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Kundura L, Cezar R, Gimenez S, Pastore M, Reynes C, Sotto A, Reynes J, Allavena C, Meyer L, Makinson A, Corbeau P. Immune profiles of pre-frail people living with HIV-1: a prospective longitudinal study. Immun Ageing 2024; 21:20. [PMID: 38481213 PMCID: PMC10935995 DOI: 10.1186/s12979-024-00416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND People living with HIV (PLWH) are at risk of frailty, which is predictive for death. As an overactivity of the immune system is thought to fuel frailty, we characterized the immune activation profiles linked to frailty. METHODS We quantified twenty-seven activation markers in forty-six virological responders (four females and forty-two males; median age, 74 years; median duration of infection, 24 years; median duration of undetectability, 13 years), whose frailty was determined according to the Fried criteria. T cell and NK cell activation was evaluated by flow cytometry, using a panel of cell surface markers. Soluble markers of inflammation, and monocyte activation and endothelial activation were measured by ELISA. The participants' immune activation was profiled by an unsupervised double hierarchical clustering analysis. We used ANOVA p-values to rank immunomarkers most related to Fried score. A Linear Discriminant Analysis (LDA) was performed to link immune activation markers to frailty. RESULTS 41% of the participants were pre-frail, including 24% with a Fried score of 1, and 17% with a Fried score of 2. ANOVA identified the 14 markers of T cell, monocyte, NK cell, endothelial activation, and inflammation the most linked to Fried 3 classes. The LDA performed with these 14 markers was capable of discriminating volunteers according to their Fried score. Two out of the 5 immune activation profiles revealed by the hierarchical clustering were linked to and predictive of pre-frailty. These two profiles were characterized by a low percentage of CD4 T cells and a high percentage of CD8 T cells, activated CD4 T cells, CD8 T cells, and NK cells, and inflammation. CONCLUSIONS We identified a particular immune activation profile associated with pre-frailty in PLWH. Profiling participants at risk of developing frailty might help to tailor the screening and prevention of medical complications fueled by loss of robustness. Further studies will indicate whether this frailty signature is specific or not of HIV infection, and whether it also precedes frailty in the general population.
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Affiliation(s)
- Lucy Kundura
- Institute of Human Genetics, CNRS-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Renaud Cezar
- Immunology Department, Nîmes University Hospital, Place du Pr Debré, Nîmes, 30029, France
| | - Sandrine Gimenez
- Institute of Human Genetics, CNRS-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Manuela Pastore
- Institute of Functional Genomics UMR5203 and BCM, CNRS-INSERM-Montpellier University, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Christelle Reynes
- Institute of Functional Genomics UMR5203 and BCM, CNRS-INSERM-Montpellier University, 141 rue de la Cardonille, Montpellier, 34396, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nîmes University Hospital, Nîmes, France
- Montpellier University, Montpellier, France
| | - Jacques Reynes
- Montpellier University, Montpellier, France
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Clotilde Allavena
- Service de Maladies Infectieuses, CHU de Nantes, Université de Nantes, Nantes, UE, 1413, France
| | - Laurence Meyer
- INSERM CESP U1018, Le Kremlin Bicêtre, France
- Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Alain Makinson
- Montpellier University, Montpellier, France
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Pierre Corbeau
- Institute of Human Genetics, CNRS-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, 34396, France.
- Immunology Department, Nîmes University Hospital, Place du Pr Debré, Nîmes, 30029, France.
- Montpellier University, Montpellier, France.
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Clemente T, Galli L, Lolatto R, Gagliardini R, Lagi F, Ferrara M, Cattelan AM, Focà E, Di Biagio A, Cervo A, Calza L, Maggiolo F, Marchetti G, Cenderello G, Rusconi S, Zazzi M, Santoro MM, Spagnuolo V, Castagna A. Cohort profile: PRESTIGIO, an Italian prospective registry-based cohort of people with HIV-1 resistant to reverse transcriptase, protease and integrase inhibitors. BMJ Open 2024; 14:e080606. [PMID: 38341206 PMCID: PMC10862296 DOI: 10.1136/bmjopen-2023-080606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The PRESTIGIO Registry was established in 2017 to collect clinical, virological and immunological monitoring data from people living with HIV (PLWH) with documented four-class drug resistance (4DR). Key research purposes include the evaluation of residual susceptibility to specific antiretrovirals and the validation of treatment and monitoring strategies in this population. PARTICIPANTS The PRESTIGIO Registry collects annual plasma and peripheral blood mononuclear cell samples and demographic, clinical, virological, treatment and laboratory data from PLWH followed at 39 Italian clinical centres and characterised by intermediate-to-high genotypic resistance to ≥1 nucleoside reverse transcriptase inhibitors, ≥1 non-nucleoside reverse transcriptase inhibitors, ≥1 protease inhibitors, plus either intermediate-to-high genotypic resistance to ≥1 integrase strand transfer inhibitors (INSTIs) or history of virological failure to an INSTI-containing regimen. To date, 229 people have been recorded in the cohort. Most of the data are collected from the date of the first evidence of 4DR (baseline), with some prebaseline information obtained retrospectively. Samples are collected from the date of enrollment in the registry. FINDINGS TO DATE The open-ended cohort has been used to assess (1) prognosis in terms of survival or development of AIDS-related or non-AIDS-related clinical events; (2) long-term efficacy and safety of different antiretroviral regimens and (3) virological and immunological factors predictive of clinical outcome and treatment efficacy, especially through analysis of plasma and cell samples. FUTURE PLANS The registry can provide new knowledge on how to implement an integrated approach to study PLWH with documented resistance to the four main antiretroviral classes, a population with a limited number of individuals characterised by a high degree of frailty and complexity in therapeutic management. Given the scheduled annual updates of PLWH data, the researchers who collaborate in the registry can send study proposals at any time to the steering committee of the registry, which evaluates every 3 months whether the research studies can be conducted on data and biosamples from the registry and whether they are aimed at a better understanding of a specific health condition, the emergence of comorbidities or the effect of potential treatments or experimental drugs that may have an impact on disease progression and quality of life. Finally, the research studies should aim to be inclusive, innovative and in touch with the communities and society as a whole. TRIAL REGISTRATION NUMBER NCT04098315.
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Affiliation(s)
- Tommaso Clemente
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Maria Cattelan
- Infectious Diseases Unit, Department of Molecular Medicine, Padua University Hospital, Padua, Italy
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, Brescia, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Adriana Cervo
- Infectious Diseases Unit, Policlinico di Modena, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Leonardo Calza
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Franco Maggiolo
- Unit of HIV-related Diseases and Experimental Therapies, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital, Legnano, Italy
- DIBIC, University of Milan, Milan, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ron R, Martínez-Sanz J, Herrera S, Ramos-Ruperto L, Díez-Vidal A, Sainz T, Álvarez-Díaz N, Correa-Pérez A, Muriel A, López-Alcalde J, Pérez-Molina JA, Moreno S, Serrano-Villar S. CD4/CD8 ratio and CD8+ T-cell count as prognostic markers for non-AIDS mortality in people living with HIV. A systematic review and meta-analysis. Front Immunol 2024; 15:1343124. [PMID: 38361925 PMCID: PMC10868578 DOI: 10.3389/fimmu.2024.1343124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Background In people living with HIV (PLHIV), the CD4/CD8 ratio has been proposed as a useful marker for non-AIDS events. However, its predictive ability on mortality over CD4 counts, and the role of CD8+ T-cell counts remain controversial. Methods We conducted a systematic review and meta-analysis of published studies from 1996 to 2023, including PLHIV on antiretroviral treatment, and reporting CD4/CD8 ratio or CD8+ counts. The primary outcome was non-AIDS mortality or all-cause mortality. We performed a standard random-effects pairwise meta-analysis comparing low versus high CD4/CD8 ratio with a predefined cut-off point of 0.5. (CRD42020170931). Findings We identified 2,479 studies for screening. 20 studies were included in the systematic review. Seven studies found an association between low CD4/CD8 ratio categories and increased mortality risk, with variable cut-off points between 0.4-1. Four studies were selected for meta-analysis, including 12,893 participants and 618 reported deaths. Patients with values of CD4/CD8 ratio below 0.5 showed a higher mortality risk (OR 3.65; 95% CI 3.04 - 4.35; I2 = 0.00%) compared to those with higher values. While the meta-analysis of CD8+ T-cell counts was not feasible due to methodological differences between studies, the systematic review suggests a negative prognostic impact of higher values (>1,138 to 1,500 cells/uL) in the long term. Conclusions Our results support the use of the CD4/CD8 ratio as a prognostic marker in clinical practice, especially in patients with values below 0.5, but consensus criteria on ratio timing measurement, cut-off values, and time to event are needed in future studies to get more robust conclusions. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020170931, identifier CRD42020170931.
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Affiliation(s)
- Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain
| | - Luis Ramos-Ruperto
- HIV Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Díez-Vidal
- HIV Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Talía Sainz
- Pediatric Tropical and Infectious Diseases, Hospital la Paz and La Paz Research Institute (IdiPAZ), Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Universidad Autoónoma de Madrid, UAM, Madrid, Spain
| | - Noelia Álvarez-Díaz
- Medical Library, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Andrea Correa-Pérez
- Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain
- Pharmacy and Medical Devices Department. Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alfonso Muriel
- Universidad de Alcalá (UAH), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jesús López-Alcalde
- Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - José A. Pérez-Molina
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá (UAH), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Grant I, Krupitsky E, Vetrova M, Umlauf A, Heaton RK, Hauger RL, Toussova O, Franklin DR, Letendre SL, Woody G, Blokhina E, Lioznov D, Zvartau E. Effects of Opioid Withdrawal on Psychobiology in People Living with HIV. Viruses 2024; 16:92. [PMID: 38257791 PMCID: PMC10818595 DOI: 10.3390/v16010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Many persons with opioid use disorders (OUDs) have HIV disease and experience clinically significant stress after they enroll in abstinence-based treatment and undergo medically assisted withdrawal. We examined whether opioid withdrawal affects virologic control, inflammatory markers, cognition, and mood in persons with an OUD and HIV, and explored whether measures of withdrawal stress, such as activation of the HPA axis, contribute to alterations in immune function, cognition, and mood. METHOD AND PARTICIPANTS Study participants were 53 persons with HIV who were admitted for OUD treatment at the City Addiction Hospital in Saint Petersburg, Russian Federation. Participants were examined at admission, at the anticipated peak of withdrawal 3 to 7 days after the last day of a clonidine-based withdrawal process lasting 7 to 14 days, and 3 to 4 weeks after completing withdrawal. At these times, participants received medical exams and were evaluated for symptoms of withdrawal, as well as cognition and mood. Viral load, plasma cortisol, DHEA sulfate ester (DHEA-S), interleukin-6 (IL-6), and soluble CD14 (sCD14) were determined. Multivariable models examined the relationships between markers of HPA activation and the other parameters over time. RESULTS HPA activation as indexed by cortisol/DHEA-S ratio increased during withdrawal, as did markers of immune activation, IL-6 and sCD14. There were no significant associations between viral load and indicators of HPA activation. In longitudinal analyses, higher cortisol/DHEA sulfate was related to worse cognition overall, and more mood disturbance. Increase in IL-6 was associated with worse cognitive performance on a learning task. There were no significant associations with sCD14. CONCLUSIONS Worsening of cognition and measures of mood disturbance during withdrawal were associated with activation of the HPA axis and some measures of inflammation. Whether repeated episodes of opioid withdrawal have a cumulative impact on long-term HIV outcomes and neurocognition is a topic for further investigation.
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Affiliation(s)
- Igor Grant
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Evgeny Krupitsky
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
- Department of Addictions, Bekhterev National Medical Research Center for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | - Marina Vetrova
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Richard L. Hauger
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA 92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92093, USA
| | - Olga Toussova
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Donald R. Franklin
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - George Woody
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Elena Blokhina
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Dmitry Lioznov
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Edwin Zvartau
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
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Basta D, Latinovic OS, Tagaya Y, Silvestri G. Potential Advantages of a Well-balanced Nutrition Regimen for People Living with Human Immunodeficiency Virus Type -1. JOURNAL OF AIDS AND HIV TREATMENT 2024; 6:11-27. [PMID: 38845818 PMCID: PMC11155617 DOI: 10.33696/aids.6.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
This review underscores the important role of nutrition in enhancing the management of Human Immunodeficiency Virus type 1 (HIV-1). Highlighting the efficacy of dietary interventions, including, the importance of omega-3 fatty acids, vitamins D and B-12, and the Mediterranean diet, we delineate how these beneficial nutritional strategies can improve the effectiveness of combined antiretroviral therapy (cART), mitigate its side effects, and ameliorate metabolic disorders in people living with HIV-1 (PLWH). Our review advocates for the integration and implementation of personalized nutritional assessments into the care plan for PLWH, proposing actionable strategies for healthcare providers in HIV-1 field. Summarizing the current standing of the relevance of the nutritional and well-planned diet recommended for the PLWH and emphasizing on the future research directions, this review establishes a foundation for nutrition as a cornerstone in comprehensive HIV-1 management. Our review aims to improve patients' health outcomes and overall quality of life for PLWH.
