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Li C, Tian Y, Zeng D, Shepherd BE. Asymptotic Properties for Cumulative Probability Models for Continuous Outcomes. MATHEMATICS (BASEL, SWITZERLAND) 2023; 11:4896. [PMID: 38374966 PMCID: PMC10875740 DOI: 10.3390/math11244896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Regression models for continuous outcomes frequently require a transformation of the outcome, which is often specified a priori or estimated from a parametric family. Cumulative probability models (CPMs) nonparametrically estimate the transformation by treating the continuous outcome as if it is ordered categorically. They thus represent a flexible analysis approach for continuous outcomes. However, it is difficult to establish asymptotic properties for CPMs due to the potentially unbounded range of the transformation. Here we show asymptotic properties for CPMs when applied to slightly modified data where bounds, one lower and one upper, are chosen and the outcomes outside the bounds are set as two ordinal categories. We prove the uniform consistency of the estimated regression coefficients and of the estimated transformation function between the bounds. We also describe their joint asymptotic distribution, and show that the estimated regression coefficients attain the semiparametric efficiency bound. We show with simulations that results from this approach and those from using the CPM on the original data are very similar when a small fraction of the data are modified. We reanalyze a dataset of HIV-positive patients with CPMs to illustrate and compare the approaches.
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Affiliation(s)
- Chun Li
- Division of Biostatistics, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, USA
| | - Yuqi Tian
- Department of Biostatistics, Vanderbilt University, Nashville, TN 37203, USA
| | - Donglin Zeng
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, TN 37203, USA
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Tian Y, Shepherd BE, Li C, Zeng D, Schildcrout JS. Analyzing clustered continuous response variables with ordinal regression models. Biometrics 2023; 79:3764-3777. [PMID: 37459181 PMCID: PMC10792095 DOI: 10.1111/biom.13904] [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: 07/17/2022] [Accepted: 06/28/2023] [Indexed: 12/21/2023]
Abstract
Continuous response data are regularly transformed to meet regression modeling assumptions. However, approaches taken to identify the appropriate transformation can be ad hoc and can increase model uncertainty. Further, the resulting transformations often vary across studies leading to difficulties with synthesizing and interpreting results. When a continuous response variable is measured repeatedly within individuals or when continuous responses arise from clusters, analyses have the additional challenge caused by within-individual or within-cluster correlations. We extend a widely used ordinal regression model, the cumulative probability model (CPM), to fit clustered, continuous response data using generalized estimating equations for ordinal responses. With the proposed approach, estimates of marginal model parameters, cumulative distribution functions , expectations, and quantiles conditional on covariates can be obtained without pretransformation of the response data. While computational challenges arise with large numbers of distinct values of the continuous response variable, we propose feasible and computationally efficient approaches to fit CPMs under commonly used working correlation structures. We study finite sample operating characteristics of the estimators via simulation and illustrate their implementation with two data examples. One studies predictors of CD4:CD8 ratios in a cohort living with HIV, and the other investigates the association of a single nucleotide polymorphism and lung function decline in a cohort with early chronic obstructive pulmonary disease.
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Affiliation(s)
- Yuqi Tian
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Chun Li
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Wang X, Zhang L, Du J, Wei Y, Wang D, Song C, Chen D, Li B, Jiang M, Zhang M, Zhao H, Kong Y. Decreased CD73+ Double-Negative T Cells and Elevated Level of Soluble CD73 Correlated With and Predicted Poor Immune Reconstitution in HIV-Infected Patients After Antiretroviral Therapy. Front Immunol 2022; 13:869286. [PMID: 35444646 PMCID: PMC9013806 DOI: 10.3389/fimmu.2022.869286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Although extensive use of antiretroviral therapy (ART) has made great progress in controlling HIV replication and improving CD4+ T cell recovery, the immune reconstitution remained insufficient in some patients, who were defined as poor immunological responders (PIRs). These PIRs were at a high risk of AIDS-related and non-AIDS complications, resulting in higher morbidity and mortality rate. Thus, it is a major challenge and urgently needed to distinguish PIRs early and improve their immune function in time. Immune activation is a key factor that leads to impaired immune reconstitution in people living with HIV (PLWH) who are receiving effective ART. Double negative T cells (DNT) were reported to associate with the control of immune activation during HIV infection. However, the precise mechanisms by which DNT cells exerted their suppressive capacity during HIV infection remained puzzled. CD73, both a soluble and a membrane-bound form, display immunosuppressive effects through producing adenosine (ADO). Thus, whether DNT cells expressed CD73 and mediated immune suppression through CD73-ADO pathway needs to be investigated. Here, we found a significant downregulation of CD73 expression on DNT cells in treatment-naïve PLWH (TNs) compared to healthy controls, accompanied with increased concentration of sCD73 in plasma. Both the frequency of CD73+ DNT cells and the level of plasma sCD73 recovered after ART treatment. However, PIRs showed decreased percentage of CD73+ DNT cells compared to immunological responders (IRs). The frequency of CD73+ DNT cells was positively correlated with CD4+ T cell count and CD4/CD8 ratio, and negatively correlated with immune activation in PLWH. The level of sCD73 also showed a negative correlation to CD4+ T cell count and CD4/CD8 ratio. More importantly, in the present cohort, a higher level of sCD73 at the time of initiating ART could predict poor immune reconstitution in PLWH after long-term ART. Our findings highlighted the importance of CD73+ DNT cells and sCD73 in the disease progression and immune reconstitution of PLWH, and provided evidences for sCD73 as a potential biomarker of predicting immune recovery.
