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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, Castel P, Derouineau J, Kousignan P, Eliazevitch M, Pierre I, Collias L, Viard JP, Gilquin J, Sobel A, Slama L, Ghosn J, Hadacek B, Thu-Huyn N, Nait-Ighil L, Cros A, Maignan A, Duvivier C, Consigny PH, Lanternier F, Shoai-Tehrani M, Touam F, Jerbi S, Bodard L, Jung C, Goujard C, Quertainmont Y, Duracinsky M, Segeral O, Blanc A, Peretti D, Cheret A, Chantalat C, Dulucq MJ, Levy Y, Lelievre JD, Lascaux AS, Dumont C, Boue F, Chambrin V, Abgrall S, Kansau I, Raho-Moussa M, De Truchis P, Dinh A, Davido B, Marigot D, Berthe H, Devidas A, Chevojon P, Chabrol A, Agher N, Lemercier Y, Chaix F, Turpault I, Bouchaud O, Honore P, Rouveix E, Reimann E, Belan AG, Godin Collet C, Souak S, Mortier E, Bloch M, Simonpoli AM, Manceron V, Cahitte I, Hiraux E, Lafon E, Cordonnier F, Zeng AF, Zucman D, Majerholc C, Bornarel D, Uludag A, Gellen-Dautremer J, Lefort A, Bazin C, Daneluzzi V, Gerbe J, Jeantils V, Coupard M, Patey O, Bantsimba J, Delllion S, Paz PC, Cazenave B, Richier L, Garrait V, Delacroix I, Elharrar B, Vittecoq D, Bolliot C, Lepretre A, Genet P, Masse V, Perrone V, Boussard JL, Chardon P, Froguel E, Simon P, Tassi S, Avettand Fenoel V, Barin F, Bourgeois C, Cardon F, Chaix ML, Delfraissy JF, Essat A, Fischer H, Lecuroux C, Meyer L, Petrov-Sanchez V, Rouzioux C, Saez-Cirion A, Seng R, Kuldanek K, Mullaney S, Young C, Zucchetti A, Bevan MA, McKernan S, Wandolo E, Richardson C, Youssef E, Green P, Faulkner S, Faville R, Herman S, Care C, Blackman H, Bellenger K, Fairbrother K, Phillips A, Babiker A, Delpech V, Fidler S, Clarke M, Fox J, Gilson R, Goldberg D, Hawkins D, Johnson A, Johnson M, McLean K, Nastouli E, Post F, Kennedy N, Pritchard J, Andrady U, Rajda N, Donnelly C, McKernan S, Drake S, Gilleran G, White D, Ross J, Harding J, Faville R, Sweeney J, Flegg P, Toomer S, Wilding H, Woodward R, Dean G, Richardson C, Perry N, Gompels M, Jennings L, Bansaal D, Browing M, Connolly L, Stanley B, Estreich S, Magdy A, O'Mahony C, Fraser P, Jebakumar SPR, David L, Mette R, Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Hovaguimian F, Martin E, Reinacher M, Rasi M, Schmidt AJ, Bernasconi E, El Amari EB, Braun DL, Calmy A, Darling K, Christinet V, Depmeier C, Hauser C, Läuchli S, Notter J, Stoeckle M, Surial B, Vernazza P, Bruggmann P, Tarr P, Haerry D, Bize R, Low N, Lehner A, Böni J, Kouyos RD, Fehr JS, Hampel B. Participation, retention and uptake in a multicentre pre-exposure prophylaxis cohort using online, smartphone-compatible data collection. HIV Med 2021; 23:146-158. [PMID: 34605153 PMCID: PMC9292805 DOI: 10.1111/hiv.13175] [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: 05/19/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Objectives The aim of the study was to assess the feasibility of a national pre‐exposure prophylaxis (PrEP) programme using smartphone‐compatible data collection. Methods This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone‐compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV‐negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow‐up (number with first follow‐up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out. Results Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52–137]. Retention at first follow‐up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33–47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment. Conclusions In a national PrEP programme using smartphone‐compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.
