sharon L Reed
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.,g Department of Pathology , University of California San Diego (UCSD) , San Diego , USA
| | - Joshua Lee
- h Department of Medicine , Stritch School of Medicine, Loyola University of Chicago , Maywood , USA
| | - Susan J Little
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
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Zipeto MA, Court AC, Sadarangani A, Delos Santos NP, Balaian L, Chun HJ, Pineda G, Morris SR, Mason CN, Geron I, Barrett C, Goff DJ, Wall R, Pellecchia M, Minden M, Frazer KA, Marra MA, Crews LA, Jiang Q, Jamieson CHM. ADAR1 Activation Drives Leukemia Stem Cell Self-Renewal by Impairing Let-7 Biogenesis. Cell Stem Cell 2016; 19:177-191. [PMID: 27292188 PMCID: PMC4975616 DOI: 10.1016/j.stem.2016.05.004] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [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: 01/03/2016] [Revised: 04/12/2016] [Accepted: 05/06/2016] [Indexed: 12/17/2022]
Abstract
Post-transcriptional adenosine-to-inosine RNA editing mediated by adenosine deaminase acting on RNA1 (ADAR1) promotes cancer progression and therapeutic resistance. However, ADAR1 editase-dependent mechanisms governing leukemia stem cell (LSC) generation have not been elucidated. In blast crisis chronic myeloid leukemia (BC CML), we show that increased JAK2 signaling and BCR-ABL1 amplification activate ADAR1. In a humanized BC CML mouse model, combined JAK2 and BCR-ABL1 inhibition prevents LSC self-renewal commensurate with ADAR1 downregulation. Lentiviral ADAR1 wild-type, but not an editing-defective ADAR1(E912A) mutant, induces self-renewal gene expression and impairs biogenesis of stem cell regulatory let-7 microRNAs. Combined RNA sequencing, qRT-PCR, CLIP-ADAR1, and pri-let-7 mutagenesis data suggest that ADAR1 promotes LSC generation via let-7 pri-microRNA editing and LIN28B upregulation. A small-molecule tool compound antagonizes ADAR1's effect on LSC self-renewal in stromal co-cultures and restores let-7 biogenesis. Thus, ADAR1 activation represents a unique therapeutic vulnerability in LSCs with active JAK2 signaling.
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Affiliation(s)
- Maria Anna Zipeto
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Angela C Court
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Anil Sadarangani
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Nathaniel P Delos Santos
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Larisa Balaian
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Hye-Jung Chun
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Gabriel Pineda
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Sheldon R Morris
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Cayla N Mason
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Ifat Geron
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Christian Barrett
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Daniel J Goff
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Russell Wall
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Maurizio Pellecchia
- School of Medicine, University of California Riverside, Riverside, CA 92521, USA
| | - Mark Minden
- Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada
| | - Kelly A Frazer
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Leslie A Crews
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Qingfei Jiang
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Catriona H M Jamieson
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center and Sanford Consortium for Regenerative Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
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Crews LA, Balaian L, Leu HS, Delos Santos NP, Court AC, Sadarangani A, Zipeto MA, La Clair JJ, Villa R, Morris SR, Storb R, Kulidjian A, Ball ED, Burkart MD, Jamieson CH. Abstract 915: RNA processing signatures of normal versus malignant progenitor cell aging predict leukemia stem cell sensitivity to RNA splicing modulation. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Human bone marrow aging is typified by decreased cellularity, stem cell exhaustion and myeloid lineage bias that may set the stage for development of myeloid malignancies. Secondary AML (sAML) is a malignancy that has been associated with alterations in RNA processing genes and currently has few effective treatment options available. A central goal of future therapeutic strategies is to prevent disease relapse and therapeutic resistance by selectively targeting unique gene products that are essential to LSC but not normal HSC function. Therefore, we established whole gene, long non-coding RNA (lncRNA), splice isoform, and RNA editing signatures of benign versus malignant bone marrow progenitor cell aging, and evaluated the therapeutic efficacy of splicing-targeted agents in pre-clinical humanized in vitro and in vivo model systems.
Methods: Whole transcriptome sequencing (RNA-Seq) was performed on FACS-purified hematopoietic stem (CD34+CD38-Lin-) and progenitor cells (CD34+CD38+Lin-) from aged (average age = 65.9 ± 6.8 years old) versus young (average age = 25.8 ± 3.0 years old) adult healthy bone marrow samples, and in leukemia stem cells (LSC) from patients with sAML (average age = 71.4 ± 7.9 years old). Comparative gene set enrichment analyses (GSEA), splice isoform, lncRNA, and RNA editing profiles were identified for normal and malignant progenitor cell aging. Then, we evaluated the spliceosome modulatory agent 17S-FD-895 in splicing reporter activity, PCR, and functional in vitro hematopoietic progenitor and in vivo LSC primagraft assays.
