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De Clercq J, De Scheerder MA, Mortier V, Verhofstede C, Vandecasteele SJ, Allard SD, Necsoi C, De Wit S, Gerlo S, Vandekerckhove L. Longitudinal patterns of inflammatory mediators after acute HIV infection correlate to intact and total reservoir. Front Immunol 2024; 14:1337316. [PMID: 38250083 PMCID: PMC10796502 DOI: 10.3389/fimmu.2023.1337316] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background Despite the beneficial effects of antiretroviral therapy (ART) initiation during acute HIV infection (AHI), residual immune activation remains a hallmark of treated HIV infection. Methods Plasma concentrations of 40 mediators were measured longitudinally in 39 early treated participants of a Belgian AHI cohort (HIV+) and in 21 HIV-negative controls (HIV-). We investigated the association of the inflammatory profile with clinical presentation, plasma viral load, immunological parameters, and in-depth characterization of the HIV reservoir. Results While levels of most soluble mediators normalized with suppressive ART, we demonstrated the persistence of a pro-inflammatory signature in early treated HIV+ participants in comparison to HIV- controls. Examination of these mediators demonstrated a correlation with their levels during AHI, which seemed to be viremia-driven, and suggested involvement of an activated myeloid compartment, IFN-γ-signaling, and inflammasome-related pathways. Interestingly, some of these pro-inflammatory mediators correlated with a larger reservoir size and slower reservoir decay. In contrast, we also identified soluble mediators which were associated with favorable effects on immunovirological outcomes and reservoir, both during and after AHI. Conclusion These data highlight how the persistent pro-inflammatory profile observed in early ART treated individuals is shaped during AHI and is intertwined with viral dynamics.
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Affiliation(s)
- Jozefien De Clercq
- HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Virginie Mortier
- Department of Diagnostic Sciences, Aids Reference Laboratory, Ghent University, Ghent, Belgium
| | - Chris Verhofstede
- Department of Diagnostic Sciences, Aids Reference Laboratory, Ghent University, Ghent, Belgium
| | | | - Sabine D Allard
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Coca Necsoi
- Department of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Gerlo
- HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Linos Vandekerckhove
- HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Taton M, Willems F, Widomski C, Martin C, Jiang Y, Renard K, Cogan A, Necsoi C, Ackerman ME, Marchant A, Dauby N. Impact of pregnancy on polyfunctional IgG and memory B cell responses to Tdap immunization. Vaccine 2023; 41:4009-4018. [PMID: 37244810 DOI: 10.1016/j.vaccine.2023.05.035] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/21/2023] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Maternal pertussis immunization using Tdap vaccine is recommended in many countries to protect newborns from severe post-natal infection. Immunological changes during pregnancy may influence the response to vaccines. The quality of IgG and memory B cell responses to Tdap immunization in pregnant women has not yet been described. METHODS The impact of pregnancy on the response to Tdap vaccination was assessed by comparing humoral immune responses in 42 pregnant and 39 non-pregnant women. The levels of serum pertussis antigens and tetanus toxoid-specific IgG, IgG subclasses, IgG Fc-mediated effector functions, as well as memory B cell frequencies were assessed before and at several time points after vaccination. RESULTS Tdap immunization induced similar levels of pertussis and tetanus-specific IgG and IgG subclasses in pregnant and non-pregnant women. Pregnant women produced IgG promoting complement deposition, and neutrophils and macrophages phagocytosis at levels comparable to non-pregnant women. They were also able to expand pertussis and tetanus-specific memory B cells at similar frequencies as non-pregnant women, suggesting equivalent "boostability". Higher levels of vaccine-specific IgG, IgG subclasses, and IgG Fc-mediated effector functions were detected in cord blood as compared to maternal blood, indicating efficient transport across the placenta. CONCLUSIONS This study demonstrates that pregnancy does not affect the quality of effector IgG and memory B cell responses to Tdap immunization and that polyfunctional IgG are efficiently transferred across the placenta. REGISTRY'S URL AND THE TRIAL'S REGISTRATION NUMBER ClinicalTrials.Gov (NCT03519373).
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Affiliation(s)
- Martin Taton
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université libre de Bruxelles (ULB), Lennik Rd. 808, Anderlecht 1070, Brussels, Belgium.
| | - Fabienne Willems
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université libre de Bruxelles (ULB), Lennik Rd. 808, Anderlecht 1070, Brussels, Belgium.
| | - Cyprien Widomski
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université libre de Bruxelles (ULB), Lennik Rd. 808, Anderlecht 1070, Brussels, Belgium.
| | - Charlotte Martin
- Department of Infectious Diseases, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Rue Haute 322, Brussels 1000, Brussels, Belgium.
| | - Yiwei Jiang
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université libre de Bruxelles (ULB), Lennik Rd. 808, Anderlecht 1070, Brussels, Belgium.
| | - Katty Renard
- Clinical Research Unit, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Rue Haute 322, Brussels 1000, Brussels, Belgium.
| | - Alexandra Cogan
- Department of Gynecology and Obstetrics, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Rue Haute 322, Brussels 1000, Brussels, Belgium.
| | - Coca Necsoi
- Department of Infectious Diseases, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Rue Haute 322, Brussels 1000, Brussels, Belgium.
| | - Margaret E Ackerman
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Dartmouth College, Rope Ferry Rd. 1, Hanover, NH 03755, USA; Thayer School of Engineering, Dartmouth College, Thayer Dr. 15, Hanover, NH 03755, USA.
| | - Arnaud Marchant
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université libre de Bruxelles (ULB), Lennik Rd. 808, Anderlecht 1070, Brussels, Belgium.
| | - Nicolas Dauby
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université libre de Bruxelles (ULB), Lennik Rd. 808, Anderlecht 1070, Brussels, Belgium; Department of Infectious Diseases, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Rue Haute 322, Brussels 1000, Brussels, Belgium.
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3
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Byonanebye DM, Polizzotto MN, Neesgaard B, Sarcletti M, Matulionyte R, Braun DL, Castagna A, de Wit S, Wit F, Fontas E, Vehreschild J, Vesterbacka J, Greenberg L, Hatleberg C, Garges H, Gallant J, Volny Anne A, Öllinger A, Mozer‐Lisewska I, Surial B, Spagnuolo V, Necsoi C, van der Valk M, Mocroft A, Law M, Ryom L, Petoumenos K. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Med 2022; 23:895-910. [PMID: 35233903 PMCID: PMC9545382 DOI: 10.1111/hiv.13273] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND.