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Affiliation(s)
- F Hovaguimian
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - E Martin
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Reinacher
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Rasi
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - A J Schmidt
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - E Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - E B El Amari
- Infectious Diseases and Internal Medicine Private Practice, Geneva, Switzerland
| | - D L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - A Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - K Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - C Depmeier
- Private practice Kalkbreite, Zurich, Switzerland
| | - C Hauser
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Läuchli
- Dermatologic Centre Zurich, Zurich, Switzerland
| | - J Notter
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - M Stoeckle
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - B Surial
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - P Bruggmann
- Arud Centre for Addiction Medicine, Zurich, Switzerland
| | - P Tarr
- Kantonsspital Baselland, University of Basel, Basel, Switzerland
| | - D Haerry
- Positive Council, Zurich, Switzerland
| | - R Bize
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - N Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - A Lehner
- Swiss AIDS Federation, Zurich, Switzerland
| | - J Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - R D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - J S Fehr
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - B Hampel
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland.,Checkpoint Zurich, Zurich, Switzerland
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3
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Reichmuth ML, Chaudron SE, Bachmann N, Nguyen H, Böni J, Metzner KJ, Perreau M, Klimkait T, Yerly S, Hirsch HH, Hauser C, Ramette A, Vernazza P, Cavassini M, Bernasconi E, Günthard HF, Kusejko K, Kouyos RD. Using longitudinally sampled viral nucleotide sequences to characterize the drivers of HIV-1 transmission. HIV Med 2020; 22:346-359. [PMID: 33368946 DOI: 10.1111/hiv.13030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Understanding the drivers of HIV-1 transmission is of importance for curbing the ongoing epidemic. Phylogenetic methods based on single viral sequences allow us to assess whether two individuals are part of the same viral outbreak, but cannot on their own assess who potentially transmitted the virus. We developed and assessed a molecular epidemiology method with the main aim to screen cohort studies for and to characterize individuals who are 'potential HIV-1 transmitters', in order to understand the drivers of HIV-1 transmission. METHODS We developed and validated a molecular epidemiology approach using longitudinally sampled viral Sanger sequences to characterize potential HIV-1 transmitters in the Swiss HIV Cohort Study. RESULTS Our method was able to identify 279 potential HIV-1 transmitters and allowed us to determine the main epidemiological and virological drivers of transmission. We found that the directionality of transmission was consistent with infection times for 72.9% of 85 potential HIV-1 transmissions with accurate infection date estimates. Being a potential HIV-1 transmitter was associated with risk factors including viral load [adjusted odds ratiomultivariable (95% confidence interval): 1.86 (1.49-2.32)], syphilis coinfection [1.52 (1.06-2.19)], and recreational drug use [1.45 (1.06-1.98)]. By contrast for the potential HIV-1 recipients, this association was weaker or even absent [1.18 (0.82-1.72), 0.89 (0.52-1.55) and 1.53 (0.98-2.39), respectively], indicating that inferred directionality of transmission is useful at the population level. CONCLUSIONS Our results indicate that longitudinally sampled Sanger sequences do not provide sufficient information to identify transmitters with high certainty at the individual level, but that they allow the drivers of transmission at the population level to be characterized.
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Affiliation(s)
- M L Reichmuth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - S E Chaudron
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - N Bachmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - H Nguyen
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - J Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - K J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - M Perreau
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - T Klimkait
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - S Yerly
- Laboratory of Virology, Geneva University Hospital, Geneva, Switzerland
| | - H H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - C Hauser
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - A Ramette
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - P Vernazza
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - H F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - K Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - R D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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4
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Hampel B, Kusejko K, Kouyos RD, Böni J, Flepp M, Stöckle M, Conen A, Béguelin C, Künzler‐Heule P, Nicca D, Schmidt AJ, Nguyen H, Delaloye J, Rougemont M, Bernasconi E, Rauch A, Günthard HF, Braun DL, Fehr J, Anagnostopoulos A, Battegay M, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fellay J, Furrer H, Fux CA, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Huber M, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner KJ, Müller N, Paioni P, Pantaleo G, Perreau M, Rudin C, Scherrer AU, Schmid P, Speck R, Tarr P, Trkola A, Vernazza P, Wandeler G, Weber R, Yerly S. Chemsex drugs on the rise: a longitudinal analysis of the Swiss HIV Cohort Study from 2007 to 2017. HIV Med 2020; 21:228-239. [DOI: 10.1111/hiv.12821] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/22/2022]
Affiliation(s)
- B Hampel
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
- Department of Public Health Epidemiology, Biostatistics and Public Health Institute University of Zurich Zurich Switzerland