Results: Disruption of pre-mRNA splicing activity has recently been implicated as a therapeutic vulnerability in some types of cancer. Comparative whole transcriptome RNA sequencing (RNA-seq) analyses revealed pre-mRNA splicing factor gene expression was significantly disrupted in human AML LSC compared with age-matched normal progenitors. Comparative splice isoform RNA-seq and qRT-PCR validation revealed recurrent intron retention and exon skipping in expressed transcripts, such as PTK2B and several protein phosphatase gene products. Notably, transcription factor profiling of AML LSC demonstrated downregulation of key tumor suppressor genes, such as IRF8 and TP53. We then investigated the LSC inhibitory efficacy of a stable and potent splicing modulatory agent, 17S-FD-895, in humanized stromal co-culture and AML LSC primagraft assays. Pharmacological spliceosome modulation disrupted AML LSC maintenance in vivo by altering splicing of stem cell survival and AML-associated transcripts at doses that spared normal hematopoietic progenitors.
Conclusions: Detection and targeted modulation of aberrant RNA processing provides an innovative strategy for AML LSC eradication with implications for treatment of a variety of human malignancies and other age-related disorders.
Citation Format: Leslie A. Crews, Larisa Balaian, Heather S. Leu, Nathaniel P. Delos Santos, Angela C. Court, Anil Sadarangani, Maria A. Zipeto, James J. La Clair, Reymundo Villa, Sheldon R. Morris, Rainer Storb, Anna Kulidjian, Edward D. Ball, Michael D. Burkart, Catriona H.M. Jamieson. RNA processing signatures of normal versus malignant progenitor cell aging predict leukemia stem cell sensitivity to RNA splicing modulation. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 915.
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Affiliation(s)
| | | | | | | | | | | | | | - James J. La Clair
- 2UC San Diego Department of Chemistry and Biochemistry, La Jolla, CA
| | - Reymundo Villa
- 2UC San Diego Department of Chemistry and Biochemistry, La Jolla, CA
| | | | - Rainer Storb
- 4Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anna Kulidjian
- 5UC San Diego Department of Orthopedic Surgery, La Jolla, CA
| | - Edward D. Ball
- 6UC San Diego Division of Bone Marrow Transplantation, La Jolla, CA
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Gianella S, Ginocchio CC, Daar ES, Dube MP, Morris SR. Genital Epstein Barr Virus is associated with higher prevalence and persistence of anal human papillomavirus in HIV-infected men on antiretroviral therapy. BMC Infect Dis 2016; 16:24. [PMID: 26809559 PMCID: PMC4727320 DOI: 10.1186/s12879-016-1356-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background Epstein Barr virus (EBV) and human papillomavirus (HPV) can co-exist in pharyngeal and cervical malignancies. However, the natural history and factors associated with persistent HPV infection among HIV-infected men who have sex with men (MSM) are unclear. Methods 131 HIV-infected MSM were followed for 48 weeks and screened for multiple co-infections, including seminal EBV DNA and high risk (HR)-HPV messenger RNA (mRNA) at several sites (semen, anal, pharynx). Primary analysis tested if seminal EBV shedding was associated with increased prevalence of HR-HPV at baseline using univariate tests and multivariable logistic regression. In participants with detectable anal HR-HPV at baseline, we tested if presence of seminal EBV shedding at baseline was also predictive of reduced HR-HPV clearance by log-rank test (over 48 weeks of follow-up). Results Baseline prevalence of HR-HPV was: anal 44 % (N = 54/121); pharynx 3.8 % (N = 5/131); semen 7.1 % (N = 7/98). Seminal EBV shedding was present in 28 % of participants and was associated with more than double the prevalence of detectable anal HR-HPV mRNA (71.4 % for EBV shedders versus 33.3 % for non-shedders, p < 0.01). In participants with detectable anal HR-HPV at baseline, we found increased persistence of HR-HPV over 48 weeks of follow-up (measured as time to first negative HR-HPV test in the EBV shedding group (p < 0.01). Conclusions Seminal EBV shedding was associated with an increased risk of having detectable anal HR-HPV in a cohort of HIV-infected MSM on suppressive ART. Future studies should examine if co-infection with EBV and HR-HPV may act synergistically in pathogenesis of anal cancer in HIV-infected individuals.