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Affiliation(s)
- Dathan M. Byonanebye
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia,School of Public HealthMakerere UniversityKampalaUganda
| | - Mark N. Polizzotto
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bastian Neesgaard
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mario Sarcletti
- Department of Dermatology, Venerology and AllergologyMedical University InnsbruckInnsbruckAustria
| | - Raimonda Matulionyte
- Department of Infectious Diseases and DermatovenerologyFaculty of MedicineVilnius University Hospital Santaros KlinikosVilnius UniversityVilniusLithuania
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital EpidemiologySwitzerland Swiss HIV Cohort Study (SHCS)Institute of Medical VirologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Antonella Castagna
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Stéphane de Wit
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands
| | - Eric Fontas
- Nice HIV CohortUniversité Côte d’Azur et Centre Hospitalier UniversitaireNiceFrance
| | - Jörg Janne Vehreschild
- Medical Department 2Hematology/OncologyUniversity Hospital of FrankfurtFrankfurtGermany,Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Jan Vesterbacka
- Swedish InfCare HIV CohortKarolinska University HospitalHuddingeSweden
| | - Lauren Greenberg
- Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Camilla Hatleberg
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | | | | | - Angela Öllinger
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | - Bernard Surial
- Department of Infectious Diseases, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Vincenzo Spagnuolo
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Coca Necsoi
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands,Division of Infectious DiseasesDepartment of Internal MedicineAmsterdam Institute for Infection and ImmunityAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Amanda Mocroft
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark,Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Matthew Law
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lene Ryom
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kathy Petoumenos
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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4
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Neesgaard B, Greenberg L, Miró JM, Grabmeier-Pfistershammer K, Wandeler G, Smith C, De Wit S, Wit F, Pelchen-Matthews A, Mussini C, Castagna A, Pradier C, d'Arminio Monforte A, Vehreschild JJ, Sönnerborg A, Anne AV, Carr A, Bansi-Matharu L, Lundgren JD, Garges H, Rogatto F, Zangerle R, Günthard HF, Rasmussen LD, Necsoi C, van der Valk M, Menozzi M, Muccini C, Peters L, Mocroft A, Ryom L. Associations between integrase strand-transfer inhibitors and cardiovascular disease in people living with HIV: a multicentre prospective study from the RESPOND cohort consortium. Lancet HIV 2022; 9:e474-e485. [PMID: 35688166 DOI: 10.1016/s2352-3018(22)00094-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although associations between older antiretroviral drug classes and cardiovascular disease in people living with HIV are well described, there is a paucity of data regarding a possible association with integrase strand-transfer inhibitors (INSTIs). We investigated whether exposure to INSTIs was associated with an increased incidence of cardiovascular disease. METHODS RESPOND is a prospective, multicentre, collaboration study between 17 pre-existing European and Australian cohorts and includes more than 32 000 adults living with HIV in clinical care after Jan 1, 2012. Individuals were eligible for inclusion in these analyses if they were older than 18 years, had CD4 cell counts and HIV viral load measurements in the 12 months before or within 3 months after baseline (latest of cohort enrolment or Jan 1, 2012), and had no exposure to INSTIs before baseline. These individuals were subsequently followed up to the earliest of the first cardiovascular disease event (ie, myocardial infarction, stroke, or invasive cardiovascular procedure), last follow-up, or Dec 31, 2019. We used multivariable negative binomial regression to assess associations between cardiovascular disease and INSTI exposure (0 months [no exposure] vs >0 to 6 months, >6 to 12 months, >12 to 24 months, >24 to 36 months, and >36 months), adjusted for cardiovascular risk factors. RESPOND is registered with ClinicalTrials.gov, NCT04090151, and is ongoing. FINDINGS 29 340 people living with HIV were included in these analyses, of whom 7478 (25·5%) were female, 21 818 (74·4%) were male, and 44 (<1%) were transgender, with a median age of 44·3 years (IQR 36·2-51·3) at baseline. As of Dec 31, 2019, 14 000 (47·7%) of 29 340 participants had been exposed to an INSTI. During a median follow-up of 6·16 years (IQR 3·87-7·52; 160 252 person-years), 748 (2·5%) individuals had a cardiovascular disease event (incidence rate of 4·67 events [95% CI 4·34-5·01] per 1000 person-years of follow-up). The crude cardiovascular disease incidence rate was 4·19 events (3·83-4·57) per 1000 person-years in those with no INSTI exposure, which increased to 8·46 events (6·58-10·71) per 1000 person-years in those with more than 0 months to 6 months of exposure, and gradually decreased with increasing length of exposure, until it decreased to similar levels of no exposure at more than 24 months of exposure (4·25 events [2·89-6·04] per 1000 person-years among those with >24 to 36 months of exposure). Compared with those with no INSTI exposure, the risk of cardiovascular disease was increased in the first 24 months of INSTI exposure and thereafter decreased to levels similar to those never exposed (>0 to 6 months of exposure: adjusted incidence rate ratio of 1·85 [1·44-2·39]; >6 to 12 months of exposure: 1·19 [0·84-1·68]; >12 to 24 months of exposure: 1·46 [1·13-1·88]; >24 to 36 months of exposure: 0·89 [0·62-1·29]; and >36 months of exposure: 0·96 [0·69-1·33]; p<0·0001). INTERPRETATION Although the potential for unmeasured confounding and channelling bias cannot fully be excluded, INSTIs initiation was associated with an early onset, excess incidence of cardiovascular disease in the first 2 years of exposure, after accounting for known cardiovascular disease risk factors. These early findings call for analyses in other large studies, and the potential underlying mechanisms explored further. FUNDING The CHU St Pierre Brussels HIV Cohort, The Austrian HIV Cohort Study, The Australian HIV Observational Database, The AIDS Therapy Evaluation in the Netherlands National Observational HIV cohort, The EuroSIDA cohort, The Frankfurt HIV Cohort Study, The Georgian National AIDS Health Information System, The Nice HIV Cohort, The ICONA Foundation, The Modena HIV Cohort, The PISCIS Cohort Study, The Swiss HIV Cohort Study, The Swedish InfCare HIV Cohort, The Royal Free HIV Cohort Study, The San Raffaele Scientific Institute, The University Hospital Bonn HIV Cohort and The University of Cologne HIV Cohorts, ViiV Healthcare, and Gilead Sciences.