| | - K Kusejko
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - RD Kouyos
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - J Böni
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - M Flepp
- Center of Infectious Diseases Zurich Zurich Switzerland
| | - M Stöckle
- Division of Infectious Diseases & Hospital Epidemiology University Hospital Basel University Basel Basel Switzerland
| | - A Conen
- Division of Infectious Diseases and Hospital Hygiene Cantonal Hospital Aarau Aarau Switzerland
| | - C Béguelin
- Department of Infectious Diseases Bern University Hospital University of Bern Bern Switzerland
| | - P Künzler‐Heule
- Institute of Nursing Science University of Basel, and University Hospital Basel Basel Switzerland
| | - D Nicca
- Institute of Nursing Science University of Basel, and University Hospital Basel Basel Switzerland
| | - AJ Schmidt
- Division of Infectious Diseases Cantonal Hospital St. Gallen St. Gallen Switzerland
| | - H Nguyen
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - J Delaloye
- Division of Infectious Diseases University Hospital Lausanne Lausanne Switzerland
| | - M Rougemont
- Division of Infectious Diseases University Hospital Geneva Geneva Switzerland
| | - E Bernasconi
- Division of Infectious Diseases Regional Hospital Lugano Lugano Switzerland
| | - A Rauch
- Department of Infectious Diseases Bern University Hospital University of Bern Bern Switzerland
| | - HF Günthard
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - DL Braun
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - J Fehr
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Department of Public Health Epidemiology, Biostatistics and Public Health Institute University of Zurich Zurich Switzerland
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5
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Surial B, Ledergerber B, Calmy A, Cavassini M, Günthard HF, Kovari H, Stöckle M, Bernasconi E, Schmid P, Fux CA, Furrer H, Rauch A, Wandeler G, Anagnostopoulos A, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Günthard HF, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Huber M, Kahlert CR, Kaiser L, Keiser O, Klimkait T, Kouyos RD, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner KJ, Müller N, Nicca D, Paioni P, Pantaleo G, Perreau M, Rauch A, Rudin C, Scherrer AU, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Wandeler G, Weber R, Yerly S. Changes in Renal Function After Switching From TDF to TAF in HIV-Infected Individuals: A Prospective Cohort Study. J Infect Dis 2020; 222:637-645. [DOI: 10.1093/infdis/jiaa125] [Citation(s) in RCA: 14] [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] [Received: 11/26/2019] [Accepted: 03/16/2020] [Indexed: 12/12/2022] Open
Abstract
AbstractBackgroundReplacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals but the impact on estimated glomerular filtration rate (eGFR) remains unclear.MethodsIn all participants from the Swiss HIV Cohort Study who switched from TDF to TAF-containing antiretroviral regimen or continued TDF, we estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models.ResultsOf 3520 participants (26.6% women, median age 50 years), 2404 (68.5%) switched to TAF. Overall, 1664 (47.3%) had an eGFR <90 mL/min and 1087 (30.9%) an UPCR ≥15 mg/mmol. In patients with baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (−1.7 mL/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% confidence interval [CI], .5–2.5) if the baseline eGFR was 60–89 mL/min, and 4.1 mL/min (95% CI, 1.6–6.6) if <60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI, 2.3–9.3) with continued use of TDF in individuals with baseline eGFR <60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR.ConclusionsSwitching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction.
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Affiliation(s)
- Bernard Surial
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcel Stöckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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6
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Kusejko K, Marzel A, Hampel B, Bachmann N, Nguyen H, Fehr J, Braun DL, Battegay M, Bernasconi E, Calmy A, Cavassini M, Hoffmann M, Böni J, Yerly S, Klimkait T, Perreau M, Rauch A, Günthard HF, Kouyos RD. Quantifying the drivers of HIV transmission and prevention in men who have sex with men: a population model-based analysis in Switzerland. HIV Med 2018; 19:688-697. [PMID: 30051600 DOI: 10.1111/hiv.12660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/25/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the huge success of antiretroviral therapy (ART), there is an ongoing HIV epidemic among men who have sex with men (MSM) in resource-rich countries. Understanding the driving factors underlying this process is important for curbing the epidemic. METHODS We simulated the HIV epidemic in MSM in Switzerland by stratifying a mathematical model by CD4 count, the care cascade and condom use. The model was parametrised with clinical, epidemiological and behavioural data from the Swiss HIV Cohort Study and surveys in the HIV-negative population. RESULTS According to our model, 3.4% of the cases that would otherwise have occurred in 2008-2015 were prevented by early initiation of ART. Only 0.6% of the cases were attributable to a change in condom use in the HIV-positive population, as less usage is mainly seen in virally suppressed MSM. Most new infections were attributable to transmission from recently infected undiagnosed individuals. It was estimated that doubling the diagnosis rate would have resulted in 11.8% fewer cases in 2001-2015. Moreover, it was estimated that introducing pre-exposure prophylaxis (PrEP) for 50% of those MSM not using condoms with occasional partners would have resulted in 22.6% fewer cases in 2012-2015. CONCLUSIONS By combining observational data on the relevant epidemiological and clinical processes with a mathematical model, we showed that the 'test and treat' approach is most effective in reducing the number of new cases. Only a moderate population-level effect was estimated for early initiation of ART and a weak effect for the change in condom use of diagnosed MSM. Protecting HIV-negative individuals who are not using condoms with PrEP was shown to have a major impact.