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Affiliation(s)
- Sara Gianella
- University of California San Diego, 500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA.
| | - Christine C Ginocchio
- North Shore-LIJ Health System, Lake Success, NY, USA. .,Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
| | - Michael P Dube
- University of Southern California Keck School of Medicine, 1300 N. Mission Road, Suite 349, Los Angeles, CA 91106, CA, USA.
| | - Sheldon R Morris
- University of California San Diego, 500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA. .,University of California San Diego, 200 Arbor Dr., Mail code 8208, San Diego, CA, 92103, USA.
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Gianella S, Smith DM, Daar ES, Dube MP, Lisco A, Vanpouille C, Margolis L, Haubrich RH, Morris SR. Genital Cytomegalovirus Replication Predicts Syphilis Acquisition among HIV-1 Infected Men Who Have Sex with Men. PLoS One 2015; 10:e0130410. [PMID: 26061824 PMCID: PMC4465639 DOI: 10.1371/journal.pone.0130410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/20/2015] [Indexed: 01/05/2023] Open
Abstract
Objective Sexually transmitted infections (STI) are common among HIV-infected men who have sex with men (MSM). While behavioral factors are important in STI acquisition, other biological factors such as immune modulation due to chronic viral infection may further predispose to STI acquisition. Design Post Hoc analysis including data collected over 12 months of follow-up from 131 HIV-infected MSM receiving antiretroviral therapy and screened for incident bacterial STI every 3 months. Methods Genital secretions collected at baseline were used to measure herpesvirus replication and inflammatory cytokines. Baseline predictors of STI were determined using survival analysis of time to incident STI. Results All participants were seropositive for cytomegalovirus (CMV), and 52% had detectable genital CMV at baseline. Thirty-five individuals acquired STI during follow-up, sometimes with multiple pathogen (17 syphilis, 21 gonorrhea, 14 chlamydia). Syphilis acquisition was associated with genital CMV replication at baseline (19.1% CMV-shedders versus 4.8% non-shedders, p=0.03) and younger age (p=0.02). Lower seminal MCP-1 was associated with higher seminal CMV levels and with syphilis acquisition (p<0.01). For syphilis acquisition, in multivariable Cox-Proportional Hazard model adjusted hazard rates were 3.56 (95%CI:1.00–12.73) for baseline CMV replication and 2.50 (0.92–6.77) for younger age. Conclusions This post hoc analysis suggest that CMV-associated decrease in seminal MCP-1 levels might predispose HIV-infected MSM to syphilis acquisition, but not other STI. Future studies should determine underlying mechanisms and if a causal association exists.
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Affiliation(s)
- Sara Gianella
- University of California, San Diego, La Jolla, California, United States of America
| | - Davey M Smith
- University of California, San Diego, La Jolla, California, United States of America; Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Michael P Dube
- University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Andrea Lisco
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Christophe Vanpouille
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Leonid Margolis
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Richard H Haubrich
- University of California, San Diego, La Jolla, California, United States of America
| | - Sheldon R Morris
- University of California, San Diego, La Jolla, California, United States of America
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Sadarangani A, Pineda G, Lennon KM, Chun HJ, Shih A, Schairer AE, Court AC, Goff DJ, Prashad SL, Geron I, Wall R, McPherson JD, Moore RA, Pu M, Bao L, Jackson-Fisher A, Munchhof M, VanArsdale T, Reya T, Morris SR, Minden MD, Messer K, Mikkola HKA, Marra MA, Hudson TJ, Jamieson CHM. GLI2 inhibition abrogates human leukemia stem cell dormancy. J Transl Med 2015; 13:98. [PMID: 25889765 PMCID: PMC4414375 DOI: 10.1186/s12967-015-0453-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/06/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dormant leukemia stem cells (LSC) promote therapeutic resistance and leukemic progression as a result of unbridled activation of stem cell gene expression programs. Thus, we hypothesized that 1) deregulation of the hedgehog (Hh) stem cell self-renewal and cell cycle regulatory pathway would promote dormant human LSC generation and 2) that PF-04449913, a clinical antagonist of the GLI2 transcriptional activator, smoothened (SMO), would enhance dormant human LSC eradication. METHODS To test these postulates, whole transcriptome RNA sequencing (RNA-seq), microarray, qRT-PCR, stromal co-culture, confocal fluorescence microscopic, nanoproteomic, serial transplantation and cell cycle analyses were performed on FACS purified normal, chronic phase (CP) chronic myeloid leukemia (CML), blast crisis (BC) phase CML progenitors with or without PF-04449913 treatment. RESULTS Notably, RNA-seq analyses revealed that Hh pathway and cell cycle regulatory gene overexpression correlated with leukemic progression. While lentivirally enforced GLI2 expression enhanced leukemic progenitor dormancy in stromal co-cultures, this was not observed with a mutant GLI2 lacking a transactivation domain, suggesting that GLI2 expression prevented cell cycle transit. Selective SMO inhibition with PF-04449913 in humanized stromal co-cultures and LSC xenografts reduced downstream GLI2 protein and cell cycle regulatory gene expression. Moreover, SMO inhibition enhanced cell cycle transit and sensitized BC LSC to tyrosine kinase inhibition in vivo at doses that spare normal HSC. CONCLUSION In summary, while GLI2, forms part of a core HH pathway transcriptional regulatory network that promotes human myeloid leukemic progression and dormant LSC generation, selective inhibition with PF-04449913 reduces the dormant LSC burden thereby providing a strong rationale for clinical trials predicated on SMO inhibition in combination with TKIs or chemotherapeutic agents with the ultimate aim of obviating leukemic therapeutic resistance, persistence and progression.
