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Trøseid M, Nielsen SD, Vujkovic-Cvijin I. Gut microbiome and cardiometabolic comorbidities in people living with HIV. MICROBIOME 2024; 12:106. [PMID: 38877521 PMCID: PMC11177534 DOI: 10.1186/s40168-024-01815-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/12/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Despite modern antiretroviral therapy (ART), people living with HIV (PLWH) have increased relative risk of inflammatory-driven comorbidities, including cardiovascular disease (CVD). The gut microbiome could be one of several driving factors, along with traditional risk factors and HIV-related risk factors such as coinfections, ART toxicity, and past immunodeficiency. RESULTS PLWH have an altered gut microbiome, even after adjustment for known confounding factors including sexual preference. The HIV-related microbiome has been associated with cardiometabolic comorbidities, and shares features with CVD-related microbiota profiles, in particular reduced capacity for short-chain fatty acid (SCFA) generation. Substantial inter-individual variation has so far been an obstacle for applying microbiota profiles for risk stratification. This review covers updated knowledge and recent advances in our understanding of the gut microbiome and comorbidities in PLWH, with specific focus on cardiometabolic comorbidities and inflammation. It covers a comprehensive overview of HIV-related and comorbidity-related dysbiosis, microbial translocation, and microbiota-derived metabolites. It also contains recent data from studies in PLWH on circulating metabolites related to comorbidities and underlying gut microbiota alterations, including circulating levels of the SCFA propionate, the histidine-analogue imidazole propionate, and the protective metabolite indole-3-propionic acid. CONCLUSIONS Despite recent advances, the gut microbiome and related metabolites are not yet established as biomarkers or therapeutic targets. The review gives directions for future research needed to advance the field into clinical practice, including promises and pitfalls for precision medicine. Video Abstract.
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Affiliation(s)
- Marius Trøseid
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Oe, 2100, Denmark
| | - Ivan Vujkovic-Cvijin
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Karsh Division of Gastroenterology & Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Carrico AW, Cherenack EM, Flentje A, Moskowitz JT, Asam K, Ghanooni D, Chavez JV, Neilands TB, Dilworth SE, Rubin LH, Gouse H, Fuchs D, Paul RH, Aouizerat BE. A positive affect intervention alters leukocyte DNA methylation in sexual minority men with HIV who use methamphetamine. Brain Behav Immun 2024; 120:151-158. [PMID: 38777283 DOI: 10.1016/j.bbi.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/16/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This epigenomics sub-study embedded within a randomized controlled trial examined whether an evidenced-based behavioral intervention model that decreased stimulant use altered leukocyte DNA methylation (DNAm). METHODS Sexual minority men with HIV who use methamphetamine were randomized to a five-session positive affect intervention (n = 32) or an attention-control condition (n = 21), both delivered during three months of contingency management for stimulant abstinence. All participants exhibited sustained HIV virologic control - an HIV viral load less than 40 copies/mL at baseline and six months post-randomization. The Illumina EPIC BeadChip measured leukocyte methylation of cytosine-phosphate-guanosine (CpG) sites mapping onto five a priori candidate genes of interest (i.e., ADRB2, BDNF, FKBP5, NR3C1, OXTR). Functional DNAm pathways and soluble markers of immune dysfunction were secondary outcomes. RESULTS Compared to the attention-control condition, the positive affect intervention significantly decreased methylation of CpG sites on genes that regulate β2 adrenergic and oxytocin receptors. There was an inconsistent pattern for the direction of the intervention effects on methylation of CpG sites on genes for glucocorticoid receptors and brain-derived neurotrophic factor. Pathway analyses adjusting for the false discovery rate (padj < 0.05) revealed significant intervention-related alterations in DNAm of Reactome pathways corresponding to neural function as well as dopamine, glutamate, and serotonin release. Positive affect intervention effects on DNAm were accompanied by significant reductions in the self-reported frequency of stimulant use. CONCLUSIONS There is an epigenetic signature of an evidence-based behavioral intervention model that reduced stimulant use, which will guide the identification of biomarkers for treatment responses.
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Affiliation(s)
- Adam W Carrico
- Robert Stempel College of Public Health & Social Work, Florida International University, United States.
| | | | - Annesa Flentje
- University of California, San Francisco School of Nursing, United States; Alliance Health Project, University of California San Francisco School of Medicine, United States
| | | | - Kesava Asam
- Department of Oral Maxillofacial Surgery, New York University College of Dentistry, United States
| | - Delaram Ghanooni
- Robert Stempel College of Public Health & Social Work, Florida International University, United States
| | - Jennifer V Chavez
- Robert Stempel College of Public Health & Social Work, Florida International University, United States
| | - Torsten B Neilands
- University of California, San Francisco School of Medicine, United States
| | | | - Leah H Rubin
- Johns Hopkins University School of Medicine, United States
| | - Hetta Gouse
- University of Miami Miller School of Medicine, United States
| | | | - Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, United States
| | - Bradley E Aouizerat
- Department of Oral Maxillofacial Surgery, New York University College of Dentistry, United States
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Jabs DA, Schneider MF, Pak JW, Beck-Engeser G, Chan F, Ambayec GC, Hunt PW. Association of Intermediate-Stage Age-Related Macular Degeneration with Plasma Inflammatory Biomarkers in Persons with AIDS. OPHTHALMOLOGY SCIENCE 2024; 4:100437. [PMID: 38304607 PMCID: PMC10831313 DOI: 10.1016/j.xops.2023.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/26/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
Purpose To evaluate associations of plasma levels of inflammatory biomarkers with age-related macular degeneration (AMD) and cataract in persons with AIDS. Design Nested case-control study (analysis 1) and nested cohort study (analysis 2). Participants Analysis 1: persons with AIDS and incident intermediate-stage AMD (n = 26) and controls without AMD matched for age, race/ethnicity, and gender (n = 49) from The Longitudinal Study of Ocular Complications of AIDS. Analysis 2: 475 persons from LSOCA with baseline plasma biomarker levels followed prospectively for cataract. Methods In both analyses, cryopreserved plasma specimens obtained at baseline were assayed for monocyte chemoattractant protein (MCP)-1 (CC motif chemokine ligand [CCL] 2), macrophage inflammatory protein (MIP)-1β (CCL4), soluble tumor necrosis factor receptor (sTNFR) 2, interleukin (IL)-18, and fractalkine (CX3 motif chemokine ligand 1 [CX3CL1]). Main Outcome Measures Analysis 1: mean difference (cases - controls) in plasma biomarker levels. Analysis 2: incident cataract. Results After adjusting for plasma human immunodeficiency virus RNA level, CD4+ T-cell count, and smoking, elevated baseline plasma levels of sTNFR2 and IL-18 (mean differences [cases - controls] 0.11 log10[pg/mL]; 95% confidence interval [CI], 0.01-0.20; P = 0.024 and 0.13 log10[pg/mL]; 95% CI, 0.01-0.24; P = 0.037, respectively) each were associated with incident AMD. In a competing risk (with mortality) analysis, elevated baseline standardized log10 plasma levels of MCP-1, sTNFR2, IL-18, and fractalkine each were associated with a decreased cataract risk. Conclusions When combined with previous data suggesting that AMD is associated with elevated plasma levels of C-reactive protein, soluble CD14, and possibly IL-6, the association of elevated plasma levels of sTNFR2 and IL-18 with incident AMD, but not with incident cataract, suggests that innate immune system activation, and possibly NLRP3 inflammasome activation, may play a role in the pathogenesis of AMD in this population. Financial Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Wilmer Eye Institute, the Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael F. Schneider
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeong Won Pak
- Department of Ophthalmology and Visual Sciences, the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gabriele Beck-Engeser
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California
| | - Fay Chan
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California
| | - Gabrielle C. Ambayec
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California
| | - Peter W. Hunt
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California
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Wilk AJ, Marceau JO, Kazer SW, Fleming I, Miao VN, Galvez-Reyes J, Kimata JT, Shalek AK, Holmes S, Overbaugh J, Blish CA. Pro-inflammatory feedback loops define immune responses to pathogenic Lentivirus infection. Genome Med 2024; 16:24. [PMID: 38317183 PMCID: PMC10840164 DOI: 10.1186/s13073-024-01290-y] [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: 04/17/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The Lentivirus human immunodeficiency virus (HIV) causes chronic inflammation and AIDS in humans, with variable rates of disease progression between individuals driven by both host and viral factors. Similarly, simian lentiviruses vary in their pathogenicity based on characteristics of both the host species and the virus strain, yet the immune underpinnings that drive differential Lentivirus pathogenicity remain incompletely understood. METHODS We profile immune responses in a unique model of differential lentiviral pathogenicity where pig-tailed macaques are infected with highly genetically similar variants of SIV that differ in virulence. We apply longitudinal single-cell transcriptomics to this cohort, along with single-cell resolution cell-cell communication techniques, to understand the immune mechanisms underlying lentiviral pathogenicity. RESULTS Compared to a minimally pathogenic lentiviral variant, infection with a highly pathogenic variant results in a more delayed, broad, and sustained activation of inflammatory pathways, including an extensive global interferon signature. Conversely, individual cells infected with highly pathogenic Lentivirus upregulated fewer interferon-stimulated genes at a lower magnitude, indicating that highly pathogenic Lentivirus has evolved to partially escape from interferon responses. Further, we identify CXCL10 and CXCL16 as important molecular drivers of inflammatory pathways specifically in response to highly pathogenic Lentivirus infection. Immune responses to highly pathogenic Lentivirus infection are characterized by amplifying regulatory circuits of pro-inflammatory cytokines with dense longitudinal connectivity. CONCLUSIONS Our work presents a model of lentiviral pathogenicity where failures in early viral control mechanisms lead to delayed, sustained, and amplifying pro-inflammatory circuits, which in turn drives disease progression.