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Affiliation(s)
- K Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - A Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - B Hampel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - N Bachmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - H Nguyen
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - J Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - D L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - A Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - M Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hoffmann
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - J Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - S Yerly
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - T Klimkait
- Molecular Virology, Department of Biomedicine-Petersplatz, University of Basel, Basel, Switzerland
| | - M Perreau
- Division of Immunology and Allergy, University of Lausanne, Lausanne, Switzerland
| | - A Rauch
- Clinic for Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - R D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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7
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Kletenkov K, Hoffmann D, Böni J, Yerly S, Aubert V, Schöni-Affolter F, Struck D, Verheyen J, Klimkait T. Role of Gag mutations in PI resistance in the Swiss HIV cohort study: bystanders or contributors? J Antimicrob Chemother 2017; 72:866-875. [PMID: 27999036 DOI: 10.1093/jac/dkw493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/15/2016] [Indexed: 12/24/2022] Open
Abstract
Background HIV Gag mutations have been reported to confer PI drug resistance. However, clinical implications are still controversial and most current genotyping algorithms consider solely the protease gene for assessing PI resistance. Objectives Our goal was to describe for HIV infections in Switzerland the potential role of the C-terminus of Gag (NC-p6) in PI resistance. We aimed to characterize resistance-relevant mutational patterns in Gag and protease and their possible interactions. Methods Resistance information on plasma samples from 2004-12 was collected for patients treated by two diagnostic centres of the Swiss HIV Cohort Study. Sequence information on protease and the C-terminal Gag region was paired with the corresponding patient treatment history. The prevalence of Gag and protease mutations was analysed for PI treatment-experienced patients versus PI treatment-naive patients. In addition, we modelled multiple paths of an assumed ordered accumulation of genetic changes using random tree mixture models. Results More than half of all PI treatment-experienced patients in our sample set carried HIV variants with at least one of the known Gag mutations, and 17.9% (66/369) carried at least one Gag mutation for which a phenotypic proof of PI resistance by in vitro mutagenesis has been reported. We were able to identify several novel Gag mutations that are associated with PI exposure and therapy failure. Conclusions Our analysis confirmed the association of Gag mutations, well known and new, with PI exposure. This could have clinical implications, since the level of potential PI drug resistance might be underestimated.
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Affiliation(s)
- K Kletenkov
- Molecular Virology, Department of Biomedicine - Petersplatz, University of Basel, Basel, Switzerland
| | - D Hoffmann
- Bioinformatics and Computational Biophysics, Centre for Medical Biotechnology, University of Duisburg-Essen, Duisburg, Germany
| | - J Böni
- Institute of Medical Virology, National Reference Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - S Yerly
- Laboratory of Virology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - V Aubert
- Division of Immunology and Allergy, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - F Schöni-Affolter
- Swiss HIV Cohort Study, Data Centre, Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - D Struck
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - J Verheyen
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - T Klimkait
- Molecular Virology, Department of Biomedicine - Petersplatz, University of Basel, Basel, Switzerland
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8
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Marzel A, Shilaih M, Turk T, Campbell NK, Yang WL, Böni J, Yerly S, Klimkait T, Aubert V, Furrer H, Calmy A, Battegay M, Cavassini M, Bernasconi E, Schmid P, Metzner KJ, Günthard HF, Kouyos RD. Mining for pairs: shared clinic visit dates identify steady HIV-positive partnerships. HIV Med 2017; 18:667-676. [PMID: 28378387 DOI: 10.1111/hiv.12507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Here we examined the hypothesis that some stable HIV-infected partnerships can be found in cohort studies, as the patients frequently attend the clinic visits together. METHODS Using mathematical approximations and shuffling to derive the probabilities of sharing a given number of visits by chance, we identified and validated couples that may represent either transmission pairs or serosorting couples in a stable relationship. RESULTS We analysed 434 432 visits for 16 139 Swiss HIV Cohort Study patients from 1990 to 2014. For 89 pairs, the number of shared visits exceeded the number expected. Of these, 33 transmission pairs were confirmed on the basis of three criteria: an extensive phylogenetic tree, a self-reported steady HIV-positive partnership, and risk group affiliation. Notably, 12 of the validated transmission pairs (36%; 12 of 33) were of a mixed ethnicity with a large median age gap [17.5 years; interquartile range (IQR) 11.8-22 years] and these patients harboured HIV-1 of predominantly non-B subtypes, suggesting imported infections. CONCLUSIONS In the context of the surge in research interest in HIV transmission pairs, this simple method widens the horizons of research on within-pair quasi-species exchange, transmitted drug resistance and viral recombination at the biological level and targeted prevention at the public health level.
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Affiliation(s)
- A Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - M Shilaih
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - T Turk
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - N K Campbell
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - W-L Yang
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - J Böni
- Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - S Yerly
- Laboratory of Virology, Geneva University Hospital, Geneva, Switzerland
| | - T Klimkait
- Molecular Virology, Department of Biomedicine-Petersplatz, University of Basel, Basel, Switzerland
| | - V Aubert
- Division of Immunology and Allergy, University Hospital Lausanne, Lausanne, Switzerland
| | - H Furrer
- Department of Infectious Diseases, Berne University Hospital and University of Berne, Berne, Switzerland
| | - A Calmy
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - P Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St. Gallen, Switzerland
| | - K J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - H F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - R D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
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9
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Bader J, Schöni-Affolter F, Böni J, Gorgievski-Hrisoho M, Martinetti G, Battegay M, Klimkait T. Correlating HIV tropism with immunological response under combination antiretroviral therapy. HIV Med 2016; 17:615-22. [PMID: 26991140 DOI: 10.1111/hiv.12365] [Citation(s) in RCA: 8] [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] [Accepted: 11/04/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A significant percentage of patients infected with HIV-1 experience only suboptimal CD4 cell recovery while treated with combination therapy (cART). It is still unclear whether viral properties such as cell tropism play a major role in this incomplete immune response. This study therefore intended to follow the tropism evolution of the HIV-1 envelope during periods of suppressive cART. METHODS Viruses from two distinct patient groups, one with good and another one with poor CD4 recovery after 5 years of suppressive cART, were genotypically analysed for viral tropism at baseline and at the end of the study period. RESULTS Patients with CCR5-tropic CC-motif chemokine receptor 5 viruses at baseline tended to maintain this tropism to the study end. Patients who had a CXCR4-tropic CXC-motif chemokine receptor 4 virus at baseline were overrepresented in the poor CD4 recovery group. Overall, however, the majority of patients presented with CCR5-tropic viruses at follow-up. CONCLUSIONS Our data lend support to the hypothesis that tropism determination can be used as a parameter for disease progression even if analysed long before the establishment of a poorer immune response. Moreover, the lasting predominating CCR5-tropism during periods of full viral control suggests the involvement of cellular mechanisms that preferentially reduce CXCR4-tropic viruses during cART.