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Affiliation(s)
- Daniele Basta
- Green Home scarl, Scientific Committee, Arcavacata di Rende (CS), Italy
| | - Olga S. Latinovic
- Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Yutaka Tagaya
- Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, University of Maryland School of Medicine, MD, 21201, USA
| | - Giovannino Silvestri
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
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Jankowski CM, Konigsberg IR, Wilson MP, Sun J, Brown TT, Julian CG, Erlandson KM. Skeletal muscle DNA methylation: Effects of exercise and HIV. Aging Cell 2024; 23:e14025. [PMID: 37920126 PMCID: PMC10776118 DOI: 10.1111/acel.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023] Open
Abstract
Aging, human immunodeficiency virus (HIV) infection, and antiretroviral therapy modify the epigenetic profile and function of cells and tissues, including skeletal muscle (SkM). In some cells, accelerated epigenetic aging begins very soon after the initial HIV infection, potentially setting the stage for the early onset of frailty. Exercise imparts epigenetic modifications in SkM that may underpin some health benefits, including delayed frailty, in people living with HIV (PWH). In this first report of exercise-related changes in SkM DNA methylation among PWH, we investigated the impact of 24 weeks of aerobic and resistance exercise training on SkM (vastus lateralis) DNA methylation profiles and epigenetic age acceleration (EAA) in older, virally suppressed PWH (n = 12) and uninfected controls (n = 18), and associations of EAA with physical function at baseline. We identified 983 differentially methylated positions (DMPs) in PWH and controls at baseline and 237 DMPs after training. The influence of HIV serostatus on SkM methylation was more pronounced than that of exercise training. There was little overlap in the genes associated with the probes most significantly differentiated by exercise training within each group. Baseline EAA (mean ± SD) was similar between PWH (-0.4 ± 2.5 years) and controls (0.2 ± 2.6 years), and the exercise effect was not significant (p = 0.79). EAA and physical function at baseline were not significantly correlated (all p ≥ 0.10). This preliminary investigation suggests HIV-specific epigenetic adaptations in SkM with exercise training but confirmation in a larger study that includes transcriptomic analysis is warranted.
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Affiliation(s)
| | - Iain R. Konigsberg
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Melissa P. Wilson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Jing Sun
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMarylandBaltimoreUSA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins UniversityMarylandBaltimoreUSA
| | - Colleen G. Julian
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
- Division of Geriatric Medicine, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
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Hernandez-Ruiz V, Antonio-Villa NE, Crabtree-Ramírez BE, Belaunzarán-Zamudio PF, Caro-Vega Y, Brañas F, Amieva H, Avila-Funes JA. Characterization of data-driven geriatric syndrome clusters in older people with HIV: a Mexican multicenter cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100502. [PMID: 37181819 PMCID: PMC10172708 DOI: 10.1016/j.lana.2023.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023]
Abstract
Background As living with HIV has been proposed as a condition that may accelerate aging, the main objective of this work was to estimate the prevalence of geriatric syndromes (GS) among older Mexicans with HIV dwelling in the community. Secondly, to evaluate whether the accumulation of GS could be associated with an adverse HIV-related clinical profile, independent of chronological age. Methods Multicenter, cross-sectional study including 501 community-dwelling people aged ≥50 years with HIV. The overall prevalence of nine selected GS and their cumulative number were estimated. An Age-Independent Cumulative Geriatric Syndromes scale (AICGSs) was constructed, and correlations between the AICGSs and HIV-related parameters assessed. Finally, k-mean clustering analyses were performed to test the secondary objective. Findings Median age 56 (IQR: 53-61) years, 81.6% of men. Polypharmacy (74.8%), sensorial deficit (71.2%), cognitive impairment (53.6%), physical disability (41.9%), pre-frailty (27.9%), and falls (29.7%), were the more prevalent GS. A significant negative correlation was found between the AICGSs and normalized values of CD4+ nadir cell counts (r = -0.126; 95%: CI: -0.223 to -0.026, p < 0.05). Similarly, a significant inverse adjusted association between the CD4+ nadir cells and the AICGSs was observed on linear regression analysis (β -0.058; 95%: CI: -0.109 to -0.007, p = 0.03). Cluster analysis identified three differentiated groups varying by age, metabolic comorbidities, AICGSs, and HIV-related parameters. Interpretation An elevated prevalence of GS was observed in the studied population. Moreover, the accumulation of GS was associated with adverse HIV-related profiles, independent of age. Thus, early detection and management of GS are crucial to promote healthier aging trajectories in people with HIV. Funding This work was funded in part by the National Center for the Prevention and Control of HIV/AIDS in Mexico (CENSIDA)-National Ministry of Health.
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Affiliation(s)
- Virgilio Hernandez-Ruiz
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, F-33000, Bordeaux, France
| | | | - Brenda E. Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pablo F. Belaunzarán-Zamudio
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanink Caro-Vega
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fátima Brañas
- Sección de Geriatría, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Hélène Amieva
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, F-33000, Bordeaux, France
| | - José Alberto Avila-Funes
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, F-33000, Bordeaux, France
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Corresponding author. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14080, Tlalpan, Mexico City, Mexico.
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8
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Clemente T, Caccia R, Galli L, Galli A, Poli A, Marchetti GC, Bandera A, Zazzi M, Santoro MM, Cinque P, Castagna A, Spagnuolo V. Inflammation burden score in multidrug-resistant HIV-1 infection. J Infect 2023; 86:453-461. [PMID: 36913985 DOI: 10.1016/j.jinf.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 12/22/2022] [Accepted: 03/09/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES Four-class drug-resistant (4DR) people living with HIV (PLWH) are a fragile population with a high burden of disease. No data on their inflammation and T-cell exhaustion markers are currently available. METHODS Inflammation, immune activation and microbial translocation biomarkers were measured through ELISA in 30 4DR-PLWH with HIV-1 RNA ≥ 50 copies/mL, 30 non-viremic 4DR-PLWH and 20 non-viremic non-4DR-PLWH. Groups were matched by age, gender and smoking habit. T-cell activation and exhaustion markers were assessed by flow cytometry in 4DR-PLWH. An inflammation burden score (IBS) was calculated from soluble marker levels and associated factors were estimated through multivariate regression. RESULTS The highest plasma biomarker concentrations were observed in viremic 4DR-PLWH, the lowest ones in non-4DR-PLWH. Endotoxin core immunoglobulin G showed an opposite trend. Among 4DR-PLWH, CD38/HLA-DR and PD-1 were more expressed on CD4+ (p = 0.019 and 0.034, respectively) and CD8+ (p = 0.002 and 0.032, respectively) cells of viremic compared to non-viremic subjects. An increased IBS was significantly associated with 4DR condition, higher values of viral load and a previous cancer diagnosis. CONCLUSIONS Multidrug-resistant HIV infection is associated with a higher IBS, even when viremia is undetectable. Therapeutic approaches aimed to reduce inflammation and T-cell exhaustion in 4DR-PLWH need to be investigated.
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Affiliation(s)
- Tommaso Clemente
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Roberta Caccia
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Andrea Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Andrea Poli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | | | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy.
| | | | - Paola Cinque
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella Castagna
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy; Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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9
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Pereira-Manfro WF, da Silva GP, Costa PR, Costa DA, Ferreira BDS, Barreto DM, Frota ACC, Hofer CB, Kallas EG, Milagres LG. Expression of TIGIT, PD-1 and HLA-DR/CD38 markers on CD8-T cells of children and adolescents infected with HIV and uninfected controls. Rev Inst Med Trop Sao Paulo 2023; 65:e14. [PMID: 36753067 PMCID: PMC9901578 DOI: 10.1590/s1678-9946202365014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023] Open
Abstract
Immune exhaustion and senescence are scarcely studied in HIV-pediatric patients. We studied the circulatory CD8 T cells activation/exhaustion and senescent phenotype of children and adolescents vertically infected with HIV or uninfected controls based on the expression of human leukocyte antigen (HLA-DR), CD38, T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), programmed death 1 (PD-1) and CD57 by flow cytometry, during approximately one year. Eleven HIV-infected (HI) and nine HIV-uninfected (HU) children/adolescents who received two doses or one dose of meningococcal C conjugate vaccine (MenC), respectively, were involved in this study. Blood samples were collected before the immunization (T0), 1-2 months after the first dose (T1), and 1-2 months after the second dose (T2), which was administered approximately one year after the first one. HI patients not receiving combined antiretroviral therapy (cART) showed a higher frequency of CD8 T cells TIGIT+, PD-1+ or CD57+, as well as a higher frequency of CD8 T cells co-expressing CD38/HLA-DR/TIGIT or CD38/HLA-DR/PD-1 when compared to HI treated or HU individuals, at all times that they were assessed. CD8 T cells co-expressing CD38/DR/TIGIT were inversely correlated with the CD4/CD8 ratio but positively associated with viral load. The co-expression of CD38/DR/TIGIT or CD38/DR/PD-1 on CD8 T cells was also inversely associated with the CD4 T cells expressing co-stimulatory molecules CD127/CD28. The results showed a higher expression of exhaustion/senescence markers on CD8 T cells of untreated HI children/adolescents and its correlations with viral load.
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Affiliation(s)
- Wânia Ferraz Pereira-Manfro
- Universidade do Estado do Rio de Janeiro, Departamento de
Microbiologia, Imunologia e Parasitologia, Rio de Janeiro, Rio de Janeiro,
Brazil
| | - Giselle Pereira da Silva
- Universidade do Estado do Rio de Janeiro, Departamento de
Microbiologia, Imunologia e Parasitologia, Rio de Janeiro, Rio de Janeiro,
Brazil
| | - Priscilla Ramos Costa
- Universidade de São Paulo, Faculdade de Medicina, Divisão de
Imunologia Clínica e Alergia, São Paulo, São Paulo, Brazil
| | - Dayane Alves Costa
- Universidade de São Paulo, Faculdade de Medicina, Divisão de
Imunologia Clínica e Alergia, São Paulo, São Paulo, Brazil
| | | | - Daniela Mena Barreto
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de
Janeiro, Rio de Janeiro, Brazil
| | | | - Cristina Barroso Hofer
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de
Janeiro, Rio de Janeiro, Brazil,Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Departamento de Medicina Preventiva Rio de Janeiro, Rio de Janeiro, Brazil
| | - Esper Georges Kallas
- Universidade de São Paulo, Faculdade de Medicina, Divisão de
Imunologia Clínica e Alergia, São Paulo, São Paulo, Brazil
| | - Lucimar Gonçalves Milagres
- Universidade do Estado do Rio de Janeiro, Departamento de
Microbiologia, Imunologia e Parasitologia, Rio de Janeiro, Rio de Janeiro,
Brazil
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10
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Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
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Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
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11
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Erlandson KM, Fitch KV, McCallum SA, Ribaudo HJ, Overton ET, Zanni MV, Bloomfield GS, Brown TT, Fichtenbaum CJ, Bares S, Aberg JA, Douglas PS, Fulda ES, Santana-Bagur JL, Castro JG, Moran LE, Mave V, Supparatpinyo K, Ponatshego PL, Schechter M, Grinspoon SK. Geographical Differences in the Self-Reported Functional Impairment of People With Human Immunodeficiency Virus (HIV) and Associations With Cardiometabolic Risk. Clin Infect Dis 2022; 75:1154-1163. [PMID: 35165682 PMCID: PMC9525090 DOI: 10.1093/cid/ciac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We sought to explore multinational differences in functional status by global burden of disease (GBD) regions in the REPRIEVE cohort. METHODS REPRIEVE is a prospective, double-blind, randomized, placebo-controlled, multicenter, phase III primary cardiovascular prevention study of pitavastatin calcium vs placebo among people with human immunodeficiency virus (HIV, PWH) ages 40-75 on antiretroviral therapy (ART). GBD super regions were defined using World Health Organization classifications. Participants were categorized by impairment on the Duke Activity Status Instrument (DASI: none, some, moderate, severe). Logistic regression models examined risk factors and GBD regions associated with functional impairment. The association between functional impairment and cardiometabolic risk was also explored. RESULTS Of 7736 participants, the majority were from high-income countries (n = 4065), were male (65%), and had received ART for ≥ 10 years. The median DASI score was 58.2 (interquartile range [IQR] 50.2, 58.2); 36% reported at least some impairment. In adjusted analyses, functional impairment was significantly more frequent among participants from Southeast/East Asia. Other factors associated with greater impairment included female sex, Black race, older age, current/former smoking, higher body mass index, use of ART for ≥ 10 years, and select ART regimens; differences were seen in risks across GBD regions. Functional impairment was associated with increased cardiometabolic risk. CONCLUSIONS Over 1/3 of middle-aged and older PWH in a global cohort across diverse GBD regions demonstrate functional impairments. The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction; these longitudinal associations will be further investigated over REPRIEVE trial follow-up.
