1
|
Zhao H, Feng A, Luo D, Yuan T, Lin YF, Ling X, Zhong H, Li J, Li L, Zou H. Factors associated with immunological non-response after ART initiation: a retrospective observational cohort study. BMC Infect Dis 2024; 24:138. [PMID: 38287246 PMCID: PMC10823693 DOI: 10.1186/s12879-024-09021-9] [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: 07/18/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Among people living with HIV (PLHIV) on antiretroviral therapy (ART), the mortality of immunological non-responders (INRs) is higher than that of immunological responders (IRs). However, factors associated with immunological non-response following ART are not well documented. METHODS We obtained data for HIV patients from the National Free Antiretroviral Treatment Program database in China. Patients were grouped into IRs (CD4 cell count ≥ 350 cells/μl after 24 months' treatment), immunological incomplete responders (ICRs) (200-350 cells/μl) and INRs (< 200 cells/μl). Multivariable logistic regression was used to assess factors associated with immunological non-response. RESULTS A total of 3900 PLHIV were included, among whom 2309 (59.2%) were IRs, 1206 (30.9%) ICRs and 385 (9.9%) INRs. In multivariable analysis, immunological non-response was associated with being male (2.07, 1.39-3.09), older age [40-49 years (vs. 18-29 years): 2.05, 1.29-3.25; 50-59 years: 4.04, 2.33-7.00; ≥ 60 years: 5.51, 2.84-10.67], HBV co-infection (1.63, 1.14-2.34), HCV co-infection (2.01, 1.01-4.02), lower CD4 + T cell count [50-200 cells/μl (vs. 200-350 cells/μl): 40.20, 16.83-96.01; < 50 cells/μl: 215.67, 85.62-543.26] and lower CD4/CD8 ratio (2.93, 1.98-4.34) at baseline. Compared with patients treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens, those receiving protease inhibitors (PIs) based regimens were less likely to be INRs (0.47, 0.26-0.82). CONCLUSIONS We found a sizable immunological non-response rate among HIV-infected patients. Being male, older age, coinfection with HBV and HCV, lower CD4 + T cell count and lower CD4/CD8 ratio are risk factors of immunological non-response, whereas PIs-based regimens is a protective factor.
Collapse
Affiliation(s)
- Heping Zhao
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Anping Feng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Dan Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xuemei Ling
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huolin Zhong
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junbin Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China.
- School of Public Health, Southwest Medical University, Luzhou, China.
- Kirby Institute, University of New South Wales, Sydney, Australia.
| |
Collapse
|
2
|
Cuellar LE, Meza K, Holguín AM, Velarde J, Portillo-Alvarez D, Castro V, Sulca-Huamani O, Intimayta-Escalante C, Gaby-Pérez R, Patel A. Clinicopathological Features and Mortality in Patients With Kaposi Sarcoma and HIV: A Retrospective Analysis of a Thirty-Year Study From a Peruvian Oncologic Center. JCO Glob Oncol 2022; 8:e2100379. [PMID: 35728013 PMCID: PMC9232365 DOI: 10.1200/go.21.00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Kaposi's sarcoma (KS) is a multifocal angioproliferative disease. In Peru, the implementation of the highly active antiretroviral treatment (HAART) program was in 2005, the model for treating patients with HIV-positive KS shifted to a potential cure. In this study, we aim to compare clinicopathological characteristics and prognostic factors associated with outcomes in patients with HIV-positive KS. METHODS We developed a retrospective cohort study that includes patients with HIV/AIDS and KS seen in the Instituto Nacional de Enfermedades Neoplasicas between 1987 and 2017. Patients were divided into two groups according to the implementation of HAART in our country: the non-HAART group and those treated with HAART after 2005. Multivariate analysis for overall survival (OS) was performed with the Cox proportional hazard regression model. RESULTS There was a greater visceral compromise and more extensive oral cavity involvement in the non-HAART group (60% 31.7%, P < .01). Regarding the immune status, there was a significant difference from the CD4 count at 1-year follow-up (73 v 335, P = .01). The CD4/CD8 rate were significant different before QT (0.23 v 0.13, P = .01) and at 1-year follow-up (0.12 v 0.32, P = .03.). The estimated 5-year OS rate was significantly lower (P = .0001) for the non-HAART group (41.7%; 95% CI, 25.9 to 56.9) compared with the HAART group (79.3%; 95% CI, 66.8 to 87.5). In the multivariate model for OS, full-HAART regimen and previous diagnosis of HIV/AIDS (P < .01) were significantly associated with longer survival. CONCLUSION Clinical and demographic characteristics of our patients are compatible with the literature, but we report a higher rate of gastrointestinal involvement. Furthermore, our findings provide evidence for the importance of HAART and its ability to reduce KS-related mortality. ![]()
Collapse
Affiliation(s)
- Luis E. Cuellar
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
- Facultad de Medicina Hipólito Unanue, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Kelly Meza
- Weill Cornell Medicine, New York, NY
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Juan Velarde
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | - Victor Castro
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Oliver Sulca-Huamani
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Rushmely Gaby-Pérez
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Arpan Patel
- Division of Hematology and Medical Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| |
Collapse
|
3
|
Targeting the Gut Microbiota of Vertically HIV-Infected Children to Decrease Inflammation and Immunoactivation: A Pilot Clinical Trial. Nutrients 2022; 14:nu14050992. [PMID: 35267967 PMCID: PMC8912579 DOI: 10.3390/nu14050992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/11/2022] Open
Abstract
Aims: Children with HIV exhibit chronic inflammation and immune dysfunction despite antiretroviral therapy (ART). Strategies targeting persistent inflammation are needed to improve health in people living with HIV. The gut microbiota likely interacts with the immune system, but the clinical implications of modulating the dysbiosis by nutritional supplementation are unclear. Methods: Pilot, double-blind, randomized placebo-controlled trial in which 24 HIV-infected on ART were randomized to supplementation with a daily mixture of symbiotics, omega-3/6 fatty acids and amino acids, or placebo four weeks, in combination with ART. We analyzed inflammatory markers and T-cell activation changes and their correlations with shifts in fecal microbiota. Results: Twenty-four HIV-infected children were recruited and randomized to receive a symbiotic nutritional supplement or placebo. Mean age was 12 ± 3.9 years, 62.5% were female. All were on ART and had HIV RNA < 50/mL. We did not detect changes in inflammatory (IL-6, IL-7, IP-10), microbial translocation (sCD14), mucosal integrity markers (IFABP, zonulin) or the kynurenine to tryptophan ratio, or changes in markers of the adaptive immune response in relation to the intervention. However, we found correlations between several key bacteria and the assessed inflammatory and immunological parameters, supporting a role of the microbiota in immune modulation in children with HIV. Conclusions: In this exploratory study, a four-week nutritional supplementation had no significant effects in terms of decreasing inflammation, microbial translocation, or T-cell activation in HIV-infected children. However, the correlations found support the interaction between gut microbiota and the immune system.