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Affiliation(s)
- J Bader
- Molecular Virology, Department of Biomedicine - Petersplatz, University of Basel, Basel, Switzerland
| | - F Schöni-Affolter
- Swiss HIV Cohort Study (SHCS) Data Center, University Hospital Lausanne, Lausanne, Switzerland
| | - J Böni
- Institute of Medical Virology, National Center for Retroviruses, University of Zürich, Zürich, Switzerland
| | | | - G Martinetti
- Department of Microbiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - T Klimkait
- Molecular Virology, Department of Biomedicine - Petersplatz, University of Basel, Basel, Switzerland
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10
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Scherrer AU, von Wyl V, Yang WL, Kouyos RD, Böni J, Yerly S, Klimkait T, Aubert V, Cavassini M, Battegay M, Furrer H, Calmy A, Vernazza P, Bernasconi E, Günthard HF, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S. Emergence of Acquired HIV-1 Drug Resistance Almost Stopped in Switzerland: A 15-Year Prospective Cohort Analysis. Clin Infect Dis 2016; 62:1310-1317. [PMID: 26962075 DOI: 10.1093/cid/ciw128] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 11/10/2015] [Accepted: 01/05/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Drug resistance is a major barrier to successful antiretroviral treatment (ART). Therefore, it is important to monitor time trends at a population level. METHODS We included 11 084 ART-experienced patients from the Swiss HIV Cohort Study (SHCS) between 1999 and 2013. The SHCS is highly representative and includes 72% of patients receiving ART in Switzerland. Drug resistance was defined as the presence of ≥1 major mutation in a genotypic resistance test. To estimate the prevalence of drug resistance, data for patients with no resistance test was imputed based on the patient's risk of harboring drug-resistant viruses. RESULTS The emergence of new drug resistance mutations declined dramatically from 401 to 23 patients between 1999 and 2013. The upper estimated prevalence limit of drug resistance among ART-experienced patients decreased from 57.0% in 1999 to 37.1% in 2013. The prevalence of 3-class resistance decreased from 9.0% to 4.4% and was always <0.4% for patients who initiated ART after 2006. Most patients actively participating in the SHCS in 2013 with drug-resistant viruses initiated ART before 1999 (59.8%). Nevertheless, in 2013, 94.5% of patients who initiated ART before 1999 had good remaining treatment options based on Stanford algorithm. CONCLUSIONS Human immunodeficiency virus type 1 drug resistance among ART-experienced patients in Switzerland is a well-controlled relic from the era before combination ART. Emergence of drug resistance can be virtually stopped with new potent therapies and close monitoring.