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Affiliation(s)
- Bastian Neesgaard
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Lauren Greenberg
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, UK
| | - Stéphane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Cristina Mussini
- Modena HIV Cohort, Università Degli Studi di Modena, Modena, Italy
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France
| | | | - Jörg J Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany; Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anders Sönnerborg
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Alain V Anne
- European AIDS Treatment Group (EATG), Brussels, Belgium
| | - Andrew Carr
- HIV and Immunology Unit, St Vincent's Hospital, Sydney, NSW, Australia; The Australian HIV Observational Database (AHOD), UNSW Sydney, Sydney, NSW, Australia
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jens D Lundgren
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Marianna Menozzi
- Modena HIV Cohort, Università Degli Studi di Modena, Modena, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Lars Peters
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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5
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Verdikt R, Bendoumou M, Bouchat S, Nestola L, Pasternak AO, Darcis G, Avettand-Fenoel V, Vanhulle C, Aït-Ammar A, Santangelo M, Plant E, Douce VL, Delacourt N, Cicilionytė A, Necsoi C, Corazza F, Passaes CPB, Schwartz C, Bizet M, Fuks F, Sáez-Cirión A, Rouzioux C, De Wit S, Berkhout B, Gautier V, Rohr O, Van Lint C. Novel role of UHRF1 in the epigenetic repression of the latent HIV-1. EBioMedicine 2022; 79:103985. [PMID: 35429693 PMCID: PMC9038550 DOI: 10.1016/j.ebiom.2022.103985] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The multiplicity, heterogeneity, and dynamic nature of human immunodeficiency virus type-1 (HIV-1) latency mechanisms are reflected in the current lack of functional cure for HIV-1. Accordingly, all classes of latency-reversing agents (LRAs) have been reported to present variable ex vivo potencies. Here, we investigated the molecular mechanisms underlying the potency variability of one LRA: the DNA methylation inhibitor 5-aza-2'-deoxycytidine (5-AzadC). METHODS We employed epigenetic interrogation methods (electrophoretic mobility shift assays, chromatin immunoprecipitation, Infinium array) in complementary HIV-1 infection models (latently-infected T-cell line models, primary CD4+ T-cell models and ex vivo cultures of PBMCs from HIV+ individuals). Extracellular staining of cell surface receptors and intracellular metabolic activity were measured in drug-treated cells. HIV-1 expression in reactivation studies was explored by combining the measures of capsid p24Gag protein, green fluorescence protein signal, intracellular and extracellular viral RNA and viral DNA. FINDINGS We uncovered specific demethylation CpG signatures induced by 5-AzadC in the HIV-1 promoter. By analyzing the binding modalities to these CpG, we revealed the recruitment of the epigenetic integrator Ubiquitin-like with PHD and RING finger domain 1 (UHRF1) to the HIV-1 promoter. We showed that UHRF1 redundantly binds to the HIV-1 promoter with different binding modalities where DNA methylation was either non-essential, essential or enhancing UHRF1 binding. We further demonstrated the role of UHRF1 in the epigenetic repression of the latent viral promoter by a concerted control of DNA and histone methylations. INTERPRETATION A better understanding of the molecular mechanisms of HIV-1 latency allows for the development of innovative antiviral strategies. As a proof-of-concept, we showed that pharmacological inhibition of UHRF1 in ex vivo HIV+ patient cell cultures resulted in potent viral reactivation from latency. Together, we identify UHRF1 as a novel actor in HIV-1 epigenetic silencing and highlight that it constitutes a new molecular target for HIV-1 cure strategies. FUNDING Funding was provided by the Belgian National Fund for Scientific Research (F.R.S.-FNRS, Belgium), the « Fondation Roi Baudouin », the NEAT (European AIDS Treatment Network) program, the Internationale Brachet Stiftung, ViiV Healthcare, the Télévie, the Walloon Region (« Fonds de Maturation »), « Les Amis des Instituts Pasteur à Bruxelles, asbl », the University of Brussels (Action de Recherche Concertée ULB grant), the Marie Skodowska Curie COFUND action, the European Union's Horizon 2020 research and innovation program under grant agreement No 691119-EU4HIVCURE-H2020-MSCA-RISE-2015, the French Agency for Research on AIDS and Viral Hepatitis (ANRS), the Sidaction and the "Alsace contre le Cancer" Foundation. This work is supported by 1UM1AI164562-01, co-funded by National Heart, Lung and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute on Drug Abuse and the National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Roxane Verdikt
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Maryam Bendoumou
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Sophie Bouchat
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Lorena Nestola
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Alexander O Pasternak
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Virology, Amsterdam 1105 AZ, the Netherland
| | - Gilles Darcis
- Infectious Diseases Department, Liège University Hospital, Liège 4000, Belgium
| | - Véronique Avettand-Fenoel
- AP-HP, Hôpital Necker-Enfants-Malades, Service de Microbiologie clinique, Paris 75015, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris 75006, France; INSERM, U1016, Institut Cochin, Paris, 75014, France; CNRS, UMR8104, Paris 75014, France
| | - Caroline Vanhulle
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Amina Aït-Ammar
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Marion Santangelo
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Estelle Plant
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Valentin Le Douce
- Centre for Research in Infectious Diseases, University College Dublin, Dublin 4, Ireland
| | - Nadège Delacourt
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium
| | - Aurelija Cicilionytė
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Virology, Amsterdam 1105 AZ, the Netherland
| | - Coca Necsoi
- Service des Maladies Infectieuses, CHU St-Pierre, Université Libre de Bruxelles (ULB), Brussels 1000, Belgium
| | - Francis Corazza
- Laboratory of Immunology, IRISLab, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels 1020, Belgium
| | | | - Christian Schwartz
- Laboratoire DHPI EA7292, Université de Strasbourg, Schiltigheim, 67300, France; IUT Louis Pasteur, Université de Strasbourg, Schiltigheim, 67300, France
| | - Martin Bizet
- Laboratory of Cancer Epigenetics, Faculty of Medicine, ULB-Cancer Research Center (U-CRC), Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - François Fuks
- Laboratory of Cancer Epigenetics, Faculty of Medicine, ULB-Cancer Research Center (U-CRC), Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Asier Sáez-Cirión
- Départements de Virologie et Immunologie, Institut Pasteur, Unité HIV, Inflammation et Persistance, Paris 75015, France
| | - Christine Rouzioux
- AP-HP, Hôpital Necker-Enfants-Malades, Service de Microbiologie clinique, Paris 75015, France
| | - Stéphane De Wit
- Service des Maladies Infectieuses, CHU St-Pierre, Université Libre de Bruxelles (ULB), Brussels 1000, Belgium
| | - Ben Berkhout
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Virology, Amsterdam 1105 AZ, the Netherland
| | - Virginie Gautier
- Centre for Research in Infectious Diseases, University College Dublin, Dublin 4, Ireland
| | - Olivier Rohr
- Laboratoire DHPI EA7292, Université de Strasbourg, Schiltigheim, 67300, France; IUT Louis Pasteur, Université de Strasbourg, Schiltigheim, 67300, France
| | - Carine Van Lint
- Service of Molecular Virology, Department of Molecular Biology (DBM), Université Libre de Bruxelles (ULB), Gosselies 6041, Belgium.