Collapse
|
4
|
Evaluation of Thymic Output and Regulatory T Cells in Kidney Transplant Recipients with Chronic Antibody-Mediated Rejection. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6627909. [PMID: 33628795 PMCID: PMC7889358 DOI: 10.1155/2021/6627909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 01/23/2021] [Indexed: 01/26/2023]
Abstract
Background Regulatory T cells (Tregs) and recent thymic emigrants (RTEs) have an essential role in the regulation of allogeneic immune responses. However, their mechanisms of action in chronic antibody-mediated rejection (cAMR) are still unclear. In this study, we aimed to compare Treg and RTE levels between stable graft function (SGF) patients and cAMR subjects after kidney transplantation. Method Mononuclear cells (MNs) were separated from peripheral blood, and flow cytometry analysis was performed for detection of CD4+ and CD25high as Treg markers and CD4+, CD31+, and CD45RA+ as RTE immunophenotyping markers. Result The level of peripheral Treg cells was significantly lower in cAMR subjects in comparison to stable graft function patients. Moreover, SGF patients who had received cyclosporine A had a higher level of Treg in comparison to the tacrolimus recipients. Nevertheless, the RTE level between SGF and cAMR patients did not show any significant differences. Conclusion It seems that Treg cells are significantly associated with transplant outcomes in cAMR patients, and prescribed immunosuppressive drugs can influence the frequency of this crucial subset of T cells. Although these drugs are beneficial and inevitable for allograft maintenance, more investigations are needed to elucidate their complete effects on different immune cell subsets which some of them like Tregs are in favor of transplant tolerance. Besides, the thymic output is seemingly not a beneficial biomarker for predicting cAMR; however, more in vivo and in vitro studies are needed for revealing the precise role of Tregs and RTEs in the transplantation context.
Collapse
|
5
|
Sainz T, Gosalbes MJ, Talavera A, Jimenez-Hernandez N, Prieto L, Escosa L, Guillén S, Ramos JT, Muñoz-Fernández MÁ, Moya A, Navarro ML, Mellado MJ, Serrano-Villar S. Effect of a Nutritional Intervention on the Intestinal Microbiota of Vertically HIV-Infected Children: The Pediabiota Study. Nutrients 2020; 12:nu12072112. [PMID: 32708743 PMCID: PMC7400861 DOI: 10.3390/nu12072112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS The gut microbiota exerts a critical influence in the immune system. The gut microbiota of human virus immunodeficiency (HIV)-infected children remains barely explored. We aimed to characterize the fecal microbiota in vertically HIV-infected children and to explore the effects of its modulation with a symbiotic nutritional intervention. METHODS a pilot, double blind, randomized placebo-controlled study including HIV-infected children who were randomized to receive a nutritional supplementation including prebiotics and probiotics or placebo for four weeks. HIV-uninfected siblings were recruited as controls. The V3-V4 region of the 16S rRNA gene was sequenced in fecal samples. RESULTS 22 HIV-infected children on antiretroviral therapy (ART) and with viral load (VL) <50/mL completed the follow-up period. Mean age was 11.4 ± 3.4 years, eight (32%) were male. Their microbiota showed reduced alpha diversity compared to controls and distinct beta diversity at the genus level (Adonis p = 0.042). Patients showed decreased abundance of commensals Faecalibacterium and an increase in Prevotella, Akkermansia and Escherichia. The nutritional intervention shaped the microbiota towards the control group, without a clear directionality. CONCLUSIONS Vertical HIV infection is characterized by changes in gut microbiota structure, distinct at the compositional level from the findings reported in adults. A short nutritional intervention attenuated bacterial dysbiosis, without clear changes at the community level. SUMMARY In a group of 24 vertically HIV-infected children, in comparison to 11 uninfected controls, intestinal dysbiosis was observed despite effective ART. Although not fully effective to restore the microbiota, a short intervention with pre/probiotics attenuated bacterial dysbiosis.
Collapse
Affiliation(s)
- Talía Sainz
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, 28046 Madrid, Spain; (L.E.); (M.J.M.)
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
- Correspondence: ; Tel.: +34-917277201
| | - María José Gosalbes
- Área Genómica y Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46010 Valencia, Spain; (M.J.G.); (N.J.-H.); (A.M.)
- CIBER en Epidemiología y Salud Pública, 28029 Madrid, Spain
| | - Alba Talavera
- Bioinformatics Unit, Hospital Universitario Ramón y Cajal and IRYCIS, 28034 Madrid, Spain;
| | - Nuria Jimenez-Hernandez
- Área Genómica y Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46010 Valencia, Spain; (M.J.G.); (N.J.-H.); (A.M.)
- CIBER en Epidemiología y Salud Pública, 28029 Madrid, Spain
| | - Luis Prieto
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
- Servicio de Pediatría, Hospital 12 de Octubre and I+12, 28041 Madrid, Spain
| | - Luis Escosa
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, 28046 Madrid, Spain; (L.E.); (M.J.M.)
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
| | - Sara Guillén
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
- Servicio de Pediatría, Hospital de Getafe, 28901 Madrid, Spain
| | - José Tomás Ramos
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
- Spain Servicio de Pediatría, Hospital Clinico San Carlos and UCM, 28040 Madrid, Spain
| | - María Ángeles Muñoz-Fernández
- Laboratorio InmunoBiología Molecular, Sección Inmunología, Hospital General Universitario Gregorio Marañón and Spanish HIV HGM BioBank, Madrid Spain, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28007 Madrid, Spain;
| | - Andrés Moya
- Área Genómica y Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46010 Valencia, Spain; (M.J.G.); (N.J.-H.); (A.M.)
- CIBER en Epidemiología y Salud Pública, 28029 Madrid, Spain
- Instituto de Biología Integrativa de Sistemas, Universidad de Valencia, 46003 Valencia, Spain
| | - Maria Luisa Navarro
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - María José Mellado
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, 28046 Madrid, Spain; (L.E.); (M.J.M.)
- Red de Investigación CoRISpe integrada en la Red en Infectología Pediátrica (RITIP), 28046 Madrid, Spain; (L.P.); (S.G.); (J.T.R.); (M.L.N.)
| | - Sergio Serrano-Villar
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal and IRYCIS, 28034 Madrid, Spain;
| |
Collapse
|
6
|
Yang X, Su B, Zhang X, Liu Y, Wu H, Zhang T. Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders. J Leukoc Biol 2020; 107:597-612. [PMID: 31965635 PMCID: PMC7187275 DOI: 10.1002/jlb.4mr1019-189r] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/25/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022] Open
Abstract
The morbidity and mortality of HIV type-1 (HIV-1)-related diseases were dramatically diminished by the grounds of the introduction of potent antiretroviral therapy, which induces persistent suppression of HIV-1 replication and gradual recovery of CD4+ T-cell counts. However, ∼10-40% of HIV-1-infected individuals fail to achieve normalization of CD4+ T-cell counts despite persistent virological suppression. These patients are referred to as "inadequate immunological responders," "immunodiscordant responders," or "immunological non-responders (INRs)" who show severe immunological dysfunction. Indeed, INRs are at an increased risk of clinical progression to AIDS and non-AIDS events and present higher rates of mortality than HIV-1-infected individuals with adequate immune reconstitution. To date, the underlying mechanism of incomplete immune reconstitution in HIV-1-infected patients has not been fully elucidated. In light of this limitation, it is of substantial practical significance to deeply understand the mechanism of immune reconstitution and design effective individualized treatment strategies. Therefore, in this review, we aim to highlight the mechanism and risk factors of incomplete immune reconstitution and strategies to intervene.
Collapse
Affiliation(s)
- Xiaodong Yang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Xin Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Yan Liu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| |
Collapse
|
7
|
Tenofovir-Based Highly Active Antiretroviral Therapy Is Associated with Superior CD4 T Cells Repopulation Compared to Zidovudine-Based HAART in HIV 1 Infected Adults. Int J Chronic Dis 2018; 2018:3702740. [PMID: 29850480 PMCID: PMC5932490 DOI: 10.1155/2018/3702740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 12/23/2022] Open
Abstract
Tenofovir-based highly active antiretroviral therapy (HAART) is one of the preferred first-line therapies in the management of HIV 1 infection. Ghana has since 2014 adopted this recommendation; however there is paucity of scientific data that reflects the safety and efficacy of the tenofovir-based therapy compared to zidovudine in the Ghanaian health system. This study sought to assess the comparative immune reconstitution potential between tenofovir and zidovudine-based HAART regimens, which includes lamivudine and efavirenz in combination therapy. It also aimed to investigate the adverse drug reactions/events (ADREs) associated with pharmacotherapy with these agents in a total of 106 HAART naïve HIV patients. The study included 80 patients in the tenofovir cohort while 26 patients were on the zidovudine regimen. The occurrence of HIV comorbidities profile was assessed at diagnosis and throughout the study period. The baseline CD4 T cells count of the participants was also assessed at diagnosis and repeated at a median period of five months (range 4–6 months), after commencing treatment with either tenofovir- or zidovudine-based HAART. After five months of the HAART, the tenofovir cohort recorded higher CD4 T cell count change from baseline compared to the zidovudine cohort (p < 0.0001). The patients on the tenofovir-based HAART and female sex however appeared to be associated with more multiple ADREs.