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Affiliation(s)
| | - Kathleen V Fitch
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sara A McCallum
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edgar T Overton
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Markella V Zanni
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sara Bares
- Specialty Care Center, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith A Aberg
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Evelynne S Fulda
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jose G Castro
- University of Miami Infectious Disease Research Unit At Jackson Memorial Hospital, Miami, Florida, USA
| | - Laura E Moran
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Medical College, Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Ponego L Ponatshego
- Gaborone Prevention/Treatment Trials, Princess Marina Hospital, Gaborone, Botswana
| | - Mauro Schechter
- Projeto Praça Onze Pesquisa Em Saúde, Cidade Nova, Rio de Janeiro, Brazil
| | - Steven K Grinspoon
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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Breen EC, Sehl ME, Shih R, Langfelder P, Wang R, Horvath S, Bream JH, Duggal P, Martinson J, Wolinsky SM, Martínez-Maza O, Ramirez CM, Jamieson BD. Accelerated aging with HIV begins at the time of initial HIV infection. iScience 2022; 25:104488. [PMID: 35880029 PMCID: PMC9308149 DOI: 10.1016/j.isci.2022.104488] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/06/2021] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
Living with HIV infection is associated with early onset of aging-related chronic conditions, sometimes described as accelerated aging. Epigenetic DNA methylation patterns can evaluate acceleration of biological age relative to chronological age. The impact of initial HIV infection on five epigenetic measures of aging was examined before and approximately 3 years after HIV infection in the same individuals (n=102). Significant epigenetic age acceleration (median 1.9-4.8 years) and estimated telomere length shortening (all p≤ 0.001) were observed from pre-to post-HIV infection, and remained significant in three epigenetic measures after controlling for T cell changes. No acceleration was seen in age- and time interval-matched HIV-uninfected controls. Changes in genome-wide co-methylation clusters were also significantly associated with initial HIV infection (p≤ 2.0 × 10-4). These longitudinal observations clearly demonstrate an early and substantial impact of HIV infection on the epigenetic aging process, and suggest a role for HIV itself in the earlier onset of clinical aging.
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Affiliation(s)
- Elizabeth Crabb Breen
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Mary E. Sehl
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Roger Shih
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Peter Langfelder
- Center for Neurobehavioral Genetics, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA 21205, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA,Altos Labs, San Diego, CA 92121, USA
| | - Jay H. Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Graduate Program in Immunology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA 21205, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Steven M. Wolinsky
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Otoniel Martínez-Maza
- Departments of Obstetrics & Gynecology and Microbiology, Immunology, & Molecular Genetics, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Christina M. Ramirez
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Beth D. Jamieson
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA,Corresponding author
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13
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Agus A, Agus S, Suka A. Interleukin-15 is a significant predictor of sarcopenia in human immunodeficiency virus infected patients on antiretroviral therapy: A cross-sectional study. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.354418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Yuan S, Chen X, Lin H, Shi R, Li J, Xu L, Qiao S, Ding Y, He N. Interaction of declined handgrip strength and HIV infection on neurocognitive impairment. J Neurovirol 2021; 28:217-224. [PMID: 34873670 DOI: 10.1007/s13365-021-01036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 12/01/2022]
Abstract
Neurocognitive impairment (NCI) persists among people living with HIV (PLWH) despite the success of combination antiretroviral therapy (cART). Although muscular waning or decreased handgrip strength has been widely reported to be associated with cognitive erosion in general elders, such association has not been examined in PLWH who commonly experience decreased handgrip strength and NCI. Furthermore, whether HIV infection modifies such association remains to be addressed. A cross-sectional analysis was conducted with 2808 HIV-positive and 5402 HIV-negative adults participating in the baseline survey of the CHART (Comparative HIV and Aging Research in Taizhou) cohort, China, 2017 - 2019. HIV-positive individuals showed weaker handgrip strength than HIV-negative controls (34.0 kg vs 37.7 kg). Multivariate logistic regression analysis indicated that both HIV infection (aOR = 4.35, p < 0.001) and every 5-kg decrease in "Handgrip strength" (aOR = 1.27, p < 0.001) were significantly associated with NCI, and there was a significant interaction between reduced handgrip strength and HIV infection on NCI (aOR = 1.14, p = 0.015). In stratified analyses adjusting for potential confounders, the association between reduced handgrip strength and NCI was significant among PLWH at all age groups but only significant among HIV-negative controls at 30 - 44 and 60 - 89 ages. Handgrip strength decline is significantly associated with the risk of NCI among PLWH. HIV infection may exacerbate the adverse effect of poor handgrip strength on NCI, especially at younger ages. Early detection of handgrip strength decline could facilitate delivery of compensatory strategies or assistive services to PLWH with or at high risk of NCI.
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Affiliation(s)
- Shiying Yuan
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Taizhou City of Zhejiang Province, Taizhou, China
| | - Haijiang Lin
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.,Taizhou City Center for Disease Control and Prevention, Taizhou City of Zhejiang Province, Taizhou, China
| | - Ruizi Shi
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Jing Li
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Lulu Xu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Shijie Qiao
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Yingying Ding
- Taizhou City Center for Disease Control and Prevention, Taizhou City of Zhejiang Province, Taizhou, China
| | - Na He
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China. .,Key Laboratory of Health Technology Assessment of National Commission of Health, Fudan University, Shanghai, China.
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15
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Kousari A, Moser C, Olefsky M, Brown TT, Currier JS, McComsey GA, Scherzinger A, Stein JH, Lake JE, Erlandson KM. Poorer Muscle Quality and Quantity With ART Initiation Is Associated With Greater Inflammation and Immune Activation. J Acquir Immune Defic Syndr 2021; 88:399-405. [PMID: 34326283 PMCID: PMC8556226 DOI: 10.1097/qai.0000000000002776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We have previously shown that the initiation of antiretroviral therapy (ART) is associated with a decrease in skeletal muscle density (greater fat accumulation), suggesting that gains in lean body mass seen in many ART studies may reflect gains in low quality, fatty muscle. Here, we explore whether skeletal muscle density and area are associated with markers of inflammation and immune activation. METHODS ART-naïve people with HIV were randomized to raltegravir or ritonavir-boosted atazanavir or darunavir, each with tenofovir disoproxil fumarate/emtricitabine. Abdominal computed tomography scans from baseline and week 96 were reanalyzed for psoas density and area and correlations explored with inflammation [interleukin-6 (IL-6) and high-sensitivity C-reactive protein] and immune activation [soluble CD14 (sCD14), soluble CD163 (sCD163), and %CD38+HLADR+ on CD4+ or CD8+ T cells]. RESULTS Two hundred twenty-two participants had available inflammation/immune activation markers and paired computed tomography scans. At baseline, lower psoas density (greater fat) correlated with higher IL-6 (r = -0.26, P < 0.001) and sCD163 (r -0.15, P = 0.03) and lower lean psoas area correlated with higher IL-6, high-sensitivity C-reactive protein, sCD14, sCD163, and %CD38+HLADR+ on CD4+ T cells (r = -0.30-0.13; all P ≤ 0.05). From baseline to week 96, greater percent decrease in total psoas density (more fat) correlated with greater increase in IL-6 (r = -0.14; P = 0.04); greater % decrease in lean psoas area correlated greater increases in IL-6, sCD14, sCD163, and %CD38+HLADR+ on CD8+ T cells (r = -0.15 to -0.18; all P < 0.04). CONCLUSIONS Greater fat infiltration within the psoas muscle (lower density) and greater loss in lean psoas muscle area were associated with higher inflammation and immune activation, which may portend important effects on muscle function and cardiometabolic risk.
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Affiliation(s)
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health; Boston, MA
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16
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Hernández-Favela CG, Hernández-Ruiz VA, Bello-Chavolla OY, Crabtree-Ramírez B, Sierra-Madero J, Amieva H, Erlandson KM, Avila-Funes JA. Higher Veterans Aging Cohort Study 2.0 Index Score Predicts Functional Decline Among Older Adults Living with HIV. AIDS Res Hum Retroviruses 2021; 37:878-883. [PMID: 34465139 DOI: 10.1089/aid.2020.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Living with HIV has been proposed as a risk factor for the early development of functional decline. Composite marker tools like the Veterans Aging Cohort Study (VACS) Index, which includes HIV-associated and non-HIV-related markers of disease may better reflect multiorgan system injury and potentially predict functional outcomes. Therefore, the objective of this work is to determine whether higher VACS 2.0 Index scores predicts functional decline among older adults living with HIV (OALWH). Longitudinal study, including 131 adults ages 50 or older who underwent a comprehensive geriatric assessment at baseline and follow-up, at least a year apart. Functional status was determined by the gait speed (seconds for a 4-m distance). Linear regression models were constructed to determine the relationship between VACS 2.0 Index at baseline with gait speed at follow-up adjusted for potential confounders. The median for age was 58.0 years (range 50-84), and 81.7% were male. At baseline, the median VACS 2.0 Index score was 50.4 (interquartile range 42.2-65.3). The adjusted linear regression analysis found that higher baseline VACS 2.0 Index scores were significantly associated with a decline in gait speed (p = .033) at follow-up. The results suggest that the VACS 2.0 Index works as a predictor of functional decline as showed by decline in gait speed and might serve as an easy tool to identify OALWH who might need additional resources or interventions to prevent it.
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Affiliation(s)
| | - Virgilio Alejandro Hernández-Ruiz
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | | | - Brenda Crabtree-Ramírez
- Department de Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Sierra-Madero
- Department de Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hélène Amieva
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Kristine M. Erlandson
- Division of Infectious Diseases and Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - José Alberto Avila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
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17
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Dias JP, Haberlen SA, Dobs AS, Lake JE, Palella FJ, Kingsley LA, Price JC, Basaria S, Varadhan R, Margolick JB, Thio CL, Brown TT. Longitudinal Changes in Sex Hormone-Binding Globulin in Men With HIV. J Acquir Immune Defic Syndr 2021; 87:1178-1186. [PMID: 33990494 PMCID: PMC8263509 DOI: 10.1097/qai.0000000000002723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sex hormone-binding globulin (SHBG) is a glycoprotein that regulates sex hormone bioavailability and increases with age in the general population. SHBG concentrations are higher in people with HIV, a population in whom accelerated aging has been hypothesized. It is unclear whether longitudinal changes in SHBG increase over time and differ by HIV serostatus. METHODS In a longitudinal study, SHBG was measured in 182 men with HIV (MWH) and 267 men without HIV (seronegative) from the Multicenter AIDS Cohort Study and matched for age, race, site, and time, with ≥2 SHBG serum samples over the 10 years after HAART initiation. Multivariable linear mixed-effects regression models were used to evaluate whether log-transformed SHBG [ln(SHBG)] and its rate of change differed by HIV serostatus. RESULTS At baseline, the mean age in MWH was similar to that in HIV-seronegative men (51 ± 5 vs 49 ± 6 years). However, SHBG mean values were higher in MWH compared with those in HIV-seronegative men (65.6 ± 48.8 vs. 45.4 ± 22 nmol/L, P < 0.001). In a fully adjusted model, SHBG increased over time and at a faster rate in MWH compared with that in HIV-seronegative men: [2.0%/year (95% CI: 1.4 to 2.7) vs 1.3%/year (95% CI: 0.8 to 1.8), respectively, P = 0.038]. Among MWH, higher SHBG concentrations were significantly associated with lower CD4+ T-cell count [β= -0.02 (95% CI: -0.03 to -0.0002), P < 0.05], fewer cumulative years on zidovudine [β = -0.027 (95% CI: -0.045 to -0.009), P < 0.001], and greater cumulative years on nonnucleoside reverse transcriptase inhibitors drugs [β = 0.022 (95% CI: 0.0006 to 0.04), P < 0.05]. CONCLUSIONS Aging-related increases in SHBG were faster in MWH compared with those in HIV-seronegative men and were related to poorer immunologic status and antiretroviral medication exposure. The mechanisms and consequences of these findings require further investigation.