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Affiliation(s)
- Aaron J Wilk
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Joshua O Marceau
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Samuel W Kazer
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Ira Fleming
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Vincent N Miao
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Program in Health Sciences & Technology, Harvard Medical School & MIT, Boston, MA, 02115, USA
| | - Jennyfer Galvez-Reyes
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Jason T Kimata
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Alex K Shalek
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Susan Holmes
- Department of Statistics, Stanford University, Stanford, CA, 94305, USA
| | - Julie Overbaugh
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Catherine A Blish
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA.
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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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Muthuka JK, Nyamai EM, Oluoch K, Maibvise C, Nabaweesi R. Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study. Cureus 2024; 16:e52989. [PMID: 38406047 PMCID: PMC10894621 DOI: 10.7759/cureus.52989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND AND AIMS Following antiretroviral therapy (ART) initiation, HIV-associated immune reconstitution inflammatory syndrome (IRIS), indicated by an array of opportunistic infections, may occur, presenting as either paradoxical, a worsening of a previously treated infection, or unmasking, a flare-up of an underlying, previously undiagnosed infection. The impact of ART as the backbone of HIV treatment and prevention has prolonged the survival of people living with HIV. In pregnancy, benefits have been shown by slowing HIV progression and preventing perinatal transmission; however, there have been risks of adverse reactions with ART, including immune responses to both the fetus and mother. This study sought to estimate the incidence of HIV-IRIS cumulatively and by type either paradoxical or unmasking IRIS, determine the baseline maternal and HIV clinical markers as predictors of, and analyze the log-rank test for survival time to IRIS outcome assessed by relying on an increase in CD4 count and/or a rapid decrease in viral load. METHODS An active records study was conducted between June 2019 and March 2020 among ART-naïve pregnant women attending the antenatal care units (ANCu) at the Kenyatta National and Mbagathi Hospitals, Nairobi, Kenya. Participants were aged between 20 and 49 years and had a confirmed HIV-positive test. To ascertain a true case of IRIS, the diagnosis was adjudicated for accuracy and consistency by an independent review committee. Plasma HIV viral load, CD4 counts, and routine laboratory evaluations (hemoglobin, white blood cell count (WBC)) were performed by each hospital's clinical laboratory. The IRIS incidence was assessed using the International Network for Studies Against HIV-Associated IRIS (INSHI) during the first three months after ART initiation. Multivariate Cox regression with IRIS as the outcome, using the SPSSSurvival package, examined the relationship between baseline maternal characteristics and HIV clinical markers before ART initiation and IRIS, and finally, decision-tree analysis for predicting IRIS was performed. RESULTS From a pool of 532 ART-naïve pregnant women, 133 (25%) developed IRIS, and 97 (72.9%) were in the unmasking category. The accumulated risk of experiencing IRIS symptoms increased from week two (hazard ratio (HR)=0.0287) to week 12 (HR=3.6158). Participants with a maternal BMI (MBMI) of 25-29.9 kg/m2 at baseline were at a higher risk of unmasking IRIS (HR=2.478; P=0.010). The WHO-HIV clinical stages 1 and 2 skewed towards paradoxical IRIS (regression coefficients =-0.111 and -0.276 (P<0.05)), while stage 4 skewed towards unmasking IRIS (regression coefficient=0.047, HR=1.048, P=0.941). A CD4 count > 500 cells/mm^3 skewed towards unmasking IRIS (regression coefficient=0.192, HR=1.211, P=0.416), while RNA-HIV viral loads >50 copies/ml towards paradoxical IRIS (regression coefficient=-0.199, HR=0.820, P=0.360. On decision tree analysis, 85% (P=0.001) of ART-naïve pregnant women with a baseline CD4 count below 500 copies/mm^3 presented with unmasking IRIS. CONCLUSION For ART-naïve pregnant women, unmasking IRIS is the most common type, and an MBMI of 25-29.9 kg/m2, advanced HIV infection, a CD4 count <500 cells/mm^3, and a higher parity at baseline may be clinically useful predictors. The higher proportion of ART-naïve pregnant women experiencing unmasking as compared to paradoxical IRIS supports the need for earlier assessment based on potential predictors.
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Affiliation(s)
- John K Muthuka
- Epidemiology, Public Health, and Biostatistics, Jomo Kenyatta University of Agriculture & Technology, Nairobi, KEN
- Public Health Sciences, Kenya Medical Training College, Nairobi, KEN
| | | | - Kelly Oluoch
- Pharmacy, Kenya Medical Training College, Nairobi, KEN
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Murray DD, Grund B, MacPherson CR, Ekenberg C, Zucco AG, Reekie J, Dominguez-Dominguez L, Leung P, Fusco D, Gras J, Gerstoft J, Helleberg M, Borges ÁH, Polizzotto MN, Lundgren JD. Association between ten-eleven methylcytosine dioxygenase 2 genetic variation and viral load in people with HIV. AIDS 2023; 37:379-387. [PMID: 36473831 PMCID: PMC9894145 DOI: 10.1097/qad.0000000000003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/29/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Identifying genetic factors that influence HIV-pathogenesis is critical for understanding disease pathways. Previous studies have suggested a role for the human gene ten-eleven methylcytosine dioxygenase 2 (TET2) in modulating HIV-pathogenesis. METHODS We assessed whether genetic variation in TET2 was associated with markers of HIV-pathogenesis using both gene level and single nucleotide polymorphism (SNP) level association in 8512 HIV-positive persons across five clinical trial cohorts. RESULTS Variation at both the gene and SNP-level of TET2 was found to be associated with levels of HIV viral load (HIV-VL) consistently in the two cohorts that recruited antiretroviral-naïve participants. The SNPs occurred in two clusters of high linkage disequilibrium (LD), one associated with high HIV-VL and the other low HIV-VL, and were predominantly found in Black participants. CONCLUSION Genetic variation in TET2 was associated with HIV-VL in two large antiretroviral therapy (ART)-naive clinical trial cohorts. The role of TET2 in HIV-pathogenesis warrants further investigation.
