1
|
Sebastiani G, Milic J, Tsochatzis EA, Marzolini C, Betel M, Bhagani S, Morse CG, Cinque F, Maurice JB, Ingiliz P, Price J, Lemoine M, Rockstroh JK, Guaraldi G. Letter to the Editor: People living with HIV and NAFLD-A population left behind in the global effort for liver fibrosis screening? Hepatology 2023; 78:E87-E88. [PMID: 37199181 DOI: 10.1097/hep.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Giada Sebastiani
- Division of Gastroenterology and Hepatology and Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College London, UK
| | - Catia Marzolini
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | | | | | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Felice Cinque
- Division of Gastroenterology and Hepatology and Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - James B Maurice
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College London, UK
| | - Patrick Ingiliz
- Department of Hepatology, APHP Henri-Mondor University Hospital, Creteil, France
| | - Jennifer Price
- Department of Medicine, University of California, San Francisco, California, USA
| | - Maud Lemoine
- Division of Digestive Disease, Department of Metabolism, Digestion and Reproduction, Liver Unit, St Mary's Hospital, Imperial College London, UK
| | | | | |
Collapse
|
2
|
Bloomfield GS, Hill CL, Chiswell K, Cooper L, Gray S, Longenecker CT, Louzao D, Marsolo K, Meissner EG, Morse CG, Muiruri C, Thomas KL, Velazquez EJ, Vicini J, Pettit AC, Sanders G, Okeke NL. Cardiology Encounters for Underrepresented Racial and Ethnic Groups with Human Immunodeficiency Virus and Borderline Cardiovascular Disease Risk. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01627-0. [PMID: 37160576 PMCID: PMC10632543 DOI: 10.1007/s40615-023-01627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Underrepresented racial and ethnic groups (UREGs) with HIV have a higher risk of cardiovascular disease (CVD) compared with the general population. Referral to a cardiovascular specialist improves CVD risk factor management in high-risk individuals. However, patient and provider factors impacting the likelihood of UREGs with HIV to have an encounter with a cardiologist are unknown. METHODS We evaluated a cohort of UREGs with HIV and borderline CVD risk (10-year risk ≥ 5% by the pooled cohort equations or ≥ 7.5% by Framingham risk score). Participants received HIV-related care from 2014-2020 at four academic medical centers in the United States (U.S.). Adjusted Cox proportional hazards regression was used to estimate the association of patient and provider characteristics with time to first ambulatory cardiology encounter. RESULTS A total of 2,039 people with HIV (PWH) and borderline CVD risk were identified. The median age was 45 years (IQR: 36-50); 52% were female; and 94% were Black. Of these participants, 283 (14%) had an ambulatory visit with a cardiologist (17% of women vs. 11% of men, p < .001). In fully adjusted models, older age, higher body mass index (BMI), atrial fibrillation, multimorbidity, urban residence, and no recent insurance were associated with a greater likelihood of an encounter with a cardiologist. CONCLUSION In UREGs with HIV and borderline CVD risk, the strongest determinants of a cardiology encounter were diagnosed CVD, insurance type, and urban residence. Future research is needed to determine the extent to which these encounters impact CVD care practices and outcomes in this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04025125.
Collapse
Affiliation(s)
- Gerald S Bloomfield
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA.
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA
| | - Linda Cooper
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Shamea Gray
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Chris T Longenecker
- Division of Cardiology and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Darcy Louzao
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA
| | - Keith Marsolo
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric G Meissner
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Caryn G Morse
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kevin L Thomas
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Joseph Vicini
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - April C Pettit
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Gretchen Sanders
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA
| | - Nwora Lance Okeke
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
3
|
Tanner AE, Palakshappa D, Morse CG, Mann-Jackson L, Alonzo J, Garcia M, Wright E, Dharod A, Isom S, Sucaldito AD, Aviles LR, Rhodes SD. Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure. Trials 2022; 23:998. [PMID: 36510319 PMCID: PMC9743787 DOI: 10.1186/s13063-022-06924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM). METHODS In Aim 1, we will recruit a longitudinal cohort of 1800 adult (≥18 years) PWH from our clinic-based population to determine the difference in the prevalence and incidence of cardiometabolic comorbidities between food-secure and food-insecure PWH. Food insecurity screening, indicators of cardiometabolic comorbidities, and other characteristics documented in the electronic health record (EHR) will be collected annually for up to 3 years from this cohort. In Aim 2, we will conduct a randomized controlled trial among a sample of food-insecure PWH who have prediabetes or T2DM to compare changes in insulin sensitivity over 6 months between participants in weCare/Secure and participants receiving usual care. In Aim 3, we will conduct semi-structured individual in-depth interviews to explore the effect of the intervention among intervention participants with varying insulin sensitivity outcomes. TRIAL STATUS Aim 1 (longitudinal cohort) recruitment began in May 2022 and is ongoing. Aim 2 (intervention) recruitment is planned for spring 2023 and is expected to be completed in spring 2024. Aim 3 (process evaluation) data collection will occur after sufficient completion of the 6-month assessment in Aim 2. Final results are anticipated in fall 2025. CONCLUSIONS This research seeks to advance our understanding of how food insecurity impacts the development of cardiometabolic comorbidities among PWH and how food insecurity interventions may alleviate relevant comorbidities. Given the growing interest among health systems in addressing food insecurity, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04943861 . Registered on June 29, 2021.
Collapse
Affiliation(s)
- Amanda E. Tanner
- grid.266860.c0000 0001 0671 255XDepartment of Public Health Education, University of North Carolina Greensboro, Coleman 437E, Greensboro, NC 27402 USA
| | - Deepak Palakshappa
- grid.241167.70000 0001 2185 3318Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Caryn G. Morse
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lilli Mann-Jackson
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jorge Alonzo
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Manuel Garcia
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Elena Wright
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ajay Dharod
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott Isom
- grid.241167.70000 0001 2185 3318Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ana D. Sucaldito
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lucero Refugio Aviles
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott D. Rhodes
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| |
Collapse
|
4
|
Bloomfield GS, Weir IR, Ribaudo HJ, Fitch KV, Fichtenbaum CJ, Moran LE, Bedimo R, de Filippi C, Morse CG, Piccini J, Zanni MV, LU MT, Hoffmann U, Grinspoon SK, Douglas PS. Prevalence and Correlates of Electrocardiographic Abnormalities in Adults With HIV: Insights From the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE). J Acquir Immune Defic Syndr 2022; 89:349-359. [PMID: 35147583 PMCID: PMC8837824 DOI: 10.1097/qai.0000000000002877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk of cardiovasvular disease (CVD) and sudden cardiac death. Previous work has suggested an association between HIV infection and electrocardiographic (ECG) abnormalities. There are limited data on the burden of ECG abnormalities among PWH in a multiracial, multiethnic globally representative population. SETTING One hundred twenty sites in the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE). METHODS ECG findings were grouped into clinically relevant categories using sex-specific thresholds when indicated. We used the Fisher exact tests to assess associations of demographic characteristics and ECG abnormalities. We used logistic regression model to assess associations between demographic and HIV management measures, with adjustment. RESULTS We analyzed data for 7720 PWH (99% of participants) (median age 50 years, 69% male participants). There were 3346 (43%) Black or African American, 2680 (35%) White, and 1139 (15%) Asian participants. Most of the participants (97%) had viral load that was <400 copies/mL or 400 copies/mL had approximately twice the odds of prolonged QTc compared with those that were undetectable (adjusted OR: 2.05, 95% CI: 1.22 to 3.45). CONCLUSIONS Prolonged QTc is common among male, Asian, and REPRIEVE participants with higher viral loads. These relationships warrant future investigation of linkages to ensuing CVD events among PWH.