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Affiliation(s)
- Jenny Pena Dias
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sabina A Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Adrian S. Dobs
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Jordan E Lake
- Division of Infectious Diseases, McGovern School of Medicine, Houston, TX, USA
| | - Frank J. Palella
- Division of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jennifer C. Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Shehzad Basaria
- Section on Men’s Health, Aging and Metabolism, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, United States
| | - Ravi Varadhan
- Department of Oncology; Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Chloe L Thio
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Todd T. Brown
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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18
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Pino M, Pereira Ribeiro S, Pagliuzza A, Ghneim K, Khan A, Ryan E, Harper JL, King CT, Welbourn S, Micci L, Aldrete S, Delman KA, Stuart T, Lowe M, Brenchley JM, Derdeyn CA, Easley K, Sekaly RP, Chomont N, Paiardini M, Marconi VC. Increased homeostatic cytokines and stability of HIV-infected memory CD4 T-cells identify individuals with suboptimal CD4 T-cell recovery on-ART. PLoS Pathog 2021; 17:e1009825. [PMID: 34449812 PMCID: PMC8397407 DOI: 10.1371/journal.ppat.1009825] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/23/2021] [Indexed: 01/12/2023] Open
Abstract
Clinical outcomes are inferior for individuals with HIV having suboptimal CD4 T-cell recovery during antiretroviral therapy (ART). We investigated if the levels of infection and the response to homeostatic cytokines of CD4 T-cell subsets contributed to divergent CD4 T-cell recovery and HIV reservoir during ART by studying virologically-suppressed immunologic responders (IR, achieving a CD4 cell count >500 cells/μL on or before two years after ART initiation), and virologically-suppressed suboptimal responders (ISR, did not achieve a CD4 cell count >500 cells/μL in the first two years after ART initiation). Compared to IR, ISR demonstrated higher levels of HIV-DNA in naïve, central (CM), transitional (TM), and effector (EM) memory CD4 T-cells in blood, both pre- and on-ART, and specifically in CM CD4 T-cells in LN on-ART. Furthermore, ISR had higher pre-ART plasma levels of IL-7 and IL-15, cytokines regulating T-cell homeostasis. Notably, pre-ART PD-1 and TIGIT expression levels were higher in blood CM and TM CD4 T-cells for ISR; this was associated with a significantly lower fold-changes in HIV-DNA levels between pre- and on-ART time points exclusively on CM and TM T-cell subsets, but not naïve or EM T-cells. Finally, the frequency of CM CD4 T-cells expressing PD-1 or TIGIT pre-ART as well as plasma levels of IL-7 and IL-15 predicted HIV-DNA content on-ART. Our results establish the association between infection, T-cell homeostasis, and expression of PD-1 and TIGIT in long-lived CD4 T-cell subsets prior to ART with CD4 T-cell recovery and HIV persistence on-ART.
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Affiliation(s)
- Maria Pino
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Susan Pereira Ribeiro
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Amélie Pagliuzza
- Centre de Recherche du CHUM and Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, QC, Canada
| | - Khader Ghneim
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Anum Khan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Emily Ryan
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Justin L. Harper
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Colin T. King
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Sarah Welbourn
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Luca Micci
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Sol Aldrete
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Keith A. Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Theron Stuart
- Emory Vaccine Center, Emory University, Hope Clinic, Decatur, Georgia, United States of America
| | - Michael Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Jason M. Brenchley
- Barrier Immunity Section, Laboratory of Viral Diseases, National Institutes of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Cynthia A. Derdeyn
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rafick P. Sekaly
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Nicolas Chomont
- Centre de Recherche du CHUM and Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, QC, Canada
| | - Mirko Paiardini
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Vincent C. Marconi
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, United States of America
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19
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Abstract
Since emerging into the human population in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached across the globe to infect >80 million people. The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 can range in severity from mild and asymptomatic to severe and fatal. Identifying risk factors for adverse outcomes in COVID-19 is a major challenge. In the context of the existing HIV-1 pandemic, whether COVID-19 disproportionately burdens people living with HIV-1 infection (PLWH) is unclear. The following discussion highlights pressing questions and challenges in the HIV-1 and SARS-CoV-2 syndemic, including (i) age, sex, and race as drivers of COVID-19 severity; (ii) whether chronic inflammation common in PLWH influences immune response; (iii) whether disease severity and trajectory models for COVID-19 ought to be calibrated for PLWH; (iv) vaccine considerations, and finally, (v) long-term health outcomes in PLWH that are further burdened by coinfection with SARS-CoV-2.
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Affiliation(s)
- Monty Montano
- Boston Claude D. Pepper Older Americans Independence Center, Boston, Massachusetts, USA
- Harvard University Center for AIDS Research, Boston, Massachusetts, USA
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20
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Kelly SG, Wu K, Tassiopoulos K, Erlandson KM, Koletar SL, Palella FJ. Incorporating Frailty Into the Pooled Cohort Equations to Predict Cardiovascular Disease Among Persons With HIV. J Acquir Immune Defic Syndr 2021; 87:971-977. [PMID: 33625065 PMCID: PMC8192418 DOI: 10.1097/qai.0000000000002662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The 2013 Pooled Cohort Equations (PCEs) have underestimated cardiovascular disease (CVD) events among persons with HIV (PWH). We evaluate whether the addition of frailty improves PCE's ability to estimate CVD risk among aging PWH. SETTING Multicenter study. METHODS We assessed baseline frailty and 5-year atherosclerotic CVD risk using PCEs for participants in the AIDS Clinical Trials Group A5322 observational study. The primary outcome was incident CVD. We fit Cox proportional hazards regression models for incident CVD with (1) PCEs alone and (2) PCEs and frailty together (which included separate models for frailty score, frailty status, slow gait speed, and weak grip strength). We evaluated discrimination ability for the models with and without frailty by comparing their areas under receiver operating characteristic curve (AUCs) and Uno C-statistics, as well as by calculating the net reclassification improvement and integrated discrimination improvement. RESULTS The analysis included 944 A5322 participants (759 men, 185 women, median age 50 years, 47% White non-Hispanic). Thirty-nine participants experienced incident CVD during the study period. PCEs predicted 5-year CVD risk in all models. With frailty score, frailty status, slow gait speed, or weak grip strength added, the AUC and C-statistics were relatively unchanged, and the NRI and integrated discrimination improvement indicated little improvement in model discrimination. However, frailty score independently predicted CVD risk [frailty score: hazard ratio = 1.30, 95% confidence interval (CI) = 1.00 to 1.70, P = 0.05]. CONCLUSIONS Frailty did not improve the predictive ability of PCEs. Baseline PCEs and frailty score independently predicted CVD. Incorporation of frailty assessment into clinical practice may provide corroborative and independent CVD risk estimation.
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Affiliation(s)
- Sean G Kelly
- Vanderbilt University Medical Center, Division of Infectious Diseases, Nashville, TN
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Kristine M Erlandson
- University of Colorado School of Medicine, Division of Infectious Diseases, Denver, CO
| | - Susan L Koletar
- The Ohio State University, Division of Infectious Diseases, Columbus, OH; and
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Division of Infectious Diseases Chicago, IL
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21
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Dillon SM, Abdo MH, Wilson MP, Liu J, Jankowski CM, Robertson CE, Tuncil Y, Hamaker B, Frank DN, MaWhinney S, Wilson CC, Erlandson KM. A Unique Gut Microbiome-Physical Function Axis Exists in Older People with HIV: An Exploratory Study. AIDS Res Hum Retroviruses 2021; 37:542-550. [PMID: 33787299 PMCID: PMC8260890 DOI: 10.1089/aid.2020.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Impairments in physical function and increased systemic levels of inflammation have been observed in middle-aged and older persons with HIV (PWH). We previously demonstrated that in older persons, associations between gut microbiota and inflammation differed by HIV serostatus. To determine whether relationships between the gut microbiome and physical function measurements would also be distinct between older persons with and without HIV, we reanalyzed existing gut microbiome and short chain fatty acid (SCFA) data in conjunction with previously collected measurements of physical function and body composition from the same cohorts of older (51-74 years), nonfrail PWH receiving effective antiretroviral therapy (N = 14) and age-balanced uninfected controls (N = 22). Associations between relative abundance (RA) of the most abundant bacterial taxa or stool SCFA levels with physical function and body composition were tested using HIV-adjusted linear regression models. In older PWH, but not in controls, greater RA of Alistipes, Escherichia, Prevotella, Megasphaera, and Subdoligranulum were associated with reduced lower extremity muscle function, decreased lean mass, or lower Short Physical Performance Battery (SPPB) scores. Conversely, greater RA of Dorea, Coprococcus, and Phascolarctobacterium in older PWH were associated with better muscle function, lean mass, and SPPB scores. Higher levels of the SCFA butyrate associated with increased grip strength in both PWH and controls. Our findings indicate that in older PWH, both negative and positive associations exist between stool microbiota abundance and physical function. Different relationships were observed in older uninfected persons, suggesting features of a unique gut-physical function axis in PWH.
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Affiliation(s)
- Stephanie M. Dillon
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mona H. Abdo
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Melissa P. Wilson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jay Liu
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M. Jankowski
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles E. Robertson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yunus Tuncil
- Department of Food Science, Purdue University, West Lafayette, Indiana, USA
| | - Bruce Hamaker
- Department of Food Science, Purdue University, West Lafayette, Indiana, USA
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Cara C. Wilson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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22
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Vecchio A, Nakigozi G, Nakasujja N, Kisakye A, Batte J, Mayanja R, Anok A, Robertson K, Wawer MJ, Sacktor N, Rubin LH, Saylor D. Assessment, prevalence, and correlates of frailty among middle-aged adults with HIV in rural Uganda. J Neurovirol 2021; 27:487-492. [PMID: 33788138 DOI: 10.1007/s13365-021-00969-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
We investigated the prevalence and risk factors for frailty among people with HIV (PWH) in rural Uganda (n = 55, 47% male, mean age 44 years). Frailty was defined according to the Fried criteria with self-reported physical activity level replacing the Minnesota Leisure Time Activity Questionnaire. Alternate classifications for physical activity utilized were the sub-Saharan Africa Activity Questionnaire and the International Physical Activity Questionnaire. Eleven participants (19%) were frail. Frail participants were older (p < 0.001), less likely to be on antiretroviral therapy (p = 0.03), and had higher rates of depression (p < .001) and HIV-associated neurocognitive disorder (p = 0.003). Agreement between physical activity measures was sub-optimal. Prevalence of frailty was high among PWH in rural Uganda, but larger sample sizes and local normative data are needed.
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Affiliation(s)
- Alyssa Vecchio
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | | | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Kevin Robertson
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Maria J Wawer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ned Sacktor
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Leah H Rubin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Deanna Saylor
- Johns Hopkins University School of Medicine, Baltimore, USA
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23
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Uddin MI, Hossain M, Islam S, Akter A, Nishat NS, Nila TA, Rafique TA, Leung DT, Calderwood SB, Ryan ET, Harris JB, LaRocque RC, Bhuiyan TR, Qadri F. An assessment of potential biomarkers of environment enteropathy and its association with age and microbial infections among children in Bangladesh. PLoS One 2021; 16:e0250446. [PMID: 33886672 PMCID: PMC8061931 DOI: 10.1371/journal.pone.0250446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/06/2021] [Indexed: 01/13/2023] Open
Abstract
Interventional studies targeting environment enteropathy (EE) are impeded by the lack of appropriate, validated, non-invasive biomarkers of EE. Thus, we aimed to validate the association of potential biomarkers for EE with enteric infections and nutritional status in a longitudinal birth cohort study. We measured endotoxin core antibody (EndoCab) and soluble CD14 (sCD14) in serum, and myeloperoxidase (MPO) in feces using commercially available enzyme-linked immunosorbent assay (ELISA) kits. We found that levels of serum EndoCab and sCD14 increase with the cumulative incidence of enteric infections. We observed a significant correlation between the fecal MPO level in the children at 24 months of age with the total number of bacterial and viral infections, the total number of parasitic infections, and the total number of diarrheal episodes and diarrheal duration. We observed that the levels of serum EndoCab, sCD14, and fecal MPO at 3 months of age were significantly associated with whether children were malnourished at 18 months of age or not. Biomarkers such as fecal MPO, serum EndoCab and sCD14 in children at an early age may be useful as a measure of cumulative burden of preceding enteric infections, which are predictive of subsequent malnutrition status and may be useful non-invasive biomarkers for EE.