Collapse
|
8
|
Sannier A, Stroumza N, Caligiuri G, Le Borgne-Moynier M, Andreata F, Senemaud J, Louedec L, Even G, Gaston AT, Deschildre C, Couvelard A, Ou P, Cheynier R, Nataf P, Dorent R, Nicoletti A. Thymic function is a major determinant of onset of antibody-mediated rejection in heart transplantation. Am J Transplant 2018; 18:964-971. [PMID: 29160947 DOI: 10.1111/ajt.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 01/25/2023]
Abstract
Thymic function decreases progressively with age but may be boosted in certain circumstances. We questioned whether heart transplantation was such a situation and whether thymic function was related to the onset of rejection. Twenty-eight antithymocyte globulin-treated heart transplant recipients were included. Patients diagnosed for an antibody-mediated rejection on endomyocardial biopsy had a higher proportion of circulating recent thymic emigrant CD4+ T cells and T cell receptor excision circle levels than other transplanted subjects. Thymus volume and density, assessed by computed tomography in a subset of patients, was also higher in patients experiencing antibody-mediated rejection. We demonstrate that thymic function is a major determinant of onset of antibody-mediated rejection and question whether thymectomy could be a prophylactic strategy to prevent alloimmune humoral responses.
Collapse
Affiliation(s)
- A Sannier
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | - G Even
- INSERM U1148, Paris, France
| | | | | | - A Couvelard
- Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Ou
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Cheynier
- INSERM U1016, Cochin Institute, Paris, France
| | - P Nataf
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Dorent
- INSERM U1148, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Nicoletti
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France
| |
Collapse
|
9
|
Kapoor V, Latif A, Warraich FH, Majeed A. First case of acute granulomatous interstitial nephritis with immune reconstitution inflammatory syndrome in a patient with HIV coinfected with disseminated Mycobacterium kansasii. BMJ Case Rep 2018; 2018:bcr-2017-222149. [PMID: 29477993 DOI: 10.1136/bcr-2017-222149] [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] [Indexed: 11/04/2022] Open
Abstract
Restoration of immune response by highly active antiretroviral therapy (HAART) effectively improved the overall prognosis of HIV infection. However, 25%-31.7% of patients experience paradoxical worsening of pre-existing infections or unmasking of subclinical infections after starting HAART therapy, which is termed as immune reconstitution inflammatory syndrome (IRIS). Acute granulomatous interstitial nephritis as a consequence of IRIS has never been reported with Mycobacteriumkansasiicoinfection. Here, we describe an HIV/AIDS patient coinfected with disseminated M. kansasii infection, who presented with acute kidney injury 4.5 months after initiation of HAART. The diagnostic workup revealed IRIS was the cause of acute kidney injury. Short-term course of prednisone (1 mg/kg/day) along with antimycobacterial and HAART regimen achieved significant improvement.
Collapse
Affiliation(s)
- Vikas Kapoor
- Department of Hematology and Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Azka Latif
- Department of Hematology and Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Faiza Hassan Warraich
- Department of Hematology and Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Aneela Majeed
- Department of Infectious Diseases, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
| |
Collapse
|
10
|
Ferrando-Martinez S, De Pablo-Bernal RS, De Luna-Romero M, De Ory SJ, Genebat M, Pacheco YM, Parras FJ, Montero M, Blanco JR, Gutierrez F, Santos J, Vidal F, Koup RA, Muñoz-Fernández MÁ, Leal M, Ruiz-Mateos E. Thymic Function Failure Is Associated With Human Immunodeficiency Virus Disease Progression. Clin Infect Dis 2018; 64:1191-1197. [PMID: 28158588 DOI: 10.1093/cid/cix095] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Thymic function has been mainly analyzed with surrogate peripheral markers affected by peripheral T-cell expansion, making it difficult to assess the role of thymic failure in human immunodeficiency virus (HIV) disease progression. The assay of signal-joint/DβJβ T-cell rearrangement excision circles (sj/β-TREC ratio) overcomes this limitation but has only been assayed in small cohorts. Thus, the aim of this study was to determine the role of thymic function, measured by the sj/β-TREC ratio, on CD4 T-cell maintenance in prospective HIV cohorts that include patients with a wide age range and different immunological phenotypes. Methods Seven hundred seventy-four patients including typical progressors, long-term nonprogressors (LTNPs), and vertically HIV-infected subjects were analyzed. Thymic function was quantified in peripheral blood samples using the sj/β-TREC ratio. Associations between thymic function and CD4 T-cell dynamics and combination antiretroviral therapy (cART) onset were analyzed using linear, logistic, and Cox proportional hazard models. Results Thymic function failure (sj/β-TREC ratio <10) was independently associated with HIV progression. In agreement, patients with distinctive high CD4 T-cell levels and low progression rates (vertically HIV-infected patients and LTNPs, including HIV controllers) had significantly higher thymic function levels whereas patients with thymic function failure had lower CD4 T-cell levels, lower nadir, and faster CD4 T-cell decay. Conclusions This work establishes the relevance of thymic function, measured by sj/β-TREC ratio, in HIV disease progression by analyzing a large number of patients in 3 cohorts with different HIV disease progression phenotypes. These results support and help to understand the mechanisms underlying the rationale of early cART onset.
Collapse
Affiliation(s)
- Sara Ferrando-Martinez
- Immunology Laboratory, Vaccine Research Center, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebeca S De Pablo-Bernal
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Spain
| | - Marta De Luna-Romero
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Spain
| | - Santiago J De Ory
- Molecular Immunobiology Laboratory, General University Hospital Gregorio Marañon, Health Research Institute Gregorio Marañon, Spanish HIV HGM BioBank, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
| | - Miguel Genebat
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Spain
| | - Yolanda M Pacheco
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Spain
| | - Francisco J Parras
- Infectious Disease Unit, General Universitary Hospital Gregorio Marañon, Madrid, Spain
| | - Marta Montero
- Infectious Disease Unit, Polytechnic and University Hospital La Fe, Valencia, Spain
| | - Jose Ramón Blanco
- Infectious Diseases Department, Hospital San Pedro, Center for Biomedical Research of La Rioja, Logrono, Spain
| | - Felix Gutierrez
- Hospital General de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Jesus Santos
- Infectious Diseases Unit, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga, Spain
| | - Francisco Vidal
- Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Spain
| | - Richard A Koup
- Immunology Laboratory, Vaccine Research Center, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - María Ángeles Muñoz-Fernández
- Molecular Immunobiology Laboratory, General University Hospital Gregorio Marañon, Health Research Institute Gregorio Marañon, Spanish HIV HGM BioBank, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
| | - Manuel Leal
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Spain
| | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Spain
| |
Collapse
|
11
|
Rosado-Sánchez I, Jarrín I, Pozo-Balado MM, de Pablo-Bernal RS, Herrero-Fernández I, Alvarez-Ríos AI, Rodríguez-Gallego E, Genebat M, Vera M, Berenguer J, Martín ML, Bernal E, Vidal F, Blanco J, Leal M, Pacheco YM. Higher levels of IL-6, CD4 turnover and Treg frequency are already present before cART in HIV-infected subjects with later low CD4 recovery. Antiviral Res 2017; 142:76-82. [PMID: 28343846 DOI: 10.1016/j.antiviral.2017.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
Immunological characterization of HIV-infected subjects with low CD4-recovery (LR-subjects) has been extensively performed after a variable period of combined antiretroviral therapy (cART). We now explore immunological alterations present before the cART onset. In a case-control study, we selected pre-cART samples of HIV-subjects with and without low CD4-recovery after cART (n = 21 per group). CD4 T-cell activation, senescence and exhaustion related markers were not found specifically altered before cART initiation. On the other hand, we found that LR-subjects before cART already showed increased levels of IL6 (p = 0.009) and increased frequencies of Ki67+CD4+ T-cells (p = 0.026), CD45RA-CD27+CD4+ T-cells (p = 0.008) and Treg (p = 0.001), as well as increased expression of CD95 and CD127 on CD4 T-cells (p = 0.016; p = 0.032, respectively). These parameters characterize the immunological damage in LR-subjects before the cART onset and could be associated to the mechanisms hindering the subsequent CD4 recovery.