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Affiliation(s)
- Daniel D. Murray
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, MN, USA
| | - Cameron R. MacPherson
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adrian G. Zucco
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lourdes Dominguez-Dominguez
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Preston Leung
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dahlene Fusco
- Tulane University Medical Center, Tulane University, New Orleans, LA, USA
| | - Julien Gras
- Service de Maladies infectieuses et tropicales, APHP-Hôpital Saint Louis, Paris, France
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Álvaro H. Borges
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Mark N. Polizzotto
- Clinical Hub for Interventional Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Jens D. Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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8
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Dwivedi AK, Siegel DA, Thanh C, Hoh R, Hobbs KS, Pan T, Gibson EA, Martin J, Hecht F, Pilcher C, Milush J, Busch MP, Stone M, Huang ML, Levy CN, Roychoudhury P, Hladik F, Jerome KR, Henrich TJ, Deeks SG, Lee SA. Differences in expression of tumor suppressor, innate immune, inflammasome, and potassium/gap junction channel host genes significantly predict viral reservoir size during treated HIV infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.10.523535. [PMID: 36712077 PMCID: PMC9882059 DOI: 10.1101/2023.01.10.523535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The major barrier to an HIV cure is the persistence of infected cells that evade host immune surveillance despite effective antiretroviral therapy (ART). Most prior host genetic HIV studies have focused on identifying DNA polymorphisms (e.g., CCR5Δ32 , MHC class I alleles) associated with viral load among untreated "elite controllers" (~1% of HIV+ individuals who are able to control virus without ART). However, there have been few studies evaluating host genetic predictors of viral control for the majority of people living with HIV (PLWH) on ART. We performed host RNA sequencing and HIV reservoir quantification (total DNA, unspliced RNA, intact DNA) from peripheral CD4+ T cells from 191 HIV+ ART-suppressed non-controllers. Multivariate models included covariates for timing of ART initiation, nadir CD4+ count, age, sex, and ancestry. Lower HIV total DNA (an estimate of the total reservoir) was associated with upregulation of tumor suppressor genes NBL1 (q=0.012) and P3H3 (q=0.012). Higher HIV unspliced RNA (an estimate of residual HIV transcription) was associated with downregulation of several host genes involving inflammasome ( IL1A, CSF3, TNFAIP5, TNFAIP6, TNFAIP9 , CXCL3, CXCL10 ) and innate immune ( TLR7 ) signaling, as well as novel associations with potassium ( KCNJ2 ) and gap junction ( GJB2 ) channels, all q<0.05. Gene set enrichment analyses identified significant associations with TLR4/microbial translocation (q=0.006), IL-1β/NRLP3 inflammasome (q=0.008), and IL-10 (q=0.037) signaling. HIV intact DNA (an estimate of the "replication-competent" reservoir) demonstrated trends with thrombin degradation ( PLGLB1 ) and glucose metabolism ( AGL ) genes, but data were (HIV intact DNA detected in only 42% of participants). Our findings demonstrate that among treated PLWH, that inflammation, innate immune responses, bacterial translocation, and tumor suppression/cell proliferation host signaling play a key role in the maintenance of the HIV reservoir during ART. Further data are needed to validate these findings, including functional genomic studies, and expanded epidemiologic studies in female, non-European cohorts. Author Summary Although lifelong HIV antiretroviral therapy (ART) suppresses virus, the major barrier to an HIV cure is the persistence of infected cells that evade host immune surveillance despite effective ART, "the HIV reservoir." HIV eradication strategies have focused on eliminating residual virus to allow for HIV remission, but HIV cure trials to date have thus far failed to show a clinically meaningful reduction in the HIV reservoir. There is an urgent need for a better understanding of the host-viral dynamics during ART suppression to identify potential novel therapeutic targets for HIV cure. This is the first epidemiologic host gene expression study to demonstrate a significant link between HIV reservoir size and several well-known immunologic pathways (e.g., IL-1β, TLR7, TNF-α signaling pathways), as well as novel associations with potassium and gap junction channels (Kir2.1, connexin 26). Further data are needed to validate these findings, including functional genomic studies and expanded epidemiologic studies in female, non-European cohorts.
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9
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Rogando AC, Weber KM, Xing J, Xue X, Yohannes T, Morack R, Qi Q, Clish C, Bullock K, Gustafson D, Anastos K, Sharma A, Burgess HJ, French AL. The IDOze Study: The Link Between Sleep Disruption and Tryptophan-Kynurenine Pathway Activation in Women With Human Immunodeficiency Virus. J Infect Dis 2022; 226:1451-1460. [PMID: 35801535 PMCID: PMC9989737 DOI: 10.1093/infdis/jiac287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/07/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Poor sleep is associated with human immunodeficiency virus (HIV), particularly among women with HIV (WWH), although mechanisms are unclear. We explored cross-sectional associations between sleep disruption and tryptophan-kynurenine (T/K) pathway activation, measured by the kynurenine-to-tryptophan ratio (K:T). METHODS HIV-uninfected women (HIV-) and WWH aged 35-70 years and on stable antiretroviral therapy were included. Sleep metrics were measured using wrist actigraphy. Plasma T/K pathway metabolites were measured using liquid chromatography-tandem mass spectrometry. Multivariate linear regression models examined relationships between K:T and actigraphy-based sleep metrics by HIV status. RESULTS WWH (n = 153) and HIV- women (n = 151) were demographically similar. Among WWH, median CD4 was 751 cells/µL; 92% had undetectable HIV RNA. Compared to HIV- women, WWH had higher K:T (P < .001) and kynurenine (P = .01) levels but similar tryptophan levels (P = .25). Higher K:T was associated with more wake bouts (P = .001), more time awake after sleep onset (P = .01), and lower sleep efficiency (P = .03) in WWH only. CONCLUSIONS HIV infection was associated with T/K pathway activation; this activation was associated with poorer sleep efficiency and more fragmented sleep. While longitudinal studies are needed to elucidate the directionality of these associations, these findings may help identify treatments to reduce sleep disruption in WWH by targeting residual inflammation and T/K pathway activation.
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Affiliation(s)
- Andrea C Rogando
- College of Science and Health at Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.,Hektoen Institute of Medicine/CORE Center of Cook County Health, Chicago, Illinois, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine/CORE Center of Cook County Health, Chicago, Illinois, USA
| | - Jiaqian Xing
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tsion Yohannes
- Hektoen Institute of Medicine/CORE Center of Cook County Health, Chicago, Illinois, USA
| | - Ralph Morack
- Hektoen Institute of Medicine/CORE Center of Cook County Health, Chicago, Illinois, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Clary Clish
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Kevin Bullock
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Audrey L French
- Department of Medicine, Stroger Hospital of Cook County Health, Chicago, Illinois, USA
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10
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Jabs DA, Van Natta ML, Schneider MF, Pak JW, Trang G, Jones NG, Milush J, Hunt PW. Association of elevated plasma inflammatory biomarker levels with age-related macular degeneration but not cataract in persons with AIDS. AIDS 2022; 36:177-184. [PMID: 34934018 PMCID: PMC9153135 DOI: 10.1097/qad.0000000000003104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between plasma biomarkers of systemic inflammation and incident age-related macular degeneration (AMD) in persons with the AIDS. DESIGN Case-control study. METHODS Participants with incident intermediate-stage AMD (N = 26) in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and controls (N = 60) without AMD. Cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), and intestinal fatty acid-binding protein (I-FABP). RESULTS After adjustment for age, sex, and race/ethnicity, baseline mean ± standard deviation (SD) log10(mg/ml) plasma levels of CRP (0.52 ± 0.60 vs. 0.20 ± 0.43; P = 0.01) and mean ± SD log10(pg/ml) plasma levels of sCD14 (6.31 ± 0.11 vs. 6.23 ± 0.14; P = 0.008) were significantly higher among cases (incident AMD) than among controls (no AMD). There was a suggestion that mean ± SD baseline log10(pg/ml) plasma IL-6 levels (0.24 ± 0.33 vs. 0.11 ± 0.29; P = 0.10) might be higher among cases than controls. In a separate analysis of 548 participants in LSOCA, elevated baseline levels of plasma inflammatory biomarkers were associated with a greater risk of mortality but not with an increased risk of incident cataract. CONCLUSION These data suggest that systemic inflammatory biomarkers are associated with incident AMD but not incident cataract in persons with AIDS, and that systemic inflammation may play a role in the pathogenesis of AMD.
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Affiliation(s)
- Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health
- The Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark L Van Natta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health
| | - Michael F Schneider
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health
| | - Jeong Won Pak
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Garrett Trang
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Norman G Jones
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Jeffrey Milush
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Peter W Hunt
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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11
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Pei L, Fukutani KF, Tibúrcio R, Rupert A, Dahlstrom EW, Galindo F, Laidlaw E, Lisco A, Manion M, Andrade BB, Sereti I. Plasma Metabolomics Reveals Dysregulated Metabolic Signatures in HIV-Associated Immune Reconstitution Inflammatory Syndrome. Front Immunol 2021; 12:693074. [PMID: 34211479 PMCID: PMC8239348 DOI: 10.3389/fimmu.2021.693074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory complication associated with an underlying opportunistic infection that can be observed in HIV-infected individuals shortly after the initiation of antiretroviral therapy, despite successful suppression of HIV viral load and CD4+ T cell recovery. Better understanding of IRIS pathogenesis would allow for targeted prevention and therapeutic approaches. In this study, we sought to evaluate the metabolic perturbations in IRIS across longitudinal time points using an unbiased plasma metabolomics approach as well as integrated analyses to include plasma inflammatory biomarker profile and whole blood transcriptome. We found that many lipid and amino acid metabolites differentiated IRIS from non-IRIS conditions prior to antiretroviral therapy and during the IRIS event, implicating the association between oxidative stress, tryptophan pathway, and lipid mediated signaling and the development of IRIS. Lipid and amino acid metabolic pathways also significantly correlated with inflammatory biomarkers such as IL-12p70 and IL-8 at the IRIS event, indicating the role of cellular metabolism on cell type specific immune activation during the IRIS episode and in turn the impact of immune activation on cellular metabolism. In conclusion, we defined the metabolic profile of IRIS and revealed that perturbations in metabolism may predispose HIV-infected individuals to IRIS development and contribute to the inflammatory manifestations during the IRIS event. Furthermore, our findings expanded our current understanding IRIS pathogenesis and highlighted the significance of lipid and amino acid metabolism in inflammatory complications.