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Affiliation(s)
| | | | - Shahidul Islam
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Aklima Akter
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | - Daniel T. Leung
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Firdausi Qadri
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- * E-mail: (FQ); (TRB)
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24
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Krsak M, Wada NI, Plankey MW, Kinney GL, Epeldegui M, Okafor CN, Friedman MR, Palella FJ, Erlandson KM. Self-Reported Cannabis Use and Markers of Inflammation in Men Who Have Sex With Men With and Without HIV. Cannabis Cannabinoid Res 2021; 6:165-173. [PMID: 33912681 PMCID: PMC8064959 DOI: 10.1089/can.2019.0083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Chronic inflammation contributes to aging and organ dysfunction in the general population, and is a particularly important determinant of morbidity and mortality among people with HIV (PWH). The effect of cannabis use on chronic inflammation is not well understood among PWH, who use cannabis more frequently than the general population. Materials and Methods: We evaluated participants in the Multicenter AIDS Cohort Study (MACS) beginning in 2004 with available data on cannabis use and inflammatory biomarkers. Associations of current cannabis use with plasma concentrations of inflammatory markers were adjusted for hepatitis C, tobacco smoking, and comorbidities. Markers were analyzed individually and in exploratory factor analysis (EFA). Results: We included 1352 men within the MACS. Twenty-seven percent of HIV-negative men, 41% of HIV viremic men, and 35% of virologically suppressed men reported cannabis use at baseline. Among cannabis users, 20-25% in all groups defined by HIV serostatus were daily users, and the same proportion reported weekly use. The remaining ∼50% of users in all groups reported monthly or less frequent use. Four biomarker groupings were identified by EFA: Factor 1: immune activation markers; Factor 2: proinflammatory cytokines; Factor 3: Th1- and Th2-promoting cytokines; and Factor 4: inflammatory chemokines. In EFA, daily users had 30% higher levels of Factor 2 biomarkers than nonusers (p=0.03); this was the only statistically significant difference by cannabis use status. Among individual markers, concentrations of IL-1β, IL-2, IL-6, and IL-8 (Factor 2); IL-10 (Factor 3); and BAFF (Factor 1) were higher (p<0.05) among daily cannabis users than among nonusers, after adjusting for HIV serostatus and other covariates. Discussion: Associations between daily cannabis use and proinflammatory biomarker levels did not differ by HIV serostatus. Further prospective studies with measured cannabis components are needed to clarify the impact of these compounds on inflammation. Our findings can facilitate for hypothesis generation and selection of biomarkers to include in such studies.
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Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nikolas I. Wada
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael W. Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marta Epeldegui
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- University of California Los Angeles AIDS Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Josson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Mackey Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Abstract
PURPOSE OF REVIEW Systemic inflammation increases as a consequence of aging (inflammaging) and contributes to age-related morbidities. Inflammation in people living with HIV is elevated compared with the general population even after prolonged suppression of viremia with anti-retroviral therapy. Mechanisms that contribute to inflammation during aging and in treated HIV disease are potentially interactive, leading to an exaggerated inflammatory phenotype in people with HIV. RECENT FINDINGS Recent studies highlight roles for anti-retroviral therapy, co-infections, immune system alterations, and microbiome perturbations as important contributors to HIV-associated inflammation. These factors likely contribute to increased risk of age-related morbidities in people living with HIV. Understanding mechanisms that exaggerate the inflammaging process in people with HIV may lead to improved intervention strategies, ultimately, extending both lifespan and healthspan.
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Maggi P, Ricci E, Messina V, Salzillo A, Simeone F, Iodice A, Socio GV. Dangerous liaisons? The role of inflammation and comorbidities in HIV and SARS-CoV-2 infection. Expert Rev Clin Immunol 2021; 17:201-208. [PMID: 33538189 DOI: 10.1080/1744666x.2021.1886080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION In people living with HIV (PLWH), immune activation and inflammation levels are high even when viral suppression is maintained, potentially contributing to several comorbidities, and hampering the immune response to infections such as the recent SARS-CoV-2 disease 2019 (COVID-19). AREAS COVERED Immune activation and inflammation play a role in SARS-CoV-2 infection. Severe COVID-19 patients may experience cytokine release syndrome (CRS), leading to alveolar damage, pulmonary fibrinolysis, dysregulated coagulation, and pulmonary injury. Into the systemic circulation, cytokines in excess might leak out of pulmonary circulation, causing systemic symptoms and possibly a multiple-organ dysfunction syndrome. Preexisting comorbidities are also linked to worse COVID-19 outcome: studies suggest that diabetes and hypertension are linked to higher mortality rates. Such comorbidities are more frequent in PLWH, but it is unclear if they have worse outcomes in the case of COVID-19. The literature was searched in PubMed/MEDLINE and EMBASE, and manually in COVID-19 resources. EXPERT OPINION A body of evidence shows that HIV and SARS-CoV-2 are able to activate inflammatory pathways, acute in the case of SARS-CoV-2, chronic in the case of HIV, while the comorbidities seem to represent, in the first case, a contributory cause, in the second an effect of the virus-induced damage.
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Affiliation(s)
- Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elena Ricci
- Fondazione A.S.I.A. Onlus, Buccinasco, Milan, Italy
| | - Vincenzo Messina
- Infectious and Tropical Diseases Clinic, AORN S.Anna and S.Sebastiano, Caserta, Italy
| | - Angela Salzillo
- Infectious and Tropical Diseases Clinic, AORN S.Anna and S.Sebastiano, Caserta, Italy
| | - Filomena Simeone
- Infectious and Tropical Diseases Clinic, AORN S.Anna and S.Sebastiano, Caserta, Italy
| | - Angelo Iodice
- Infectious and Tropical Diseases Clinic, AORN S.Anna and S.Sebastiano, Caserta, Italy
| | - Giuseppe Vittorio Socio
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera Di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
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27
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Bazié WW, Boucher J, Vitry J, Goyer B, Routy JP, Tremblay C, Trottier S, Jenabian MA, Provost P, Alary M, Gilbert C. Plasma Extracellular Vesicle Subtypes May be Useful as Potential Biomarkers of Immune Activation in People With HIV. Pathog Immun 2021; 6:1-28. [PMID: 33987483 PMCID: PMC8109236 DOI: 10.20411/pai.v6i1.384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background Extracellular vesicles (EVs) are intercellular messengers with epigenetic potential since they can shuttle microRNA (miRNA). EVs and miRNA play a role in human immunodeficiency virus (HIV) infection immunopathogenesis. Chronic immune activation and systemic inflammation during HIV infection despite effective antiretroviral therapy (ART) are associated with non-acquired immunodeficiency syndrome (AIDS) comorbidities in people living with HIV (PLWH). Analysis of plasma EVs and their miRNA content may be useful as immune activation or inflammatory biomarkers in PLWH receiving ART. In this study, we hypothesized that the number, size, and miRNA of large and small EVs could reflect immune activation associated with an elevated CD8 T-cell count or a low CD4/CD8 ratio in PLWH. Methods Plasma EVs subtype purified from PLWH and uninfected controls were sized using dynamic light scattering and quantified using flow cytometry and acetylcholine esterase (AChE) activity. Expression of mature miRNAs miR-92, miR-155, miR-223 was measured by quantitative reverse-transcriptase polymerase chain reaction in EVs and leucocytes. Results HIV infection induces increased production of small EVs in plasma. EV subtypes were differentially enriched in miR-92, miR-155, and miR-223. Positive correlations between CD8 T-cell count and large EVs abundance and small EVs AChE activity were observed. CD4/CD8 ratio was negatively correlated with small EV AChE activity, and miRNA-155 level per small EV was negatively correlated with CD8 T-cell count. Conclusions These findings suggest that quantifying large or small EVs and profiling miRNA content per EV might provide new functional biomarkers of immune activation and inflammation.
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Affiliation(s)
- Wilfried Wenceslas Bazié
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec, QC, Canada.,Programme de recherche sur les maladies infectieuses, Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Julien Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Julien Vitry
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Benjamin Goyer
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Jean Pierre Routy
- Chronic Viral Illness Service and Division of Hematology, McGill University Health Centre, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montréal, QC, Canada
| | - Cécile Tremblay
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Sylvie Trottier
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Mohammad-Ali Jenabian
- Département des sciences biologiques, Université de Québec à Montréal (UQAM), Montréal, QC, Canada
| | - Patrick Provost
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Michel Alary
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de médecine sociale et préventive, Faculté de médecine, Université de Laval, Québec, C, Canada.,Institut national de santé publique du Québec, Québec, QC, Canada
| | - Caroline Gilbert
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec, QC, Canada
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28
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Bristow C, George G, Hillsmith G, Rainey E, Urasa S, Koipapi S, Kisoli A, Boni J, Saria GA, Ranasinghe S, Joseph M, Gray WK, Dekker M, Walker RW, Dotchin CL, Mukaetova-Ladinska E, Howlett W, Makupa P, Paddick SM. Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania. J Neurovirol 2021; 27:58-69. [PMID: 33432552 PMCID: PMC7921045 DOI: 10.1007/s13365-020-00915-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.
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Affiliation(s)
- Clare Bristow
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Grace George
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Grace Hillsmith
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Emma Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Japhet Boni
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | | | | | - Marcella Joseph
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Marieke Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Richard W Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine L Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Elizabeta Mukaetova-Ladinska
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK
| | - William Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Philip Makupa
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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Verheij E, Wit FW, Verboeket SO, Schim van der Loeff MF, Nellen JF, Reiss P, Kirk GD. Frequency, Risk Factors, and Mediators of Frailty Transitions During Long-Term Follow-Up Among People With HIV and HIV-Negative AGEhIV Cohort Participants. J Acquir Immune Defic Syndr 2021; 86:110-118. [PMID: 33105395 PMCID: PMC7722459 DOI: 10.1097/qai.0000000000002532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/07/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND We previously demonstrated a higher prevalence of frailty among AGEhIV-cohort participants with HIV (PWH) than among age- and lifestyle-comparable HIV-negative participants. Furthermore, frailty was associated with the development of comorbidities and mortality. As frailty may be a dynamic state, we evaluated the frequency of transitions between frailty states, and explored which factors were associated with transition toward frailty in this cohort. METHODS The study enrolled 598 PWH and 550 HIV-negative participants aged ≥45 years. Of those, 497 and 479 participants, respectively, participated in ≥2 consecutive biennial study-visits between October 2010 and October 2016, contributing 918 and 915 visit-pairs, respectively. We describe the frequency, direction, and risk factors of frailty transitions. Logistic regression models with generalized estimating equations were used to evaluate determinants for transition to frailty, including HIV-status, socio-demographic, behavioral, HIV-related factors, and various inflammatory and related biomarkers. RESULTS Transitioning between frailty states in any direction occurred in 36% of a total of 1833 visit-pairs. The odds of nonfrail participants transitioning toward frailty were significantly higher for PWH, occurring in 35 PWH (7.3%) and 25 (5.2%) HIV-negative nonfrail participants, respectively (odd ratioHIV 2.19, 95% confidence interval 1.28 to 3.75). The increased risk among PWH was attenuated when sequentially adjusting for waist-hip ratio, number of pre-existent comorbidities, and the presence of depressive symptoms. CONCLUSION PWH are at increased risk of transitioning to frailty, and thereby at increased risk of adverse health outcomes. Whether optimizing the management of obesity, comorbidity, or depressive symptoms may modify the risk of becoming frail requires further investigation.
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Affiliation(s)
- Eveline Verheij
- Department of Global Health and Division of Infectious Diseases, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Ferdinand W. Wit
- Department of Global Health and Division of Infectious Diseases, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Sebastiaan O. Verboeket
- Department of Global Health and Division of Infectious Diseases, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam University Medical Center, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; and
| | - Jeannine F. Nellen
- Department of Global Health and Division of Infectious Diseases, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter Reiss
- Department of Global Health and Division of Infectious Diseases, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Gregory D. Kirk
- Departments of Epidemiology and Medicine, Schools of Public Health and Medicine, Johns Hopkins University, Baltimore, MD
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30
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Haile ZT, Sarfo B, Bonney EY, Mensah EA, Deletsu S. Association between Antiretroviral Treatment and Markers of Systemic Inflammation among HIV Patients in Ghana. Curr HIV Res 2020; 18:466-474. [PMID: 32807057 DOI: 10.2174/1570162x18666200817111152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Studies from high-income countries have reported that even after receiving antiretroviral treatment (ART), HIV-infected adults may not achieve normal levels of certain inflammatory markers that are known to be associated with the onset and development of non-communicable diseases. OBJECTIVE The aim of this study is to examine the relationship between ART and markers of systemic inflammation in HIV/AIDS patients at an urban antiretroviral clinic in Ghana. METHODS We examined serum levels of high sensitivity CRP (hsCRP), interleukin-6 (IL-6), interleukin- 18(IL-18), and tumor necrosis factor-α (sTNFR1 and sTNFR2) from 40 HIV infected patients. Kruskal-Wallis Test was used to examine the differences in markers of systemic inflammation according to the types of ART medication taken. We then utilized generalized additive models (GAM) with non-linear function to examine the association between ART and markers of systemic inflammation after adjusting for potential confounders. RESULTS Overall, 30 (75.0%) of the participants received ART and 35 (85%) were female. Kruskal- Wallis Test revealed no significant differences in the markers of systemic inflammation among the three categories of ART (none, AZT, 3TC, EFV/NVP, and TDF, 3TC/FTC, EFV/NVP). In the multivariable- adjusted GAM model, we found a significant but non-linear association between time since diagnosis and CRP levels (p=0.006). CONCLUSION Although the relatively small sample size limits the scope of the study's findings, these results suggest that individuals on ART need to be screened periodically for the development of chronic conditions. This line of investigation has the potential to influence treatment and clinical guidelines that will improve the quality of care for HIV-infected patients.