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Affiliation(s)
- Xinyue Wang
- Peking University Ditan Teaching Hospital, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leidan Zhang
- Peking University Ditan Teaching Hospital, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuqing Wei
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Di Wang
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chuan Song
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Danying Chen
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bei Li
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Meiqing Jiang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengyuan Zhang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yaxian Kong, ; Hongxin Zhao,
| | - Yaxian Kong
- Peking University Ditan Teaching Hospital, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yaxian Kong, ; Hongxin Zhao,
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Combined training in patient with aids: improved quality of life and preserved BDNF. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nguchu BA, Zhao J, Wang Y, Li Y, Wei Y, Uwisengeyimana JDD, Wang X, Qiu B, Li H. Atypical Resting-State Functional Connectivity Dynamics Correlate With Early Cognitive Dysfunction in HIV Infection. Front Neurol 2021; 11:606592. [PMID: 33519683 PMCID: PMC7841016 DOI: 10.3389/fneur.2020.606592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/01/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose: Previous studies have shown that HIV affects striato-cortical regions, leading to persisting cognitive impairment in 30-70% of the infected individuals despite combination antiretroviral therapy. This study aimed to investigate brain functional dynamics whose deficits might link to early cognitive decline or immunologic deterioration. Methods: We applied sliding windows and K-means clustering to fMRI data (HIV patients with asymptomatic neurocognitive impairment and controls) to construct dynamic resting-state functional connectivity (RSFC) maps and identify states of their reoccurrences. The average and variability of dynamic RSFC, and the dwelling time and state transitioning of each state were evaluated. Results: HIV patients demonstrated greater variability in RSFC between the left pallidum and regions of right pre-central and post-central gyri, and between the right supramarginal gyrus and regions of the right putamen and left pallidum. Greater variability was also found in the frontal RSFC of pars orbitalis of the left inferior frontal gyrus and right superior frontal gyrus (medial). While deficits in learning and memory recall of HIV patients related to greater striato-sensorimotor variability, deficits in attention and working memory were associated with greater frontal variability. Greater striato-parietal variability presented a strong link with immunologic function (CD4+/CD8+ ratio). Furthermore, HIV-infected patients exhibited longer time and reduced transitioning in states typified by weaker connectivity in specific networks. CD4+T-cell counts of the HIV-patients were related to reduced state transitioning. Conclusion: Our findings suggest that HIV alters brain functional connectivity dynamics, which may underlie early cognitive impairment. These findings provide novel insights into our understanding of HIV pathology, complementing the existing knowledge.