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Affiliation(s)
- Luxin Pei
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States.,Department of Biology, Johns Hopkins University, Baltimore, MD, United States
| | - Kiyoshi F Fukutani
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Laboratory of Inflammation and Biomarkers, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Brazil
| | - Rafael Tibúrcio
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Laboratory of Inflammation and Biomarkers, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Adam Rupert
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Eric W Dahlstrom
- Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, MT, United States
| | - Frances Galindo
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Elizabeth Laidlaw
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Andrea Lisco
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Maura Manion
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Bruno B Andrade
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Laboratory of Inflammation and Biomarkers, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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12
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Pierre F, Forman LS, Winter M, Cheng D, Ngabirano C, Emenyonu N, Hunt PW, Huang Y, Muyindike W, Samet J, Hahn JA, So-Armah K. Alcohol Consumption and Tryptophan Metabolism Among People with HIV Prior to Antiretroviral Therapy Initiation: The Uganda ARCH Cohort Study. Alcohol Alcohol 2021; 57:219-225. [PMID: 34027552 PMCID: PMC8919408 DOI: 10.1093/alcalc/agab033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Alcohol is hypothesized to have effects on the kynurenine pathway of tryptophan catabolism, a potential mechanism for alcohol-induced depression and aggression. A biomarker of this pathway, the plasma kynurenine to tryptophan ratio (K/T ratio), has been associated with HIV progression, mortality and depression. Our aim was to assess whether hazardous alcohol consumption is associated higher K/T ratio among people with HIV. METHODS Participants were a subset of the Uganda Alcohol Research Collaboration on HIV/AIDS Cohort. Alcohol consumption was categorized (abstinent, moderate and hazardous alcohol use) using the Alcohol Use Disorders Identification Test-Consumption and phosphatidylethanol (PEth). K/T ratio was the primary outcome. We used linear regression adjusted for age, sex, FIB-4, hepatitis B surface antigen, log (HIV viral load) to estimate the association between alcohol consumption and K/T ratio. RESULTS Compared to abstinent participants, hazardous drinkers and moderate drinkers had higher K/T ratio but these differences did not reach statistical significance. CONCLUSIONS Our results suggest that hazardous alcohol consumption, in the context of untreated HIV infection, may not significantly alter kynurenine to tryptophan ratio as a measure of activity of the kynurenine pathway of tryptophan metabolism.
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Affiliation(s)
- Frantz Pierre
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, 72 E Concord St, Boston, MA 02118, USA
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Debbie Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave Boston, MA 02119, USA
| | - Christine Ngabirano
- Mbarara University of Science and Technology Department of Internal Medicine P.O Box 1410 Mbarara Uganda, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Peter W Hunt
- Division of HIV/AIDS, San Francisco General Hospital, San Francisco, CA, USA
| | - Yong Huang
- Department of Bioengineering and Therapeutics, University of California San Francisco, 1700 4th Street, San Francisco, CA 94158, USA
| | - Winnie Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine P.O Box 1410 Mbarara, Uganda
| | - Jeffrey Samet
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave Crosstown, 2nd Floor Boston, MA 02118, USA
| | - Judith A Hahn
- Departments of Medicine and Epidemiology & Biostatistics, University of California San Francisco, 550 16th St., 3rd floor San Francisco, CA 94158-2549, USA
| | - Kaku So-Armah
- Corresponding author: Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor Boston, MA 02118, USA. Tel.: 617 414 6624; E-mail:
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13
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Schnittman SR, Byakwaga H, Boum Y, Kabakyenga J, Matthews LT, Burdo TH, Huang Y, Tracy RP, Haberer JE, Kembabazi A, Kaida A, Moisi D, Lederman MM, Bangsberg DR, Martin JN, Hunt PW. Changes in Immune Activation During Pregnancy and the Postpartum Period in Treated HIV Infection. Open Forum Infect Dis 2021; 8:ofab245. [PMID: 34159218 PMCID: PMC8214017 DOI: 10.1093/ofid/ofab245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background Pregnant women with HIV (PWWH) have high postpartum morbidity and mortality from infections like tuberculosis. Immunologic changes during pregnancy and postpartum periods may contribute to these risks, particularly the immunoregulatory kynurenine pathway of tryptophan catabolism, which contributes to both HIV and tuberculosis pathogenesis and increases in the early postpartum period. Methods Women with HIV initiating antiretroviral therapy (ART) in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort who were pregnant at enrollment or became pregnant during observation were studied (n = 54). Plasma kynurenine/tryptophan (KT) ratio, soluble CD14 (sCD14), sCD163, sCD27, interferon-inducible protein 10 (IP-10), D-dimer, interleukin-6, and intestinal fatty-acid binding protein levels were assessed through the first year of ART and at 3-month intervals throughout pregnancy and 1 year postpartum. Biomarker changes were assessed with linear mixed models adjusted for ART duration. Hemoglobin concentration changes were used to estimate pregnancy-related changes in plasma volume. Results The median pre-ART CD4 count was 134. D-dimer increased through the third trimester before returning to baseline postpartum, while most other biomarkers declined significantly during pregnancy, beyond what would be expected from pregnancy-associated plasma volume expansion. IP-10 and sCD14 remained suppressed for at least 12 months postpartum. KT ratio was the only biomarker that increased above prepregnancy baseline postpartum (mean + 30%; P < .001) and remained higher than baseline for ≥9 months (P ≤ .045 for all time points). Conclusions Several immune activation markers decline during pregnancy and remain suppressed postpartum, but the kynurenine pathway of tryptophan catabolism increases above baseline for ≥9 months postpartum. The mechanisms underlying postpartum kynurenine pathway activity are incompletely understood but may contribute to increased tuberculosis risk in this setting.
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Affiliation(s)
| | - Helen Byakwaga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yap Boum
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Lynn T Matthews
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tricia H Burdo
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Yong Huang
- University of California San Francisco, San Francisco, California, USA
| | | | - Jessica E Haberer
- Massachusetts General Hospital and Harvard University, Boston, Massachusetts, USA
| | - Annet Kembabazi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Angela Kaida
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Daniela Moisi
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health and Sciences University and Portland State University School of Public Health, Portland, Oregon, USA
| | - Jeffrey N Martin
- University of California San Francisco, San Francisco, California, USA
| | - Peter W Hunt
- University of California San Francisco, San Francisco, California, USA
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14
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Bourke CD, Prendergast AJ. The Anti-inflammatory Effects of Cotrimoxazole Prophylaxis for People Living With Human Immunodeficiency Virus in Sub-Saharan Africa. J Infect Dis 2021; 222:347-350. [PMID: 31714953 DOI: 10.1093/infdis/jiz495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claire D Bourke
- Blizard Institute, Queen Mary University of London, London, United Kingdom.,Zviambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, United Kingdom.,Zviambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
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15
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Lebouché B, Yero A, Shi T, Farnos O, Singer J, Kema I, Costiniuk CT, Thomas R, Brouillette MJ, Engler K, Routy JP, Jenabian MA. Impact of extended-release niacin on immune activation in HIV-infected immunological non-responders on effective antiretroviral therapy. HIV Res Clin Pract 2021; 21:182-190. [PMID: 33403940 DOI: 10.1080/25787489.2020.1866846] [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: 01/13/2023]
Abstract
BACKGROUND Background: Tryptophan (Trp) catabolism into immunosuppressive kynurenine (Kyn) is involved in immune dysregulation during HIV infection. Niacin (vitamin B3) could control the excess of tryptophan depletion and represents a potential strategy to improve immune functions and CD4 count recovery in immunological non-responder HIV-infected individuals on antiretroviral therapy (ART). METHODS Methods: In the CTN PT006 phase 2 pilot randomized trial, 20 adults on ART with CD4 ≤ 350 cells/µl, despite an undetectable viral load (VL) for at least 3 months, received 2000 mg of extended-release (ER)-niacin orally once daily for 24 weeks. Side effects, VL, CD4/CD8 counts, lipid profile, T-cell activation and senescence, Tregs and Th17 cell frequencies, Kyn/Trp ratio, and levels of IL-6, IP-10, sST2, I-FABP, and LBP were assessed following ER-niacin treatment. RESULTS Results: Thirteen participants completed the study. Treatment was interrupted in 4 patients due to loss of follow-up or personal reasons and 3 patients were discontinued due to comorbidity risks. All participants maintained a VL < 40 copies/ml, while ER-niacin did not affect CD4 and CD8 cell counts. Plasma levels of triglycerides, total, and LDL cholesterol significantly decreased, following ER-niacin treatment. ER-niacin also diminished Kyn plasma levels and slightly decreased CD4 T-cell activation. However, no improvement in CD8 subsets, Kyn/Trp ratio, Th17/Treg balance, and plasma inflammatory markers was observed. CONCLUSIONS Conclusions: Although ER-niacin combined with ART was well-tolerated among immune non-responders and decreased plasma lipids, it did not improve systemic inflammation, Kyn/Trp ratio, and CD4 cell recovery. Overall, ER-niacin was not effective to overcome chronic inflammation in PLWH.