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Affiliation(s)
- Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin OH-43016, United States
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Legon, Ghana
| | - Evelyn Y Bonney
- Department of Virology, University of Ghana Noguchi Memorial Institute for Medical Research, Legon, Ghana
| | - Eric A Mensah
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Selase Deletsu
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
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31
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Lee WS, Parsons S, Cugley D, Rogers S, Lim LL, Hall A. Increased incidence of glaucoma medication usage in middle-aged Australian males taking antiretroviral medication - a population-based study. J Ophthalmic Inflamm Infect 2020; 10:30. [PMID: 33141357 PMCID: PMC7609505 DOI: 10.1186/s12348-020-00218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To investigate a possible association between glaucoma and the use of anti-retroviral therapy (ART) for HIV in the Australian population. METHODS A retrospective review of Australian Pharmaceutical Benefits Scheme data was undertaken from July 2012 to December 2016, inclusive. Three patient groups were compared: those on both topical intraocular pressure (IOP) -lowering medication and ART, those on ART only, and those on IOP-lowering medication only, using the 2016 Australian resident population to estimate prevalence. Odds ratios (95% confidence intervals, [CI]) with Fishers exact test for p values were calculated stratified by age and gender. RESULTS The number of prescriptions for topical glaucoma medications in the general Australian population increased progressively by age with a peak prevalence in those aged 80 years and above. Prevalence of ART was highest in males aged 40-49 and 50-59 years (0.41% [CI 0.40, 0.42] and 0.44% [CI 0.43, 0.45], respectively). Our analysis identified an increase in the prescription of IOP-lowering medication in males on ART aged 30-39 (OR 2.23 [CI 1.32, 3.75], p = 0.007) and 40-49 (OR 1.86 [CI 1.42, 2.43], p < 0.001), compared to those not on ART. There were no statistically significant increased odds for females or males aged 50 years or more. CONCLUSION Compared with the known increase in glaucoma prevalence with age in the general Australian population, a statistically significant increased prevalence in use of IOP-lowering medications was found in males on ART aged 30-49 years. The mechanism for this is yet to be determined, but possible causes include sequelae of HIV infection, a drug-induced side effect, or increased medical surveillance.
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Affiliation(s)
- Wen-Shen Lee
- Ophthalmology, The Alfred Hospital, Alfred Health, Melbourne, Australia
| | - Shaun Parsons
- Ophthalmology, The Alfred Hospital, Alfred Health, Melbourne, Australia.,Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Dean Cugley
- Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Sophie Rogers
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Anthony Hall
- Ophthalmology, The Alfred Hospital, Alfred Health, Melbourne, Australia.
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32
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Abstract
PURPOSE OF REVIEW Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH. RECENT FINDINGS Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatrics, Director, Comprehensive HIV and Aging Initiative, McGill University Health Centre, Montreal, Quebec, Canada.
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33
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Erlandson KM, Wilson MP, MaWhinney S, Rapaport E, Liu J, Wilson CC, Rahkola JT, Janoff EN, Brown TT, Campbell TB, Jankowski CM. The Impact of Moderate or High-Intensity Combined Exercise on Systemic Inflammation Among Older Persons With and Without HIV. J Infect Dis 2020; 223:1161-1170. [PMID: 32779711 DOI: 10.1093/infdis/jiaa494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We investigated whether higher-intensity exercise provided greater decrease in markers of inflammation, and whether responses differed by HIV serostatus. METHODS People with HIV (PWH; n = 32) and controls (n = 37) aged 50-75 years completed 12 weeks moderate-intensity exercise, then were randomized to moderate- or high-intensity exercise for 12 additional weeks (n = 27 and 29, respectively). Inflammation biomarkers were measured at 0, 12, 24 weeks. Mixed and multiple regression models were adjusted for baseline inflammation, age, and body mass index. RESULTS Baseline tumor necrosis factor-α (TNF-α), soluble TNF receptor 2 (sTNFR2), and soluble CD14 (sCD14) were significantly higher among PWH than controls (P < .04). From week 0-12, changes in interleukin-6 (IL-6), TNF-α, and sTNFR1 were not significantly different by HIV serostatus. We found no significant interaction between HIV serostatus/exercise intensity on week 12-24 changes in IL-6, TNF-α, and sTNFR1. Among high-intensity exercisers, PWH and controls had significant increases in sCD14 (P ≤ .003), controls significant increases in IL-10 (P = .01), and PWH nonsignificant decrease in highly sensitive C-reactive protein (P = .07). Other markers were not significantly different by serostatus or intensity. CONCLUSIONS Moderate and high-intensity exercise elicited similar effects on inflammation among PWH and controls, with additional beneficial effects seen among high-intensity exercisers. Increase in sCD14 and attenuated IL-10 increase (PWH only) merit further study. CLINICAL TRIALS REGISTRATION NCT02404792.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melissa P Wilson
- School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Rapaport
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay Liu
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara C Wilson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeremy T Rahkola
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward N Janoff
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas B Campbell
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M Jankowski
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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34
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HIV-1 Persistence and Chronic Induction of Innate Immune Responses in Macrophages. Viruses 2020; 12:v12070711. [PMID: 32630058 PMCID: PMC7412260 DOI: 10.3390/v12070711] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
A hallmark of HIV-1 infection is chronic inflammation, which plays a significant role in disease pathogenesis. Acute HIV infection induces robust inflammatory responses, which are insufficient to prevent or eliminate virus in mucosal tissues. While establishment of viral set-point is coincident with downregulation of acute innate responses, systemic inflammatory responses persist during the course of chronic HIV infection. Since the introduction of combination antiviral therapy (cART), most HIV-1+ individuals can suppress viremia under detection levels for decades. However, chronic immune activation persists and has been postulated to cause HIV associated non-AIDS complications (HANA). Importantly, inflammatory cytokines and activation markers associated with macrophages are strongly and selectively correlated with the incidence of HIV-associated neurocognitive disorder (HAND), cardiovascular dysfunctions (CVD) and other HANA conditions. In this review, we discuss the roles of macrophages in facilitating viral persistence and contributing to generation of persistent inflammatory responses.
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Gabuzda D, Jamieson BD, Collman RG, Lederman MM, Burdo TH, Deeks SG, Dittmer DP, Fox HS, Funderburg NT, Pahwa SG, Pandrea I, Wilson CC, Hunt PW. Pathogenesis of Aging and Age-related Comorbidities in People with HIV: Highlights from the HIV ACTION Workshop. Pathog Immun 2020; 5:143-174. [PMID: 32856008 PMCID: PMC7449259 DOI: 10.20411/pai.v5i1.365] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
People with HIV (PWH) experience accentuated biological aging, as defined by markers of inflammation, immune dysfunction, and the epigenetic clock. They also have an elevated risk of multiple age-associated comorbidities. To discuss current knowledge, research gaps, and priorities in aging and age-related comorbidities in treated HIV infection, the NIH program staff organized a workshop held in Bethesda, Maryland in September 2019. This review article describes highlights of discussions led by the Pathogenesis/Basic Science Research working group that focused on three high priority topics: immunopathogenesis; the microbiome/virome; and aging and senescence. We summarize knowledge in these fields and describe key questions for research on the pathogenesis of aging and age-related comorbidities in PWH. Understanding the drivers and mechanisms underlying accentuated biological aging is a high priority that will help identify potential therapeutic targets to improve healthspan in older PWH.
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Affiliation(s)
- Dana Gabuzda
- Department of Cancer Immunology and Virology; Dana-Farber Cancer Institute; Boston, Massachusetts; Department of Neurology; Harvard Medical School; Boston, Massachusetts
| | - Beth D Jamieson
- Department of Medicine; David Geffen School of Medicine; University of California; Los Angeles, California
| | - Ronald G Collman
- Department of Medicine; University of Pennsylvania School of Medicine; Philadelphia, Pennsylvania
| | - Michael M Lederman
- Department of Medicine; Case Western Reserve University School of Medicine; Cleveland, Ohio
| | - Tricia H Burdo
- Department of Neuroscience; Lewis Katz School of Medicine; Temple University; Philadelphia, Pennsylvania
| | - Steven G Deeks
- Department of Medicine; University of California; San Francisco, California
| | - Dirk P Dittmer
- Department of Microbiology and Immunology; University of North Carolina School of Medicine; Chapel Hill, North Carolina
| | - Howard S Fox
- Department of Pharmacology and Experimental Neuroscience; University of Nebraska Medical Center; Omaha, Nebraska
| | - Nicholas T Funderburg
- Division of Medical Laboratory Science; School of Health and Rehabilitation Sciences; Ohio State University College of Medicine; Columbus, Ohio
| | - Savita G Pahwa
- Department of Microbiology and Immunology; University of Miami Miller School of Medicine; Miami, Florida
| | - Ivona Pandrea
- Department of Microbiology and Molecular Genetics; School of Medicine; University of Pittsburgh; Pittsburgh, Pennsylvania
| | - Cara C Wilson
- Department of Medicine; Division of Infectious Diseases; University of Colorado Anschutz Medical Campus; Aurora, Colorado
| | - Peter W Hunt
- Department of Medicine; University of California; San Francisco, California
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Dalzini A, Petrara MR, Ballin G, Zanchetta M, Giaquinto C, De Rossi A. Biological Aging and Immune Senescence in Children with Perinatally Acquired HIV. J Immunol Res 2020; 2020:8041616. [PMID: 32509884 PMCID: PMC7246406 DOI: 10.1155/2020/8041616] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic HIV-infected children suffer from premature aging and aging-related diseases. Viral replication induces an ongoing inflammation process, with the release of pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs), the activation of the immune system, and the production of proinflammatory cytokines. Although combined highly active antiretroviral therapy (ART) has significantly modified the natural course of HIV infection, normalization of T and B cell phenotype is not completely achievable; thus, many HIV-infected children display several phenotypical alterations, including higher percentages of activated cells, that favor an accelerated telomere attrition, and higher percentages of exhausted and senescent cells. All these features ultimately lead to the clinical manifestations related to premature aging and comorbidities typically observed in older general population, including non-AIDS-related malignancies. Therefore, even under effective treatment, the premature aging process of HIV-infected children negatively impacts their quality and length of life. This review examines the available data on the impact of HIV and ART on immune and biological senescence of HIV-infected children.