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Affiliation(s)
- Anil Sadarangani
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA. .,Division of Regenerative Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0820, USA.
| | - Gabriel Pineda
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Kathleen M Lennon
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Hye-Jung Chun
- Canada's Michael Smith Genome Sciences Center, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Alice Shih
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Annelie E Schairer
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Angela C Court
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Daniel J Goff
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Sacha L Prashad
- Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA.
| | - Ifat Geron
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Russell Wall
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | | | - Richard A Moore
- Canada's Michael Smith Genome Sciences Center, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Minya Pu
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Lei Bao
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | | | | | | | - Tannishtha Reya
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Sheldon R Morris
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Mark D Minden
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
| | - Karen Messer
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA.
| | - Hanna K A Mikkola
- Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA.
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Center, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | | | - Catriona H M Jamieson
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, 92037, CA, USA. .,Division of Regenerative Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0820, USA.
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Morris SR, Woods SP, Deutsch R, Little SJ, Wagner G, Morgan EE, Heaton RK, Letendre SL, Grant I, Smith DM. Dual-mixed HIV-1 coreceptor tropism and HIV-associated neurocognitive deficits. J Neurovirol 2014; 19:488-94. [PMID: 24078557 DOI: 10.1007/s13365-013-0203-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/14/2013] [Accepted: 08/20/2013] [Indexed: 11/30/2022]
Abstract
HIV coreceptor usage of CXCR4 (X4) is associated with decreased CD4+ T-cell counts and accelerated disease progression, but the role of X4 tropism in HIV-associated neurocognitive disorders (HAND) has not previously been described. This longitudinal study evaluated data on 197 visits from 72 recently HIV-infected persons who had undergone up to four sequential neurocognitive assessments over a median of 160 days (IQR, 138–192). Phenotypic tropism testing (Trofile ES, Monogram, Biosciences) was performed on stored blood samples. Multivariable mixed model repeated measures regression was used to determine the association between HAND and dual-mixed (DM) viral tropism, estimated duration of infection (EDI), HIV RNA, CD4 count, and problematic methamphetamine use. Six subjects (8.3 %) had DM at their first neurocognitive assessment and four converted to DM in subsequent sampling (for total of 10 DM) at a median EDI of 10.1 months (IQR, 7.2–12.2). There were 44 (61.1 %) subjects who demonstrated HAND on at least one study visit. HAND was associated with DM tropism (odds ratio, 4.4; 95 % CI, 0.9–20.5) and shorter EDI (odds ratio 1.1 per month earlier; 95 % CI, 1.0–1.2). This study found that recency of HIV-1 infection and the development of DM tropism may be associated with HAND in the relatively early stage of infection. Together, these data suggest that viral interaction with cellular receptors may play an important role in the early manifestation of HAND.
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Wagner GA, Pacold ME, Kosakovsky Pond SL, Caballero G, Chaillon A, Rudolph AE, Morris SR, Little SJ, Richman DD, Smith DM. Incidence and prevalence of intrasubtype HIV-1 dual infection in at-risk men in the United States. J Infect Dis 2013; 209:1032-8. [PMID: 24273040 DOI: 10.1093/infdis/jit633] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus type 1 (HIV-1) dual infection (DI) has been associated with decreased CD4 T-cell counts and increased viral loads; however, the frequency of intrasubtype DI is poorly understood. We used ultradeep sequencing (UDS) to estimate the frequency of DI in a primary infection cohort of predominantly men who have sex with men (MSM). METHODS HIV-1 genomes from longitudinal blood samples of recently infected, therapy-naive participants were interrogated with UDS. DI was confirmed when maximum sequence divergence was excessive and supported by phylogenetic analysis. Coinfection was defined as DI at baseline; superinfection was monoinfection at baseline and DI at a later time point. RESULTS Of 118 participants, 7 were coinfected and 10 acquired superinfection. Superinfection incidence rate was 4.96 per 100 person-years (95% confidence interval [CI], 2.67-9.22); 6 occurred in the first year and 4 in the second. Overall cumulative prevalence of intrasubtype B DI was 14.4% (95% CI, 8.6%-22.1%). Primary HIV-1 incidence was 4.37 per 100 person-years (95% CI, 3.56-5.36). CONCLUSIONS Intrasubtype DI was frequent and comparable to primary infection rates among MSM in San Diego; however, superinfection rates declined over time. DI is likely an important component of the HIV epidemic dynamics, and development of stronger immune responses to the initial infection may protect from superinfection.