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Affiliation(s)
- Benedictor Alexander Nguchu
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Jing Zhao
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanming Wang
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Yu Li
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Yarui Wei
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Jean de Dieu Uwisengeyimana
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Xiaoxiao Wang
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Bensheng Qiu
- Hefei National Laboratory for Physical Sciences at the Microscale, Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Wolday D, Legesse D, Kebede Y, Siraj DS, McBride JA, Striker R. Immune recovery in HIV-1 infected patients with sustained viral suppression under long-term antiretroviral therapy in Ethiopia. PLoS One 2020; 15:e0240880. [PMID: 33091053 PMCID: PMC7580989 DOI: 10.1371/journal.pone.0240880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is very little data on long-term immune recovery responses in patients on suppressive antiretroviral therapy (ART) in the setting of sub-Saharan Africa (SSA). Thus, we sought to determine CD4+ T-cell, CD8+ T-cell and CD4/CD8 ratio responses in a cohort of HIV infected individuals on sustained suppressive ART followed up for more than a decade. METHODS The cohort comprised adult patients who started ART between 2001 and 2007 and followed for up to 14 years. Trends in median CD4+ T-cells, CD8+ T-cells and CD4/CD8 ratio were reviewed retrospectively. Poisson regression models were used to identify factors associated with achieving normalized T-cell biomarkers. Kaplan-Meier curves were used to estimate the probability of attaining normalized counts while on suppressive ART. RESULTS A total of 227 patients with a median duration of follow-up on ART of 12 (IQR: 10.5-13.0) years were included. CD4 cell count increased from baseline median of 138 cells (IQR: 70-202) to 555 cells (IQR: 417-830). CD4 cell increased continuously up until 5 years, after which it plateaued up until 14 years of follow up. Only 69.6% normalized their CD4 cell count within a median of 6.5 (IQR: 3.0-10.5) years. In addition, only 15.9% of the cohort were able to achieve the median reference CD4+ T-cell threshold count in Ethiopians (≈760 cells/μL). CD8+ T-cell counts increased initially until year 1, after which continuous decrease was ascertained. CD4/CD8 ratio trend revealed continuous increase throughout the course of ART, and increased from a median baseline of 0.14 (IQR: 0.09-0.22) to a median of 0.70 (IQR: 0.42-0.95). However, only 12.3% normalized their ratio (≥ 1.0) after a median of 11.5 years. In addition, only 8.8% of the cohort were able to achieve the median reference ratio of healthy Ethiopians. CONCLUSION Determination of both CD4+ and CD8+ T-cells, along with CD4/CD8 ratio is highly relevant in long-term follow-up of patients to assess immune recovery. Monitoring ratio levels may serve as a better biomarker risk for disease progression among patients on long-term ART. In addition, the findings emphasize the relevance of initiation of ART at the early stage of HIV-1 infection.
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Affiliation(s)
- Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | - Yazezew Kebede
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Dawd S. Siraj
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Joseph A. McBride
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Robert Striker
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
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Rodríguez-Velásquez J, Prieto-Bohórquez S, Pérez-Díaz C, Correa-Herrera C, Soracipa-Muñoz Y, Jattin-Balcázar J, David-Ibarra A. Predicción temporal de CD4+ en 80 pacientes con manejo antirretroviral a partir de valores de leucocitos. INFECTIO 2020. [DOI: 10.22354/in.v24i2.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: establecer una metodología predictiva de aplicación clínica de recuentos de CD4+ en rangos de interés clínico a partir del recuento absoluto de leucocitos.Metodología: a partir de los valores secuenciales de leucocitos y linfocitos CD4+ de 9 pacientes, se observaron patrones matemáticos que posteriormente fueronaplicados en un estudio ciego con 71 casos para confirmar su capacidad predictiva, midiendo porcentajes de especificidad y sensibilidad. Resultados: se determinaron cinco patrones matemáticos que predicen en el 99% de los casos los distintos recuentos de CD4+ a partir de recuentos de leucocitos con valores de especificidad y sensibilidad del 99%. Conclusiones: los patrones matemáticos encontrados entre recuento de leucocitos y CD4+ sugieren que este fenómeno prácticamente es determinista.