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Affiliation(s)
- Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada.,Center for Outcome Research Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Alexis Yero
- Department of Biological Sciences and CERMO-FC Research Centre, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - Tao Shi
- Department of Biological Sciences and CERMO-FC Research Centre, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - Omar Farnos
- Department of Biological Sciences and CERMO-FC Research Centre, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Ido Kema
- Department of Laboratory Medicine, University of Groningen, Groningen, The Netherlands
| | - Cecilia T Costiniuk
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, QC, Canada
| | | | - Marie-Josée Brouillette
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Center for Outcome Research Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcome Research Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences and CERMO-FC Research Centre, University of Quebec at Montreal (UQAM), Montreal, QC, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, QC, Canada
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16
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Affi R, Gabillard D, Dunyach-Remy C, Ntakpe JB, Moh R, Badje A, Kouame GM, Karcher S, Le Carrou J, Danel C, Chevalier MF, Rouzioux C, Eholie SP, Lavigne JP, Inwoley A, Anglaret X, Weiss L. Association of Plasma Soluble Vascular Cell Adhesion Molecule-1 and sCD14 With Mortality in HIV-1-Infected West African Adults With High CD4 Counts. J Acquir Immune Defic Syndr 2021; 86:138-145. [PMID: 33074857 DOI: 10.1097/qai.0000000000002533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Several biomarkers of inflammation and coagulation were reported to be associated with HIV disease progression in different settings. In this article, we report the association between 11 biomarkers and medium-term mortality in HIV-infected West African adults. METHODS In Temprano ANRS 12136, antiretroviral therapy (ART)-naive HIV-infected adults with high CD4 counts were randomly assigned either to start ART immediately or defer ART until the World Health Organization criteria were met. Participants who completed the 30-month trial follow-up were invited to participate in a posttrial phase. The posttrial phase end point was all-cause death. We used multivariate Cox proportional models to analyze the association between baseline plasma biomarkers [IL-1ra, IL-6, soluble vascular cell adhesion molecule 1 (sVCAM-1), sCD14, D-dimer, fibrinogen, IP-10, sCD163, albumin, high-sensitivity C-reactive protein, and 16S rDNA] and all-cause death in the Temprano participants randomized to defer ART. RESULTS Four hundred seventy-seven patients (median age 35 years, 78% women, and median CD4 count: 379 cells/mm) were randomly assigned to defer starting ART until the World Health Organization criteria were met. The participants were followed for 2646 person-years (median 5.8 years). In the follow-up, 89% of participants started ART and 30 died. In the multivariate analysis adjusted for the study center, sex, baseline CD4 count, isoniazid preventive therapy, plasma HIV-1 RNA, peripheral blood mononuclear cell HIV-1 DNA, and ART, the risk of death was significantly associated with baseline sVCAM-1 (≥1458 vs. <1458: adjusted hazard ratio 2.57, 95% confidence interval: 1.13 to 5.82) and sCD14 (≥2187 vs. <2187: adjusted hazard ratio 2.79, interquartile range 1.29-6.02) levels. CONCLUSIONS In these sub-Saharan African adults with high CD4 counts, pre-ART plasma sVCAM-1 and sCD14 levels were independently associated with mortality.
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Affiliation(s)
- Roseline Affi
- CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire
- PACCI-ANRS Research Site, Côte d'Ivoire
- Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Delphine Gabillard
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Catherine Dunyach-Remy
- VBMI, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU de Carémeau, Nîmes, France
| | - Jean-Baptiste Ntakpe
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Raoul Moh
- PACCI-ANRS Research Site, Côte d'Ivoire
- Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Anani Badje
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Gérard M Kouame
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Sophie Karcher
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Jérome Le Carrou
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Christine Danel
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Mathieu F Chevalier
- INSERM U976, Laboratory of Human Immunology, Pathophysiology and Immunotherapy, Hôpital Saint-Louis, Paris, France
- Université de Paris, Institut de Recherche Saint Louis, Hôpital Saint-Louis, Paris, France
| | - Christine Rouzioux
- AP-HP, CHU Necker Enfants Malades, EA 7327 Université Paris Descartes, Paris, France
| | - Serge P Eholie
- PACCI-ANRS Research Site, Côte d'Ivoire
- Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Jean-Philippe Lavigne
- VBMI, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU de Carémeau, Nîmes, France
| | - Andre Inwoley
- CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire
- PACCI-ANRS Research Site, Côte d'Ivoire
- Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Xavier Anglaret
- PACCI-ANRS Research Site, Côte d'Ivoire
- INSERM U1219, University of Bordeaux, IRD, France
| | - Laurence Weiss
- Université de Paris, Institut de Recherche Saint Louis, Hôpital Saint-Louis, Paris, France
- Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France ; and
- Faculté de Médecine Paris Descartes, Université de Paris, France
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17
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Schnittman SR, Deitchman AN, Beck-Engeser G, Ahn H, York VA, Hartig H, Hecht FM, Martin JN, Deeks SG, Aweeka FT, Hunt PW. Abnormal Levels of Some Biomarkers of Immune Activation Despite Very Early Treatment of Human Immunodeficiency Virus. J Infect Dis 2020; 223:1621-1630. [PMID: 32915986 DOI: 10.1093/infdis/jiaa580] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite early antiretroviral therapy (ART), ART-suppressed people with human immunodeficiency virus (HIV) (PWH) remain at higher risk for infections and infection-related cancers than the general population. The immunologic pathways that remain abnormal in this setting, potentially contributing to these complications, are unclear. METHODS ART-suppressed PWH and HIV-negative controls, all cytomegalovirus seropositive and enriched for HIV risk factors, were sampled from an influenza vaccine responsiveness study. PWH were stratified by timing of ART initiation (within 6 months of infection [early ART] vs later) and nadir CD4+ T-cell count among later initiators. Between-group differences in kynurenine-tryptophan (KT) ratio, interferon-inducible protein 10, soluble CD14 and CD163, soluble tumor necrosis factor receptor 2, interleukin 6, and soluble urokinase plasminogen activator receptor were assessed after confounder adjustment. RESULTS Most participants (92%) were male, reflecting the demographics of early-ART initiators in San Francisco. Most biomarkers were higher among later-ART initiators. Participants in the early-ART group achieved near-normal soluble tumor necrosis factor receptor 2, interleukin 6, and soluble urokinase plasminogen activator receptor levels, but substantially higher KT ratio than those without HIV after confounder adjustment (P = .008). Soluble CD14, soluble CD163, and interferon-inducible protein 10 trended similarly. CONCLUSIONS While early-ART initiators restore near-normal levels of many inflammatory markers, the kynurenine pathway of tryptophan catabolism remains abnormally high. Because this pathway confers adaptive immune defects and predicts tuberculosis and cancer progression, this it may contribute to persistent risks of these complications in this setting.
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Affiliation(s)
- Samuel R Schnittman
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Amelia N Deitchman
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, California, USA
| | - Gabriele Beck-Engeser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - HaeLee Ahn
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Vanessa A York
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Heather Hartig
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Frederick M Hecht
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Steven G Deeks
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Francesca T Aweeka
- Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, California, USA
| | - Peter W Hunt
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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18
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Teasdale CA, Hernandez C, Zerbe A, Chege D, Hawken M, El-Sadr WM. Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya. BMC Infect Dis 2020; 20:508. [PMID: 32664854 PMCID: PMC7362533 DOI: 10.1186/s12879-020-05213-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Increased coagulation biomarkers are associated with poor outcomes among people living with HIV (PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers. Methods From March 2014 to October 2014, ART-naïve PLHIV initiating non-nucleoside reverse transcriptase inhibitor-based ART were recruited from seven clinics in western Kenya and followed for up to 12 months. Demographics, clinical history and blood specimens were collected. Logistic regression models adjusted for intrasite clustering examined associations between HIV viral load and D-Dimer at baseline. Mixed linear effects models were used to estimate mean change from baseline to 6 months overall, and by baseline viral load, sex and TB status at enrollment. Mean change in D-dimer at 6 months is reported on the log10 scale and as percentage change from baseline. Results Among 611 PLHIV enrolled, 66% were female, median age was 34 years (interquartile range (IQR) 29–43 years), 31 (5%) participants had tuberculosis and median viral load was 113,500 copies/mL (IQR: 23,600-399,000). At baseline, 311 (50.9%) PLHIV had elevated D-dimer (> 500 ng/mL) and median D-dimer was 516.4 ng/mL (IQR: 302.7–926.6) (log baseline D-dimer: 2.7, IQR: 2.5–3.0). Higher baseline D-dimer was significantly associated with higher viral load (p < 0.0001), female sex (p = 0.02) and tuberculosis (p = 0.02). After 6 months on ART, 518 (84.8%) PLHIV had achieved viral load < 1000 copies/mL and median D-dimer was 390.0 (IQR: 236.6–656.9) (log D-dimer: 2.6, IQR: 2.4–2.8). Mean change in log D-dimer from baseline to 6 months was − 0.12 (95%CI −0.15, − 0.09) (p < 0.0001) indicating at 31.3% decline (95%CI −40.0, − 23.0) in D-dimer levels over the first 6 months on ART. D-dimer decline after ART initiation was significantly greater among PLHIV with tuberculosis at treatment initiation (− 172.1, 95%CI −259.0, − 106.3; p < 0.0001) and those with log viral load > 6.0 copies/mL (− 91.1, 95%CI −136.7, − 54.2; p < 0.01). Conclusions In this large Kenyan cohort of PLHIV, women, those with tuberculosis and higher viral load had elevated baseline D-dimer. ART initiation and viral load suppression among ART-naïve PLHIV in Kenya were associated with significant decrease in D-dimer at 6 months in this large African cohort.