Collapse
Affiliation(s)
| | - Isabelle R. Weir
- Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Laura E. Moran
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | | | | | | | - Jonathan Piccini
- Duke Clinical Research Institute, Duke University School of Medicine, Durham NC
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael T. LU
- Massachusetts General Hospital Cardiovascular Imaging Research Center and Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- Massachusetts General Hospital Cardiovascular Imaging Research Center and Harvard Medical School, Boston, MA
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham NC
| |
Collapse
|
5
|
Nelson AJ, O’Brien EC, Kaltenbach LA, Green JB, Lopes RD, Morse CG, Al-Khalidi HR, Aroda VR, Cavender MA, Gaynor T, Kirk JK, Lingvay I, Magwire ML, McGuire DK, Pak J, Pop-Busui R, Richardson CR, Senyucel C, Kelsey MD, Pagidipati NJ, Granger CB. Use of Lipid-, Blood Pressure-, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease. JAMA Netw Open 2022; 5:e2148030. [PMID: 35175345 PMCID: PMC8855234 DOI: 10.1001/jamanetworkopen.2021.48030] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Based on contemporary estimates in the US, evidence-based therapies for cardiovascular risk reduction are generally underused among patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE To determine the use of evidence-based cardiovascular preventive therapies in a broad US population with diabetes and ASCVD. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used health system-level aggregated data within the National Patient-Centered Clinical Research Network, including 12 health systems. Participants included patients with diabetes and established ASCVD (ie, coronary artery disease, cerebrovascular disease, and peripheral artery disease) between January 1 and December 31, 2018. Data were analyzed from September 2020 until January 2021. EXPOSURES One or more health care encounters in 2018. MAIN OUTCOMES AND MEASURES Patient characteristics by prescription of any of the following key evidence-based therapies: high-intensity statin, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) and sodium glucose cotransporter-2 inhibitors (SGLT2I) or glucagon-like peptide-1 receptor agonist (GLP-1RA). RESULTS The overall cohort included 324 706 patients, with a mean (SD) age of 68.1 (12.2) years and 144 169 (44.4%) women and 180 537 (55.6%) men. A total of 59 124 patients (18.2% ) were Black, and 41 470 patients (12.8%) were Latinx. Among 205 885 patients with specialized visit data from the prior year, 17 971 patients (8.7%) visited an endocrinologist, 54 330 patients (26.4%) visited a cardiologist, and 154 078 patients (74.8%) visited a primary care physician. Overall, 190 277 patients (58.6%) were prescribed a statin, but only 88 426 patients (26.8%) were prescribed a high-intensity statin; 147 762 patients (45.5%) were prescribed an ACEI or ARB, 12 724 patients (3.9%) were prescribed a GLP-1RA, and 8989 patients (2.8%) were prescribed an SGLT2I. Overall, 14 918 patients (4.6%) were prescribed all 3 classes of therapies, and 138 173 patients (42.6%) were prescribed none. Patients who were prescribed a high-intensity statin were more likely to be men (59.9% [95% CI, 59.6%-60.3%] of patients vs 55.6% [95% CI, 55.4%-55.8%] of patients), have coronary atherosclerotic disease (79.9% [95% CI, 79.7%-80.2%] of patients vs 73.0% [95% CI, 72.8%-73.3%] of patients) and more likely to have seen a cardiologist (40.0% [95% CI, 39.6%-40.4%] of patients vs 26.4% [95% CI, 26.2%-26.6%] of patients). CONCLUSIONS AND RELEVANCE In this large cohort of US patients with diabetes and ASCVD, fewer than 1 in 20 patients were prescribed all 3 evidence-based therapies, defined as a high-intensity statin, either an ACEI or ARB, and either an SGLT2I and/or a GLP-1RA. These findings suggest that multifaceted interventions are needed to overcome barriers to the implementation of evidence-based therapies and facilitate their optimal use.
Collapse
Affiliation(s)
- Adam J. Nelson
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | | | - Caryn G. Morse
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | | | - Tanya Gaynor
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
| | | | | | | | - Darren K. McGuire
- University of Texas Southwestern Medical Center, Dallas
- Parkland Health and Hospital System, Dallas, Texas
| | - Jonathan Pak
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
| | | | | | | | | | | | | |
Collapse
|
6
|
Kumar PN, Hernández-Sánchez J, Nagel S, Feng Y, Cai F, Rabin J, Morse CG, Nadig NR, Ashraf O, Gotur DB, McComsey GA, Gafoor K, Perin P, Thornton SC, Stubbings W, Lin CJF, Tsai L. Safety and Efficacy of Tocilizumab 4 or 8 mg/kg in Hospitalized Patients With Moderate to Severe Coronavirus Disease 2019 Pneumonia: A Randomized Clinical Trial. Open Forum Infect Dis 2022; 9:ofab608. [PMID: 35024375 PMCID: PMC8690270 DOI: 10.1093/ofid/ofab608] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tocilizumab, an interleukin 6 receptor (IL-6R) antagonist monoclonal antibody, has shown efficacy in patients with coronavirus disease 2019 (COVID-19) pneumonia, but the optimal dose is unknown. METHODS Patients hospitalized for moderate to severe COVID-19 pneumonia were randomized 1:1 to receive standard of care treatment and 1-2 doses of intravenous tocilizumab 4 mg/kg or 8 mg/kg (open-label). Primary pharmacokinetic and pharmacodynamic end points were serum concentrations of tocilizumab and soluble interleukin 6 receptor (sIL-6R), IL-6, ferritin, and C-reactive protein (CRP), from baseline to day 60. The secondary end point was safety. Key exploratory efficacy end points included clinical status, time to discharge, mortality rate, and incidence of mechanical ventilation. RESULTS Of 100 patients randomized, 49 received tocilizumab 4 mg/kg and 48 received 8 mg/kg. In pharmacokinetic and sIL-6R assessments, dose-dependent differences were seen in patients who received 1 or 2 doses of 4 or 8 mg/kg. Serum concentrations of IL-6, ferritin, and CRP and safety outcomes were comparable between groups. Through day 60, serious adverse events were reported in 30.6% and 25.0% of patients in the 4- and 8-mg/kg groups, respectively. Eight patients (16.3%) in the 4-mg/kg group and 6 (12.5%) in the 8-mg/kg group died. Exploratory time-to-event outcomes favored 8 mg/kg within the first 2 weeks. CONCLUSIONS In patients with moderate to severe COVID-19 pneumonia who received tocilizumab 4 or 8 mg/kg, pharmacokinetic and sIL-6R assessments showed expected dose-dependent effects; pharmacodynamic assessments and safety were comparable, with no new safety signals. Further study is required before a lower dose of tocilizumab can be recommended in patients with COVID-19 pneumonia. CLINICAL TRIALS REGISTRATION NCT04363736.