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Vivancos-Gallego MJ, Okhai H, Perez-Elías MJ, Gomez-Ayerbe C, Moreno-Zamora A, Casado JL, Quereda C, Sanz JM, Sanchez-Conde M, Serrano-Villar S, Del Campo S, Dronda F, Galan JC, Sabin CA, Moreno S. CD4 +:CD8 + T-cell ratio changes in people with HIV receiving antiretroviral treatment. Antivir Ther 2020; 25:91-100. [PMID: 32338638 DOI: 10.3851/imp3354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cofactors associated with persistently abnormal CD4+:CD8+ T-cell ratio in people with HIV (PWH) on antiretroviral treatment (ART) might change over time as the population of people with HIV ages or as new ART drugs become available. The main objective of our study was to determine the long-term associations of baseline factors, including the CD4+ T-cell count and ratio, with ratio normalization (≥1). In addition to this, we explored whether the ratio remained associated with the risk of both AIDS and non-AIDS events among individuals on suppressive ART. METHODS Clinic-based study in a tertiary, university hospital in Madrid. People with HIV starting a first-line ART regimen (January 2006-June 2017) were included in a prospective national multicentre cohort (CoRIS). People with controlled HIV-infection within the first year of ART initiation and complete CD4+ and CD8+ T-cell records were selected. Cox proportional hazard (PH) regression models were used to estimate the cumulative incidence of ratio normalization and to examine associations with socio-demographic and clinical variables. To investigate factors independently associated with the development of AIDS and non-AIDS events we used a time updated Poisson regression model. RESULTS The study included 557 subjects. During follow-up (median 5.24 years), 44% of participants achieved a ratio of 1 within a median of 1.49 years. In a multivariate PH model, pre-ART factors negatively associated with ratio normalization were the pre-ART CD4+:CD8+ T-cell ratio and mode of HIV acquisition. For the secondary analysis, 1.3 events/100 person years of follow-up were observed. After adjustment, older age, HIV RNA >200 copies/ml and CD4+:CD8+ T-cell ratios over follow-up, remained significantly associated with the development of AIDS and non-AIDS events. In contrast, pre-ART ratio was not associated with the risk of AIDS and non-AIDS events. CONCLUSIONS In summary, our study showed that higher pre-ART CD4+:CD8+ T-cell ratio is associated with rates of ratio normalization ≥1. In addition, the risk of AIDS and non-AIDS events seems to be predicted by the time updated CD4+:CD8+ T-cell ratio not by the pre-ART CD4+:CD8+ T-cell ratio. Therefore, CD4+:CD8+ T-cell ratio should be considered as a dynamic marker for translation into clinical practice.
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Affiliation(s)
- Maria J Vivancos-Gallego
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Hajra Okhai
- Institute for Global Health, UCL, Royal Free Campus, London, United Kingdom
| | - Maria J Perez-Elías
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Cristina Gomez-Ayerbe
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Ana Moreno-Zamora
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Jose L Casado
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Carmen Quereda
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Javier Martinez Sanz
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Matilde Sanchez-Conde
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Santos Del Campo
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Fernando Dronda
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Juan Carlos Galan
- Microbiology Department, IRYCIS, University Hospital Ramón y Cajal, Madrid, Spain
| | - Caroline A Sabin
- Institute for Global Health, UCL, Royal Free Campus, London, United Kingdom
| | - Santiago Moreno
- Department of Infectious Diseases, University Hospital Ramon y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.,Department of Medicine and Medical Specialties, Alcala University, Madrid, Spain
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Immune profile at HIV infection diagnosis: Evolution in the French Alps area over the last 20 years. Med Mal Infect 2019; 50:428-432. [PMID: 31757516 DOI: 10.1016/j.medmal.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Health of HIV-infected people relies on early antiretroviral therapy, i.e. early diagnosis. We aimed to determine whether the characteristics at HIV diagnosis in two French medical centres changed over the last 20 years. PATIENTS AND METHODS All individuals diagnosed with HIV infection in Grenoble University Hospital (N=814) and Annecy Hospital (N=246) between 1997 and 2015 were included. We collected age, country of birth, mode of transmission, CD4T cell count, CD4/CD8 ratio, and HIV viral load. RESULTS Among the 1060 patients (mean age 37.4±11 years, 70.2% of men), 42.5% were men having sex with men (MSM); 65.2% were born in France, and 24.4% were born in Africa. Mean CD4T cell count at diagnosis was 396±288/mm3 and was stable over the study period when considering all patients; when considering the MSM group, a significant increase over time was observed, with a mean increase of 7.3 CD4/mm3 per year (P<0.001). A higher CD4 count at diagnosis was observed after 2005 (400±289 vs 468±271/mm3, P=0.005). The proportion of MSM patients with a CD4 count<200/mm3 at diagnosis was lower after 2005 (14.7% after 2005 and 25.6% before, P=0.028) This was not observed in heterosexual patients (born in Africa or not). CONCLUSION In the MSM population, CD4 count at diagnosis is higher after 2005, suggesting that screening campaigns have become more efficient. This was not observed in other populations, who should be better targeted in future strategies.