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6
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Greenberg L, Ryom L, Neesgaard B, Miró JM, Dahlerup Rasmussen L, Zangerle R, Grabmeier-Pfistershammer K, Günthard HF, Kusejko K, Smith C, Mussini C, Menozzi M, Wit F, Van Der Valk M, d’Arminio Monforte A, De Wit S, Necsoi C, Pelchen-Matthews A, Lundgren J, Peters L, Castagna A, Muccini C, Vehreschild JJ, Pradier C, Bruguera Riera A, Sönnerborg A, Petoumenos K, Garges H, Rogatto F, Dedes N, Bansi-Matharu L, Mocroft A. Integrase strand transfer inhibitor use and cancer incidence in a large cohort setting. Open Forum Infect Dis 2022; 9:ofac029. [PMID: 35198646 PMCID: PMC8860165 DOI: 10.1093/ofid/ofac029] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Limited data exist examining the association between incident cancer and cumulative integrase inhibitor (INSTI) exposure. Methods Participants were followed from baseline (latest of local cohort enrollment or January 1, 2012) until the earliest of first cancer, final follow-up, or December 31, 2019. Negative binomial regression was used to assess associations between cancer incidence and time-updated cumulative INSTI exposure, lagged by 6 months. Results Of 29 340 individuals, 74% were male, 24% were antiretroviral treatment (ART)-naive, and median baseline age was 44 years (interquartile range [IQR], 36–51). Overall, 13 950 (48%) individuals started an INSTI during follow-up. During 160 657 person-years of follow-up ([PYFU] median 6.2; IQR, 3.9–7.5), there were 1078 cancers (incidence rate [IR] 6.7/1000 PYFU; 95% confidence interval [CI], 6.3–7.1). The commonest cancers were non-Hodgkin lymphoma (n = 113), lung cancer (112), Kaposi’s sarcoma (106), and anal cancer (103). After adjusting for potential confounders, there was no association between cancer risk and INSTI exposure (≤6 months vs no exposure IR ratio: 1.15 [95% CI, 0.89–1.49], >6–12 months; 0.97 [95% CI, 0.71–1.32], >12–24 months; 0.84 [95% CI, 0.64–1.11], >24–36 months; 1.10 [95% CI, 0.82–1.47], >36 months; 0.90 [95% CI, 0.65–1.26] [P = .60]). In ART-naive participants, cancer incidence decreased with increasing INSTI exposure, mainly driven by a decreasing incidence of acquired immune deficiency syndrome cancers; however, there was no association between INSTI exposure and cancer for those ART-experienced (interaction P < .0001). Conclusions Cancer incidence in each INSTI exposure group was similar, despite relatively wide CIs, providing reassuring early findings that increasing INSTI exposure is unlikely to be associated with an increased cancer risk, although longer follow-up is needed to confirm this finding.
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Affiliation(s)
- Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
- Correspondence: Lauren Greenberg, PhD, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Rowland Hill Street, NW3 2PF, United Kingdom ()
| | - Lene Ryom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jose M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria
| | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Colette Smith
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | | | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Marc Van Der Valk
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), HIV Monitoring Foundation, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Stéphane De Wit
- CHU Saint-Pierre, Infectious Diseases, Saint-PIerre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Jens Lundgren
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Jörg Janne Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d’Azur et Centre Hospitalier Universitaire, Nice, France
| | - Andreu Bruguera Riera
- PISCIS Cohort Study, Centre Estudis Epidemiologics de ITS i VIH de Catalunya, Badalona, Spain
| | - Anders Sönnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden
| | - Kathy Petoumenos
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Harmony Garges
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | - Nikos Dedes
- European AIDS Treatment Group, Brussels, Belgium
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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7
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Bukkems VE, Necsoi C, Tenorio CH, Garcia C, Alejandre IA, Weiss F, Lambert JS, van Hulzen A, Richel O, Te Brake LHM, van der Meulen E, Burger D, Konopnicki D, Colbers A. Tenofovir alafenamide plasma concentrations are reduced in pregnant women living with HIV: data from the PANNA Network. Clin Infect Dis 2021; 75:623-629. [PMID: 34864950 PMCID: PMC9464066 DOI: 10.1093/cid/ciab1010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tenofovir alafenamide (TAF), a prodrug of tenofovir (TFV), is included in the majority of the recommended first-line antiretroviral regimens for patients living with HIV, but there are limited data on TAF use in pregnant women. We aimed to examine the plasma pharmacokinetics of TAF and TFV in pregnant women from Europe. METHODS Pregnant women living with HIV were included from treatment centers across Europe, and intensive pharmacokinetic sampling in the third trimester and postpartum was performed. Pharmacokinetic parameters of TAF and TFV were determined with noncompartmental analysis. The proportion of women with a TAF AUCtau below the target of 53.1 ng*h/mL was determined. Clinical efficacy and safety outcome parameters were reported. RESULTS In total, 20 pregnant women living with HIV were included. At the third trimester, geometric mean TAF AUClast and Cmax were decreased by 46% and 52%, respectively, compared with postpartum. TFV AUC0-24h, Cmax, and Ctrough decreased by 33%, 30% and 34%, respectively. The proportion of women with a TAF AUClast <53.1 ng*h/mL was 6% at third trimester and 0% postpartum. One out of 20 women had a viral load >50 copies/mL at third trimester and no mother-to-child transmission occurred. CONCLUSIONS TAF plasma concentrations were reduced by about half in women living with HIV during third trimester of pregnancy, but remained above the predefined efficacy target in the majority of the pregnant women. TFV concentrations were reduced by approximately 30% during third trimester. Despite the observed exposure decrease, high virologic efficacy was observed in this study.