Collapse
Affiliation(s)
- Princy N Kumar
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | | | - Yuning Feng
- Genentech, Inc, South San Francisco, California, USA
| | - Fang Cai
- Genentech, Inc, South San Francisco, California, USA
| | - Joseph Rabin
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Caryn G Morse
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nandita R Nadig
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Obaid Ashraf
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Deepa B Gotur
- Weill Cornell Medical College and Houston Methodist Hospital, Houston, Texas, USA
| | - Grace A McComsey
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA
| | - Khalid Gafoor
- Jamaica Hospital Medical Center, Richmond Hill, New York, USA
| | | | - Sarah C Thornton
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | - Celia J F Lin
- Genentech, Inc, South San Francisco, California, USA
| | - Larry Tsai
- Genentech, Inc, South San Francisco, California, USA
| |
Collapse
|
7
|
Clemency BM, Varughese R, Gonzalez-Rojas Y, Morse CG, Phipatanakul W, Koster DJ, Blaiss MS. Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:42-49. [PMID: 34807241 PMCID: PMC8609464 DOI: 10.1001/jamainternmed.2021.6759] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
Importance Systemic corticosteroids are commonly used in treating severe COVID-19. However, the role of inhaled corticosteroids in the treatment of patients with mild to moderate disease is less clear. Objective To determine the efficacy of the inhaled steroid ciclesonide in reducing the time to alleviation of all COVID-19-related symptoms among nonhospitalized participants with symptomatic COVID-19 infection. Design, Setting, and Participants This phase 3, multicenter, double-blind, randomized clinical trial was conducted at 10 centers throughout the US and assessed the safety and efficacy of a ciclesonide metered-dose inhaler (MDI) for treating nonhospitalized participants with symptomatic COVID-19 infection who were screened from June 11, 2020, to November 3, 2020. Interventions Participants were randomly assigned to receive ciclesonide MDI, 160 μg per actuation, for a total of 2 actuations twice a day (total daily dose, 640 μg) or placebo for 30 days. Main Outcomes and Measures The primary end point was time to alleviation of all COVID-19-related symptoms (cough, dyspnea, chills, feeling feverish, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell) by day 30. Secondary end points included subsequent emergency department visits or hospital admissions for reasons attributable to COVID-19. Results A total of 413 participants were screened and 400 (96.9%) were enrolled and randomized (197 [49.3%] in the ciclesonide arm and 203 [50.7%] in the placebo arm; mean [SD] age, 43.3 [16.9] years; 221 [55.3%] female; 2 [0.5%] Asian, 47 [11.8%] Black or African American, 3 [0.8%] Native Hawaiian or other Pacific Islander, 345 [86.3%] White, and 1 multiracial individuals [0.3%]; 172 Hispanic or Latino individuals [43.0%]). The median time to alleviation of all COVID-19-related symptoms was 19.0 days (95% CI, 14.0-21.0) in the ciclesonide arm and 19.0 days (95% CI, 16.0-23.0) in the placebo arm. There was no difference in resolution of all symptoms by day 30 (odds ratio, 1.28; 95% CI, 0.84-1.97). Participants who were treated with ciclesonide had fewer subsequent emergency department visits or hospital admissions for reasons related to COVID-19 (odds ratio, 0.18; 95% CI, 0.04-0.85). No participants died during the study. Conclusions and Relevance The results of this randomized clinical trial demonstrated that ciclesonide did not achieve the primary efficacy end point of reduced time to alleviation of all COVID-19-related symptoms. Trial Registration ClinicalTrials.gov Identifier: NCT04377711.
Collapse
Affiliation(s)
- Brian M. Clemency
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Renoj Varughese
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | | | - Caryn G. Morse
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wanda Phipatanakul
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | |
Collapse
|
8
|
Mollan KR, Eron JJ, Krajewski TJ, Painter W, Duke ER, Morse CG, Goecker EA, Premkumar L, Wolfe CR, Szewczyk LJ, Alabanza PL, Loftis AJ, Degli-Angeli EJ, Brown AJ, Dragavon JA, Won JJ, Keys J, Hudgens MG, Fang L, Wohl DA, Cohen MS, Baric RS, Coombs RW, Sheahan TP, Fischer WA. Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Virus in Symptomatic Coronavirus Disease 2019 (COVID-19) Outpatients: Host, Disease, and Viral Correlates. Clin Infect Dis 2021; 75:e1028-e1036. [PMID: 35022711 PMCID: PMC9402664 DOI: 10.1093/cid/ciab968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectious virus isolation in outpatients with coronavirus disease 2019 (COVID-19) has been associated with viral RNA levels and symptom duration, little is known about the host, disease, and viral determinants of infectious virus detection. METHODS COVID-19 adult outpatients were enrolled within 7 days of symptom onset. Clinical symptoms were recorded via patient diary. Nasopharyngeal swabs were collected to quantitate SARS-CoV-2 RNA by reverse transcriptase polymerase chain reaction and for infectious virus isolation in Vero E6-cells. SARS-CoV-2 antibodies were measured in serum using a validated ELISA assay. RESULTS Among 204 participants with mild-to-moderate symptomatic COVID-19, the median nasopharyngeal viral RNA was 6.5 (interquartile range [IQR] 4.7-7.6 log10 copies/mL), and 26% had detectable SARS-CoV-2 antibodies (immunoglobulin (Ig)A, IgM, IgG, and/or total Ig) at baseline. Infectious virus was recovered in 7% of participants with SARS-CoV-2 antibodies compared to 58% of participants without antibodies (prevalence ratio [PR] = 0.12, 95% confidence interval [CI]: .04, .36; P = .00016). Infectious virus isolation was also associated with higher levels of viral RNA (mean RNA difference +2.6 log10, 95% CI: 2.2, 3.0; P < .0001) and fewer days since symptom onset (PR = 0.79, 95% CI: .71, .88 per day; P < .0001). CONCLUSIONS The presence of SARS-CoV-2 antibodies is strongly associated with clearance of infectious virus. Seropositivity and viral RNA levels are likely more reliable markers of infectious virus clearance than subjective measure of COVID-19 symptom duration. Virus-targeted treatment and prevention strategies should be administered as early as possible and ideally before seroconversion. CLINICAL TRIALS REGISTRATION NCT04405570.
Collapse
Affiliation(s)
- Katie R Mollan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Joseph J Eron
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Taylor J Krajewski
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | | | - Elizabeth R Duke
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Caryn G Morse
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin A Goecker
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Lakshmanane Premkumar
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | | | | | - Paul L Alabanza
- Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Amy James Loftis
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Emily J Degli-Angeli
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ariane J Brown
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Joan A Dragavon
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - John J Won
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Jessica Keys
- Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Michael G Hudgens
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Lei Fang
- Pharstat Inc., Raleigh, North Carolina, USA
| | - David A Wohl
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Myron S Cohen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ralph S Baric
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Robert W Coombs
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | | | - William A Fischer
- Correspondence: W. A. Fischer II: 130 Mason Farm Rd, CB#7020, Chapel Hill, NC 27599 ()
| |
Collapse
|
9
|
Mollan KR, Eron JJ, Krajewski TJ, Painter W, Duke ER, Morse CG, Goecker EA, Premkumar L, Wolfe CR, Szewczyk LJ, Alabanza PL, Loftis AJ, Degli-Angeli EJ, Brown AJ, Dragavon JA, Won JJ, Keys J, Hudgens MG, Fang L, Wohl DA, Cohen MS, Baric RS, Coombs RW, Sheahan TP, Fischer WA. Infectious SARS-CoV-2 Virus in Symptomatic COVID-19 Outpatients: Host, Disease, and Viral Correlates. medRxiv 2021:2021.05.28.21258011. [PMID: 34100024 PMCID: PMC8183023 DOI: 10.1101/2021.05.28.21258011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND While SARS-CoV-2 infectious virus isolation in outpatients with COVID-19 has been associated with viral RNA levels and symptom duration, little is known about the host, disease and viral determinants of infectious virus detection. METHODS COVID-19 adult outpatients were enrolled within 7 days of symptom onset. Clinical symptoms were recorded via patient diary. Nasopharyngeal swabs were collected to quantitate SARS-CoV-2 RNA by reverse transcriptase polymerase chain reaction and for infectious virus isolation in Vero E6-cells. SARS-CoV-2 antibodies were measured in serum using a validated ELISA assay. RESULTS Among 204 participants with mild-to-moderate symptomatic COVID19, the median nasopharyngeal viral RNA was 6.5 (IQR 4.7-7.6 log10 copies/mL), and 26% had detectable SARS-CoV-2 antibodies (IgA, IgM, IgG, and/or total Ig) at baseline. Infectious virus was recovered in 7% of participants with SARS-CoV-2 antibodies compared to 58% of participants without antibodies (probability ratio (PR)=0.12, 95% CI: 0.04, 0.36; p=0.00016). Infectious virus isolation was also associated with higher levels of viral RNA (mean RNA difference +2.6 log10, 95% CI: 2.2, 3.0; p<0.0001) and fewer days since symptom onset (PR=0.79, 95% CI: 0.71, 0.88 per day; p<0.0001). CONCLUSIONS The presence of SARS-CoV-2 antibodies is strongly associated with clearance of infectious virus isolation. Seropositivity and viral RNA levels are likely more reliable markers of infectious virus clearance than subjective measure of COVID-19 symptom duration. Virus-targeted treatment and prevention strategies should be administered as early as possible and ideally before seroconversion. CLINICALTRIALSGOV IDENTIFIER NCT04405570.