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Acute HIV Infection and CD4/CD8 Ratio Normalization After Antiretroviral Therapy Initiation. J Acquir Immune Defic Syndr 2019; 79:510-518. [PMID: 30142143 DOI: 10.1097/qai.0000000000001843] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We estimated the effect of initiating virologically suppressive antiretroviral therapy (ART) during acute HIV infection versus chronic HIV infection (AHI vs. CHI) on CD4/CD8 ratio normalization. SETTING A prospective clinical cohort study. METHODS We included patients initiating ART with AHI and CHI between 2000 and 2015 and compared time from ART initiation to the first normal CD4/CD8 ratio (defined as CD4/CD8 ≥1) using Kaplan-Meier curves and multivariable Cox proportional hazards models. Patient time was censored at virologic failure, lost to follow-up, or death. We also characterized CD4, CD8, and CD4/CD8 trajectories over the first 3 years of ART. RESULTS The 1198 patients were 27% female and 60% African American, with a median age of 37 years (interquartile range 28-47) at ART initiation. The 83 AHI patients were more likely male, younger, and of white race, than CHI patients. After 2 years of suppressive ART, 70% of AHI patients achieved a normal CD4/CD8 ratio, compared to 6%-38% of CHI patients, with greater likelihood of normalization at higher baseline CD4 counts. Time to normalization was shortest among AHI patients, followed by CHI patients with higher baseline CD4. The adjusted hazard ratio for time to normalization for AHI patients compared to CHI patients with baseline CD4 >350 was 4.33 (95% CI: 3.16 to 5.93). Higher baseline CD4/CD8 ratio was also associated with time to normalization (adjusted hazard ratio 1.54; 1.46, 1.63, per 0.1 increase in ratio). CONCLUSIONS Initiating ART during AHI at higher baseline CD4 cell counts and CD4/CD8 ratios was associated with shorter time to CD4/CD8 ratio normalization.
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Castilho JL, Turner M, Shepherd BE, Koethe JR, Furukawa SS, Bofill CE, Raffanti S, Sterling TR. CD4/CD8 Ratio and CD4 Nadir Predict Mortality Following Noncommunicable Disease Diagnosis in Adults Living with HIV. AIDS Res Hum Retroviruses 2019; 35:960-967. [PMID: 31407605 DOI: 10.1089/aid.2019.0064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Incidence of noncommunicable diseases (NCDs), including cardiovascular disease (CVD), cirrhosis, and non-AIDS-defining cancers (NADCs), have been associated with HIV viremia, CD4 cell counts, and CD4/CD8 ratio in persons living with HIV (PLWH). This study examined the importance of these markers to mortality risk following NCD diagnosis. We examined factors associated with mortality following incident CVD, cirrhosis, or NADCs in a clinical cohort of PLWH between 1998 and 2015. We calculated Kaplan-Meier estimates and used multivariable Cox proportional hazard models. We included 341 patients with NCDs (CVD = 169, cancer = 103, and cirrhosis = 67), of whom 129 died. Median age at NCD diagnosis was 49 years and median proportion of time before NCD with virologic suppression was 64%. Median survival after CVD was longer than for cancer or cirrhosis (11.6 years vs. 4.8 and 3.4 years, respectively; log rank test p < .001). In multivariable Cox proportional hazard models, higher CD4/CD8 ratio preceding NCD (adjusted hazard ratio [aHR] per 0.1 increase = 0.92 [95% confidence interval 0.85-0.99]) and higher CD4 nadir (aHR per 100 cells/μL = 0.84 [0.72-0.97]) were associated with decreased mortality risk. Neither CD4 cell count before NCD nor HIV viremia was statistically associated with mortality in adjusted models. When restricted to 116 patients with virologic suppression for ≥80% of time before NCD, only CD4 nadir was associated with mortality risk. Low CD4/CD8 ratio and CD4 nadir were associated with increased mortality risk after NCD, suggesting that prior immunosuppression or ongoing immune imbalance remain important for outcomes following serious NCDs.