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Affiliation(s)
- Sara Gianella
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA 92093-0679, USA
| | - Richard Haubrich
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA 92093-0679, USA
| | - Sheldon R Morris
- University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA 92093-0679, USA
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Gianella S, Morris SR, Tatro E, Vargas MV, Haubrich RH, Daar ES, Dube MP, Richman DD, Little SJ, Smith DM. Virologic correlates of anti-CMV IgG levels in HIV-1-infected men. J Infect Dis 2013; 209:452-6. [PMID: 23964106 DOI: 10.1093/infdis/jit434] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In human immunodeficiency virus (HIV)-infected individuals, higher levels of anti-cytomegalovirus (CMV) immunoglobulin G (IgG) antibody have been associated with increased immune activation, increased HIV transmission, cardiovascular complications, and neurocognitive impairment. However, the mechanism of these observations is unknown. This analysis of 228 HIV-infected men found that higher CMV IgG levels were positively associated with older age and antiretroviral treatment. Higher frequency of detectable CMV in peripheral blood mononuclear cells and recurrent seminal CMV reactivations were associated with lower plasma CMV IgG levels, suggesting that immune response to CMV rather than direct effect of viral replication is likely responsible for adverse clinical outcome observed in other studies.
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Affiliation(s)
| | - Davey M. Smith
- University of California–San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, California
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Zhang F, Morris SR, McGowan JP, Milam J, Dube M, Daar ES, Dubson I, Hill CS, Haubrich RH, Ginocchio CC. P3.244 Prevalence of Sexually Transmitted Infections in Multiple Sample Types Collected from HIV-1 Positive Men: Abstract P3.244 Table 1. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wagner GA, Pacold ME, Vigil E, Caballero G, Morris SR, Kosakovsky Pond SL, Little SJ, Richman DD, Gianella S, Smith DM. Using ultradeep pyrosequencing to study HIV-1 coreceptor usage in primary and dual infection. J Infect Dis 2013; 208:271-4. [PMID: 23599311 DOI: 10.1093/infdis/jit168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
HIV-1 dual infection (DI) and CXCR4 (X4) coreceptor usage are associated with accelerated disease progression but frequency and dynamics of coreceptor usage during DI is unknown. Ultradeep sequencing was used to interrogate for DI and infer coreceptor usage in longitudinal blood samples of 102 subjects. At baseline, X4 usage was high (23 subjects harbored X4 variants) and was not associated with infection duration or DI. Coreceptor usage changed over time in 12 of 47 participants, and X4 usage emerged in 4 of 41 monoinfections vs 2 of 5 superinfections (P = .12), suggesting a weak statistical trend toward occurrence of superinfection and acquiring X4 usage.
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Gianella S, Smith DM, Vargas MV, Little SJ, Richman DD, Daar ES, Dube MP, Zhang F, Ginocchio CC, Haubrich RH, Morris SR. Shedding of HIV and human herpesviruses in the semen of effectively treated HIV-1-infected men who have sex with men. Clin Infect Dis 2013; 57:441-7. [PMID: 23595831 DOI: 10.1093/cid/cit252] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current antiretroviral therapy (ART) suppresses human immunodeficiency virus (HIV) in blood to undetectable levels in most infected individuals; however, some men shed HIV in semen despite suppressed levels in blood. METHODS This study included 114 chronically HIV type 1-infected men who have sex with men, who were receiving ART with blood plasma HIV <500 copies/mL. Asymptomatic participants were screened for bacterial sexually transmitted infections (STIs) and nonspecific genital inflammation. Levels of HIV and 7 human herpesviruses were measured by real-time polymerase chain reaction in seminal plasma. Predictors of HIV seminal shedding were determined for the entire cohort, and on the subset of 100 subjects with blood plasma HIV <50 copies/mL. RESULTS Eleven subjects (9.6%) had detectable levels of seminal HIV (median, 2.1 log10 copies/mL), and 72 (63.2%) had at least 1 herpesvirus detected in their seminal plasma. Detectable levels of seminal HIV were present more often in persons with plasma HIV between 50 and 500 copies/mL compared to those <50 copies/mL (P values adjusted for false discovery rate [FDR] = 0.08). There was a trend for high-level cytomegalovirus (CMV; >4 log10 DNA copies/mL; FDR-adjusted P = .08), and presence of Epstein-Barr virus (FDR-adjusted P = .06) in semen to be associated with detectable seminal HIV levels. In a subanalysis of 100 subjects with blood plasma HIV <50 copies/mL, high levels of CMV in semen was the only significant predictor for seminal HIV shedding. CONCLUSIONS Low-level HIV replication in blood and high-level seminal CMV shedding, but not presence of asymptomatic STIs, is associated with seminal shedding of HIV in men receiving ART, conferring a potential risk for HIV transmission.