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Affiliation(s)
- Vera E Bukkems
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | - Coca Necsoi
- Saint-Pierre University Hospital, Brussels, Belgium
| | | | - Coral Garcia
- Hospital Universtario Virgen de las Nieves, Granada, Spain
| | - Irene Alba Alejandre
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Fabian Weiss
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - John S Lambert
- Mater Misericordiae University Hospital, Dublin, Ireland.,Rotunda hospitals, Dublin, Ireland.,UCD school of medicine and medical science, Dublin, Ireland
| | - Astrid van Hulzen
- Department of internal medicine, Isala Hospital, Zwolle, the Netherlands
| | - Olivier Richel
- Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Lindsey H M Te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | - Eric van der Meulen
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | - David Burger
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | | | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
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8
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Bukkems V, Necsoi C, Tenorio CH, Garcia C, Rockstroh J, Schwarze-Zander C, Lambert JS, Burger D, Konopnicki D, Colbers A. Clinically Significant Lower Elvitegravir Exposure During the Third Trimester of Pregnant Patients Living With Human Immunodeficiency Virus: Data From the Pharmacokinetics of ANtiretroviral agents in HIV-infected pregNAnt women (PANNA) Network. Clin Infect Dis 2021; 71:e714-e717. [PMID: 32330231 PMCID: PMC7744974 DOI: 10.1093/cid/ciaa488] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
This phase 4 study investigated the influence of pregnancy on the pharmacokinetics of elvitegravir/cobicistat in 14 women with human immunodeficiency virus type 1. The results support the recommendation against elvitegravir/cobicistat use during pregnancy, as the elvitegravir concentration at the end of the dosing interval (Ctrough) was reduced by 77%, with 85% of pregnant women having a Ctrough below the effective concentration (EC90). Clinical Trials Registration. NCT00825929.
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Affiliation(s)
- Vera Bukkems
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coca Necsoi
- Saint-Pierre University Hospital, Brussels, Belgium
| | | | - Coral Garcia
- Hospital Universtario Virgen de las Nieves, Granada, Spain
| | | | | | - John S Lambert
- Mater Misericordiae University Hospital, Dublin, Ireland.,Rotunda Hospitals, Dublin, Ireland.,University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - David Burger
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Gobert C, Van Hauwermeiren C, Quoidbach C, Reschner A, Necsoi C, Benslimane A, Nagant C, Van den Wijngaert S, Delforge M, Corazza F, De Wit S, Dauby N. Tetanus seroprotection in people living with HIV: Risk factors for seronegativity, evaluation of medical history and a rapid dipstick test. Vaccine 2021; 39:1963-1967. [PMID: 33715902 DOI: 10.1016/j.vaccine.2021.02.062] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/14/2021] [Accepted: 02/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Tetanus is a vaccine-preventable disease. Booster immunization is required in order to induce long-lived tetanus-toxoid (TT) specific antibody response. We investigated the prevalence and risk factors of TT seronegativity in a cohort of people living with HIV (PWH) in Belgium along with the respective performance of vaccine history and a rapid dipstick test (Tetanus Quick Stick ® or TQS) compared to ELISA testing. METHODS PWH were prospectively enrolled and answered a questionnaire. ELISA was performed on serum or plasma using a commercial kit. A TT antibody level ≥ 0.15 IU / mL was considered protective. The TQS test was performed on a limited number of subjects. RESULTS Three-hundred forty-four subjects were included. The prevalence of tetanus seroprotection was 84,9%. Median age was 46.7 and 68% were born outside Belgium. Antiretroviral therapy coverage was almost universal (98.5%). After multivariable analysis, two risk factors were independently associated with TT seronegativity: an education level equivalent or below than secondary school and being born outside Europe. Vaccine history was shown to be unreliable (sensitivity: 43.8%; specificity: 76.5%; positive predictive value: 91.4% and negative predictive value :19.3%). The correlation between vaccine history and tetanus seroprotection was low (kappa coefficient = 0.09). The TQS performances were good (sensitivity 86.4%, specificity 96.0%, positive predictive value 99.3%, negative predictive value 52.17%). The correlation between TQS and tetanus seroprotection was substantial (kappa coefficient = 0.61). CONCLUSIONS In this cohort of PWH with a high proportion of migrants, socio-demographic and educational factors were associated with TT seronegativity while HIV-related factors were not, indicating that vaccine information should be tailored to cultural and educational background. As vaccine history is not reliable, TQS could represent an efficient tool for screening of TT-seronegativity.
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Affiliation(s)
- Cathy Gobert
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Celine Van Hauwermeiren
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Catherine Quoidbach
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anca Reschner
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Coca Necsoi
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Asma Benslimane
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Carole Nagant
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Sigi Van den Wijngaert
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Marc Delforge
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francis Corazza
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium; Centre for Environmental Health and Occupational Health, School of Public Health, Université libre de Bruxelles (ULB), Belgium.