Collapse
Affiliation(s)
- Katie R Mollan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Joseph J Eron
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Taylor J Krajewski
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Wendy Painter
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Elizabeth R Duke
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Caryn G Morse
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Erin A Goecker
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Lakshmanane Premkumar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Cameron R Wolfe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Laura J Szewczyk
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Paul L Alabanza
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Amy James Loftis
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Emily J Degli-Angeli
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Ariane J Brown
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Joan A Dragavon
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - John J Won
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Jessica Keys
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Michael G Hudgens
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Lei Fang
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - David A Wohl
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Myron S Cohen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Ralph S Baric
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Robert W Coombs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Timothy P Sheahan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - William A Fischer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| |
Collapse
|
10
|
Maurice JB, Goldin R, Hall A, Price JC, Sebastiani G, Morse CG, Prat L, Perazzo H, Garvey L, Ingiliz P, Guaraldi G, Tsochatzis E, Lemoine M. Increased BMI and Type 2 diabetes are the main predictors of NAFLD and advanced fibrosis in liver biopsies of patients with HIV mono-infection. Clin Infect Dis 2020; 73:e2184-e2193. [PMID: 32877569 DOI: 10.1093/cid/ciaa1302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Liver disease is an important cause of morbidity and mortality in people living with HIV (PLWH), of which non-alcoholic fatty liver disease (NAFLD) is an increasingly recognised cause. There is limited data investigating NAFLD in HIV mono-infection and histologically defined disease. We aimed to identify who is at risk of fibrosis, NAFLD and NASH among PLWH, and explore the diagnostic accuracy of non-invasive markers of fibrosis. METHODS Retrospective cross-sectional international multicentre study including patients with HIV mono-infection, without chronic viral hepatitis or other known causes of chronic liver disease, who underwent liver biopsy for abnormal liver biochemistry and/or clinical suspicion of liver fibrosis. RESULTS One hundred and sixteen patients from 5 centres were included. Sixty-three (54%) had NAFLD, of whom 57 (92%) had NASH. Overall, 36 (31%) had advanced fibrosis (≥F3) and 3 (3%) cirrhosis. Of the 53 cases without NAFLD, 15 (28%) had advanced fibrosis. Collagen proportionate area (CPA) was similar between cases with and without NAFLD (3% vs 2%). Body mass index (BMI) was independently associated with NAFLD (aOR 1.2 95% CI 1.08-1.34), and type 2 diabetes was independently associated with advanced fibrosis (aOR 3.42 95% CI 1.00-11.71)). The area under the curve for advanced fibrosis was 0.65 and 0.66 for both NAFLD Fibrosis Score (NFS) and FIB-4. Cut-off values of -1.455 (NFS) and 1.3 (FIB-4) have negative predictive values of 0.80 and 0.82, respectively. CONCLUSION Advanced fibrosis is strongly associated with type 2 diabetes in PLWH. Serological markers require further optimisation.
Collapse
Affiliation(s)
- James B Maurice
- Department of Metabolism, Digestion and Reproduction, Section of Hepatology, St Mary's hospital, Imperial College London, UK.,Department of Hepatology, Royal Free Hospital NHS Trust, London, UK
| | - Robert Goldin
- Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Hall
- Department of Histopathology, Royal Free Hospital NHS Trust, London, UK
| | - Jennifer C Price
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, USA
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre (MUHC), Montreal, QC, Canada.,Division of Gastroenterology and Hepatology, MUHC, Montreal, QC, Canada
| | - Caryn G Morse
- Department of Infectious Disease, Wake Forest Baptist Medical Centre, Winston-Salem, USA
| | - Laura Prat
- Department of Hepatology, Royal Free Hospital NHS Trust, London, UK
| | - Hugo Perazzo
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Lucy Garvey
- Department of Infectious Disease, Imperial College Healthcare NHS Trust, London, UK
| | | | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy
| | - Emmanouil Tsochatzis
- Department of Hepatology, Royal Free Hospital NHS Trust, London, UK.,Institute for Liver and Digestive Health, University College London, UK
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Section of Hepatology, St Mary's hospital, Imperial College London, UK
| |
Collapse
|
11
|
Guaraldi G, Maurice JB, Marzolini C, Monteith K, Milic J, Tsochatzis E, Bhagani S, Morse CG, Price JC, Ingiliz P, Lemoine M, Sebastiani G. New Drugs for NASH and HIV Infection: Great Expectations for a Great Need. Hepatology 2020; 71:1831-1844. [PMID: 32052857 DOI: 10.1002/hep.31177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
In recent years, there has been an increasing number of clinical trials for the treatment of nonalcoholic steatohepatitis (NASH). People living with human immunodeficiency virus (PLWH) are commonly excluded from these studies, usually due to concerns over drug-drug interactions associated with antiretroviral therapy. The Steatohepatitis in HIV Emerging Research Network, a group of international experts in hepatology and infectious diseases, discusses our current understanding on the interaction between human immunodeficiency virus and NASH, and the issues related to the inclusion of PLWH in NASH clinical trials. Recent trials addressing NASH treatment in PLWH are discussed. The risk of drug-drug interactions between antiretroviral therapy and aramchol, cenicriviroc, elafibranor, obeticholic acid and resmetirom (MGL-3196), which are currently in phase 3 trials for the treatment of NASH, are reviewed. A model for trial design to include PLWH is proposed, strongly advocating for the scientific community to include this group as a subpopulation within studies.
Collapse
Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - James B Maurice
- Hepatology Unit, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Catia Marzolini
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Kenneth Monteith
- Coalition des Organismes Communautaires Québécois de Lutte Contre le Sida, Montréal, QC, Canada
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Emmanuel Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
| | - Sanjay Bhagani
- Royal Free London, NHS Foundation Trust, London, United Kingdom
| | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Jennifer C Price
- Department of Medicine, University of California, San Francisco, CA
| | - Patrick Ingiliz
- Center for Infectiology, Berlin, Germany.,Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Royal Victoria Hospital - Site Glen, Montréal, QC, Canada.,Division of Infectious Diseases, McGill University Health Center, Royal Victoria Hospital-Site Glen, Montréal, QC, Canada
| | | |
Collapse
|
12
|
Mann-Jackson L, Choi D, Sutfin EL, Song EY, Foley KL, Wilkin AM, Morse CG, Rojas NF, Oh TS, Rhodes SD. A Qualitative Systematic Review of Cigarette Smoking Cessation Interventions for Persons Living with HIV. J Cancer Educ 2019; 34:1045-1058. [PMID: 31037506 PMCID: PMC6819245 DOI: 10.1007/s13187-019-01525-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Persons living with HIV (PLWH) have disproportionately high rates of both cigarette smoking and tobacco-induced negative health outcomes. The goal of this qualitative systematic review was to identify gaps in the existing literature and future directions for smoking cessation support for PLWH. Three online databases were searched from their inception through December 31, 2017, using designated search terms. Peer-reviewed English-language articles that documented an intervention designed to increase smoking cessation among PLWH were reviewed. Data were abstracted using a standardized form to document study and intervention characteristics and results. Thirty-two articles, describing 28 unique intervention studies, met inclusion criteria. Interventions consisted primarily of combinations of counseling, pharmacotherapy, and the use of information and communications technology; few interventions were implemented at the clinic level. Thirteen interventions resulted in significant improvements in cessation-related outcomes. Information and communications technology and clinic-level interventions had the greatest potential for increasing smoking cessation among PLWH. Efficacious interventions designed for PLWH in the US South, and for groups of PLWH facing additional health disparities (e.g., communities of color and sexual and gender minorities), are needed. There is also a need for more rigorous research designs to test the efficacy of interventions designed to increase cessation-related outcomes among PLWH.