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Affiliation(s)
- Annalisa Dalzini
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | - Maria Raffaella Petrara
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | - Giovanni Ballin
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | | | - Carlo Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
- Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
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Guaraldi G, Maurice JB, Marzolini C, Monteith K, Milic J, Tsochatzis E, Bhagani S, Morse CG, Price JC, Ingiliz P, Lemoine M, Sebastiani G. New Drugs for NASH and HIV Infection: Great Expectations for a Great Need. Hepatology 2020; 71:1831-1844. [PMID: 32052857 DOI: 10.1002/hep.31177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
In recent years, there has been an increasing number of clinical trials for the treatment of nonalcoholic steatohepatitis (NASH). People living with human immunodeficiency virus (PLWH) are commonly excluded from these studies, usually due to concerns over drug-drug interactions associated with antiretroviral therapy. The Steatohepatitis in HIV Emerging Research Network, a group of international experts in hepatology and infectious diseases, discusses our current understanding on the interaction between human immunodeficiency virus and NASH, and the issues related to the inclusion of PLWH in NASH clinical trials. Recent trials addressing NASH treatment in PLWH are discussed. The risk of drug-drug interactions between antiretroviral therapy and aramchol, cenicriviroc, elafibranor, obeticholic acid and resmetirom (MGL-3196), which are currently in phase 3 trials for the treatment of NASH, are reviewed. A model for trial design to include PLWH is proposed, strongly advocating for the scientific community to include this group as a subpopulation within studies.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - James B Maurice
- Hepatology Unit, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Catia Marzolini
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Kenneth Monteith
- Coalition des Organismes Communautaires Québécois de Lutte Contre le Sida, Montréal, QC, Canada
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Emmanuel Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
| | - Sanjay Bhagani
- Royal Free London, NHS Foundation Trust, London, United Kingdom
| | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Jennifer C Price
- Department of Medicine, University of California, San Francisco, CA
| | - Patrick Ingiliz
- Center for Infectiology, Berlin, Germany.,Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Royal Victoria Hospital - Site Glen, Montréal, QC, Canada.,Division of Infectious Diseases, McGill University Health Center, Royal Victoria Hospital-Site Glen, Montréal, QC, Canada
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Abstract
PURPOSE OF REVIEW This article describes the use of biomarkers in expanding our understanding of chronic non-AIDS comorbidities among persons living with HIV (PLWH) receiving antiretroviral therapy (ART). RECENT FINDINGS We review current evidence that biomarkers of chronic immune activation and inflammation associate with a broad spectrum of end-organ diseases in PLWH. We discuss how ART may impact inflammation associated with HIV infection and the degree to which inflammation persists despite effective suppression of viral replication in plasma. We then discuss the limitations of the current literature, which lacks evidence of causality and disproportionately involves a few protein biomarkers that are unable to disentangle complex and overlapping biological pathways. SUMMARY Premature end-organ disease among PLWH has been repeatedly associated with higher levels of blood biomarkers reflecting inflammation and immune activation, which, despite viral suppression and CD4 T-cell increases after ART treatment, remain elevated relative to uninfected persons. There remain important unanswered questions with implications for the development of anti-inflammatory treatment strategies aimed at mitigating excess risk for end-organ comorbidities among PLWH.
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Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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HENDERSON LJ, JOHNSON TP, SMITH BR, REOMA LB, SANTAMARIA UA, BACHANI M, DEMARINO C, BARCLAY RA, SNOW J, SACKTOR N, MCARTHUR J, LETENDRE S, STEINER J, KASHANCHI F, NATH A. Presence of Tat and transactivation response element in spinal fluid despite antiretroviral therapy. AIDS 2019; 33 Suppl 2:S145-S157. [PMID: 31789815 PMCID: PMC11032747 DOI: 10.1097/qad.0000000000002268] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to measure the protein concentration and biological activity of HIV-1 Tat in cerebrospinal fluid (CSF) of individuals on suppressive antiretroviral therapy (ART). DESIGN CSF was collected from 68 HIV-positive individuals on ART with plasma viral load less than 40 copies/ml, and from 25 HIV-negative healthy controls. Duration of HIV infection ranged from 4 to more than 30 years. METHODS Tat levels in CSF were evaluated by an ELISA. Tat protein and viral RNA were quantified from exosomes isolated from CSF, followed by western blot or quantitative reverse transcription PCR, respectively. Functional activity of Tat was assessed using an LTR transactivation assay. RESULTS Tat protein was detected in 36.8% of CSF samples from HIV-positive patients. CSF Tat concentration increased in four out of five individuals after initiation of therapy, indicating that Tat was not inhibited by ART. Similarly, exosomes from 34.4% of CSF samples were strongly positive for Tat protein and/or TAR RNA. Exosomal Tat retained transactivation activity in a CEM-LTR reporter assay in 66.7% of samples assayed, which indicates that over half of the Tat present in CSF is functional. Presence of Tat in CSF was highly associated with previous abuse of psychostimulants (cocaine or amphetamines; P = 0.01) and worse performance in the psychomotor speed (P = 0.04) and information processing (P = 0.02) cognitive domains. CONCLUSION Tat and TAR are produced in the central nervous system despite adequate ART and are packaged into CSF exosomes. Tat remains biologically active within this compartment. These studies suggest that Tat may be a quantifiable marker of the viral reservoir and highlight a need for new therapies that directly inhibit Tat.
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Affiliation(s)
- Lisa J. HENDERSON
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Tory P. JOHNSON
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan R. SMITH
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Lauren Bowen REOMA
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Ulisses A. SANTAMARIA
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Muzna BACHANI
- Translational Neuroscience Center, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda Maryland
| | - Catherine DEMARINO
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas Virginia
| | - Robert A. BARCLAY
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas Virginia
| | - Joseph SNOW
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ned SACKTOR
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin MCARTHUR
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Scott LETENDRE
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, San Diego California
| | - Joseph STEINER
- Translational Neuroscience Center, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda Maryland
| | - Fatah KASHANCHI
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas Virginia
| | - Avindra NATH
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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41
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Tran T, Guardigni V, Pencina KM, Amato AA, Floyd M, Brawley B, Mozeleski B, McKinnon J, Woodbury E, Heckel E, Li Z, Storer T, Sax PE, Montano M. Atypical Skeletal Muscle Profiles in Human Immunodeficiency Virus-Infected Asymptomatic Middle-Aged Adults. Clin Infect Dis 2019; 66:1918-1927. [PMID: 29293942 DOI: 10.1093/cid/cix1121] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/21/2017] [Indexed: 12/25/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-infected individuals are at increased risk of age-associated functional impairment, even with effective antiretroviral therapy (ART). A concurrent characterization of skeletal muscle, physical function, and immune phenotype in aviremic middle-aged HIV-infected adults represents a knowledge gap in prognostic biomarker discovery. Methods We undertook a prospective observational study of 170 middle-aged, HIV-infected ambulatory men and women with CD4+ T-cell counts of at least 350/µL and undetectable plasma viremia while on effective ART, and uninfected control participants. We measured biomarkers for inflammation and immune activation, fatigue, the Veterans Aging Cohort Study mortality index, and physical function. A subset also received a skeletal muscle biopsy and computed tomography scan. Results Compared to the uninfected participants, HIV-infected participants displayed increased immune activation (P < .001), inflammation (P = .001), and fatigue (P = .010), and in a regression model adjusting for age and sex displayed deficits in stair-climb power (P < .001), gait speed (P = .036), and predicted metabolic equivalents (P = .019). Skeletal muscle displayed reduced nuclear peroxisome proliferator-activated receptor-γ coactivator 1α-positive myonuclei (P = .006), and increased internalized myonuclei (P < .001) that correlated with immune activation (P = .003) and leukocyte infiltration (P < .001). Internalized myonuclei improved a model for HIV discrimination, increasing the C-statistic from 0.84 to 0.90. Conclusions Asymptomatic HIV-infected middle-aged adults display atypical skeletal muscle profiles, subclinical deficits in physical function, and persistent inflammation and immune activation. Identifying biomarker profiles for muscle dysregulation and risk for future functional decline in the HIV-infected population will be key to developing and monitoring preventive interventions. Clinical Trials Registration NCT03011957.
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Affiliation(s)
- Thanh Tran
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Viola Guardigni
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karol M Pencina
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anthony A Amato
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Floyd
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brooke Brawley
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian Mozeleski
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer McKinnon
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erin Woodbury
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Heckel
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhuoying Li
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tom Storer
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul E Sax
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Monty Montano
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
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Guaraldi G, Franconi I, Milic J, Besutti G, Pintassilgo I, Scaglioni R, Ligabue G, Riva N, Raimondi A, Menozzi M, Carli F, Zona S, Santoro A, Malagoli A, Borghi V, Torricelli P, Cossarizza A, Mussini C. Thymus Imaging Detection and Size Is Inversely Associated With Metabolic Syndrome and Frailty in People With HIV. Open Forum Infect Dis 2019; 6:ofz435. [PMID: 31660382 PMCID: PMC6809752 DOI: 10.1093/ofid/ofz435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may experience accentuating aging in relation to immuno-activation. Little is known regarding thymus (THY) involution in this process. We sought to investigate the relationship between THY imaging detection/size and clinically relevant aging outcomes such as metabolic syndrome (MetS), multimorbidity (MM), and frailty in PWH. METHODS This was a cross-sectional observational study including 665 HIV patients (81% males; median age, 53 years) attending Modena HIV Metabolic Clinic from 2014 to 2017. They underwent thoracic computed tomography scan as part of the medical assessment for cardiovascular disease, in which THY detection and size were reported using a semiquantitative score. Outcome measures were MetS, MM, and frailty. RESULTS THY was detected in 27.0% of subjects; 71.1% showed THY size of grade 1-2, and 28.9% exhibited grade ≥3. Covariates that inversely correlated with THY detection were age, male gender, body mass index (BMI), and HIV duration. Covariates that inversely correlated with MetS were age, HIV duration, BMI, and THY grade 1-2. Covariates that inversely correlated with MM were age, HIV duration, and CD4 nadir. Covariates that inversely correlated with frailty were age, HIV duration, CD4 nadir, BMI, and THY detection. CONCLUSIONS THY is inversely associated with MetS and frailty in PWH.
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Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Iacopo Franconi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Radiology Unit, University of Modena and Reggio Emilia, Italy
| | - Ines Pintassilgo
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Guido Ligabue
- Radiology Unit, University of Modena and Reggio Emilia, Italy
| | - Nicoletta Riva
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Alessandro Raimondi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Marianna Menozzi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Federica Carli
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Stefano Zona
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Antonella Santoro
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Vanni Borghi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | | | - Andrea Cossarizza
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
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Oliveira VH, Wiechmann SL, Narciso AM, Webel AR, Deminice R. Muscle strength is impaired in men but not in women living with HIV taking antiretroviral therapy. Antivir Ther 2019; 23:11-19. [PMID: 28327461 DOI: 10.3851/imp3159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence that HIV antiretroviral therapy adverse effects may be sex-dependent, but data examining these sex differences in muscle strength is scarce. Our aim was to compare dynamic and isokinetic parameters of muscle strength between HIV-infected men and women to HIV-uninfected subjects. METHODS In this cross-sectional study, muscle strength was evaluated in 44 HIV-infected (20 men, 24 women) and 25 age-, race- and body mass index-matched HIV-uninfected subjects (11 men, 14 women). We assessed knee flexion and extension efforts in isokinetic dynamometer at angular velocities of 60° and 180°/s, and 1 repetition maximum test (1RM) for bench press, leg press and arm curl exercises, respectively. Lean body mass (LBM) was measured using bioelectrical impedance. RESULTS HIV-infected men had significantly less dynamic muscle strength for 1RM total (262.5 versus 357.2 kg), bench press (48.6 versus 60.3 kg), leg press (182.7 versus 261 kg) and arm curl (31.2 versus 36.5 kg) compared to HIV-uninfected men (P≤0.05); no differences were found among women. Men had lower values for peak torque in extension and flexion movements at 60°/s and 180°/s, while HIV-infected women presented higher peak torque in extension movement at 60°/s compared to controls. No differences were found in LBM. Moreover, isokinetic evaluation demonstrated that HIV-infected subjects showed greater acceleration and deceleration time in some variables, compared to controls, related to difficulty in activating motor units. CONCLUSIONS HIV infection is associated with impaired dynamic and isokinetic strength in men compared to HIV-uninfected controls, but not in women.
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Affiliation(s)
- Vitor Hf Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Brazil
| | - Susana L Wiechmann
- University Hospital, Institute of Health Science, State University of Londrina, Londrina, Brazil
| | - Argéria Ms Narciso
- University Hospital, Institute of Health Science, State University of Londrina, Londrina, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Brazil
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Kelly SG, Wu K, Tassiopoulos K, Erlandson KM, Koletar SL, Palella FJ. Frailty Is an Independent Risk Factor for Mortality, Cardiovascular Disease, Bone Disease, and Diabetes Among Aging Adults With Human Immunodeficiency Virus. Clin Infect Dis 2019; 69:1370-1376. [PMID: 30590451 PMCID: PMC6938206 DOI: 10.1093/cid/ciy1101] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We characterized associations between frailty and incident cardiovascular disease (CVD), diabetes mellitus (DM), bone disease, and mortality within a cohort of aging persons with human immunodeficiency virus (PWH). METHODS Participants underwent frailty evaluations using the Fried frailty assessment (baseline and annually). Frailty was defined as having ≥3 frailty criteria. Clinical outcomes of mortality, CVD events, DM, and bone disease events were recorded throughout the study period (baseline to most recent study or clinic visit, or date of clinical outcome, whichever came first). Poisson regression models were used to evaluate associations between baseline frailty, change in frailty score over 48 weeks, and each clinical outcome. RESULTS Among 821 men and 195 women (median age 51 years), 62 (6%) were frail at baseline. Frailty scores increased by ≥1 component among 194 participants (19%) from baseline to 48 weeks. Baseline frailty was associated with an increased risk of incident CVD and DM, with a trend toward a significant association with bone events. Among frailty components, slow gait speed was associated with incident DM and borderline associated with incident CVD. An increase in frailty from baseline to week 48 was associated with mortality but not with the other clinical outcomes. CONCLUSIONS Baseline frailty was associated with multiple adverse health outcomes (incident CVD, DM, and bone disease), while increase in frailty score was associated with mortality among PWH engaged in care. Incorporation of frailty assessments into the care of PWH may assist in improvement of functional status and risk stratification for age-related chronic diseases.