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Affiliation(s)
- Sara Gianella
- University of California, San Diego, La Jolla, CA 92093-0679, USA.
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Goff DJ, Court Recart A, Sadarangani A, Chun HJ, Barrett CL, Krajewska M, Leu H, Low-Marchelli J, Ma W, Shih AY, Wei J, Zhai D, Geron I, Pu M, Bao L, Chuang R, Balaian L, Gotlib J, Minden M, Martinelli G, Rusert J, Dao KH, Shazand K, Wentworth P, Smith KM, Jamieson CAM, Morris SR, Messer K, Goldstein LSB, Hudson TJ, Marra M, Frazer KA, Pellecchia M, Reed JC, Jamieson CHM. A Pan-BCL2 inhibitor renders bone-marrow-resident human leukemia stem cells sensitive to tyrosine kinase inhibition. Cell Stem Cell 2013; 12:316-28. [PMID: 23333150 DOI: 10.1016/j.stem.2012.12.011] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/09/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
Leukemia stem cells (LSCs) play a pivotal role in the resistance of chronic myeloid leukemia (CML) to tyrosine kinase inhibitors (TKIs) and its progression to blast crisis (BC), in part, through the alternative splicing of self-renewal and survival genes. To elucidate splice-isoform regulators of human BC LSC maintenance, we performed whole-transcriptome RNA sequencing, splice-isoform-specific quantitative RT-PCR (qRT-PCR), nanoproteomics, stromal coculture, and BC LSC xenotransplantation analyses. Cumulatively, these studies show that the alternative splicing of multiple prosurvival BCL2 family genes promotes malignant transformation of myeloid progenitors into BC LSCS that are quiescent in the marrow niche and that contribute to therapeutic resistance. Notably, sabutoclax, a pan-BCL2 inhibitor, renders marrow-niche-resident BC LSCs sensitive to TKIs at doses that spare normal progenitors. These findings underscore the importance of alternative BCL2 family splice-isoform expression in BC LSC maintenance and suggest that the combinatorial inhibition of prosurvival BCL2 family proteins and BCR-ABL may eliminate dormant LSCs and obviate resistance.
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Affiliation(s)
- Daniel J Goff
- Stem Cell Program, Department of Medicine, Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
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Gianella S, Morris SR, Anderson C, Spina CA, Vargas MV, Young JA, Richman DD, Little SJ, Smith DM. Herpes viruses and HIV-1 drug resistance mutations influence the virologic and immunologic milieu of the male genital tract. AIDS 2013; 27:39-47. [PMID: 22739399 PMCID: PMC3769229 DOI: 10.1097/qad.0b013e3283573305] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To further understand the role that chronic viral infections of the male genital tract play on HIV-1 dynamics and replication. DESIGN Retrospective, observational study including 236 paired semen and blood samples collected from 115 recently HIV-1 infected antiretroviral naive men who have sex with men. METHODS In this study, we evaluated the association of seminal HIV-1 shedding to coinfections with seven herpes viruses, blood plasma HIV-1 RNA levels, CD4 T-cell counts, presence of transmitted drug resistance mutations (DRMs) in HIV-1 pol, participants' age and stage of HIV-infection using multivariate generalized estimating equation methods. Associations between herpes virus shedding, seminal HIV-1 levels, number and immune activation of seminal T-cells was also investigated (Mann-Whitney). RESULTS Seminal herpes virus shedding was observed in 75.7% of individuals. Blood HIV-1 RNA levels (P < 0.01) and seminal cytomegalovirus (CMV) and human herpes virus (HHV)-8 levels (P < 0.05) were independent predictors of detectable seminal HIV-1 RNA; higher seminal HIV-1 levels were associated with CMV and Epstein-Barr virus (EBV) seminal shedding, and absence of DRM (P < 0.05). CMV and EBV seminal shedding was associated with higher number of seminal T-lymphocytes, but only presence of seminal CMV DNA was associated with increased immune activation of T-lymphocytes in semen and blood. CONCLUSION Despite high median CD4 T-cells numbers, we found a high frequency of herpes viruses seminal shedding in our cohort. Shedding of CMV, EBV and HHV-8 and absence of DRM were associated with increased frequency of HIV-1 shedding and/or higher levels of HIV-1 RNA in semen, which are likely important cofactors for HIV-1 transmission.