Collapse
Affiliation(s)
- Isaac Rosado-Sánchez
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
| | | | - María M Pozo-Balado
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Rebeca S de Pablo-Bernal
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Inés Herrero-Fernández
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Ana I Alvarez-Ríos
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital IBiS/CSIC/SAS/University of Seville, Seville, Spain
| | - Esther Rodríguez-Gallego
- Infectious Diseases and HIV/AIDS Unit, Department of Internal Medicine, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Miguel Genebat
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Mar Vera
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Juan Berenguer
- Infectious Diseases and HIV Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María L Martín
- Infectious Diseases Service, Hospital Son Dureta, Palma de Mallorca, Spain
| | - Enrique Bernal
- Service of Internal Medicine, Hospital Reina Sofía, Murcia, Spain
| | - Francesc Vidal
- Infectious Diseases and HIV/AIDS Unit, Department of Internal Medicine, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Julià Blanco
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain
| | - Manuel Leal
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Yolanda M Pacheco
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
| |
Collapse
|
12
|
Rosado-Sánchez I, Herrero-Fernández I, Genebat M, Ruiz-Mateos E, Leal M, Pacheco YM. Thymic Function Impacts the Peripheral CD4/CD8 Ratio of HIV-Infected Subjects. Clin Infect Dis 2016; 64:152-158. [PMID: 27986677 DOI: 10.1093/cid/ciw711] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/18/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The persistence of an inverted CD4/CD8 ratio has been extensively associated with the increased morbimortality of chronic human immunodeficiency virus (HIV)-infected subjects. Thymic function is crucial for the maintenance of T cell homeostasis. We explored the impact of thymic function on the CD4/CD8 ratio of HIV-infected subjects. METHODS In a cohort of 53 antiretroviral-naive HIV-infected subjects, the measure of thymic volume, as a representative marker for thymic function, was available at baseline and at 12, 24, and 48 weeks post antiretroviral treatment. RESULTS Baseline thymic volume was associated with the CD4/CD8 ratio ( Ρ: = 0.413, P = .002), being this association highly dependent on the CD4 T cell levels. In subjects who achieved undetectable viral load after treatment (n = 33), a higher baseline thymic volume was associated with a higher increase in CD4 T cell counts and a decreasing trend in CD8 T cell counts during follow-up. Moreover, the baseline thymic volume was independently associated with the normalization of the CD4/CD8 ratio after 96 weeks of treatment (odds ratio, 95% confidence interval: 1.95 (1.07-3.55); P = .03). CONCLUSIONS Our data indicate the relevance of the remaining thymic function before the start of treatment to the CD4/CD8 ratio of HIV- infected subjects and, hence, potentially, in their clinical progression.
Collapse
Affiliation(s)
- I Rosado-Sánchez
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - I Herrero-Fernández
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - M Genebat
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - E Ruiz-Mateos
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - M Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - Yolanda M Pacheco
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| |
Collapse
|
13
|
Antiretroviral therapy suppressed participants with low CD4+ T-cell counts segregate according to opposite immunological phenotypes. AIDS 2016; 30:2275-87. [PMID: 27427875 PMCID: PMC5017266 DOI: 10.1097/qad.0000000000001205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text Background: The failure to increase CD4+ T-cell counts in some antiretroviral therapy suppressed participants (immunodiscordance) has been related to perturbed CD4+ T-cell homeostasis and impacts clinical evolution. Methods: We evaluated different definitions of immunodiscordance based on CD4+ T-cell counts (cutoff) or CD4+ T-cell increases from nadir value (ΔCD4) using supervised random forest classification of 74 immunological and clinical variables from 196 antiretroviral therapy suppressed individuals. Unsupervised clustering was performed using relevant variables identified in the supervised approach from 191 individuals. Results: Cutoff definition of CD4+ cell count 400 cells/μl performed better than any other definition in segregating immunoconcordant and immunodiscordant individuals (85% accuracy), using markers of activation, nadir and death of CD4+ T cells. Unsupervised clustering of relevant variables using this definition revealed large heterogeneity between immunodiscordant individuals and segregated participants into three distinct subgroups with distinct production, programmed cell-death protein-1 (PD-1) expression, activation and death of T cells. Surprisingly, a nonnegligible number of immunodiscordant participants (22%) showed high frequency of recent thymic emigrants and low CD4+ T-cell activation and death, very similar to immunoconcordant participants. Notably, human leukocyte antigen - antigen D related (HLA-DR) PD-1 and CD45RA expression in CD4+ T cells allowed reproducing subgroup segregation (81.4% accuracy). Despite sharp immunological differences, similar and persistently low CD4+ values were maintained in these participants over time. Conclusion: A cutoff value of CD4+ T-cell count 400 cells/μl classified better immunodiscordant and immunoconcordant individuals than any ΔCD4 classification. Immunodiscordance may present several, even opposite, immunological patterns that are identified by a simple immunological follow-up. Subgroup classification may help clinicians to delineate diverse approaches that may be needed to boost CD4+ T-cell recovery.
Collapse
|
14
|
Massanella M, Gómez-Mora E, Carrillo J, Curriu M, Ouchi D, Puig J, Negredo E, Cabrera C, Clotet B, Blanco J. Increased ex vivo cell death of central memory CD4 T cells in treated HIV infected individuals with unsatisfactory immune recovery. J Transl Med 2015; 13:230. [PMID: 26183947 PMCID: PMC4504072 DOI: 10.1186/s12967-015-0601-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background High levels of ex vivo CD4 T-cell death and the accumulation of highly differentiated and/or immunosenescent T cells have been associated with poor CD4 T-cell recovery in treated HIV-infected individuals. However, the relationship between cell death and T-cell differentiation is still unclear. Methods We have analyzed cell death, immunosenescence and differentiation parameters in HAART-treated subjects (VL <50 copies/mL for more than 2 years) with CD4 T-cell count <350 cells/μL (immunodiscordant, n = 23) or >400 cells/μL (immunoconcordant, n = 33). We included 11 healthy individuals as reference. Results As expected, suboptimal CD4 T-cell recovery was associated with low frequencies of naïve cells, high frequencies of transitional and effector memory cells and a subsequent low ratio of central/transitional memory cells in the CD4 compartment. These alterations correlated with spontaneous CD4 T-cell death. A deeper analysis of cell death in CD4 T-cell subsets showed increased cell death in memory cells of immunodiscordant individuals, mainly affecting central memory cells. Immunosenescence was also higher in immunodiscordant individuals albeit unrelated to cell death. The CD8 compartment was similar in both HIV-infected groups, except for an underrepresentation of naïve cells in immunodiscordant individuals. Conclusion Immunodiscordant individuals show alterations in memory CD4 T-cell differentiation associated with a short ex vivo lifespan of central memory cells and an in vivo low central/transitional memory cell ratio. These alterations may contribute to poor CD4 T-cell repopulation. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0601-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marta Massanella
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain. .,Department of Pathology, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Elisabet Gómez-Mora
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain.