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10
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Neesgaard B, Mocroft A, Zangerle R, Wit F, Lampe F, Günthard HF, Necsoi C, Law M, Mussini C, Castagna A, Monforte AD, Pradier C, Chkhartisvilli N, Reyes-Uruena J, Vehreschild JJ, Wasmuth JC, Sönnerborg A, Stephan C, Greenberg L, Llibre JM, Volny-Anne A, Peters L, Pelchen-Matthews A, Vannappagari V, Gallant J, Rieger A, Youle M, Braun D, De Wit S, Petoumenos K, Borghi V, Spagnuolo V, Tsertsvadze T, Lundgren J, Ryom L. Virologic and immunologic outcomes of treatment with integrase inhibitors in a real-world setting: The RESPOND cohort consortium. PLoS One 2020; 15:e0243625. [PMID: 33382756 PMCID: PMC7774984 DOI: 10.1371/journal.pone.0243625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare virologic and immunologic outcomes of integrase inhibitor (INSTI)-containing, contemporary boosted protease inhibitor (PI/b)-containing and non-nucleotide reverse transcriptase inhibitor (NNRTI)-containing regimens in a real-life setting. Methods Using logistic regression, virologic and immunologic outcomes of INSTI use were compared to outcomes of PI/b or NNRTI treatment 12 months after treatment start or switch, for participants in the RESPOND cohort consortium. A composite treatment outcome (cTO) was used, defining success as viral load (VL) <200 copies/mL and failure as at least one of: VL ≥200 copies/mL, unknown VL in the time window, any changes of antiretroviral therapy (ART) regimen, AIDS, or death. In addition, on-treatment analysis including only individuals with known VL and no regimen changes was performed. Favorable immunologic response was defined as a 25% increase in CD4 count or as reaching ≥750 CD4 cells/μL. Results Between January 2012 and January 2019, 13,703 (33.0% ART-naïve) individuals were included, of whom 7,147 started/switched to a regimen with an INSTI, 3,102 to a PI/b and 3,454 to an NNRTI-containing regimen. The main reason for cTO failure in all treatment groups were changes in ART regimen. Compared to INSTIs, the adjusted odds ratio (aOR) of cTO success was significantly lower for PI/b (0.74 [95% confidence interval, CI 0.67–0.82], p <0.001), but similar for NNRTIs (1.07 [CI 0.97–1.17], p = 0.11). On-treatment analysis and sensitivity analyses using a VL cut-off of 50 copies/mL were consistent. Compared to INSTIs, the aORs of a 25% increase in CD4 count were lower for NNRTIs (0.80 [CI 0.71–0.91], p<0.001) and PI/b (0.87 [CI 0.76–0.99], p = 0.04). Conclusion In this large analysis of a real-world population, cTO and on-treatment success were similar between INSTIs and NNRTIs, but lower for PI/b, though residual confounding cannot be fully excluded. Obtaining favorable immunologic outcomes were more likely for INSTIs than the other drug classes.
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Affiliation(s)
- Bastian Neesgaard
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), Stichting HIV Monitoring (SHM), Amsterdam, Netherlands
| | - Fiona Lampe
- Royal Free Hospital, University College London, London, United Kingdom
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Matthew Law
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | | | - Christian Pradier
- Nice HIV Cohort, Université Côte d’Azur et Centre Hospitalier Universitaire, Nice, France
| | | | - Juliana Reyes-Uruena
- PISCIS Cohort, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), CIBERESP, Badalona, Spain
| | - Jörg Janne Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Anders Sönnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden
| | - Christoph Stephan
- Infectious Diseases Unit, Medical Dept. no.2, Frankfurt University Hospital, Goethe-University, Frankfurt, Germany
| | - Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Josep M. Llibre
- Infectious Diseases and Fight AIDS Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | - Lars Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Vani Vannappagari
- ViiV Healthcare, Research Triangle, North Carolina, United States of America
| | - Joel Gallant
- Gilead Sciences, Foster City, California, United States of America
| | - Armin Rieger
- Wiener Medizinische Universität, Vienna, Austria
| | - Mike Youle
- Royal Free Hospital, University College London, London, United Kingdom
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stephane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Kathy Petoumenos
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Vanni Borghi
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Vincenzo Spagnuolo
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Jens Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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11
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Greenberg L, Ryom L, Neesgaard B, Wandeler G, Staub T, Gisinger M, Skoll M, Günthard HF, Scherrer A, Mussini C, Smith C, Johnson M, De Wit S, Necsoi C, Pradier C, Wit F, Lehmann C, d'Arminio Monforte A, Miró JM, Castagna A, Spagnuolo V, Sönnerborg A, Law M, Hutchinson J, Chkhartishvili N, Bolokadze N, Wasmuth JC, Stephan C, Vannappagari V, Rogatto F, Llibre JM, Duvivier C, Hoy J, Bloch M, Bucher HC, Calmy A, Volny Anne A, Pelchen-Matthews A, Lundgren JD, Peters L, Bansi-Matharu L, Mocroft A. Clinical outcomes of two-drug regimens vs. three-drug regimens in antiretroviral treatment-experienced people living with HIV. Clin Infect Dis 2020; 73:e2323-e2333. [PMID: 33354721 DOI: 10.1093/cid/ciaa1878] [Citation(s) in RCA: 9] [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] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Limited data exist comparing clinical outcomes of two-drug regimens (2DRs) and three-drug regimens (3DRs) in people living with HIV. METHODS Antiretroviral treatment-experienced individuals in RESPOND switching to a new 2DR or 3DR from 1/1/12-1/10/18 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression. RESULTS Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median 52.6 years [interquartile range 46.7-59.0] vs 47.7 [39.7-54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%).There were 619 events during 27,159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU [95% CI 20.7-24.5]) on 3DRs, 79 (30.9/1000 PYFU [24.8-38.5]) on 2DRs. The most common events were death (7.5/1000 PYFU [95% CI 6.5-8.6]) and non-AIDS cancer (5.8/1000 PYFU [4.9-6.8]). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio: 0.92 [0.72-1.19]; p=0.53). CONCLUSIONS This is the first large, international cohort assessing clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes; further research on resistance barriers and long-term durability of 2DRs is needed.