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Affiliation(s)
- Sara Gianella
- Department of Pathology, University of California, San Diego, La Jolla, CA 92093-0679, USA.
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Gianella S, Anderson CM, Vargas MV, Richman DD, Little SJ, Morris SR, Smith DM. Cytomegalovirus DNA in semen and blood is associated with higher levels of proviral HIV DNA. J Infect Dis 2012; 207:898-902. [PMID: 23275608 DOI: 10.1093/infdis/jis777] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Over three-fourths of human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) have at least one herpesvirus detected in their semen, and cytomegalovirus (CMV) is the most prevalent. The presence of CMV is associated with higher T-cell immune activation and with HIV disease progression in treated and untreated individuals. In this study of 113 antiretroviral (ART)-naive HIV-infected MSM, we found that CMV replication in blood and semen was associated with higher levels of HIV DNA in peripheral blood mononuclear cells. These observations suggest that interventions aimed to reduce CMV replication and, thus, systemic immune activation could decrease the size of the latent HIV reservoir.
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Affiliation(s)
- Sara Gianella
- University of California-San Diego, 9500 Gilman Dr, MC 0679, La Jolla, CA 92093-0679, USA.
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Gianella S, Morris SR, Vargas MV, Young JA, Callahan B, Richman DD, Little SJ, Smith DM. Role of seminal shedding of herpesviruses in HIV Type 1 Transmission. J Infect Dis 2012; 207:257-61. [PMID: 23148284 DOI: 10.1093/infdis/jis683] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To investigate the role of genital shedding of herpesviruses in human immunodeficiency virus type 1 (HIV) transmission, we compared 20 HIV-infected men who did and 26 who did not transmit HIV to their sex partners. As described previously, HIV transmission was associated with the potential source partner having higher levels of HIV RNA in blood and semen, having lower CD4(+) T cell counts, having bacterial coinfections in the genital tract, and not using antiretroviral therapy. This study extended these findings by observing significant associations between HIV transmission and the following characteristics, especially among therapy-naive potential source partners: seminal cytomegalovirus (CMV) shedding, seminal Epstein-Barr virus shedding, and levels of anti CMV immunoglobulin in blood plasma.
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Affiliation(s)
- Sara Gianella
- University of California-San Diego, La Jolla 92093-0679, USA.
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Ma W, Gutierrez A, Goff DJ, Geron I, Sadarangani A, Jamieson CAM, Court AC, Shih AY, Jiang Q, Wu CC, Li K, Smith KM, Crews LA, Gibson NW, Deichaite I, Morris SR, Wei P, Carson DA, Look AT, Jamieson CHM. NOTCH1 signaling promotes human T-cell acute lymphoblastic leukemia initiating cell regeneration in supportive niches. PLoS One 2012; 7:e39725. [PMID: 22768113 PMCID: PMC3387267 DOI: 10.1371/journal.pone.0039725] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/25/2012] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Leukemia initiating cells (LIC) contribute to therapeutic resistance through acquisition of mutations in signaling pathways, such as NOTCH1, that promote self-renewal and survival within supportive niches. Activating mutations in NOTCH1 occur commonly in T cell acute lymphoblastic leukemia (T-ALL) and have been implicated in therapeutic resistance. However, the cell type and context specific consequences of NOTCH1 activation, its role in human LIC regeneration, and sensitivity to NOTCH1 inhibition in hematopoietic microenvironments had not been elucidated. METHODOLOGY AND PRINCIPAL FINDINGS We established humanized bioluminescent T-ALL LIC mouse models transplanted with pediatric T-ALL samples that were sequenced for NOTCH1 and other common T-ALL mutations. In this study, CD34(+) cells from NOTCH1(Mutated) T-ALL samples had higher leukemic engraftment and serial transplantation capacity than NOTCH1(Wild-type) CD34(+) cells in hematopoietic niches, suggesting that self-renewing LIC were enriched within the NOTCH1(Mutated) CD34(+) fraction. Humanized NOTCH1 monoclonal antibody treatment reduced LIC survival and self-renewal in NOTCH1(Mutated) T-ALL LIC-engrafted mice and resulted in depletion of CD34(+)CD2(+)CD7(+) cells that harbor serial transplantation capacity. CONCLUSIONS These results reveal a functional hierarchy within the LIC population based on NOTCH1 activation, which renders LIC susceptible to targeted NOTCH1 inhibition and highlights the utility of NOTCH1 antibody targeting as a key component of malignant stem cell eradication strategies.