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Affiliation(s)
- Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich
| | - Wan-Lin Yang
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
| | | | - Sabine Yerly
- Laboratory of Virology, Division of Infectious Diseases
| | | | | | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
| | - Hansjakob Furrer
- Department of Infectious Diseases, Berne University Hospital and University of Berne
| | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital
| | - Pietro Vernazza
- Division of Infectious Diseases, Cantonal Hospital St Gallen
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
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11
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Marzel A, Shilaih M, Yang WL, Böni J, Yerly S, Klimkait T, Aubert V, Braun DL, Calmy A, Furrer H, Cavassini M, Battegay M, Vernazza PL, Bernasconi E, Günthard HF, Kouyos RD, Aubert V, Battegay M, Bernasconi E, Böni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard HF, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos RD, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schöni-Affolter F, Schmid P, Schüpbach J, Speck R, Tarr P, Trkola A, Vernazza PL, Weber R, Yerly S. HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study. Clin Infect Dis 2015; 62:115-122. [PMID: 26387084 DOI: 10.1093/cid/civ732] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Reducing the fraction of transmissions during recent human immunodeficiency virus (HIV) infection is essential for the population-level success of "treatment as prevention". METHODS A phylogenetic tree was constructed with 19 604 Swiss sequences and 90 994 non-Swiss background sequences. Swiss transmission pairs were identified using 104 combinations of genetic distance (1%-2.5%) and bootstrap (50%-100%) thresholds, to examine the effect of those criteria. Monophyletic pairs were classified as recent or chronic transmission based on the time interval between estimated seroconversion dates. Logistic regression with adjustment for clinical and demographic characteristics was used to identify risk factors associated with transmission during recent or chronic infection. FINDINGS Seroconversion dates were estimated for 4079 patients on the phylogeny, and comprised between 71 (distance, 1%; bootstrap, 100%) to 378 transmission pairs (distance, 2.5%; bootstrap, 50%). We found that 43.7% (range, 41%-56%) of the transmissions occurred during the first year of infection. Stricter phylogenetic definition of transmission pairs was associated with higher recent-phase transmission fraction. Chronic-phase viral load area under the curve (adjusted odds ratio, 3; 95% confidence interval, 1.64-5.48) and time to antiretroviral therapy (ART) start (adjusted odds ratio 1.4/y; 1.11-1.77) were associated with chronic-phase transmission as opposed to recent transmission. Importantly, at least 14% of the chronic-phase transmission events occurred after the transmitter had interrupted ART. CONCLUSIONS We demonstrate a high fraction of transmission during recent HIV infection but also chronic transmissions after interruption of ART in Switzerland. Both represent key issues for treatment as prevention and underline the importance of early diagnosis and of early and continuous treatment.
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Affiliation(s)
- Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology, University of Zurich
| | - Mohaned Shilaih
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology, University of Zurich
| | - Wan-Lin Yang
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology, University of Zurich
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich
| | | | - Thomas Klimkait
- Molecular Virology, Department of Biomedicine-Petersplatz, University of Basel
| | | | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology, University of Zurich
| | | | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern
| | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
| | | | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology, University of Zurich
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology, University of Zurich
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12
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Hasse B, Tarr PE, Marques-Vidal P, Waeber G, Preisig M, Mooser V, Valeri F, Djalali S, Andri R, Bernasconi E, Calmy A, Cavassini M, Vernazza P, Battegay M, Weber R, Senn O, Vollenweider P, Ledergerber B, Aubert V, Barth J, Battegay M, Bernasconi E, Böni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Metzner K, Müller N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schöni-Affolter F, Schmid P, Schultze D, Schüpbach J, Speck R, Staehelin C, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S, Jean-Michel A, Murielle B, Jean Michel G, Christoph H, Thomas L, Pedro MV, Vincent M, Fred P, Martin P, Peter V, Roland VK, Aidacic V, Gerard W, Jürg B, Markus B, Heinz B, Martin B, Hans-Ulrich B, Ivo B, Reto C, Isabelle C, Corinne C, Sima D, Peter D, Simone E, Andrea F, Markus F, Claudius F, Jakob F, Ali GM, Matthias G, Denis H, Marcel H, Walter H, Simon H, Felix H, Paul H, Eva K, Vladimir K, Daniel K, Stephan K, Beat K, Benedict K, Heidi K, Vesna L, Giovanni L, Werner LH, Phillippe L, Severin L, Christoph M, Jürgen M, Damian M, Werner M, Titus M, Valentina N, Jakob R, Thomas R, Hana S, Frank S, Georg S, Oliver S, Pietro S, Jacques S, Alfred S, Alois S, Claudia S, Othmar S, Phuoc TT, Marco V, Alessandro V, René VA, Hans W, Fritz W, Johanna WS, Joseph W, Marco Z. Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population. Open Forum Infect Dis 2015; 2:ofv108. [PMID: 26284258 PMCID: PMC4536331 DOI: 10.1093/ofid/ofv108] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 04/28/2015] [Accepted: 07/05/2015] [Indexed: 01/12/2023] Open
Abstract
AIDS-associated morbidity has diminished due to excellent viral control. Multimorbidity are more prevalent and incident in Swiss HIV-positive persons compared to HIV-negative controls. However, smoking, but not HIV status, had a strong impact on cardiovascular risk and multimorbidity. Background. Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods. We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results. Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2–2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1–2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44–1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5–2.4; smoking: IRR = 2.0, 95% CI = 1.6–2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9–3.8; smoking: IRR = 2.6, 95% CI = 1.9–3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4–2.4; smoking: IRR = 1.7, 95% CI = 1.4–2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions. Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.