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Affiliation(s)
- Sean G Kelly
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kunling Wu
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | | | | | - Susan L Koletar
- Department of Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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45
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Hoenigl M, Moser CB, Funderburg N, Bosch R, Kantor A, Zhang Y, Eugen-Olsen J, Finkelman M, Reiser J, Landay A, Moisi D, Lederman MM, Gianella S. Soluble Urokinase Plasminogen Activator Receptor Is Predictive of Non-AIDS Events During Antiretroviral Therapy-mediated Viral Suppression. Clin Infect Dis 2019; 69:676-686. [PMID: 30418519 PMCID: PMC6669298 DOI: 10.1093/cid/ciy966] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/08/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite effective antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection remains associated with higher morbidity and mortality, driven, in part, by increased inflammation. Our objective was to identify associations between levels of plasma biomarkers of chronic inflammation, microbial translocation, and monocyte activation, with occurrence of non-AIDS events. METHODS Participants (141 cases, 310 matched controls) were selected from a longitudinal observational trial; all were virally suppressed on ART at year 1 and thereafter. Soluble urokinase plasminogen activator receptor (suPAR), lipopolysaccharide binding protein (LBP), beta-D-glucan (BDG), intestinal fatty-acid binding protein, oxidized low-density lipoproteins, and soluble CD163 were measured pre-ART, after 1-year of ART, and pre-event. At each time point, conditional logistic regression analysis assessed associations of the biomarkers with events and adjusted for relevant covariates to calculate odds ratios (ORs) according to 1 interquartile range (IQR) difference. RESULTS At all time points, higher levels of suPAR were associated with increased risk of non-AIDS events (OR per 1 IQR was 1.7 before ART-initiation, OR per 1 IQR was 2.0 after 1 year of suppressive ART, and OR 2.1 pre-event). Higher levels of BDG and LBP at year 1 and pre-event (but not at baseline) were associated with increased risk of non-AIDS events. No associations were observed for other biomarkers. CONCLUSIONS Elevated levels of suPAR were strongly, consistently, and independently predictive of non-AIDS events at every measured time point. Interventions that target the suPAR pathway should be investigated to explore its role in the pathogenesis of non-AIDS-related outcomes in HIV infection.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, Austria
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Carlee B Moser
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nicholas Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Ronald Bosch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Denmark
| | | | - Jochen Reiser
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Alan Landay
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Daniela Moisi
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael M Lederman
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sara Gianella
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, Austria
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Saylor D, Kumar A, Nakigozi G, Anok A, Batte J, Kisakye A, Mayanja R, Nakasujja N, Robertson KR, Gray RH, Wawer MJ, Pardo CA, Sacktor N. Interleukin-6 is associated with mortality and neuropsychiatric outcomes in antiretroviral-naïve adults in Rakai, Uganda. J Neurovirol 2019; 25:735-740. [PMID: 31165368 DOI: 10.1007/s13365-019-00759-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/16/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022]
Abstract
Serum interleukin-6 (IL-6) and D-dimer have been associated with multiple adverse outcomes in HIV-infected (HIV+) individuals, but their association with neuropsychiatric outcomes, including HIV-associated neurocognitive disorder (HAND) and depression, headaches, and peripheral neuropathy have not been investigated. Three hundred ninety-nine HIV+ antiretroviral therapy (ART)-naïve adults in Rakai, Uganda, were enrolled in a longitudinal cohort study and completed a neurological evaluation, neurocognitive assessment, and venous blood draw. Half of the participants had advanced immunosuppression (CD4 count < 200 cells/μL), and half had moderate immunosuppression (CD4 count 350-500 cells/μL). All-cause mortality was determined by verbal autopsy within 2 years. HAND was determined using Frascati criteria, and depression was defined by the Center for Epidemiologic Studies-Depression (CES-D) scale. Neuropathy was defined as the presence of > 1 neuropathy symptom and > 1 neuropathy sign. Headaches were identified by self-report. Serum D-dimer levels were determined using ELISA and IL-6 levels using singleplex assays. Participants were 53% male, mean age 35 + 8 years, and mean education 5 + 3 years. Participants with advanced immunosuppression had significantly higher levels of IL-6 (p < 0.001) and a trend toward higher D-dimer levels (p = 0.06). IL-6 was higher among participants with HAND (p = 0.01), with depression (p = 0.03) and among those who died within 2 years (p = 0.001) but not those with neuropathy or headaches. D-dimer did not vary significantly by any outcome. Systemic inflammation as measured by serum IL-6 is associated with an increased risk of advanced immunosuppression, all-cause mortality, HAND, and depression but not neuropathy or headaches among ART-naïve HIV+ adults in rural Uganda.
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Affiliation(s)
- Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. .,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
| | - Anupama Kumar
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | | | - Kevin R Robertson
- Department of Neurology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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Abstract
PURPOSE OF REVIEW As a consequence of antiretroviral therapy, the proportion of older HIV-infected adults is increasing, with a concomitant shift in burden of illness to age-related syndromes and disease. Frailty is an age-related syndrome of increased vulnerability to stress, predictive of major adverse clinical outcomes among HIV-infected and uninfected persons alike. Understanding frailty pathogenesis is critical to developing interventions to improve health outcomes in HIV. Here, we review the current evidence for the relationship between inflammation and frailty in HIV, and the potential for novel, inflammation-targeted interventions. RECENT FINDINGS Dysregulated inflammation has been consistently associated with frailty in elderly HIV-uninfected persons. Dysregulated inflammation is also central to HIV pathophysiology and several recent studies have demonstrated the important association of inflammation with frailty in HIV. Some evidence suggests that anti-inflammatory therapies may be effective in ameliorating the adverse impact of frailty among aging HIV-infected adults, though further investigation is necessary. Inflammation has been implicated in frailty in HIV infection, and improved understanding of the role that inflammation plays in frailty pathogenesis is key to the development of effective therapies to slow or prevent frailty in the vulnerable HIV-infected population.
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Colomb F, Giron LB, Trbojevic-Akmacic I, Lauc G, Abdel-Mohsen M. Breaking the Glyco-Code of HIV Persistence and Immunopathogenesis. Curr HIV/AIDS Rep 2019; 16:151-168. [PMID: 30707400 PMCID: PMC6441623 DOI: 10.1007/s11904-019-00433-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Glycoimmunology is an emerging field focused on understanding how immune responses are mediated by glycans (carbohydrates) and their interaction with glycan-binding proteins called lectins. How glycans influence immunological functions is increasingly well understood. In a parallel way, in the HIV field, it is increasingly understood how the host immune system controls HIV persistence and immunopathogenesis. However, what has mostly been overlooked, despite its potential for therapeutic applications, is the role that the host glycosylation machinery plays in modulating the persistence and immunopathogenesis of HIV. Here, we will survey four areas in which the links between glycan-lectin interactions and immunology and between immunology and HIV are well described. For each area, we will describe these links and then delineate the opportunities for the HIV field in investigating potential interactions between glycoimmunology and HIV persistence/immunopathogenesis. RECENT FINDINGS Recent studies show that the human glycome (the repertoire of human glycan structures) plays critical roles in driving or modulating several cellular processes and immunological functions that are central to maintaining HIV infection. Understanding the links between glycoimmunology and HIV infection may create a new paradigm for discovering novel glycan-based therapies that can lead to eradication, functional cure, or improved tolerance of lifelong infection.
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Affiliation(s)
- Florent Colomb
- The Wistar Institute, 3601 Spruce Street, Philadelphia, PA, USA
| | - Leila B Giron
- The Wistar Institute, 3601 Spruce Street, Philadelphia, PA, USA
| | | | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Borongajska cesta 83h, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovacica 1, Zagreb, Croatia
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Guaraldi G, Zona S, Silva AR, Menozzi M, Dolci G, Milic J, Carli F, Mussini C. The dynamic association between Frailty, CD4 and CD4/CD8 ratio in people aging with HIV. PLoS One 2019; 14:e0212283. [PMID: 30763363 PMCID: PMC6375603 DOI: 10.1371/journal.pone.0212283] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/30/2019] [Indexed: 01/02/2023] Open
Abstract
Objective To investigate the association between current CD4+ T-cell count and CD4/CD8+ ratio with severity of frailty among people aging with HIV. Methods Cross-sectional observational study analysing data from all study visits in the ongoing prospective Modena HIV Metabolic Clinic Cohort between 2006 and 2015. Frailty severity was assessed using a frailty index (FI). We visualized the relationships between frailty index score and current CD4 cell count and CD4/CD8 ratio on two different curves adjusted for age, sex, and duration of HIV infection. Results Frailty index scores exhibited an inverse relationship with current CD4 count, up to 900 cells/μL. The CD4/CD8 ratio was inversely correlated with frailty index both below and above the cut-off of 900 CD4 cells/μL. Conclusions Frailty in PLWH is inversely associated with both immune-activation, depicted by CD4/CD8 ratio and immune-deficit depicted by CD4 count. The first association shows a linear shape while the second shows a hook-shape with a turning point at 900 cells. Above this cut off level CD4 do not represent a significant risk factor for frailty.
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Affiliation(s)
- Giovanni Guaraldi
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - Stefano Zona
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Ana Rita Silva
- Department of Infectious Diseases, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marianna Menozzi
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Dolci
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Carli
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
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50
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Hale TM, Guardigni V, Roitmann E, Vegreville M, Brawley B, Woodbury E, Storer TW, Sax PE, Montano M. Middle-Aged Men With HIV Have Diminished Accelerometry-Based Activity Profiles Despite Similar Lab-Measured Gait Speed: Pilot Study. JMIR Mhealth Uhealth 2019; 7:e11190. [PMID: 30707104 PMCID: PMC6376331 DOI: 10.2196/11190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People aging with HIV are living with increased risk for functional decline compared with uninfected adults of the same age. Early preclinical changes in biomarkers in middle-aged individuals at risk for mobility and functional decline are needed. OBJECTIVE This pilot study aims to compare measures of free-living activity with lab-based measures. In addition, we aim to examine differences in the activity level and patterns by HIV status. METHODS Forty-six men (23 HIV+, 23 HIV-) currently in the MATCH (Muscle and Aging Treated Chronic HIV) cohort study wore a consumer-grade wristband accelerometer continuously for 3 weeks. We used free-living activity to calculate the gait speed and time spent at different activity intensities. Accelerometer data were compared with lab-based gait speed using the 6-minute walk test (6-MWT). Plasma biomarkers were measured and biobehavioral questionnaires were administered. RESULTS HIV+ men more often lived alone (P=.02), reported more pain (P=.02), and fatigue (P=.048). In addition, HIV+ men had lower blood CD4/CD8 ratios (P<.001) and higher Veterans Aging Cohort Study Index scores (P=.04) and T-cell activation (P<.001) but did not differ in levels of inflammation (P=.30) or testosterone (P=.83). For all participants, accelerometer-based gait speed was significantly lower than the lab-based 6-MWT gait speed (P<.001). Moreover, accelerometer-based gait speed was significantly lower in HIV+ participants (P=.04) despite the absence of differences in the lab-based 6-MWT (P=.39). HIV+ participants spent more time in the lowest quartile of activity compared with uninfected (P=.01), who spent more time in the middle quartiles of activity (P=.02). CONCLUSIONS Accelerometer-based assessment of gait speed and activity patterns are lower for asymptomatic men living with HIV compared with uninfected controls and may be useful as preclinical digital biomarkers that precede differences captured in lab-based measures.
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Affiliation(s)
- Timothy M Hale
- Partners HealthCare, Pivot Labs, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Viola Guardigni
- Harvard Medical School, Boston, MA, United States
- S.Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Bologna, Italy
- Brigham & Women's Hospital, Boston, MA, United States
| | | | | | | | - Erin Woodbury
- Brigham & Women's Hospital, Boston, MA, United States
| | - Thomas W Storer
- Harvard Medical School, Boston, MA, United States
- Brigham & Women's Hospital, Boston, MA, United States
| | - Paul E Sax
- Harvard Medical School, Boston, MA, United States
- Brigham & Women's Hospital, Boston, MA, United States
| | - Monty Montano
- Harvard Medical School, Boston, MA, United States
- Brigham & Women's Hospital, Boston, MA, United States
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