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Affiliation(s)
- Wenxue Ma
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Alejandro Gutierrez
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Daniel J. Goff
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Ifat Geron
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Anil Sadarangani
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Christina A. M. Jamieson
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Angela C. Court
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Alice Y. Shih
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Qingfei Jiang
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Christina C. Wu
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Kang Li
- Oncology Research Unit, Pfizer Global Research and Development, La Jolla Laboratories, San Diego, California, United States of America
| | - Kristen M. Smith
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Leslie A. Crews
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Neil W. Gibson
- Oncology Research Unit, Pfizer Global Research and Development, La Jolla Laboratories, San Diego, California, United States of America
| | - Ida Deichaite
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Sheldon R. Morris
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Ping Wei
- Oncology Research Unit, Pfizer Global Research and Development, La Jolla Laboratories, San Diego, California, United States of America
| | - Dennis A. Carson
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - A. Thomas Look
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Catriona H. M. Jamieson
- Department of Medicine, Stem Cell Program and Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
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Abstract
In this study 15 banked samples of HIV-related Non-Hodgkin's Lymphoma (NHL) cases were tested for HIV co-receptor usage and SDF1 3'A polymorphism. Reportable tropism from 9 plasma samples had 1 (11.1%) HIV case with CXCR4 and 8 (88.9%) with CCR5 usage, even though most of the cases occurred at a late stage of HIV (2/3 had CD4 counts below 200), where expected CXCR4 usage would be 60%. Based on the expected proportion of less than 50% CCR5 in chronically infected individuals, this would suggest that in NHL may be associated with CCR5 usage (P = 0.04).
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Affiliation(s)
- Erin Reid
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, 150 West Washington St, San Diego, CA 92103, USA.
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Raheem O, Kulidjian AA, Wu C, Jeong YB, Yamaguchi T, Smith KM, Goff D, Leu H, Morris SR, Cacalano NA, Masuda K, Jamieson CHM, Kane CJ, Jamieson CAM. A novel patient-derived intra-femoral xenograft model of bone metastatic prostate cancer that recapitulates mixed osteolytic and osteoblastic lesions. J Transl Med 2011; 9:185. [PMID: 22035283 PMCID: PMC3269442 DOI: 10.1186/1479-5876-9-185] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 10/28/2011] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer metastasizes to bone in the majority of patients with advanced disease leading to painfully debilitating fractures, spinal compression and rapid decline. In addition, prostate cancer bone metastases often become resistant to standard therapies including androgen deprivation, radiation and chemotherapy. There are currently few models to elucidate mechanisms of interaction between the bone microenvironment and prostate cancer. It is, thus, essential to develop new patient-derived, orthotopic models. Here we report the development and characterization of PCSD1 (Prostate Cancer San Diego 1), a novel patient-derived intra-femoral xenograft model of prostate bone metastatic cancer that recapitulates mixed osteolytic and osteoblastic lesions. Methods A femoral bone metastasis of prostate cancer was removed during hemiarthroplasty and transplanted into Rag2-/-;γc-/- mice either intra-femorally or sub-cutaneously. Xenograft tumors that developed were analyzed for prostate cancer biomarker expression using RT-PCR and immunohistochemistry. Osteoblastic, osteolytic and mixed lesion formation was measured using micro-computed tomography (microCT). Results PCSD1 cells isolated directly from the patient formed tumors in all mice that were transplanted intra-femorally or sub-cutaneously into Rag2-/-;γc-/- mice. Xenograft tumors expressed human prostate specific antigen (PSA) in RT-PCR and immunohistochemical analyses. PCSD1 tumors also expressed AR, NKX3.1, Keratins 8 and 18, and AMACR. Histologic and microCT analyses revealed that intra-femoral PCSD1 xenograft tumors formed mixed osteolytic and osteoblastic lesions. PCSD1 tumors have been serially passaged in mice as xenografts intra-femorally or sub-cutaneously as well as grown in culture. Conclusions PCSD1 xenografts tumors were characterized as advanced, luminal epithelial prostate cancer from a bone metastasis using RT-PCR and immunohistochemical biomarker analyses. PCSD1 intra-femoral xenografts formed mixed osteoblastic/osteolytic lesions that closely resembled the bone lesions in the patient. PCSD1 is a new primary prostate cancer bone metastasis-derived xenograft model to study metastatic disease in the bone and to develop novel therapies for inhibiting prostate cancer growth in the bone-niche.
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Affiliation(s)
- Omer Raheem
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
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