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Affiliation(s)
- Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich
| | - Philip E Tarr
- Division of Infectious Diseases and Hospital Epidemiology , Kantonsspital Baselland Bruderholz, University of Basel , Bruderholz
| | | | | | | | - Vincent Mooser
- Pathology and Laboratory Medicine , Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois)
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich
| | - Sima Djalali
- Institute of Primary Care, University of Zurich, University Hospital Zurich
| | - Rauch Andri
- Division of Infectious Diseases and Hospital Epidemiology , University and Inselspital Berne
| | - Enos Bernasconi
- Division of Infectious Diseases , Regional Hospital , Lugano
| | - Alexandra Calmy
- Division of Infectious Diseases , University Hospital Geneva
| | - Matthias Cavassini
- Division of Infectious Diseases , Centre Hospitalier Universitaire Vaudois and University of Lausanne
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology , Cantonal Hospital , St. Gallen
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel , Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich
| | | | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich
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Schaerer V, Haubitz S, Kovari H, Ledergerber B, Ambrosioni J, Cavassini M, Stoeckle M, Schmid P, Decosterd L, Aouri M, Böni J, Günthard HF, Furrer H, Metzner KJ, Fehr J, Rauch A. Protease inhibitors to treat hepatitis C in the Swiss HIV Cohort Study: high efficacy but low treatment uptake. HIV Med 2015; 16:599-607. [PMID: 26135140 DOI: 10.1111/hiv.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/13/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Direct-acting antiviral agents (DAAs) have become the standard of care for the treatment of chronic hepatitis C virus (HCV) infection. We aimed to assess treatment uptake and efficacy in routine clinical settings among HIV/HCV coinfected patients after the introduction of the first generation DAAs. METHODS Data on all Swiss HIV Cohort Study (SHCS) participants starting HCV protease inhibitor (PI) treatment between September 2011 and August 2013 were collected prospectively. The uptake and efficacy of HCV therapy were compared with those in the time period before the availability of PIs. RESULTS Upon approval of PI treatment in Switzerland in September 2011, 516 SHCS participants had chronic HCV genotype 1 infection. Of these, 57 (11%) started HCV treatment during the following 2 years with either telaprevir, faldaprevir or boceprevir. Twenty-seven (47%) patients were treatment-naïve, nine (16%) were patients with relapse and 21 (37%) were partial or null responders. Twenty-nine (57%) had advanced fibrosis and 15 (29%) had cirrhosis. End-of-treatment virological response was 84% in treatment-naïve patients, 88% in patients with relapse and 62% in previous nonresponders. Sustained virological response was 78%, 86% and 40% in treatment-naïve patients, patients with relapse and nonresponders, respectively. Treatment uptake was similar before (3.8 per 100 patient-years) and after (6.1 per 100 patient-years) the introduction of PIs, while treatment efficacy increased considerably after the introduction of PIs. CONCLUSIONS The introduction of PI-based HCV treatment in HIV/HCV-coinfected patients improved virological response rates, while treatment uptake remained low. Therefore, the introduction of PIs into the clinical routine was beneficial at the individual level, but had only a modest effect on the burden of HCV infection at the population level.
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Affiliation(s)
- V Schaerer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - S Haubitz
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - M Cavassini
- University Hospital Lausanne, Lausanne, Switzerland
| | - M Stoeckle
- University Hospital Basel, Basel, Switzerland
| | - P Schmid
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - L Decosterd
- University Hospital Lausanne, Lausanne, Switzerland
| | - M Aouri
- University Hospital Lausanne, Lausanne, Switzerland
| | - J Böni
- University of Zurich, Institute of Medical Virology, Zurich, Switzerland
| | - H F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - H Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - J Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - A Rauch
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
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Kouyos RD, Hasse B, Calmy A, Cavassini M, Furrer H, Stöckle M, Vernazza PL, Bernasconi E, Weber R, Günthard HF, Aubert V, Battegay M, Bernasconi E, Böni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schöni-Affolter F, Schmid P, Schüpbach J, Speck R, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S. Increases in Condomless Sex in the Swiss HIV Cohort Study. Open Forum Infect Dis 2015; 2:ofv077. [PMID: 26180827 PMCID: PMC4498263 DOI: 10.1093/ofid/ofv077] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 02/16/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023] Open
Abstract
Condomless sex is a key driver of sexually transmitted diseases. In this study, we assess the long-term changes (2000-2013) of the occurrence of condomless sex among human immunodeficiency virus (HIV)-infected individuals enrolled in the Swiss HIV Cohort study. The frequencies with which HIV-infected individuals reported condomless sex were either stable or only weakly increasing for 2000-2008. For 2008-2013, these rates increased significantly for stable relationships among heterosexuals and men who have sex with men (MSM) and for occasional relationships among MSM. Our results highlight the increasing public health challenge posed by condomless sex and show that condomless sex has been increasing even in the most recent years.