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Affiliation(s)
- Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Therese Staub
- Infectious Diseases, CHL (Centre Hospitalier Luxembourg), Luxembourg
| | | | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Scherrer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Margaret Johnson
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Stéphane De Wit
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Coca Necsoi
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), Stichting HIV Monitoring (SHM), Amsterdam, Netherlands
| | | | | | - Jose M Miró
- Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | | | | | - Anders Sönnerborg
- Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Sweden
| | - Matthew Law
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Jolie Hutchinson
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Nikoloz Chkhartishvili
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Natalia Bolokadze
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Christoph Stephan
- Medical Department no. 2, Infectious Diseases Unit, Goethe-University Hospital Frankfurt, Frankfurt a.M., Germany
| | | | | | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol · Department of Internal Medicine, HIV Unit, Barcelona, Spain
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark Bloch
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Heiner C Bucher
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit in Geneva University Hospital, Geneva, Switzerland
| | | | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
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12
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Mocroft A, Neesgard B, Zangerle R, Rieger A, Castagna A, Spagnuolo V, Antinori A, Lampe FC, Youle M, Vehreschild JJ, Mussini C, Borghi V, Begovac J, Duvivier C, Gunthard HF, Rauch A, Tiraboschi J, Chkhartishvili N, Bolokadze N, Wit F, Wasmuth JC, De Wit S, Necsoi C, Pradier C, Svedhem V, Stephan C, Petoumenos K, Garges H, Rogatto F, Peters L, Ryom L. Treatment outcomes of integrase inhibitors, boosted protease inhibitors and nonnucleoside reverse transcriptase inhibitors in antiretroviral-naïve persons starting treatment. HIV Med 2020; 21:599-606. [PMID: 32588958 DOI: 10.1111/hiv.12888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although outcomes of antiretroviral therapy (ART) have been evaluated in randomized controlled trials, experiences from subpopulations defined by age, CD4 count or viral load (VL) in heterogeneous real-world settings are limited. METHODS The study design was an international multicohort collaboration. Logistic regression was used to compare virological and immunological outcomes at 12 ± 3 months after starting ART with an integrase strand transfer inhibitor (INSTI), contemporary nonnucleoside reverse transcriptase inhibitor (NNRTI) or boosted protease inhibitor (PI/b) with two nucleos(t)ides after 1 January 2012. The composite treatment outcome (cTO) defined success as VL < 200 HIV-1 RNA copies/mL with no regimen change and no AIDS/death events. Immunological success was defined as a CD4 count > 750 cells/μL or a 33% increase where the baseline CD4 count was ≥ 500 cells/μL. Poisson regression compared clinical failures (AIDS/death ≥ 14 days after starting ART). Interactions between ART class and age, CD4 count, and VL were determined for each endpoint. RESULTS Of 5198 ART-naïve persons in the International Cohort Consortium of Infectious Diseases (RESPOND), 45.4% started INSTIs, 26.0% PI/b and 28.7% NNRTIs; 880 (17.4%) were aged > 50 years, 2539 (49.4%) had CD4 counts < 350 cells/μL and 1891 (36.8%) had VL > 100 000 copies/mL. Differences in virological and immunological success and clinical failure among ART classes were similar across age groups (≤ 40, 40-50 and > 50 years), CD4 count categories (≤ 350 vs. > 350 cells/μL) and VL categories at ART initiation (≤ 100 000 vs. > 100 000 copies/mL), with all investigated interactions being nonsignificant (P > 0.05). CONCLUSIONS Differences among ART classes in virological, immunological and clinical outcomes in ART-naïve participants were consistent irrespective of age, immune suppression or VL at ART initiation. While confounding by indication cannot be excluded, this provides reassuring evidence that such subpopulations will equally benefit from contemporary ART.
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Affiliation(s)
- A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - B Neesgard
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - R Zangerle
- Medical University of Innsbruck, Innsbruch, Austria
| | - A Rieger
- Medical University of Vienna, Vienna, Austria
| | - A Castagna
- Vita-Salute San Raffaele University, Milano, Italy
| | - V Spagnuolo
- Vita-Salute San Raffaele University, Milano, Italy
| | - A Antinori
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - F C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - M Youle
- Royal Free Hospital, London, UK
| | | | | | - V Borghi
- University of Modena, Modena, Italy
| | - J Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - C Duvivier
- Necker University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - H F Gunthard
- University of Zurich, Zurich, Switzerland.,University Hospital of Zurich, Zurich, Switzerland
| | - A Rauch
- University Hospital Berne, Bern, Switzerland
| | - J Tiraboschi
- PISCIS Cohort Study, Bellvitge Hospital, Barcelona, Spain
| | | | - N Bolokadze
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - F Wit
- Stichting HIV Monitoring (SHM), Amsterdam, the Netherlands
| | | | - S De Wit
- Infectious Disease Research Centre, Brussels, Belgium
| | - C Necsoi
- Infectious Disease Research Centre, Brussels, Belgium
| | - C Pradier
- Côte d'Azur University and University Hospital Center, Nice, France
| | - V Svedhem
- Karolinska University Hospital, Stockholm, Sweden
| | - C Stephan
- Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany
| | | | | | - F Rogatto
- Gilead Sciences, Foster City, CA, USA
| | - L Peters
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Ryom
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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13
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Ghazi L, Baker JV, Sharma S, Jain MK, Palfreeman A, Necsoi C, Murray DD, Neaton JD, Drawz PE. Role of Inflammatory Biomarkers in the Prevalence and Incidence of Hypertension Among HIV-Positive Participants in the START Trial. Am J Hypertens 2020; 33:43-52. [PMID: 31800000 DOI: 10.1093/ajh/hpz132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/11/2019] [Revised: 04/03/2019] [Accepted: 08/08/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The association between hypertension (HTN) and inflammatory biomarkers (interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hsCRP]) in HIV-positive persons with CD4+ count >500 cells/mm3 is unknown. METHODS We studied HTN in participants of the Strategic Timing of AntiRetroviral Treatment (START) trial of immediate vs. deferred antiretroviral therapy (ART) in HIV-positive, ART naive adults with CD4+ count > 500 cells/mm3. HTN was defined as having a systolic blood pressure (BP) ≥140 mmHg, a diastolic BP ≥90 mmHg, or using BP-lowering therapy. Logistic and discrete Cox regression models were used to study the association between baseline biomarker levels with prevalent and incident HTN. RESULTS Among 4,249 participants with no history of cardiovascular disease, the median age was 36 years, 55% were nonwhite, and the prevalence of HTN at baseline was 18.9%. After adjustment for race, age, gender, body mass index (BMI), diabetes, smoking, HIV RNA and CD4+ levels, associations of IL-6 and hsCRP with HTN prevalence were not significant (OR per twofold higher:1.10, 95% confidence interval [CI]: 0.99, 1.20 for IL-6 and 1.05, 95% CI: 0.99, 1.10 for hsCRP). Overall incidence of HTN was 6.8 cases/100 person years. In similarly adjusted models, neither IL-6 (Hazard ratios [HR] per twofold higher IL-6 levels: 0.97, 95% CI: 0.88, 1.08) nor hsCRP (HR per twofold higher hsCRP levels: 0.97, 95% CI: 0.92, 1.02) were associated with risk of incident HTN. Associations did not differ by treatment group. Age, race, gender, and BMI were significantly associated with both the prevalence and incidence of HTN. CONCLUSIONS Traditional risk factors and not baseline levels of IL-6 or hsCRP were associated with the prevalence and incidence of HTN in START.