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Affiliation(s)
- Chloe A Teasdale
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, 55 W125th Street, Room 543, New York, NY, 10027, USA. .,ICAP at Columbia University, Mailman School of Public Health, Columbia University, 22 W168th Street, New York, NY, 10032, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th Street, New York, NY, 10032, USA.
| | - Cecilia Hernandez
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 22 W168th Street, New York, NY, 10032, USA
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 22 W168th Street, New York, NY, 10032, USA
| | - Duncan Chege
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 22 W168th Street, New York, NY, 10032, USA
| | - Mark Hawken
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 22 W168th Street, New York, NY, 10032, USA
| | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, 22 W168th Street, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th Street, New York, NY, 10032, USA
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19
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Dirajlal-Fargo S, Albar Z, Sattar A, Kulkarni M, Bowman E, Funderburg N, Nazzinda R, Kityo C, Musiime V, McComsey GA. Relationship between economic insecurity, inflammation, monocyte activation and intestinal integrity in children living with HIV in Uganda. AIDS Care 2020; 32:1451-1456. [PMID: 32539474 DOI: 10.1080/09540121.2020.1776822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We aimed to evaluate differences in socio-economic variables in a Ugandan cohort of children with perinatally acquired HIV (PHIVs), HIV exposed uninfected (HEU) and HIV unexposed uninfected (HIV-) children and their associations with markers of inflammation and intestinal integrity. This is a cross-sectional study in 57 PHIV, 59 HEU and 56 HIV - children aged 2-10 years old enrolled in Uganda. Mean age of all participants was 7 years and 55% were girls. Compared to HEU and HIV - children, PHIVs were more likely to have parents that only completed a primary education, live in a household without electricity and live in poverty (p≤0.034). PHIVs living in poverty had higher IL-6 (p=0.006), those with lack of electricity had higher hsCRP, IL6, sTNFRII and d-dimer (p≤0.048) and PHIVs with an unprotected water source had higher IL6 and d-dimer (p≤0.016). After adjusting for demographic and HIV variables, IL-6 and d-dimer remained associated with lack of electricity and having an unprotected water source only in PHIVs (p<0.019). Our findings suggest that addressing economic insecurity may mitigate the persistent low-level inflammation in HIV that lead to many end organ disease. Longitudinal studies are needed to better understand the impact of socioeconomic factors on HIV inflammation and comorbidities.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Zainab Albar
- Case Western Reserve University, Cleveland, OH, USA
| | - Abdus Sattar
- Case Western Reserve University, Cleveland, OH, USA
| | - Manjusha Kulkarni
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, USA
| | - Emily Bowman
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, USA
| | - Nicholas Funderburg
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, USA
| | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Grace A McComsey
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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20
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Siedner MJ, Bwana MB, Asiimwe S, Amanyire G, Musinguzi N, Castillo-Mancilla J, Tracy RP, Katz IT, Bangsberg DR, Hunt PW, Orrell C, Haberer JE. Timing of Antiretroviral Therapy and Systemic Inflammation in Sub-Saharan Africa: Results From the META Longitudinal Cohort Study. J Infect Dis 2020; 220:1172-1177. [PMID: 31188451 PMCID: PMC6736121 DOI: 10.1093/infdis/jiz259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/16/2019] [Indexed: 11/14/2022] Open
Abstract
Chronic inflammation predicts complications in persons with human immunodeficiency virus infection. We compared D-dimer, soluble CD14, and interleukin 6 levels before and 12 months after antiretroviral therapy (ART) initiation, among individuals starting ART during earlier-stage (CD4 T-cell count >350/µL) or late-stage disease (CD4 T-cell count <200/µL). Female sex, older age, viral load, and late-stage disease were associated with pre-ART biomarkers (n = 661; P < .05). However, there were no differences in biomarkers by disease stage after 12 months of ART (n = 438; P > .05), owing to loss from observation and greater declines in biomarkers in late-stage initiators (P < .001). Earlier initiation of ART is associated with decreased inflammation, but levels seem to converge between earlier and later initiators surviving to 12 months.
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Affiliation(s)
- Mark J Siedner
- Harvard Medical School, Boston.,Massachusetts General Hospital, Boston.,Mbarara University of Science and Technology, Uganda.,Africa Health Research Institute, Kwa-Zulu Natal, South Africa
| | | | - Stephen Asiimwe
- Mbarara University of Science and Technology, Uganda.,Kabwohe Clinical Research Center, Uganda
| | | | | | | | | | - Ingrid T Katz
- Harvard Medical School, Boston.,Brigham and Women's Hospital, Boston
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | | | | | - Jessica E Haberer
- Harvard Medical School, Boston.,Massachusetts General Hospital, Boston
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21
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Delagreverie HM, Bauduin C, De Castro N, Grinsztejn B, Chevrier M, Jouenne F, Mourah S, Kalidi I, Pilotto JH, Brites C, Tregnago Barcellos N, Amara A, Wittkop L, Molina JM, Delaugerre C. Impact of Raltegravir or Efavirenz on Cell-Associated Human Immunodeficiency Virus-1 (HIV-1) Deoxyribonucleic Acid and Systemic Inflammation in HIV-1/Tuberculosis Coinfected Adults Initiating Antiretroviral Therapy. Open Forum Infect Dis 2020; 7:ofz549. [PMID: 32083147 PMCID: PMC7019658 DOI: 10.1093/ofid/ofz549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background In view of the fast viremia decline obtained with integrase inhibitors, we studied the respective effects of initiating efavirenz (EFV) or raltegravir (RAL)-based antiretroviral therapy (ART) regimens on human immunodeficiency virus (HIV)-1 deoxyribonucleic acid (DNA) levels and inflammation biomarkers in the highly inflammatory setting of advanced HIV-1 disease with tuberculosis (TB) coinfection. Methods We followed cell-associated HIV-1 DNA, high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), soluble CD14 and D-Dimer levels for 48 weeks after ART initiation in the participants to the ANRS12-180 REFLATE-TB study. This phase II open-label randomized study included ART-naive people with HIV and TB treated with rifampicin to receive RAL 400 mg twice daily (RAL400), RAL 800 mg twice daily (RAL800) or EFV 600 mg QD with tenofovir and lamivudine. Results In 146 participants, the median (interquartile range [IQR]) week (W)0 HIV-1 DNA level was 4.7 (IQR, 4.3–5.1) log10 copies/106 CD4+, and the reduction by W48 was −0.8 log10 copies/106 CD4+ on EFV, −0.9 on RAL400, and −1.0 on RAL800 (P = .74). Baseline median (IQR) hsCRP, IL-6, sCD14, and D-Dimer levels were 6.9 (IQR, 3.3–15.6) mg/L, 7.3 (IQR, 3.5–12.3) pg/mL, 3221 (IQR, 2383–4130) ng/mL, and 975 (IQR, 535–1970) ng/mL. All biomarker levels decreased over the study: the overall W0–W48 mean (95% confidence interval) fold-change on ART was 0.37 (IQR, 0.28–0.48) for hsCRP, 0.42 (IQR, 0.35–0.51) for IL-6, 0.51 (IQR, 0.47–0.56) for sCD14, and 0.39 (IQR, 0.32–0.47) for D-Dimers. There were no differences in biomarker reduction across treatment arms. Conclusions In participants with HIV and TB, EFV, RAL400, or RAL800 effectively and equally reduced inflammation and HIV-1 DNA levels.