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Affiliation(s)
- Jessica L. Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John R. Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally S. Furukawa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carmen E. Bofill
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen Raffanti
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Rodriguez J, Prieto S, Correa C, Melo M, Dominguez D, Olarte N, Suárez D, Aragón L, Torres F, Santacruz F. Prediction of CD4+ Cells Counts in HIV/AIDS Patients based on Sets and Probability Theories. Curr HIV Res 2019; 16:416-424. [PMID: 30843490 DOI: 10.2174/1570162x17666190306125819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies have developed methodologies for predicting the number of CD4+ cells from the total leukocyte and lymphocytes count based on mathematical methodologies, obtaining percentages of effectiveness prediction higher than 90% with a value of less than 5000 leukocytes. OBJECTIVE To improve the methodology probabilities prediction in 5000-9000 leukocytes ranges. METHOD from sets A, B, C and D defined in a previous study, and based on CD4+ prediction established on the total number of leukocytes and lymphocytes, induction was performed using data from 10 patients with HIV, redefining the sets A and C that describe the lymphocytes behavior relative to leukocytes. Subsequently, we evaluated with previous research prediction probabilities parameters from a sample of 100 patients, calculating the belonging probability to each sample and organized in predetermined ranges leukocytes, of each of the sets defined, their unions and intersections. Then the same procedure was performed with the new sets and the probability values obtained with the refined method were compared with respect to previously defined, by measures of sensitivity (SENS) and Negative Predictive Value (NPV) for each range. RESULTS probabilities with values greater than 0.83 were found in five of the nine ranges inside the new sets. The probability for the set A∪C increased from 0.06 to 0.18 which means increases between 0.06 and 0.09 for the intersection (A∪C) ∩ (B∪D), making evident the prediction improvement with new sets defined. CONCLUSION The results show that the new defined sets achieved a higher percentage of effectiveness to predict the CD4+ value cells, which represents a useful tool that can be proposed as a substitute for clinical values obtained by the flow cytometry.
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Affiliation(s)
- Javier Rodriguez
- Insight Group Director, Focusing Area and Special Internship "Physical and Mathematical Theories Applied to Medicine", Nueva Granada Military University - Clinica del Country Research Center, Bogota, Colombia
| | - Signed Prieto
- Insight Group Researcher, Nueva Granada Military University, Clinica del Country Research Center, Bogota, Colombia
| | - Catalina Correa
- Insight Group Researcher, Teacher of Major and Special "Physical and Mathematical Theories Applied to Medicine", Medicine Faculty, Nueva Granada Military University, Clinica del Country Research Center, Bogota, Colombia
| | - Martha Melo
- Magister in Educational Institutions Management, FRACUMNG Group Researcher, Basic and Applied Sciences Faculty, Nueva Granada Military University, Bogota, Colombia
| | - Dario Dominguez
- Magister in Economics, FRACUMNG Research Group Director, Basic and Applied Sciences Faculty, Nueva Granada Military University, Bogota, Colombia
| | - Nancy Olarte
- Esp in Information Technologies Applied to Education, GI-iTEC Group Researcher, Engineering Faculty, Nueva Granada Military University, Bogota, Colombia
| | - Daniela Suárez
- Special Internship and Focusing Area "Physical and Mathematical Theories Applied to Medicine", Medicine Faculty, Nueva Granada Military University, Bogota, Colombia
| | - Laura Aragón
- Special Internship and Focusing Area "Physical and Mathematical Theories Applied to Medicine", Medicine Faculty, Nueva Granada Military University, Bogota, Colombia
| | - Fernando Torres
- Special Internship and Focusing Area "Physical and Mathematical Theories Applied to Medicine", Medicine Faculty, Nueva Granada Military University, Bogota, Colombia
| | - Fernando Santacruz
- Special Internship and Focusing Area "Physical and Mathematical Theories Applied to Medicine", Medicine Faculty, Nueva Granada Military University, Bogota, Colombia
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13
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Guillén S, Prieto L, Jiménez de Ory S, González-Tomé MI, Rojo P, Navarro ML, Mellado MJ, Escosa L, Sainz T, Francisco L, Muñoz-Fernández MÁ, Ramos JT. Prognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children. PLoS One 2019; 14:e0220552. [PMID: 31381604 PMCID: PMC6681936 DOI: 10.1371/journal.pone.0220552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution. METHODS Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit. RESULTS 146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5-6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000-1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003-0.720). CONCLUSIONS CD4/CD8 >1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1).