Collapse
Affiliation(s)
- Lilli Mann-Jackson
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - David Choi
- Stanford University, 401 Quarry Road, Palo Alto, CA, 94304, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Eunyoung Y Song
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kristie L Foley
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Aimee M Wilkin
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Nicole F Rojas
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Timothy S Oh
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Scott D Rhodes
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| |
Collapse
|
13
|
Migueles SA, Chairez C, Lin S, Gavil NV, Rosenthal DM, Pooran M, Natarajan V, Rupert A, Dewar R, Rehman T, Sherman BT, Adelsberger J, Leitman SF, Stroncek D, Morse CG, Connors M, Lane HC, Kovacs JA. Adoptive lymphocyte transfer to an HIV-infected progressor from an elite controller. JCI Insight 2019; 4:130664. [PMID: 31415245 DOI: 10.1172/jci.insight.130664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDHIV-infected patients with poor virologic control and multidrug-resistant virus have limited therapeutic options. The current study was undertaken to evaluate the safety, immunologic effects, and antiviral activity of peripheral lymphocytes transferred from an elite controller, whose immune system is able to control viral replication without antiretroviral medications, to an HLA-B*2705-matched progressor.METHODSApproximately 22 billion cells were collected from an elite controller by lymphapheresis and infused within 6 hours into a recipient with a preinfusion CD4+ T cell count of 10 cells/μL (1%) and HIV plasma viral load of 114,993 copies/mL.RESULTSDonor cells were cleared from the recipient's peripheral blood by day 8. A transient decrease in viral load to 58,421 (day 3) was followed by a rebound to 702,972 (day 6) before returning to baseline values by day 8. The decreased viral load was temporally associated with peak levels of donor T cells, including CD8+ T cells that had high levels of expression of Ki67, perforin, and granzyme B. Notably, recipient CD8+ T cells also showed increased expression of these markers, especially in HIV-specific tetramer-positive cells.CONCLUSIONThese results suggest that the adoptive transfer of lymphocytes from an HIV-infected elite controller to an HIV-infected patient with progressive disease may be able to perturb the immune system of the recipient in both positive and negative ways.TRIAL REGISTRATIONClinicalTrials.gov NCT00559416.FUNDINGIntramural Research Programs of the US NIH Clinical Center and the National Institute of Allergy and Infectious Diseases (NIAID); the National Cancer Institute.
Collapse
Affiliation(s)
- Stephen A Migueles
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Cheryl Chairez
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Siying Lin
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Noah V Gavil
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Danielle M Rosenthal
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Milad Pooran
- Critical Care Medicine Department, NIH Clinical Center, NIH, Bethesda, Maryland, USA
| | - Ven Natarajan
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Adam Rupert
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Robin Dewar
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Tauseef Rehman
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Brad T Sherman
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Joseph Adelsberger
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Susan F Leitman
- Department of Transfusion Medicine, NIH Clinical Center, NIH, Bethesda, Maryland, USA
| | - David Stroncek
- Department of Transfusion Medicine, NIH Clinical Center, NIH, Bethesda, Maryland, USA
| | - Caryn G Morse
- Critical Care Medicine Department, NIH Clinical Center, NIH, Bethesda, Maryland, USA
| | - Mark Connors
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - H Clifford Lane
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Joseph A Kovacs
- Critical Care Medicine Department, NIH Clinical Center, NIH, Bethesda, Maryland, USA
| |
Collapse
|
14
|
Chaudhury CS, Purdy JB, Liu CY, Morse CG, Stanley TL, Kleiner D, Hadigan C. Unanticipated increases in hepatic steatosis among human immunodeficiency virus patients receiving mineralocorticoid receptor antagonist eplerenone for non-alcoholic fatty liver disease. Liver Int 2018; 38:797-802. [PMID: 29509992 PMCID: PMC7939026 DOI: 10.1111/liv.13734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/24/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease is common in human immunodeficiency virus, but there are no approved therapies. The aim of this open-label proof-of-concept study was to determine the effect of the mineralocorticoid receptor antagonist eplerenone on hepatic fat in human immunodeficiency virus-infected patients with hepatic fat ≥5% by magnetic resonance spectroscopy. METHODS Five subjects received eplerenone (25 mg daily × 1 week followed by 50 mg daily × 23 weeks). Laboratory tests were done at each visit, and the primary endpoint, change in hepatic fat content, was determined by MRI spectroscopy at baseline and week 24. RESULTS The study was stopped early after observing unexpected significant increases in hepatic fat at week 24 (mean increase 13.0 ± 7.3%, P = .02). The increases in steatosis were accompanied by a tendency for transaminase values to decrease (alanine aminotransferase mean change -14 ± 16 IU/L, P = .14). There were no consistent changes in other metabolic parameters or blood pressure. Repeat assessment of hepatic steatosis 1-2 months after stopping study medication revealed improvements in steatosis towards baseline values. CONCLUSIONS The unexpected observation of increased hepatic steatosis with the administration of eplerenone led to early termination of the investigation. While limited because of the small number of participants and the open-label design, this study provides data to suggest that mineralocorticoid receptor antagonism with eplerenone may not be an effective approach to treat hepatic steatosis in human immunodeficiency virus or the general population. Additional research is needed to determine the pathophysiological mechanism behind these unanticipated observations.
Collapse
Affiliation(s)
- Chloe S. Chaudhury
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | | | | | | | | | | | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| |
Collapse
|
15
|
Chwiki S, Campos MM, McLaughlin ME, Kleiner DE, Kovacs JA, Morse CG, Abu-Asab MS. Adverse effects of antiretroviral therapy on liver hepatocytes and endothelium in HIV patients: An ultrastructural perspective. Ultrastruct Pathol 2017; 41:186-195. [PMID: 28277148 DOI: 10.1080/01913123.2017.1282066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Human immunodeficiency virus and antiretroviral therapy (ART) together can be far more detrimental to liver cells than either of the two unaided. However, ultrastructural aspects of the synergistic effects of HIV and ART have been understudied. In a patient cohort receiving ART, this study characterizes ultrastructurally sinusoidal degeneration, hepatocytic aberrations, mitochondrial dysfunction, accumulation of bulky lipid droplets (steatosis), and occlusion of sinusoidal lumina. Mitochondrial dysfunction causes the accumulation of acetyl-CoA which leads to insulin upregulation and resistance, lipid synthesis, and steatosis. Lipid droplets deposited in the sinusoids could be the source of the blood's lipid profile alterations in HIV patients on ART.