| | - Jorge Carrillo
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain.
| | - Marta Curriu
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain.
| | - Dan Ouchi
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain.
| | - Jordi Puig
- Fundació Lluita contra la SIDA, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, 08916, Badalona, Spain.
| | - Eugènia Negredo
- Fundació Lluita contra la SIDA, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, 08916, Badalona, Spain. .,Universitat de Vic-Central de Catalunya, UVIC-UCC, 08500, Vic, Spain.
| | - Cecilia Cabrera
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain.
| | - Bonaventura Clotet
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain. .,Fundació Lluita contra la SIDA, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, 08916, Badalona, Spain. .,Universitat de Vic-Central de Catalunya, UVIC-UCC, 08500, Vic, Spain.
| | - Julià Blanco
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916, Badalona, Spain. .,Universitat de Vic-Central de Catalunya, UVIC-UCC, 08500, Vic, Spain.
| |
Collapse
|
15
|
Massanella M, Negredo E, Clotet B, Blanco J. Immunodiscordant responses to HAART--mechanisms and consequences. Expert Rev Clin Immunol 2014; 9:1135-49. [PMID: 24168417 DOI: 10.1586/1744666x.2013.842897] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A relevant fraction of HIV-1-infected individuals (ranging from 15 to 30%) presenting virologically successful highly active antiretroviral therapy fail to recover CD4 T-cell counts. These individuals, called immunodiscordant or immunological nonresponders, are at increased risk of clinical progression and death. Although older age, lower nadir CD4 T-cell count and HCV co-infection are some of clinical predictive factors, immunological mechanisms rely on impaired thymic production and accumulation of apoptosis-prone CD4 T cells. Indeed, immunodiscordant individuals may show increased tissue fibrosis and damage of gut-associated lymphoid tissue that results in higher hyperactivation, inflammation and immunosenescence, altered Treg/Th17 ratio and increased T-cell death. A better knowledge of the final pathogenic mechanism and factors influencing CD4 T-cell recovery will help to select the optimal therapeutic strategies for them.
Collapse
Affiliation(s)
- Marta Massanella
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | | | | | | |
Collapse
|
16
|
Leathers CA, Azar MM, Badve SS, Roth TD, Loehrer PJ, Nelson RP. Opportunistic infections in a patient with HIV and thymoma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 1:413-5. [PMID: 24565551 DOI: 10.1016/j.jaip.2013.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/05/2013] [Accepted: 03/28/2013] [Indexed: 12/24/2022]
Affiliation(s)
- Carrie A Leathers
- Department of Internal Medicine, Division of Hematology-Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Ind.
| | - Marwan M Azar
- Department of Internal Medicine, Division of Hematology-Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Ind
| | - Sunil S Badve
- Department of Internal Medicine, Division of Hematology-Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Ind
| | - Trenton D Roth
- Department of Internal Medicine, Division of Hematology-Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Ind
| | - Patrick J Loehrer
- Department of Internal Medicine, Division of Hematology-Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Ind
| | - Robert P Nelson
- Department of Internal Medicine, Division of Hematology-Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Ind
| |
Collapse
|
17
|
Genebat M, Pulido I, Romero-Sánchez MC, González-Serna A, Ferrando-Martínez S, Machmach K, Pacheco YM, Muñoz-Fernández MÁ, Ruiz-Mateos E, Leal M. Patients on a combined antiretroviral therapy after maraviroc clinical test show no immunovirological impairment. Antiviral Res 2012; 95:207-11. [DOI: 10.1016/j.antiviral.2012.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 06/19/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
|
18
|
HIV RNA suppression and immune restoration: can we do better? Clin Dev Immunol 2012; 2012:515962. [PMID: 22489250 PMCID: PMC3318265 DOI: 10.1155/2012/515962] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/02/2012] [Accepted: 01/15/2012] [Indexed: 11/23/2022]
Abstract
HAART has significantly changed the natural history of HIV infection: patients receiving antiretrovirals are usually able to control viremia, even though not all virological responders adequately recover their CD4+ count. The reasons for poor immune restoration are only partially known and they include genetic, demographic and immunologic factors. A crucial element affecting immune recovery is immune activation, related to residual viremia; indeed, a suboptimal virological control (i.e., low levels of plasma HIV RNA) has been related with higher levels of chronic inflammation and all-cause mortality. The sources of residual viremia are not yet completely known, even though the most important one is represented by latently infected cells. Several methods, including 2-LTR HIV DNA and unspliced HIV RNA measurement, have been developed to estimate residual viremia and predict the outcome of antiretroviral therapy. Considering that poor immunologic responders are exposed to a higher risk of both AIDS-related and non-AIDS-related diseases, there is a need of new therapeutic strategies, including immunomodulators and drugs targeting the latent viral reservoirs, in order to face residual viremia but also to “drive” the host immunologic responses.
Collapse
|
19
|
Rajasuriar R, Gouillou M, Spelman T, Read T, Hoy J, Law M, Cameron PU, Petoumenos K, Lewin SR. Clinical predictors of immune reconstitution following combination antiretroviral therapy in patients from the Australian HIV Observational Database. PLoS One 2011; 6:e20713. [PMID: 21674057 PMCID: PMC3107235 DOI: 10.1371/journal.pone.0020713] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 05/08/2011] [Indexed: 12/03/2022] Open
Abstract
Background A small but significant number of patients do not achieve CD4 T-cell counts >500cells/µl despite years of suppressive cART. These patients remain at risk of AIDS and non-AIDS defining illnesses. The aim of this study was to identify clinical factors associated with CD4 T-cell recovery following long-term cART. Methods Patients with the following inclusion criteria were selected from the Australian HIV Observational Database (AHOD): cART as their first regimen initiated at CD4 T-cell count <500cells/µl, HIV RNA<500copies/ml after 6 months of cART and sustained for at least 12 months. The Cox proportional hazards model was used to identify determinants associated with time to achieve CD4 T-cell counts >500cells/µl and >200cells/µl. Results 501 patients were eligible for inclusion from AHOD (n = 2853). The median (IQR) age and baseline CD4 T-cell counts were 39 (32–47) years and 236 (130–350) cells/µl, respectively. A major strength of this study is the long follow-up duration, median (IQR) = 6.5(3–10) years. Most patients (80%) achieved CD4 T-cell counts >500cells/µl, but in 8%, this took >5 years. Among the patients who failed to reach a CD4 T-cell count >500cells/µl, 16% received cART for >10 years. In a multivariate analysis, faster time to achieve a CD4 T-cell count >500cells/µl was associated with higher baseline CD4 T-cell counts (p<0.001), younger age (p = 0.019) and treatment initiation with a protease inhibitor (PI)-based regimen (vs. non-nucleoside reverse transcriptase inhibitor, NNRTI; p = 0.043). Factors associated with achieving CD4 T-cell counts >200cells/µl included higher baseline CD4 T-cell count (p<0.001), not having a prior AIDS-defining illness (p = 0.018) and higher baseline HIV RNA (p<0.001). Conclusion The time taken to achieve a CD4 T-cell count >500cells/µl despite long-term cART is prolonged in a subset of patients in AHOD. Starting cART early with a PI-based regimen (vs. NNRTI-based regimen) is associated with more rapid recovery of a CD4 T-cell count >500cells/µl.