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Affiliation(s)
- Sara Guillén
- Department Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - Luis Prieto
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pablo Rojo
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Luisa Navarro
- Department of Pediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Luis Escosa
- Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Talía Sainz
- Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Francisco
- Department of Pediatrics, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - José Tomás Ramos
- Department of Pediatrics, Hospital Clínico Universitario San Carlos, Madrid, Spain
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14
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CD4/CD8 Ratio as a Predictor for the Occurrence of Metabolic Syndrome in HIV / AIDS Patients During 6 Months of cART Therapy. J Med Biochem 2019; 38:489-495. [PMID: 31496914 PMCID: PMC6708296 DOI: 10.2478/jomb-2018-0049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022] Open
Abstract
Background HIV infection is characterized by progressive depletion of CD4+ T cells due to their reduced synthesis and increased destruction followed by marked activation and expansion of CD8+ T lymphocytes. CD4/CD8 ratio was traditionally described as a marker of immune system ageing in the general population, but it increasingly appears as a marker of different outcomes in the HIV-infected population. The main objective of this study is to examine the power of CD4/CD8 ratio in predicting the occurrence of metabolic syndrome (MetS) in HIV-positive patients receiving cART therapy. Methods 80 HIV/AIDS subjects were included in a retrospective case-control study. Flow cytometry was used to determine the percentage of CD4+ and CD8+ cells in peripheral blood of these patients. The values of biochemical parameters (triglycerides, HDL, blood sugar, blood counts), immunological parameters (CD4/CD8, PCR), anthropometric measurements and type of cART therapy were evaluated in this study. Results After six months of cART therapy 19 (23.8%) subjects had all the elements necessary for making the diagnosis of MetS. Using multivariate analysis CD4/CD8 ratio was statistically significant (p < 0.05) and had the largest effect on development of MetS (Wald = 9.01; OR = 0.45), followed by cART (Wald = 7.87; OR = 0.10) and triglycerides (Wald = 5.27; OR = 1.7). On the other hand, body weight and waist circumference showed no statistically significant effect on the development of MetS after six months of cART, p > 0.05. Conclusions CD4/CD8 ratio proved to be a significant marker for prediction of metabolic syndrome in HIV/AIDS patients.
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15
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Immune response to a Tdap booster in vertically HIV-infected adolescents. Vaccine 2018; 36:5609-5616. [PMID: 30087050 DOI: 10.1016/j.vaccine.2018.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pertussis cases have increased worldwide and knowledge on immune response and cytokine profile after Tdap vaccine in immunodeficient adolescents is scarce. OBJECTIVE To evaluate the immune response after Tdap in HIV-infected (HIV) and in healthy adolescents (CONTROL). METHODOLOGY Thirty HIV adolescents with CD4 cell counts >200 and 30 CONTROLs were immunized with Tdap, after a prior whole-cell DTP vaccine primary scheme. Blood samples were collected immediately before and after vaccine. Lymphocyte immunophenotyping was performed by flow cytometry; tetanus, diphtheria and pertussis toxin antibodies were assessed by ELISA; whole blood was stimulated with tetanus toxoid and Bordetella pertussis and supernatants were assessed for cytokines by xMAP. RESULTS Mean age of HIV and CONTROL groups were 17.9 e 17.1 years, respectively. Pain at injection site was more intense in CONTROL group. HIV group had similar increase in tetanus antibodies at 28 days (geometric mean concentration, GMC, 15.6; 95% CI, 7.52-32.4) than CONTROL group (GMC, 23.1; 95% CI, 15.0-35.5), but lower diphtheria antibodies at 28 days (GMC, 2.3; 95% CI, 0.88-6.19) than CONTROL group (GMC, 16.4; 95% CI, 10.3-26.2); for pertussis, the percentage of individuals who seroconverted was lower in HIV than CONTROL group (HIV, 62.1% versus CONTROL, 100%; p = .002). Both groups built a cellular immune response to tetanus, with a Th2 (IL-4, IL-5 and IL-13) and Th1 (IFN-γ) response, with lower cytokine levels in HIV than in CONTROL group. Especially for pertussis, cellular and humoral responses were less intense in HIV adolescents, with a lower Th1 and Th17 profile and higher IL-10 levels. HIV-infected adolescents on viral suppression showed an enhanced immune response to all the three vaccine antigens, although still at lower levels if compared to CONTROL group. CONCLUSIONS Both groups tolerated well and built an immune response after Tdap. However, HIV-infected adolescents would probably benefit from more frequent booster doses.
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16
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Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, Sax PE, Smith DM, Thompson MA, Buchbinder SP, Del Rio C, Eron JJ, Fätkenheuer G, Günthard HF, Molina JM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA 2018; 320:379-396. [PMID: 30043070 PMCID: PMC6415748 DOI: 10.1001/jama.2018.8431] [Citation(s) in RCA: 440] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. OBJECTIVE To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. EVIDENCE REVIEW New evidence collected since the International Antiviral Society-USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. FINDINGS ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. CONCLUSIONS AND RELEVANCE Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.