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Affiliation(s)
- Héloïse M Delagreverie
- Laboratoire de Virologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Université de Paris, Paris, France
| | - Claire Bauduin
- ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux University, Bordeaux, France
| | - Nathalie De Castro
- Maladies Infectieuses et Tropicales, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute-Fiocruz, STD/AIDS Clinical Research Laboratory, Rio de Janeiro, Brazil
| | - Marc Chevrier
- Laboratoire de Biochimie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanélie Jouenne
- Laboratoire de Pharmacologie, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samia Mourah
- Laboratoire de Pharmacologie, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Issa Kalidi
- Laboratoire d'Hématologie, Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Carlos Brites
- Hospital Universitário Profesor Edgar Santos, Laboratório de Pesquisa em Doenças Infecciosas, Bahia, Brazil
| | | | - Ali Amara
- INSERM U944, Université de Paris, Paris, France
| | - Linda Wittkop
- ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux University, Bordeaux, France.,Pole de Santé Publique, Service d'Information Medicale, Bordeaux, France
| | - Jean-Michel Molina
- INSERM U944, Université de Paris, Paris, France.,Maladies Infectieuses et Tropicales, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Constance Delaugerre
- Laboratoire de Virologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, Université de Paris, Paris, France
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22
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Siedner MJ, Triant V. Undetectable = Untransmittable and Your Health: The Personal Benefits of Early and Continuous Therapy for HIV Infection. J Infect Dis 2019; 219:173-176. [PMID: 30032272 DOI: 10.1093/infdis/jiy445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mark J Siedner
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Mbarara University of Science and Technology, Uganda.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Virginia Triant
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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23
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Inflammatory biomarkers prior to antiretroviral therapy as prognostic markers of 12-month mortality in South Africa and Uganda. AIDS 2019; 33:2043-2048. [PMID: 31274541 PMCID: PMC6774817 DOI: 10.1097/qad.0000000000002305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine the utility of biomarkers of immune activation, systemic inflammation and coagulopathy prior to antiretroviral therapy to predict mortality during the first year of antiretroviral therapy (ART) in sub-Saharan Africa. DESIGN A prospective, observational cohort. METHODS We measured soluble CD14, interleukin-6 and D-dimer in nonpregnant individuals initiating ART in South Africa and Uganda in the Measuring Early Treatment Adherence (META) Study. We used survival analysis methods to estimate their association with 12-month mortality, and fit receiver operator curves (ROC) to assess the prognostic value of each biomarker. RESULTS Six-hundred and sixty individuals were enrolled and had pretreatment biomarkers measured. Approximately 60% were women, with a median CD4 cell count of 187 cells/μl [interquartile range (IQR) 111-425] and approximately half were enrolled each from South Africa and Uganda. We observed 34 deaths for a crude mortality of 5.3 deaths/100 person-years (py) (95% confidence interval 3.8-7.4), which ranged from 0/100 py to 13.7/100 py in the lowest and highest tertile of pretreatment sCD14, respectively. In Cox models, all three biomarkers were strongly predictive of the hazard of death (adjusted hazard ratio 3-6, all P < 0.01). In multivariable models including biomarkers, both pretreatment CD4 cell count and pretreatment viral load became borderline or nonsignificantly associated with mortality. The c-statistic for area under ROC was higher for all three biomarkers than for CD4 cell count (P < 0.01). CONCLUSION Biomarkers of immune activation, systemic inflammation and coagulopathy prior to ART initiation are strongly predictive of early death on treatment after adjustment for CD4 cell count. Such biomarkers might serve as important prognostic indicators for patient triage in this population.
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24
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Jabs DA, Van Natta ML, Trang G, Jones N, Milush JM, Cheu R, Klatt NR, Pak JW, Danis RP, Hunt PW. Association of Systemic Inflammation With Retinal Vascular Caliber in Patients With AIDS. Invest Ophthalmol Vis Sci 2019; 60:2218-2225. [PMID: 31108552 PMCID: PMC6528842 DOI: 10.1167/iovs.18-26070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To evaluate relationships among retinal vascular caliber and biomarkers of systemic inflammation in patients with AIDS. Methods A total of 454 participants with AIDS had retinal vascular caliber (central retinal artery equivalent and central retinal vein equivalent) determined from enrollment retinal photographs by reading center graders masked to clinical and biomarker information. Cryopreserved plasma specimens were assayed for inflammatory biomarkers, including C-reactive protein (CRP), IL-6, interferon-γ inducible protein (IP)-10, kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Results In the simple linear regression of retinal vascular caliber on plasma biomarkers, elevated CRP, IL-6, and IP-10 were associated with retinal venular dilation, and elevated KT ratio with retinal arteriolar narrowing. In the multiple linear regression, including baseline characteristics and plasma biomarkers, AMD was associated with dilation of retinal arterioles (mean difference: 9.1 μm; 95% confidence interval [CI] 5.2, 12.9; P < 0.001) and venules (mean difference, 10.9 μm; 95% CI, 5.3, 16.6; P < 0.001), as was black race (P < 0.001). Hyperlipidemia was associated with retinal venular narrowing (mean difference, -7.5 μm; 95% CI, -13.7, -1.2; P = 0.02); cardiovascular disease with arteriolar narrowing (mean difference, -5.2 μm; 95% CI, -10.3, -0.1; P = 0.05); age with arteriolar narrowing (slope, -0.26 μm/year; 95% CI, -0.46, -0.06; P = 0.009); and IL-6 with venular dilation (slope, 5.3 μm/standard deviation log10[plasma IL-6 concentration]; 95% CI, 2.7, 8.0; P < 0.001). Conclusions These data suggest that retinal vascular caliber is associated with age, race, AMD, hyperlipidemia, cardiovascular disease, and selected biomarkers of systemic inflammation.
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Affiliation(s)
- Douglas A Jabs
- Department of Ophthalmology, the Icahn School of Medicine at Mount Sinai, New York, New York, United States.,Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, New York, United States.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Mark L Van Natta
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Garrett Trang
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California, United States
| | - Norman Jones
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California, United States
| | - Jeffrey M Milush
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California, United States
| | - Ryan Cheu
- Department of Pharmaceutics, University of Washington, Seattle, Washington, United States
| | - Nichole R Klatt
- Department of Pediatrics, the University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jeong Won Pak
- Department of Ophthalmology and Visual Sciences, The University of Wisconsin, Madison, School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Ronald P Danis
- Department of Ophthalmology and Visual Sciences, The University of Wisconsin, Madison, School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Peter W Hunt
- Department of Medicine, the University of California, San Francisco, School of Medicine, San Francisco, California, United States
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25
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Swainson LA, Ahn H, Pajanirassa P, Khetarpal V, Deleage C, Estes JD, Hunt PW, Munoz-Sanjuan I, McCune JM. Kynurenine 3-Monooxygenase Inhibition during Acute Simian Immunodeficiency Virus Infection Lowers PD-1 Expression and Improves Post-Combination Antiretroviral Therapy CD4 + T Cell Counts and Body Weight. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2019; 203:899-910. [PMID: 31285277 PMCID: PMC6684450 DOI: 10.4049/jimmunol.1801649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/17/2019] [Indexed: 01/31/2023]
Abstract
The kynurenine pathway (KP) is a key regulator of many important physiological processes and plays a harmful role in cancer, many neurologic conditions, and chronic viral infections. In HIV infection, KP activity is consistently associated with reduced CD4 T cell counts and elevated levels of T cell activation and viral load; it also independently predicts mortality and morbidity from non-AIDS events. Kynurenine 3-monooxygenase (KMO) is a therapeutically important target in the KP. Using the nonhuman primate model of SIV infection in rhesus macaques, we investigated whether KMO inhibition could slow the course of disease progression. We used a KMO inhibitor, CHDI-340246, to perturb the KP during early acute infection and followed the animals for 1 y to assess clinical outcomes and immune phenotype and function during pre-combination antiretroviral therapy acute infection and combination antiretroviral therapy-treated chronic infection. Inhibition of KMO in acute SIV infection disrupted the KP and prevented SIV-induced increases in downstream metabolites, improving clinical outcome as measured by both increased CD4+ T cell counts and body weight. KMO inhibition increased naive T cell frequency and lowered PD-1 expression in naive and memory T cell subsets. Importantly, early PD-1 expression during acute SIV infection predicted clinical outcomes of body weight and CD4+ T cell counts. Our data indicate that KMO inhibition in early acute SIV infection provides clinical benefit and suggest a rationale for testing KMO inhibition as an adjunctive treatment in SIV/HIV infection to slow the progression of the disease and improve immune reconstitution.