Collapse
Affiliation(s)
- Sarah Chwiki
- a Section of Histopathology , National Eye Institute, NIH , Bethesda , MD , USA
| | | | - Mary E McLaughlin
- b Laboratory of Immunoregulation , National Institute of Allergy and Infectious Diseases, NIH , Bethesda , MD , USA
| | - David E Kleiner
- c Laboratory of Pathology , National Cancer Institute, NIH , Bethesda , MD , USA
| | - Joseph A Kovacs
- d Critical Care Medicine Department, AIDS Section, Clinical Center, NIH , Bethesda , MD , USA
| | - Caryn G Morse
- d Critical Care Medicine Department, AIDS Section, Clinical Center, NIH , Bethesda , MD , USA
| | - Mones S Abu-Asab
- a Section of Histopathology , National Eye Institute, NIH , Bethesda , MD , USA
| |
Collapse
|
16
|
Meissner EG, McLaughlin M, Matthews L, Gharib AM, Wood BJ, Levy E, Sinkus R, Virtaneva K, Sturdevant D, Martens C, Porcella SF, Goodman ZD, Kanwar B, Myers R, Subramanian M, Hadigan C, Masur H, Kleiner DE, Heller T, Kottilil S, Kovacs JA, Morse CG. Simtuzumab treatment of advanced liver fibrosis in HIV and HCV-infected adults: results of a 6-month open-label safety trial. Liver Int 2016; 36:1783-1792. [PMID: 27232579 PMCID: PMC5116256 DOI: 10.1111/liv.13177] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/25/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic liver injury can result in fibrosis that may progress over years to end-stage liver disease. The most effective anti-fibrotic therapy is treatment of the underlying disease, however when not possible, interventions to reverse or slow fibrosis progression are needed. AIM The aim of this study was to study the safety and tolerability of simtuzumab, a monoclonal antibody directed against lysyl oxidase-like 2 (LOXL2) enzyme, in subjects with hepatitis C virus (HCV), human immunodeficiency virus (HIV), or HCV-HIV co-infection and advanced liver disease. METHODS Eighteen subjects with advanced liver fibrosis received simtuzumab 700 mg intravenously every 2 weeks for 22 weeks. Transjugular liver biopsies were performed during screening and at the end of treatment to measure hepatic venous pressure gradient (HVPG) and to stage fibrosis. RESULTS Treatment was well-tolerated with no discontinuations due to adverse events. No significant changes were seen in HVPG or liver biopsy fibrosis score after treatment. Exploratory transcriptional and protein profiling using paired pre- and post-treatment liver biopsy and serum samples suggested up-regulation of TGF-β3 and IL-10 pathways with treatment. CONCLUSION In this open-label, pilot clinical trial, simtuzumab treatment was well-tolerated in HCV- and HIV-infected subjects with advanced liver disease. Putative modulation of TGF-β3 and IL-10 pathways during simtuzumab treatment merits investigation in future trials.
Collapse
Affiliation(s)
- Eric G. Meissner
- National Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation, Bethesda, MD,Medical University of South Carolina, Division of Infectious Diseases, Department of Microbiology and Immunology, Charleston, SC,NIH Clinical Center, Critical Care Medicine Department, AIDS Section, Bethesda, MD
| | - Mary McLaughlin
- National Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation, Bethesda, MD
| | - Lindsay Matthews
- NIH Clinical Center, Critical Care Medicine Department, AIDS Section, Bethesda, MD
| | - Ahmed M. Gharib
- National Institute of Diabetes and Digestive and Kidney Diseases, Biomedical and Metabolic Imaging Branch, Bethesda, MD
| | | | - Elliot Levy
- NIH Clinical Center, Radiology and Imaging Sciences
| | - Ralph Sinkus
- Kings College, Biomedical Engineering, Imaging Sciences and Biomedical Engineering Division, London
| | - Kimmo Virtaneva
- National Institute of Allergy and Infectious Diseases, Genomics Unit, Research Technology Section, Rocky Mountain Laboratories, Hamilton, Montana
| | - Dan Sturdevant
- National Institute of Allergy and Infectious Diseases, Genomics Unit, Research Technology Section, Rocky Mountain Laboratories, Hamilton, Montana
| | - Craig Martens
- National Institute of Allergy and Infectious Diseases, Genomics Unit, Research Technology Section, Rocky Mountain Laboratories, Hamilton, Montana
| | - Stephen F. Porcella
- National Institute of Allergy and Infectious Diseases, Genomics Unit, Research Technology Section, Rocky Mountain Laboratories, Hamilton, Montana
| | | | | | | | | | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation, Bethesda, MD
| | - Henry Masur
- NIH Clinical Center, Critical Care Medicine Department, AIDS Section, Bethesda, MD
| | | | - Theo Heller
- National Institute of Diabetes and Digestive and Kidney Diseases, Liver Diseases Branch, Bethesda, MD
| | - Shyam Kottilil
- National Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation, Bethesda, MD
| | - Joseph A. Kovacs
- NIH Clinical Center, Critical Care Medicine Department, AIDS Section, Bethesda, MD
| | - Caryn G. Morse
- NIH Clinical Center, Critical Care Medicine Department, AIDS Section, Bethesda, MD
| |
Collapse
|
17
|
Morse CG, McLaughlin M, Matthews L, Proschan M, Thomas F, Gharib AM, Abu-Asab M, Orenstein A, Engle RE, Hu X, Lempicki R, Hadigan C, Kleiner DE, Heller T, Kovacs JA. Nonalcoholic Steatohepatitis and Hepatic Fibrosis in HIV-1-Monoinfected Adults With Elevated Aminotransferase Levels on Antiretroviral Therapy. Clin Infect Dis 2015; 60:1569-78. [PMID: 25681381 DOI: 10.1093/cid/civ101] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/13/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Persistent aminotransferase elevations are common in human immunodeficiency virus (HIV)-infected patients on antiretroviral therapy (ART), including those without hepatitis B or C coinfection, but their clinical significance is unknown. METHODS HIV-infected adults with aminotransferase levels elevated above the upper limit of normal for ≥6 months while receiving ART, and without chronic viral hepatitis or other known causes of chronic liver disease, underwent a detailed metabolic assessment and liver biopsy. RESULTS Sixty-two HIV-infected subjects completed the study. Forty (65%) had clinically significant liver pathology, including 34 (55%) with nonalcoholic steatohepatitis (NASH) and 11 (18%) with bridging fibrosis, 10 of whom also had NASH. Nonspecific abnormalities alone were seen in 22 (35%) subjects, including mild steatosis, mild to moderate inflammation, and evidence of drug adaptation. Insulin resistance, obesity, and the presence of either of 2 minor alleles in the PNPLA3 gene were significantly associated with increased risk of NASH and fibrosis. NASH and/or fibrosis were not associated with duration of HIV infection or ART, specific antiretroviral drugs, history of opportunistic infection, immune status, or duration of aminotransferase elevation. CONCLUSIONS HIV-infected adults with chronic aminotransferase elevations while receiving ART have a high rate of liver disease. Noninvasive testing can help identify liver disease in such patients, but liver biopsy is necessary to definitively identify those at risk for liver disease progression and complications. Longitudinal follow-up of this cohort will better characterize the natural history of aminotransferase elevations in this population and identify noninvasive biomarkers of liver disease progression.
Collapse
Affiliation(s)
- Caryn G Morse
- Critical Care Medicine Department, AIDS Section, National Institutes of Health (NIH) Clinical Center
| | | | - Lindsay Matthews
- Critical Care Medicine Department, AIDS Section, National Institutes of Health (NIH) Clinical Center
| | - Michael Proschan
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases (NIAID)
| | | | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
| | - Mones Abu-Asab
- Histology Core, National Eye Institute, Bethesda, Maryland
| | | | | | - Xiaojun Hu
- Leidos Biomedical Research, Inc, Frederick
| | | | | | | | - Theo Heller
- Liver Diseases Branch, NIDDK, Bethesda, Maryland
| | - Joseph A Kovacs
- Critical Care Medicine Department, AIDS Section, National Institutes of Health (NIH) Clinical Center
| |
Collapse
|
18
|
Burbelo PD, Ching KH, Morse CG, Alevizos I, Bayat A, Cohen JI, Ali MA, Kapoor A, Browne SK, Holland SM, Kovacs JA, Iadarola MJ. Altered antibody profiles against common infectious agents in chronic disease. PLoS One 2013; 8:e81635. [PMID: 24312567 PMCID: PMC3847058 DOI: 10.1371/journal.pone.0081635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/14/2013] [Indexed: 12/02/2022] Open
Abstract
Despite the important diagnostic value of evaluating antibody responses to individual human pathogens, antibody profiles against multiple infectious agents have not been used to explore health and disease mainly for technical reasons. We hypothesized that the interplay between infection and chronic disease might be revealed by profiling antibodies against multiple agents. Here, the levels of antibodies against a panel of 13 common infectious agents were evaluated with the quantitative Luciferase Immunoprecipitation Systems (LIPS) in patients from three disease cohorts including those with pathogenic anti-interferon-γ autoantibodies (IFN-γ AAB), HIV and Sjögren’s syndrome (SjS) to determine if their antibody profiles differed from control subjects. The IFN-γ AAB patients compared to controls demonstrated statistically higher levels of antibodies against VZV (p=0.0003), EBV (p=0.002), CMV (p=0.003), and C. albicans (p=0.03), but lower antibody levels against poliovirus (p=0.04). Comparison of HIV patients with blood donor controls revealed that the patients had higher levels of antibodies against CMV (p=0.0008), HSV-2 (p=0.0008), EBV (p=0.001), and C. albicans (p=0.01), but showed decreased levels of antibodies against coxsackievirus B4 (p=0.0008), poliovirus (p=0.0005), and HHV-6B (p=0.002). Lastly, SjS patients had higher levels of anti-EBV antibodies (p=0.03), but lower antibody levels against several enteroviruses including a newly identified picornavirus, HCoSV-A (p=0.004), coxsackievirus B4 (p=0.04), and poliovirus (p=0.02). For the IFN-γ AAB and HIV cohorts, principal component analysis revealed unique antibody clusters that showed the potential to discriminate patients from controls. The results suggest that antibody profiles against these and likely other common infectious agents may yield insight into the interplay between exposure to infectious agents, dysbiosis, adaptive immunity and disease activity.