Collapse
Affiliation(s)
- Reena Rajasuriar
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, University Malaya, Kuala Lumpur, Federal Territory, Malaysia
| | - Maelenn Gouillou
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Tim Spelman
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Tim Read
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Jennifer Hoy
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales, Australia
- Infectious Disease Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales, Australia
| | - Paul U. Cameron
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Infectious Disease Unit, The Alfred Hospital, Melbourne, Victoria, Australia
- Centre for Virology, Burnet Institute, Melbourne, Victoria, Australia
| | - Kathy Petoumenos
- National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales, Australia
| | - Sharon R. Lewin
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Infectious Disease Unit, The Alfred Hospital, Melbourne, Victoria, Australia
- Centre for Virology, Burnet Institute, Melbourne, Victoria, Australia
- * E-mail:
| |
Collapse
|
20
|
TROCAI (tropism coreceptor assay information): a new phenotypic tropism test and its correlation with Trofile enhanced sensitivity and genotypic approaches. J Clin Microbiol 2010; 48:4453-8. [PMID: 20943871 DOI: 10.1128/jcm.00953-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The only clinically validated assay available to determine HIV tropism is Trofile, an assay that possesses some limitations. Our first aim was to develop a new phenotypic tropism test (TROCAI [tropism coreceptor assay information]) and to categorize results generated by this test according to the virological response to a short-term exposure to the CCR5 receptor antagonist maraviroc (maraviroc clinical test). Our second aim was to compare TROCAI results to those obtained by Trofile enhanced sensitivity (ES) and to different genotypic algorithms. TROCAI assayed HIV tropism in 33 HIV-infected patient viral isolates obtained from a modified coculture, followed by multiple infection cycles of indicator cells. TROCAI obtained a reportable result in all patients with viral loads of >500 HIV RNA copies/ml and in 3/6 patients with <500 HIV RNA copies/ml (30/33 patients, 91.9%). Patients who responded to maraviroc had an X4-using virus proportion in indicator cell supernatant of 0 to 0.41%. Hence, we used the threshold of 0.5% to categorize TROCAI results as R5 (<0.5%) or dual/mixed (>0.5%). The concordance between TROCAI and Trofile (ES) was 22/24 (91.6%), and with genotypic approaches it was 22/26 (84.6%). TROCAI results, which were categorized in this study by the maraviroc clinical test, could be used as a test in addition to those currently used to select patients for treatment with CCR5 antagonists.
Collapse
|
21
|
Bandera A, Ferrario G, Saresella M, Marventano I, Soria A, Zanini F, Sabbatini F, Airoldi M, Marchetti G, Franzetti F, Trabattoni D, Clerici M, Gori A. CD4+ T cell depletion, immune activation and increased production of regulatory T cells in the thymus of HIV-infected individuals. PLoS One 2010; 5:e10788. [PMID: 20520721 PMCID: PMC2875388 DOI: 10.1371/journal.pone.0010788] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 04/19/2010] [Indexed: 01/06/2023] Open
Abstract
Mechanisms by which HIV affects the thymus are multiple and only partially known, and the role of thymic dysfunction in HIV/AIDS immunopathogenesis remains poorly understood. To evaluate the effects of HIV infection on intra-thymic precursors of T cells in HIV-infected adults, we conducted a detailed immunophenotypic study of thymic tissue isolated from 7 HIV-infected and 10 HIV-negative adults who were to undergo heart surgery. We found that thymuses of HIV-infected individuals were characterized by a relative depletion of CD4+ single positive T cells and a corresponding enrichment of CD8+ single positive T cells. In addition, thymocytes derived from HIV-infected subjects showed increased levels of activated and proliferating cells. Our analysis also revealed a decreased expression of interleukin-7 receptor in early thymocytes from HIV-infected individuals, along with an increase in this same expression in mature double- and single-positive cells. Frequency of regulatory T cells (CD25+FoxP3+) was significantly increased in HIV-infected thymuses, particularly in priorly-committed CD4 single positive cells. Our data suggest that HIV infection is associated with a complex set of changes in the immunophenotype of thymocytes, including a reduction of intrathymic CD4+ T cell precursors, increased expression of activation markers, changes in the expression pattern of IL-7R and enrichment of T regulatory cells generation.
Collapse
Affiliation(s)
- Alessandra Bandera
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kolte L, Ryder LP, Albrecht-Beste E, Jensen FK, Nielsen SD. HIV-infected patients with a large thymus maintain higher CD4 counts in a 5-year follow-up study of patients treated with highly active antiretroviral therapy. Scand J Immunol 2009; 70:608-13. [PMID: 19906203 DOI: 10.1111/j.1365-3083.2009.02328.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CD4 recovery in HIV-infected patients treated with highly active antiretroviral therapy (HAART) is in part believed to be dependent on the degree of preserved thymic function. We investigated whether the thymus has a prolonged effect on CD4 recovery. Total and naïve CD4 counts as well as thymic output determined as the number of CD4 + cells containing T-cell receptor-rearrangement excision DNA circles were measured prospectively in 25 HIV-infected patients with known thymic size during 5 years of HAART. Patients with larger thymic size had at all time points of follow-up significantly higher CD4 counts than patients with minimal thymic size (P = 0.0036). The CD4 increase from time of initiation of HAART until 6 months of follow-up differed significantly between the two thymic groups (P = 0.045), but did not at later time points. Thymic output remained significantly higher in patients with larger thymic size at follow-up. However, no difference in the increase in thymic output was seen between thymic groups. In conclusion, the importance of the thymus to the rate of cellular restoration seems primarily to lie within the first two years of HAART. However, patients with larger thymic size are able to maintain higher CD4 counts even after 5 years of HAART.
Collapse
Affiliation(s)
- L Kolte
- Department of Infectious Diseases, 144, Copenhagen University Hospital, Hvidovre, 2650 Hvidovre, Denmark.
| | | | | | | | | |
Collapse
|
23
|
Genebat M, Ruiz-Mateos E, Leon JA, Gonzalez-Serna A, Pulido I, Rivas I, Ferrando-Martinez S, Sanchez B, Munoz-Fernandez MA, Leal M. Correlation between the Trofile(R) test and virological response to a short-term maraviroc exposure in HIV-infected patients. J Antimicrob Chemother 2009; 64:845-9. [DOI: 10.1093/jac/dkp293] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
24
|
Molina-Pinelo S, Vallejo A, Díaz L, Soriano-Sarabia N, Ferrando-Martínez S, Resino S, Muñoz-Fernández MA, Leal M. Premature immunosenescence in HIV-infected patients on highly active antiretroviral therapy with low-level CD4 T cell repopulation. J Antimicrob Chemother 2009; 64:579-88. [PMID: 19608579 DOI: 10.1093/jac/dkp248] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse the role of thymic function and its association with cellular immunosenescence markers in patients with low-level CD4 T cell repopulation, despite complete HIV RNA replication control on highly active antiretroviral therapy (HAART). METHODS Cellular immunosenescence markers comparing patients with CD4 T cell counts <or=250 cells/mm(3) for >or=48 weeks (n = 11) and patients with a CD4 T cell count >or=500 cells/mm(3) (n = 11) were investigated. Both groups were also compared with 11 healthy volunteers of similar age. Naive CD4 T cell counts, beta- and delta-T cell rearrangement excision circles, recent thymic emigrants, replicative senescence marker, cell activation, and rate of apoptosis were analysed. The Mann-Whitney U-test was used to compare parameters between both low-level and high-level CD4 T cell repopulation groups, and healthy volunteers. RESULTS Our results showed a lower thymic activity in patients with low-level CD4 T cell repopulation, leading to a decline in CD4 T cell production. On the other hand, a higher activation along with a higher replicative senescence of CD4 T cells contributed to a higher rate of apoptotic CD4 T cells in this group of patients. CONCLUSIONS We propose a model with several different related mechanisms involved in premature immune senescence in HIV-infected patients with low-level CD4 repopulation on HAART. The understanding of such different mechanisms could help find effective strategies to prevent immune decay.