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Affiliation(s)
- Louise A Swainson
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA 94110;
| | - Haelee Ahn
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA 94110
| | - Priya Pajanirassa
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA 94110
| | | | - Claire Deleage
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD 21701
| | - Jacob D Estes
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD 21701
| | - Peter W Hunt
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA 94110
| | | | - Joseph M McCune
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA 94110
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26
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Reid MJ, Ma Y, Golovaty I, Okello S, Sentongo R, Feng M, Tsai AC, Kakuhikire B, Tracy R, Hunt PW, Siedner M, Tien PC. Association of Gut Intestinal Integrity and Inflammation with Insulin Resistance in Adults Living with HIV in Uganda. AIDS Patient Care STDS 2019; 33:299-307. [PMID: 31188016 DOI: 10.1089/apc.2019.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We conducted a cross-sectional study of 148 HIV+ on HIV antiretroviral therapy and 149 HIV- adults in Mbarara, Uganda, to estimate the association between HIV infection and homeostasis model assessment of insulin resistance (HOMA-IR) using multivariable regression analysis. In addition, we evaluated whether intestinal fatty acid-binding protein (I-FABP), monocyte activation markers soluble (s)CD14 and sCD163, and proinflammatory cytokine interleukin 6 (IL-6) mediated this association. HOMA-IR was greater among HIV+ than HIV- adults [median (interquartile range): 1.3 (0.7-2.5) vs. 0.9 (0.5-2.4); p = 0.008]. In models adjusted for sociodemographic variables, diet, hypertension, and smoking history, HIV infection was associated with 37% [95% confidence intervals (95% CIs): 5-77] greater HOMA-IR compared with HIV- participants. The magnitude of association was greater when I-FABP was included as a covariate although the additive effect was modest (40% CI: 8-82). By contrast adding sCD14 to the model was associated with greater HOMA-IR (59%; 95% CI: 21-109) among HIV+ participants compared with HIV- participants. Among HIV+ participants, greater CD4 nadir was non-significantly associated with greater HOMA-IR (22%; 95% CI: -2 to 52). Each 5-unit increase in body mass index (BMI; 49% greater HOMA-IR; 95% CI: 18-87) and female sex (71%; 95% CI: 17-150) remained associated in adjusted models. In this study of mainly normal-weight Ugandan adults, HIV infection, female sex, and greater BMI were all associated with greater insulin resistance (IR). This association was strengthened modestly after adjustment for sCD14, suggesting possible distinct immune pathways to IR that are independent of HIV or related to inflammatory changes occurring on HIV treatment.
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Affiliation(s)
- Michael J.A. Reid
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Iya Golovaty
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maggie Feng
- Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Peter W. Hunt
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Department of Experimental Medicine, University of California, San Francisco, San Francisco, California
| | - Mark Siedner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California
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27
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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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28
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Jabs DA, Van Natta ML, Trang G, Jones NG, Milush JM, Cheu R, Klatt NR, Danis RP, Hunt PW. Association of Age-related Macular Degeneration With Mortality in Patients With Acquired Immunodeficiency Syndrome; Role of Systemic Inflammation. Am J Ophthalmol 2019; 199:230-237. [PMID: 30552890 DOI: 10.1016/j.ajo.2018.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the relationships among age-related macular degeneration (AMD), mortality, and biomarkers of systemic inflammation in patients with acquired immunodeficiency syndrome (AIDS). DESIGN Case-control study. METHODS In participants with intermediate-stage AMD at enrollment in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and 2:1 controls matched for age and sex, cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Main outcome measure was mortality. RESULTS The study included 189 patients with AMD and 385 controls. In the unadjusted analysis, AMD was associated with mortality (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02, 2.15; P = .04). In an adjusted analysis, CRP (HR 1.36; 95% CI 1.08, 1.71; P = .009), IL-6 (HR 1.45; 95% CI 1.11, 1.90; P = .006), and IP-10 (HR 1.41; 95% CI 1.08, 1.84; P = .01) were associated with mortality. In a Cox regression analysis adjusted for human immunodeficiency virus load, blood CD4+ T cell level, CRP, IL-6, and IP-10, the association of AMD with mortality was attenuated (HR 1.08; 95% CI 0.73, 1.59; P = .70), primarily by the addition of the inflammatory biomarkers. CONCLUSIONS These data suggest that the increased mortality observed in patients with AIDS with AMD is, at least in part, a result of systemic inflammation.
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Affiliation(s)
- Douglas A Jabs
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Mark L Van Natta
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Garrett Trang
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Norman G Jones
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Jeffrey M Milush
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Ryan Cheu
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Nichole R Klatt
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ronald P Danis
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, The University of Wisconsin, Madison, Madison, Wisconsin, USA
| | - Peter W Hunt
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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29
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Church JA, Parker EPK, Kosek MN, Kang G, Grassly NC, Kelly P, Prendergast AJ. Exploring the relationship between environmental enteric dysfunction and oral vaccine responses. Future Microbiol 2018; 13:1055-1070. [PMID: 29926747 PMCID: PMC6136084 DOI: 10.2217/fmb-2018-0016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
Abstract
Oral vaccines significantly underperform in low-income countries. One possible contributory factor is environmental enteric dysfunction (EED), a subclinical disorder of small intestinal structure and function among children living in poverty. Here, we review studies describing oral vaccine responses and EED. We identified eight studies evaluating EED and oral vaccine responses. There was substantial heterogeneity in study design and few consistent trends emerged. Four studies reported a negative association between EED and oral vaccine responses; two showed no significant association; and two described a positive correlation. Current evidence is therefore insufficient to determine whether EED contributes to oral vaccine underperformance. We identify roadblocks in the field and future research needs, including carefully designed studies those can investigate this hypothesis further.
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Affiliation(s)
- James A Church
- Zvitambo Institute for Maternal & Child Health Research, Harare, Zimbabwe
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, UK
| | - Edward PK Parker
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK
| | - Margaret N Kosek
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK
| | - Paul Kelly
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, UK
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal & Child Health Research, Harare, Zimbabwe
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, UK
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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30
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Chitre AS, Kattah MG, Rosli YY, Pao M, Deswal M, Deeks SG, Hunt PW, Abdel-Mohsen M, Montaner LJ, Kim CC, Ma A, Somsouk M, McCune JM. A20 upregulation during treated HIV disease is associated with intestinal epithelial cell recovery and function. PLoS Pathog 2018; 14:e1006806. [PMID: 29505600 PMCID: PMC5854440 DOI: 10.1371/journal.ppat.1006806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 03/15/2018] [Accepted: 12/13/2017] [Indexed: 02/06/2023] Open
Abstract
TRIAL REGISTRATION ClinicalTrials.gov Clinical Trial NCT00594880.
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Affiliation(s)
- Avantika S. Chitre
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Michael G. Kattah
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Yenny Y. Rosli
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Montha Pao
- Division of HIV/AIDS, University of California, San Francisco, San Francisco, CA, United States of America
| | - Monika Deswal
- Division of HIV/AIDS, University of California, San Francisco, San Francisco, CA, United States of America
| | - Steven G. Deeks
- Division of HIV/AIDS, University of California, San Francisco, San Francisco, CA, United States of America
| | - Peter W. Hunt
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | | | - Luis J. Montaner
- The Wistar Institute, Philadelphia, PA, United States of America
| | - Charles C. Kim
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Averil Ma
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Joseph M. McCune
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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31
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Justice AC, Erlandson KM, Hunt PW, Landay A, Miotti P, Tracy RP. Can Biomarkers Advance HIV Research and Care in the Antiretroviral Therapy Era? J Infect Dis 2018; 217:521-528. [PMID: 29165684 PMCID: PMC5853399 DOI: 10.1093/infdis/jix586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
Despite achieving human immunodeficiency virus type 1 (HIV-1) RNA suppression below levels of detection and, for most, improved CD4+ T-cell counts, those aging with HIV experience excess low-level inflammation, hypercoagulability, and immune dysfunction (chronic inflammation), compared with demographically and behaviorally similar uninfected individuals. A host of biomarkers that are linked to chronic inflammation are also associated with HIV-associated non-AIDS-defining events, including cardiovascular disease, many forms of cancer, liver disease, renal disease, neurocognitive decline, and osteoporosis. Furthermore, chronic HIV infection may interact with long-term treatment toxicity and weight gain after ART initiation. These observations suggest that future biomarker-guided discovery and treatment may require attention to multiple biomarkers and, possibly, weighted indices. We are clinical trialists, epidemiologists, pragmatic trialists, and translational scientists. Together, we offer an operational definition of a biomarker and consider how biomarkers might facilitate progress along the translational pathway from therapeutic discovery to intervention trials and clinical management among people aging with or without HIV infection.
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Affiliation(s)
- Amy C Justice
- VA Connecticut Healthcare System West Haven, Yale University, New Haven, Connecticut
- School of Medicine, Yale University, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Peter W Hunt
- Division of Experimental Medicine, Department of Medicine, University of California–San Francisco
| | - Alan Landay
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois
| | - Paolo Miotti
- Office of AIDS Research, National Institutes of Health, Bethesda, Maryland
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Colchester
- Department of Biochemistry, University of Vermont Larner College of Medicine, Colchester
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32
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Siedner MJ. Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework. J Aging Health 2017; 31:109-138. [PMID: 28831864 DOI: 10.1177/0898264317724549] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. METHODS A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. RESULTS We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. CONCLUSIONS Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.
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Affiliation(s)
- Mark J Siedner
- 1 Harvard Medical School, Boston, MA, USA.,2 Massachusetts General Hospital, Boston, MA, USA.,3 Mbarara University of Science and Technology, Mbarara, Uganda
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