Collapse
Affiliation(s)
- Peter D. Burbelo
- Clinical Dental Research Core, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, United States of America
- *
| | - Kathryn H. Ching
- Western Regional Research Center, U.S. Department of Agriculture, Albany, California, United States of America
| | - Caryn G. Morse
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ilias Alevizos
- Sjögren Syndrome Clinic, Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ahmad Bayat
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jeffrey I. Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mir A. Ali
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Amit Kapoor
- Center for Infection and Immunity, Columbia University, New York, New York, United States of America
| | - Sarah K. Browne
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Steven M. Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Joseph A. Kovacs
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michael J. Iadarola
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| |
Collapse
|
19
|
Caplan M, Trivedi A, McLaughlin M, Hebou A, Kleiner DE, Heller T, Morse CG. Primary Biliary Cirrhosis Overlapping with Autoimmune Hepatitis in an HIV-Infected Patient on Antiretroviral Therapy. ACTA ACUST UNITED AC 2013; 1:270-273. [PMID: 26807302 PMCID: PMC4723101 DOI: 10.5455/jihp.20130624104921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Liver disease in HIV-infected patients is complex and multifactorial. Drug toxicity and infections are common causes of elevations in liver-associated enzymes. Immune reconstitution and unmasking of autoimmune disease may also play a role, particularly in the era of effective combination antiretroviral therapy. In this case report, we describe the first reported biopsy-confirmed case of autoimmune hepatitis and primary biliary cirrhosis overlap syndrome presenting in an HIV-infected patient following initiation of antiretroviral therapy.
Collapse
Affiliation(s)
- Margaret Caplan
- Clinical Research Directorate/CMRP, SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Apurva Trivedi
- Liver Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Mary McLaughlin
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | | | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Caryn G Morse
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| |
Collapse
|
20
|
Oppenheimer AP, Koh C, McLaughlin M, Williamson JC, Norton TD, Laudadio J, Heller T, Kleiner DE, High KP, Morse CG. Vanishing bile duct syndrome in human immunodeficiency virus infected adults: A report of two cases. World J Gastroenterol 2013; 19:115-21. [PMID: 23326172 PMCID: PMC3542762 DOI: 10.3748/wjg.v19.i1.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/02/2012] [Accepted: 08/03/2012] [Indexed: 02/06/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) is a group of rare disorders characterized by ductopenia, the progressive destruction and disappearance of intrahepatic bile ducts leading to cholestasis. Described in association with medications, autoimmune disorders, cancer, transplantation, and infections, the specific mechanisms of disease are not known. To date, only 4 cases of VBDS have been reported in human immunodeficiency virus (HIV) infected patients. We report 2 additional cases of HIV-associated VBDS and review the features common to the HIV-associated cases. Presentation includes hyperbilirubinemia, normal liver imaging, and negative viral and autoimmune hepatitis studies. In HIV-infected subjects, VBDS occurred at a range of CD4+ T-cell counts, in some cases following initiation or change in antiretroviral therapy. Lymphoma was associated with two cases; nevirapine, antibiotics, and viral co-infection were suggested as etiologies in the other cases. In HIV-positive patients with progressive cholestasis, early identification of VBDS and referral for transplantation may improve outcomes.
Collapse
|
21
|
Pau AK, Penzak SR, Boyd SD, McLaughlin M, Morse CG. Impaired maraviroc and raltegravir clearance in a human immunodeficiency virus-infected patient with end-stage liver disease and renal impairment: a management dilemma. Pharmacotherapy 2012; 32:e1-6. [PMID: 22392831 DOI: 10.1002/phar.1003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Current product labels for maraviroc and raltegravir provide no dosing guidance for patients with end-stage liver disease and worsening renal function. We describe a 41-year-old man with human immunodeficiency virus (HIV) infection and rapidly progressive liver failure and vanishing bile duct syndrome at presentation. Despite discontinuation of all potential offending drugs, the patient's liver function continued to deteriorate. To achieve and maintain HIV suppression while awaiting liver transplantation, a regimen consisting of maraviroc, raltegravir, and enfuvirtide was started. These agents were chosen because the patient was not exposed to them before the onset of liver failure. While receiving product label-recommended twice-daily dosing of these drugs, he achieved and maintained HIV suppression. During a complicated and prolonged hospitalization, the patient also developed renal dysfunction. As hepatic metabolism is the primary route of clearance of maraviroc and raltegravir, we predicted that using approved doses of these drugs could result in significant drug accumulation. Since the safety profiles of supratherapeutic concentrations of these agents are not well defined, we chose to use therapeutic drug monitoring to guide further dosing. The reported concentrations showed severely impaired metabolic clearance of both drugs, with markedly prolonged elimination half-lives of 189 hours for maraviroc and 61 hours for raltegravir. Previously reported half-lives for maraviroc and raltegravir in HIV-infected patients with normal hepatic and renal function are 14-18 hours and 9-12 hours, respectively. Based on these results, the dosing intervals were extended from twice/day to twice/week for maraviroc and every 48 hours for raltegravir. Unfortunately, the patient's clinical condition continued to deteriorate, and he eventually died of complications related to end-stage liver disease. This case illustrates the difficulties in managing antiretroviral therapy in an HIV-infected patient with combined severe liver and renal failure. Prolonged excessively high exposure to maraviroc and raltegravir is likely to result in some level of concentration-dependent toxicity. Until more data are available, therapeutic drug monitoring remains the only evidence-based approach to optimize dosage selection of these drugs in this patient population.
Collapse
Affiliation(s)
- Alice K Pau
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | | | | | |
Collapse
|
22
|
Morse CG, Voss JG, Rakocevic G, McLaughlin M, Vinton CL, Huber C, Hu X, Yang J, Huang DW, Logun C, Danner RL, Rangel ZG, Munson PJ, Orenstein JM, Rushing EJ, Lempicki RA, Dalakas MC, Kovacs JA. HIV infection and antiretroviral therapy have divergent effects on mitochondria in adipose tissue. J Infect Dis 2012; 205:1778-87. [PMID: 22476717 DOI: 10.1093/infdis/jis101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) affect mitochondrial DNA (mtDNA) content and function, comprehensive evaluations of their effects on mitochondria in muscle, adipose tissue, and blood cells are limited. METHODS Mitochondrial DNA quantification, mitochondrial genome sequencing, and gene expression analysis were performed on muscle, adipose tissue, and peripheral blood mononuclear cell (PBMC) samples from untreated HIV-positive patients, HIV-positive patients receiving nucleoside reverse transcriptase inhibitor (NRTI)-based ART, and HIV-negative controls. RESULTS The adipose tissue mtDNA/nuclear DNA (nDNA) ratio was increased in untreated HIV-infected patients (ratio, 353) and decreased in those receiving ART (ratio, 162) compared with controls (ratio, 255; P < .05 for both comparisons); the difference between the 2 HIV-infected groups was also significant (P = .002). In HIV-infected participants, mtDNA/nDNA in adipose tissue correlated with the level of activation (CD38+ /HLA-DR+) for CD4+ and CD8+ lymphocytes. No significant differences in mtDNA content were noted in muscle or PMBCs among groups. Exploratory DNA microarray analysis identified differential gene expression between patient groups, including a subset of adipose tissue genes. CONCLUSIONS HIV infection and ART have opposing effects on mtDNA content in adipose tissue; immune activation may mediate the effects of HIV, whereas NRTIs likely mediate the effects of ART.