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Affiliation(s)
- Lama Ghazi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason V Baker
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mamta K Jain
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Adrian Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Coca Necsoi
- Service des Maladies Infectieuses, CHU St-Pierre, ULB, Bruxelles, Belgium
| | - Daniel D Murray
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul E Drawz
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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14
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Bouchat S, Verdikt R, Delacourt N, Vanhulle C, Van Driessche B, Darcis G, Pasternak A, Avettand-Fenoel V, Necsoi C, Ledouce V, Bendoumou M, Schwartz C, De Wit S, Saez-Cirion A, Berkhout B, Gautier V, Rouzioux C, Rohr O, Van Lint C. O2 Identification of a new factor involved in DNA methylation-mediated repression of latent HIV-1. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30818-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Raben D, Mocroft A, Rayment M, Mitsura VM, Hadziosmanovic V, Sthoeger ZM, Palfreeman A, Morris S, Kutsyna G, Vassilenko A, Minton J, Necsoi C, Estrada VP, Grzeszczuk A, Johansson VS, Begovac J, Ong ELC, Cabié A, Ajana F, Celesia BM, Maltez F, Kitchen M, Comi L, Dragsted UB, Clumeck N, Gatell J, Gazzard B, d’Arminio Monforte A, Rockstroh J, Yazdanpanah Y, Champenois K, Jakobsen ML, Sullivan A, Lundgren JD. Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study. PLoS One 2015; 10:e0140845. [PMID: 26560105 PMCID: PMC4641587 DOI: 10.1371/journal.pone.0140845] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022] Open
Abstract
European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32–97), lowest in Northern Europe (median 44%, IQR 22–68%) and highest in Eastern Europe (median 99%, IQR 86–100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0–4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.
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Affiliation(s)
- D. Raben
- CHIP, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - A. Mocroft
- University College London, London, United Kingdom
| | - M. Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | - V. Hadziosmanovic
- Clinical Center University of Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia
| | - Z. M. Sthoeger
- Ben Ari Institute of Clinical Immunology, Rehovot, Israel
| | - A. Palfreeman
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Morris
- Western General Hospital, Edinburgh, United Kingdom
| | | | | | - J. Minton
- St James’s University Hospital, Leeds, United Kingdom
| | - C. Necsoi
- Saint-Pierre University Hospital, Brussels, Belgium
| | | | - A. Grzeszczuk
- Medical University of Bialystok, Department of Infectious Diseases and Hepatology, Bialystok, Poland
| | - V. Svedhem Johansson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J. Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - E. L. C. Ong
- The Newcastle upon Tyne Hospital, Newcastle, United Kingdom
| | - A. Cabié
- Centre Hospitalier Universitaire de Fort de France, Fort de France, Martinique
| | - F. Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | - B. M. Celesia
- Unit of Infectious Diseases University of Catania, ARNAS Garibaldi, Catania, Italy
| | - F. Maltez
- Hospital Curry Cabral, Lisbon, Portugal
| | - M. Kitchen
- Medical University of Innsbruck Innsbruck, Austria
| | - L. Comi
- Unit of Infectious Diseases, San Paolo Hospital, Milan, Italy
| | | | - N. Clumeck
- Saint-Pierre University Hospital, Brussels, Belgium
| | - J. Gatell
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - B. Gazzard
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Y. Yazdanpanah
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- IAME, UMR 1137, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Service de Biostatistique, Paris, France
| | | | | | - A. Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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16
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Clumeck N, Mwamba C, Kabeya K, Calvez V, Matanda S, Vaira D, Peytavin G, Necsoi C, Delforge M, Kadiebwe D, Milolo C, Ilunga J, Kapend L. First-line therapy with LPV/r vs NVP and 2 NRTIs in a developing country: W144 of a randomized trial. BMC Infect Dis 2014. [PMCID: PMC4220866 DOI: 10.1186/1471-2334-14-s2-o2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Gennotte AF, Semaille P, Ellis C, Necsoi C, Abdulatif M, Chellum N, Evaldre C, Laporte F, Mernier M, Ounchif K, Gidiuta D, Schellens MJ, Clumeck N. Feasibility and acceptability of HIV screening through the use of rapid tests by general practitioners in a Brussels area with a substantial African community. HIV Med 2014; 14 Suppl 3:57-60. [PMID: 24033907 DOI: 10.1111/hiv.12061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess:1) if HIV screening with rapid tests in neighbourhoods with a substantial African community is feasible and acceptable among GPs and patients; 2) HIV seroprevalence. METHODS Multicenter prospective study with 10 trained physicians. Use of HIV standard test and INSTI Ultrarapid test. INCLUSION CRITERIA MSM, sex worker, multiple sexual partners, having returned or coming from a country with high HIV prevalence, IVDU, Indicator conditions as defined by HIV Indicator Diseases across Europe Study, having an AIDS-defining illness, having had a recent pregnancy or abortion; or presenting other risks. RESULTS From August 2010 to August 2011, 10 trained GPs offered an HIV test to 224 patients: 51% ♀, 48% ♂, 43% Caucasians, 45% Africans. INCLUSION CRITERIA 32% "high risk group", 9% returning from an endemic country, 29% with an indicator condition; 12 patients (6%) refused the standard test. The INSTI was offered to 217(97%), 197 performed with 2 reactive rapid tests confirmed. The seroprevalence according to ethnic origin was 0% among Caucasians and 2.2% among Africans and was 1.5% among patients with an indicator condition. 1087 consecutive consultations of the same GPs were recorded: 42% patients had ≥ 1 inclusion criteria among which 41% of offered tests, that is to say 59% of "missed opportunities". The reasons for not offering the test as recorded for 55% of patients:"not indicated" 44.5%, "no time" 33%, "impossible to propose" 15%, test completed previously 11%, known HIV-positive 4%. CONCLUSIONS Standard and rapid tests are well received by patients but were usually not offered by doctors who have been trained.
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Affiliation(s)
- A-F Gennotte
- Division of Infectious Diseases, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, Belgium
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18
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De Wit S, Delforge M, Kabeya K, Necsoi C, Clumeck N. Darunavir in patients who failed on fos-amprenavir: efficacy at week 48. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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