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Affiliation(s)
| | | | - Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jennifer F Hoy
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | | | - Paul E Sax
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Susan P Buchbinder
- San Francisco Department of Public Health and University of California San Francisco
| | - Carlos Del Rio
- Emory University Rollins School of Public Health and School of Medicine, Atlanta, Georgia
| | - Joseph J Eron
- University of North Carolina at Chapel Hill School of Medicine
| | - Gerd Fätkenheuer
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany, and German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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17
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Abstract
The introduction of combination antiretroviral therapy (cART) in the 1990s has dramatically changed the course of HIV infection, decreasing the risk for both AIDS- and non-AIDS-related events. Cancers, cardiovascular disease (CVD), liver and kidney disease, neurological disorders and frailty have become of great importance lately in the clinical management as they represent the principal cause of death in people living with HIV who receive cART (Kirk et al. in Clin Infect Dis 45(1):103-10, 2007; Strategies for Management of Antiretroviral Therapy Study et al. N Engl J Med 355(22):2283-2296, 2006; Ances et al. J Infect Dis 201(3):336-340, 2010; Desquilbet et al. J Gerontol A Biol Sci Med Sci 62(11):1279-1286, 2007; Lifson et al. HIV Clin Trials 9(3):177-185, 2008). Despite the undeniable achievements of cART, we are now faced with its limitations: a considerable proportion of individuals, referred as to immunological non-responders, fails to reconstitute the immune system despite optimal treatment and viral suppression (Kelley et al. Clin Infect Dis 48(6):787-794, 2009; Robbins et al. Clin Infect Dis 48(3):350-361, 2009) and remains at high risk for opportunistic infections and non-AIDS-related events (Strategies for Management of Antiretroviral Therapy Study et al. N Engl J Med 355(22):2283-2296, 2006). Moreover, the generalized state of immune activation and inflammation, linked to serious non-AIDS events, persists despite successful HIV suppression with cART. Finally, the current strategies have so far failed to eradicate the virus, and inflammation appears a driving force in viral persistence. In the light of all this, it is of fundamental importance to investigate the pathophysiological processes that link incomplete immune recovery, immune activation and HIV persistence to design targeted therapies that could impact on the three.
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Affiliation(s)
- Elena Bruzzesi
- Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,Department of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. .,Department of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy.
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18
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Borrajo A, Ranazzi A, Pollicita M, Bruno R, Modesti A, Alteri C, Perno CF, Svicher V, Aquaro S. Effects of Amprenavir on HIV-1 Maturation, Production and Infectivity Following Drug Withdrawal in Chronically-Infected Monocytes/Macrophages. Viruses 2017; 9:v9100277. [PMID: 28956865 PMCID: PMC5691629 DOI: 10.3390/v9100277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022] Open
Abstract
A paucity of information is available on the activity of protease inhibitors (PI) in chronically-infected monocyte-derived macrophages (MDM) and on the kinetics of viral-rebound after PI removal in vitro. To fill this gap, the activity of different concentrations of amprenavir (AMP) was evaluated in chronically-infected MDM by measuring p24-production every day up to 12 days after drug administration and up to seven days after drug removal. Clinically-relevant concentrations of AMP (4 and 20 μM) drastically decreased p24 amount released from chronically-infected MDM from Day 2 up to Day 12 after drug administration. The kinetics of viral-rebound after AMP-removal (4 and 20 μM) showed that, despite an initial increase, p24-production over time never reached the level observed for untreated-MDM, suggesting a persistent intracellular drug activity. In line with this, after AMP-removal, human immunodeficiency virus 1 (HIV-1) infectivity and intracellular the p24/p55 ratio (reflecting virion-maturation) were remarkably lower than observed for untreated MDM. Overall, AMP shows high efficacy in blocking HIV-1 replication in chronically-infected MDM, persisting even after drug-removal. This highlights the role of protease inhibitors in preventing the establishment of this important HIV-1 reservoir, thus reducing viral-dissemination in different anatomical compartments.
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Affiliation(s)
- Ana Borrajo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy.
- Clinical Virology Group, Institute of Biomedical Research of A Coruña (INIBIC)-University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15001 A Coruña, Spain.
| | - Alessandro Ranazzi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy.
| | - Michela Pollicita
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy.
| | - Rosalinda Bruno
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
| | - Andrea Modesti
- Department of Clinical Sciences and Translational Medicine University of Rome Tor Vergata, 00133 Roma, Italy.
| | - Claudia Alteri
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy.
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy.
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy.
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
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