Collapse
Affiliation(s)
- Sonia Molina-Pinelo
- Laboratory of Inmunovirology, Service of Infectious Diseases, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | | | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Nogueras M, Navarro G, Antón E, Sala M, Cervantes M, Amengual M, Segura F. Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more. BMC Infect Dis 2006; 6:159. [PMID: 17087819 PMCID: PMC1654166 DOI: 10.1186/1471-2334-6-159] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Accepted: 11/06/2006] [Indexed: 11/12/2022] Open
Abstract
Background Over the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIV-infected patients with regard to younger HIV-infected patients. Methods A prospective cohort study (1998–2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13–40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chi-squared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and Two-Way ANOVA from random factors. Results G1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001). Conclusion Older patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed.
Collapse
Affiliation(s)
- MaMercedes Nogueras
- Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Gemma Navarro
- Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Esperança Antón
- Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Montserrat Sala
- Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Manel Cervantes
- Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - MaJosé Amengual
- UDIAT Diagnosis Centre, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Ferran Segura
- Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
27
|
Resino S, Seoane E, Pérez A, Ruiz-Mateos E, Leal M, Muñoz-Fernández MÁ. Different profiles of immune reconstitution in children and adults with HIV-infection after highly active antiretroviral therapy. BMC Infect Dis 2006; 6:112. [PMID: 16839416 PMCID: PMC1534048 DOI: 10.1186/1471-2334-6-112] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 07/13/2006] [Indexed: 12/03/2022] Open
Abstract
Background Recent advances in characterizing the immune recovery of HIV-1-infected people have highlighted the importance of the thymus for peripheral T-cell diversity and function. The aim of this study was to investigate differences in immune reconstitution profiles after highly active antiretroviral therapy (HAART) between HIV-children and adults. Methods HIV patients were grouped according to their previous clinical and immunological status: 9 HIV-Reconstituting-adults (HIV-Rec-adults) and 10 HIV-Reconstituting-children (HIV-Rec-children) on HAART with viral load (VL) ≤400 copies/ml and CD4+ ≥500 cells/μL at least during 6 months before the study and CD4+ ≤300 cells/μL anytime before. Fifteen healthy-adults and 20 healthy-children (control subjects) were used to calculate Z-score values to unify value scales between children and adults to make them comparable. Results HIV-Rec-children had higher T-cell receptor excision circles (TREC) and lower interleukin (IL)-7 levels than HIV-Rec-adults (p < 0.05). When we analyzed Z-score values, HIV-Rec-children had higher TREC Z-score levels (p = 0.03) than HIV-Rec-adults but similar IL-7 Z-score levels. Regarding T-cell subsets, HIV-Rec-children had higher naïve CD4+ (CD4+CD45RA hi+CD27+), naïve CD8+ (CD8+CD45RA hi+CD27+), and memory CD8+ (CD8+CD45RO+) cells/μl than HIV-Rec-adults, but similar memory CD4+ (CD4+CD45RO+) counts. HIV-Rec-children had lower naïve CD8+ Z-score values than HIV-Rec-adults (p = 0.05). Conclusion Our data suggest that HIV-Rec-children had better thymic function than HIV-Rec-adults and this fact affects the peripheral T-cell subsets. Thus, T-cell recovery after HAART in HIV-Rec-adults could be the consequence of antigen-independent peripheral T-cell expansion while in HIV-Rec-children thymic output could play a predominant role in immune reconstitution.
Collapse
Affiliation(s)
- Salvador Resino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Elena Seoane
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Alicia Pérez
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Ezequiel Ruiz-Mateos
- Grupo de Estudio Hepatitis Vírica y SIDA, Hospital Universitario "Virgen del Rocío", Sevilla, Spain
| | - Manuel Leal
- Grupo de Estudio Hepatitis Vírica y SIDA, Hospital Universitario "Virgen del Rocío", Sevilla, Spain
| | - Maria Á Muñoz-Fernández
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| |
Collapse
|
28
|
Molina-Pinelo S, Vivancos J, De Felipe B, Soriano-Sarabia N, Valladares A, De la Rosa R, Vallejo A, Leal M. Thymic volume predicts CD4 T-cell decline in HIV-infected adults under prolonged treatment interruption. J Acquir Immune Defic Syndr 2006; 42:203-6. [PMID: 16760798 DOI: 10.1097/01.qai.0000219778.12551.c0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the predictive capacity of thymic volume in CD4 T-cell loss after treatment interruption in HIV-infected patients with high nadir CD4 count. METHODS Thirty-nine HIV-infected patients with CD4 counts greater than or equal to 500 cells/microL, nadir CD4 counts greater than or equal to 250 cells/microL, and plasma viral loads less than 50 copies/mL for at least the past 12 months began a treatment interruption program. The event of interest for this study was the decrease of CD4 count below 350 cells/microL. Kaplan-Meier curves were used for all time-to-event analyses, and log-rank tests were used for comparison between groups in the univariate analysis. All variables with statistical association with CD4 T-cell loss were analyzed using multivariate Cox proportional hazards regression models. RESULTS Twenty-three percent of the patients had a decrease in CD4 count to less than 350 cells/microL. In the univariate analysis, only thymic volume was statistically significant with this event (P = 0.02). Nadir CD4 count nearly reached statistical significance. However, age, sex, HCV coinfection, CD4 count, T-cell receptor excision circle-bearing cells, and early viral load rebound did not show statistical differences. Thymic volume and CD4 T-cell loss were independently associated using Cox proportional hazards regression model (P = 0.04; relative risk, 0.76; 95% confidence interval, 0.59-0.99). CONCLUSIONS In this study, we demonstrate for the first time that thymic volume predicts CD4 T-cell loss in patients with nadir CD4 count greater than or equal to 250 cells/muL under treatment interruption.
Collapse
Affiliation(s)
- Sonia Molina-Pinelo
- Viral Hepatitis and AIDS Unit, Service of Internal Medicine,Virgen del Rocío University Hospital, Seville, Spain
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Knysz B, Bolanowski M, Klimczak M, Gladysz A, Zwolinska K. Graves' Disease as an Immune Reconstitution Syndrome in an HIV-1–Positive Patient Commencing Effective Antiretroviral Therapy: Case Report and Literature Review. Viral Immunol 2006; 19:102-7. [PMID: 16553555 DOI: 10.1089/vim.2006.19.102] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Combination antiretroviral therapy (cART) reduces morbidity and mortality in human immunodeficiency virus (HIV) infection, but it may also alter the clinical course of subclinical opportunistic infections and can even induce autoimmune disease. These atypical presentations are known as immune restoration disease (IRD), immune reconstitution syndrome/immune recovery syndrome (IRS), or immune restoration inflammatory syndrome (IRIS). We report the case of a 27-year-old, HIV-1-positive woman who developed hyperthyroidism attributable to Graves' disease (GD) after commencing potent cART. At the initiation of cART, her CD4 T cell count was 15 cells/microL and plasma HIV RNA 35 000 copies/mL. Her commencement of cART resulted in complete viral suppression and subsequent improvement of the CD4 T-cell count. Three years later, the diagnosis of GD was established based on a typical clinical picture and the results of hormonal and immunological analyses. It coincided with a 58-fold rise of the CD4 T cells. Retrospective analysis of serum samples revealed normal thyroid function and lack of anti-thyroid peroxidase (anti-TPO), anti- thyroid-stimulating hormone receptor (anti-TSHR), and anti-thyroglobulin (anti-TG) autoantibodies at the beginning of cART. HLA class II gene examination did not reveal susceptibility for the GD development in this patient. We suggest that GD in our patient was an IRD, and advise this as a possible differential diagnosis in patients presenting with hyperthyroidism on cART. To provide further details relevant to this case, we also review the literature concerning IRD-GD.