Collapse
Affiliation(s)
- Caryn G Morse
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1403, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Morse CG, Kovacs JA. Does atovaquone provide effective prophylaxis for Pneumocystis pneumonia in children with leukemia? Nat Clin Pract Oncol 2007; 4:566-7. [PMID: 17700556 DOI: 10.1038/ncponc0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 07/06/2007] [Indexed: 05/16/2023]
|
25
|
Morse CG, Mican JM, Jones EC, Joe GO, Rick ME, Formentini E, Kovacs JA. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis 2007; 44:739-48. [PMID: 17278070 DOI: 10.1086/511683] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 11/13/2006] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Osteonecrosis is increasingly recognized as a debilitating complication of human immunodeficiency virus (HIV) infection, but the natural history has not been well described. We previously documented a high prevalence (4.4%) of magnetic resonance imaging (MRI)-documented osteonecrosis of the hip in a cohort of 339 asymptomatic HIV-infected patients. The present study was designed to determine the incidence of newly diagnosed osteonecrosis in this cohort and to describe the natural history of osteonecrosis in HIV-infected patients. METHODS Asymptomatic HIV-infected patients with a previous hip MRI negative for osteonecrosis underwent follow-up MRI. Patients with asymptomatic or symptomatic osteonecrosis were enrolled in a natural history study, which included serial MRIs and a physiotherapy follow-up. RESULTS Two hundred thirty-nine patients underwent a second MRI a median of 23 months after the initial MRI. Osteonecrosis of the femoral head was diagnosed in 3 patients (incidence, 0.65 cases per 100 person-years). During the period of January 1999 through April 2006, symptomatic hip osteonecrosis developed in 13 clinic patients (incidence, 0.26 cases per 100 person-years). Among 22 patients enrolled with symptomatic hip osteonecrosis, 18 had bilateral involvement of the femoral heads, and 7 had osteonecrosis involving other bones. Two (11%) of 18 asymptomatic patients and 13 (59%) of 22 symptomatic patients underwent total hip replacement. The percentage of involvement of the weight-bearing surface of the femoral head and the rate of progression to total hip replacement was significantly greater (P<.001) in symptomatic patients than in asymptomatic patients. CONCLUSIONS HIV-infected patients are at approximately 100-fold greater risk of developing osteonecrosis than the general population. Disease progression is slower in asymptomatic patients than in symptomatic patients. Given the high frequency of total hip replacement in symptomatic patients, studies to assess preventive and treatment strategies are essential.
Collapse
Affiliation(s)
- Caryn G Morse
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland 20892-1662, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Over the past 10 years, in conjunction with the broad availability of potent antiretroviral regimens, the care of human immunodeficiency virus (HIV)-infected patients has shifted from prevention and treatment of opportunistic infections and malignancies to management of the metabolic and related complications associated with HIV infection and its treatment. Metabolic disorders, including lipodystrophy, dyslipidemia, and insulin resistance, occur at a high rate in HIV-infected individuals receiving highly active antiretroviral therapy (HAART). These disorders are associated with increased risk of cardiovascular disease and have become an important cause of morbidity and mortality in HIV-infected patients. Herein, we present the case of a patient with HIV infection who responded well to HAART but developed multiple complications potentially related to this therapy. This article reviews the clinical characteristics of the metabolic and skeletal disturbances observed in HIV infection and discusses strategies for their management.
Collapse
Affiliation(s)
- Caryn G Morse
- National Institute of Allergy and Infectious Diseases-Clinical Center HIV/AIDS Program, Critical Care Medicine Department, NIH Clinical Center, Bethesda, Md, USA
| | | |
Collapse
|
27
|
Crater DD, Heise S, Perzanowski M, Herbert R, Morse CG, Hulsey TC, Platts-Mills T. Asthma hospitalization trends in Charleston, South Carolina, 1956 to 1997: twenty-fold increase among black children during a 30-year period. Pediatrics 2001; 108:E97. [PMID: 11731624 DOI: 10.1542/peds.108.6.e97] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The increase in asthma prevalence has been documented worldwide, affecting many races living in many different climates. Multiple studies have demonstrated that the most striking prevalence and morbidity of asthma in the United States has been in black children, but little research has determined the scale of the increase, or specifically when the disease became severe in this group. This study sought to determine exactly when the rise in asthma hospitalizations among black patients began and what the pattern of asthma hospitalizations has been in different races and age groups over a 40-year period in 1 urban area. METHODS A retrospective chart review of discharges from the Medical University of South Carolina was conducted from 1956 to 1997. Charts with the primary discharge diagnosis of asthma were examined for discharge date, race, and age group (0- to 4-year-olds, 5- to 18-year-olds, 19- to 50-year-olds, > or =51-year-olds). The diagnostic codes used were based on the International Classification of Diseases (ICD)-6, 1956-1957; ICD-7, 1958-1967; ICD-8, 1968-1978; and ICD-9, 1979-1997. Over the period studied, this hospital was the primary inpatient provider for children in this area, and the only provider for uninsured children. Between 1960 and 1990, the racial makeup of the area remained stable, as did the percentage of blacks living at the poverty level. The raw number of asthma discharges, rate per 10 000 discharges of the same race, and rate per 100 000 population in Charleston County were tabulated for each age group and racial category. RESULTS Over the time period examined, there has been a progressive increase in asthma hospitalizations in black individuals of all age groups and in whites under 18 years. The most striking increase has been in black children 0 to 18 years old (figure). The increase either as raw values or as a rate per 100 000 began around 1970, and was linear. This increase in black children discharged with asthma as a rate per 100 000 population was 20-fold: the rate increased from 18 in 1970 to 370 in 1997. Asthma discharges as a rate per 10 000 black children discharged increased by 24-fold from 1960 to 1997. Total discharges from the hospital increased from 49 000 to 128 000 per year over this period. Blacks made up only 28% of discharges in 1957, but that proportion increased to 56% in 1960 and remained relatively stable over the following 35 years. The increase seen in white children 0 to 18 years of age as a rate per 100 000 population was 5-fold and began around 1980. Both increases seem to be consistent over the time period studied, and continued to 1997. [figure: see text]. CONCLUSIONS Among a predominantly poor black population living in a southern US city, there has been a steady increase in childhood asthma hospitalizations over the past 30 years. A significant although less dramatic rise has occurred in white children. Over this time period, although there have been many changes in lifestyle that could have contributed to this rise, there have been no major changes in housing conditions for poor patients. In addition, Medicaid coverage for children in South Carolina did not change significantly until 1999. The time course of these increases parallels increases reported in other Western populations, suggesting that there must be 1 or more common factors contributing to the rise. Many explanations have been offered for the changes in incidence and severity of asthma. The scale of the change, time course, and linearity of the increase in this study represent a challenge to many of the hypotheses proposed to explain this epidemic.
Collapse
Affiliation(s)
- D D Crater
- Department of Pediatrics, Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | | | | | | | | |
Collapse
|