Collapse
Affiliation(s)
- Brygida Knysz
- Department of Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland.
| | | | | | | | | |
Collapse
|
30
|
Fernandez S, Nolan RC, Price P, Krueger R, Wood C, Cameron D, Solomon A, Lewin SR, French MA. Thymic function in severely immunodeficient HIV type 1-infected patients receiving stable and effective antiretroviral therapy. AIDS Res Hum Retroviruses 2006; 22:163-70. [PMID: 16478398 DOI: 10.1089/aid.2006.22.163] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The role of the thymus in long-term immune reconstitution has not been addressed in HIV patients who were severely immunodeficient prior to successful treatment with combination antiretroviral therapy (ART). Adult HIV-1 patients (n = 78) with nadir CD4+ T cell counts <100 T cells/microl, at least 12 months on ART and 6 months of complete viral suppression (<50 HIV RNA copies/ml) were selected from a patient database. The cohort was divided according to current CD4+ T cell counts and patients from the lowest (n = 15) and highest (n = 12) tertiles were studied. Thymic volume was assessed by spiral computed tomography. Naive (CD45RA+CD62L+) and replicating (Ki67+) T cells were quantitated by flow cytometry, T cell receptor excision circles (TREC) were assessed by real-time PCR, and serum IL-7 and testosterone by immunoassay. Patients with low CD4+ T cell counts had smaller thymuses [0(0-5.3) vs. 3.5(0-15.6) cm(3), p = 0.04] and were more likely to have no detectable thymus. They had similar proportions of replicating cells, but fewer naive CD4+ and CD8+ T cells and less TREC in CD4+ and CD8+ T cells/ml of blood than patients with high CD4+ T cell counts. However, some patients with no detectable thymus had high numbers of naive and TREC-bearing T cells. Thus, the recovery of CD4+ T cells in severely immunodeficient HIV patients with a virological response to ART is probably limited by thymic function. However, the data are consistent with extrathymic T cell production contributing to the naive T cell pool in some patients.
Collapse
Affiliation(s)
- Sonia Fernandez
- School of Surgery and Pathology, University of Western Australia, Department of Clinical Immunology and Biochemical Genetics, Royal Perth Hospital, The University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Current models hold that CD4+ depletion occurs as a result of direct and indirect effects of HIV, which both kill peripheral CD4+ cells and prevent adequate regeneration. Although age-associated involution diminishes thymic reserve and HIV is clearly thymotoxic, clinical trials have nonetheless shown that large proportions of patients who sustain adequate control of viral replication with highly active antiretroviral therapy (HAART) will demonstrate some evidence for thymic-dependent immune reconstitution, which is associated with improved immune competence. Furthermore, patients with insufficient or absent immune reconstitution following HAART generally lack evidence for thymopoiesis. Current studies are focused on improving our understanding of the causes for thymic failure in HIV infection. Recent work has demonstrated that some HIV strains, especially those that are CXCR4 trophic, are more thymotoxic and may contribute to irreversible thymic damage in this population.
Collapse
Affiliation(s)
- Rohan Hazra
- Pediatric Oncology Branch, National Cancer Institute, Bldg. 10-CRC Rm. 1W-3940, 10 Center Drive, MSC 1104, Bethesda, MD 20892, USA
| | | |
Collapse
|
32
|
Buseyne F, Le Chenadec J, Burgard M, Bellal N, Mayaux MJ, Rouzioux C, Rivière Y, Blanche S. In HIV type 1-infected children cytotoxic T lymphocyte responses are associated with greater reduction of viremia under antiretroviral therapy. AIDS Res Hum Retroviruses 2005; 21:719-27. [PMID: 16131312 DOI: 10.1089/aid.2005.21.719] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The evolution of the HIV-specific CD8+ T cell response in patients receiving potent combination therapy has been well documented in adult patients. However, no study reported whether baseline HIV-specific CD8+ T cell response is linked to treatment outcome. The aims of this study were to investigate both the impact of baseline memory cytotoxic T lymphocytes (CTL) on treatment outcome and the effect of potent therapy on memory HIV-specific CTL in HIV-1-infected pediatric patients. The study group comprised 30 children who started a first-line combination treatment including at least three drugs from two different classes and were longitudinally followed during treatment. Their memory HIV-specific responses were measured at baseline and during treatment, as well as their plasma viremia and CD4+ levels. The intensity of memory Gag-specific CTL and the breadth of the CTL response at the beginning of treatment were significantly correlated with lower plasma viral load during treatment, independently of baseline plasma viral load, CD4+ counts, and age. Children with partially controlled viral replication had enhanced Gag-specific CTL compared to their baseline value. This improvement of antiviral responses during treatment was not observed when viral replication was either fully suppressed or uncontrolled. In conclusion, our results show that higher baseline HIV-specific CTL are linked to lower viremia under combination therapy. This result adds further support to the hypothesis that cooperation between the antiviral immune response and antiviral drugs could be helpful for therapeutic management of HIV-infected patients.
Collapse
Affiliation(s)
- Florence Buseyne
- Unité Postulante d'Immunopathologie Virale, URA CNRS 1930, Institut Pasteur, Bat. Lwoff, 75015 Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Kolber MA. Impact of immune plasticity on development of cellular memory responses to human immunodeficiency virus type 1. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2005; 11:1002-7. [PMID: 15539497 PMCID: PMC524776 DOI: 10.1128/cdli.11.6.1002-1007.2004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michael A Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101, USA.
| |
Collapse
|
34
|
Ho Tsong Fang R, Khatissian E, Monceaux V, Cumont MC, Beq S, Ameisen JC, Aubertin AM, Israël N, Estaquier J, Hurtrel B. Disease progression in macaques with low SIV replication levels: on the relevance of TREC counts. AIDS 2005; 19:663-73. [PMID: 15821392 DOI: 10.1097/01.aids.0000166089.93574.5a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND An attenuated immunodeficiency virus has been long considered innocuous. Nevertheless, converging data suggest that low levels of viral replication can still provoke AIDS. Pathogenesis of these attenuated infections is not understood. OBJECTIVES To determine the pathogenicity of a long-term attenuated infection and to delineate T-cell dynamics during such an infection. METHODS This is a cross-sectional study of 12 rhesus macaques infected with SIV Delta nef for 8 years. We evaluated apoptosis (annexin V), activation (HLA-DR, Ki67), and newly generated T cells (TCR excision circle: TREC). RESULTS Infection with SIV Delta nef induced pathological CD4 T-cell depletion after 8 years of infection. Virus replication and CD8 T-cell activation positively correlated with the rate of disease progression. The frequency of TREC within CD8+CD45RA+ cells increased in SIV Delta nef-infected animals compared to age-matched non-infected controls. Moreover, in the cohort of infected animals, TREC+CD45RA+CD4+ T-cell counts correlated strongly with non-progression to AIDS. The animal with the lowest rate of disease progression exhibited a 115-fold increase in TREC+CD45RA+CD4+ T-cell counts compared to age-matched non-infected controls. In contrast, the animal showing the fastest rate of progression to AIDS displayed 600-fold lower TREC+CD45RA+CD4+ T-cell counts compared to age-matched non-infected controls. CONCLUSIONS Our results suggest that the thymus plays a major role in the pathogenesis of an attenuated SIV infection and that a sustained thymic output could maintain CD4 T-cell homeostasis in the context of low viral loads.
Collapse
Affiliation(s)
- Raphaël Ho Tsong Fang
- Unité de Physiopathologie des Infections Lentivirales, Institut Pasteur, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Evidence-based medicine: the dilemma of transplantation in patients with HIV infection. Curr Opin Organ Transplant 2004. [DOI: 10.1097/01.mot.0000142726.14201.8a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|