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Affiliation(s)
- Roger D Kouyos
- University Hospital Zurich Division of Infectious Diseases and Hospital Epidemiology ; Institute of Medical Virology , University of Zurich , Switzerland
| | - Barbara Hasse
- University Hospital Zurich Division of Infectious Diseases and Hospital Epidemiology
| | - Alexandra Calmy
- Division of Infectious Diseases , Geneva University Hospital , Switzerland
| | | | - Hansjakob Furrer
- Department of Infectious Diseases , Bern University Hospital and University of Bern , Switzerland
| | - Marcel Stöckle
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel , Switzerland
| | - Pietro L Vernazza
- Division of Infectious Diseases , Cantonal Hospital St. Gallen , Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases , Regional Hospital Lugano , Switzerland
| | - Rainer Weber
- University Hospital Zurich Division of Infectious Diseases and Hospital Epidemiology
| | - Huldrych F Günthard
- University Hospital Zurich Division of Infectious Diseases and Hospital Epidemiology ; Institute of Medical Virology , University of Zurich , Switzerland
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15
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Wandeler G, Schlauri M, Jaquier ME, Rohrbach J, Metzner KJ, Fehr J, Ambrosioni J, Cavassini M, Stöckle M, Schmid P, Bernasconi E, Keiser O, Salazar-Vizcaya L, Furrer H, Rauch A, Aubert V, Battegay M, Bernasconi E, Böni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schöni-Affolter F, Schmid P, Schüpbach J, Speck R, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Incident Hepatitis C Virus Infections in the Swiss HIV Cohort Study: Changes in Treatment Uptake and Outcomes Between 1991 and 2013. Open Forum Infect Dis 2015; 2:ofv026. [PMID: 26034775 PMCID: PMC4438905 DOI: 10.1093/ofid/ofv026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 11/03/2014] [Accepted: 02/12/2015] [Indexed: 12/29/2022] Open
Abstract
Background. The hepatitis C virus (HCV) epidemic is evolving rapidly in patients infected with human immunodeficiency virus (HIV). We aimed to describe changes in treatment uptake and outcomes of incident HCV infections before and after 2006, the time-point at which major changes in HCV epidemic became apparent. Methods. We included all adults with an incident HCV infection before June 2012 in the Swiss HIV Cohort Study, a prospective nationwide representative cohort of individuals infected with HIV. We assessed the following outcomes by time period: the proportion of patients starting an HCV therapy, the proportion of treated patients achieving a sustained virological response (SVR), and the proportion of patients with persistent HCV infection during follow-up. Results. Of 193 patients with an HCV seroconversion, 106 were diagnosed before and 87 after January 2006. The proportion of men who have sex with men increased from 24% before to 85% after 2006 (P < .001). Hepatitis C virus treatment uptake increased from 33% before 2006 to 77% after 2006 (P < .001). Treatment was started during early infection in 22% of patients before and 91% after 2006 (P < .001). An SVR was achieved in 78% and 29% (P = .01) of patients treated during early and chronic HCV infection. The probability of having a detectable viral load 5 years after diagnosis was 0.67 (95% confidence interval [CI], 0.58-0.77) in the group diagnosed before 2006 and 0.24 (95% CI, 0.16-0.35) in the other group (P < .001). Conclusions. In recent years, increased uptake and earlier initiation of HCV therapy among patients with incident infections significantly reduced the proportion of patients with replicating HCV.
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Affiliation(s)
- Gilles Wandeler
- Department of Infectious Diseases , Bern University Hospital and University of Bern , ; Institute of Social and Preventive Medicine , University of Bern
| | - Marion Schlauri
- Department of Infectious Diseases , Bern University Hospital and University of Bern
| | - Marie-Eve Jaquier
- Department of Infectious Diseases , Bern University Hospital and University of Bern
| | - Janine Rohrbach
- Department of Infectious Diseases , Bern University Hospital and University of Bern
| | - Karin J Metzner
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich, University of Zurich
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich, University of Zurich
| | | | | | | | | | | | - Olivia Keiser
- Institute of Social and Preventive Medicine , University of Bern
| | | | - Hansjakob Furrer
- Department of Infectious Diseases , Bern University Hospital and University of Bern
| | - Andri Rauch
- Department of Infectious Diseases , Bern University Hospital and University of Bern
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16
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Hasse B, Iff M, Ledergerber B, Calmy A, Schmid P, Hauser C, Cavassini M, Bernasconi E, Marzolini C, Tarr PE, Aubert V, Barth J, Battegay M, Bernasconi E, Böni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Metzner K, Müller N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schöni-Affolter F, Schmid P, Schultze D, Schüpbach J, Speck R, Staehelin C, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Obesity Trends and Body Mass Index Changes After Starting Antiretroviral Treatment: The Swiss HIV Cohort Study. Open Forum Infect Dis 2014; 1:ofu040. [PMID: 25734114 PMCID: PMC4281814 DOI: 10.1093/ofid/ofu040] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 03/11/2014] [Accepted: 05/20/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The factors that contribute to increasing obesity rates in human immunodeficiency virus (HIV)-positive persons and to body mass index (BMI) increase that typically occurs after starting antiretroviral therapy (ART) are incompletely characterized. METHODS We describe BMI trends in the entire Swiss HIV Cohort Study (SHCS) population and investigate the effects of demographics, HIV-related factors, and ART on BMI change in participants with data available before and 4 years after first starting ART. RESULTS In the SHCS, overweight/obesity prevalence increased from 13% in 1990 (n = 1641) to 38% in 2012 (n = 8150). In the participants starting ART (n = 1601), mean BMI increase was 0.92 kg/m(2) per year (95% confidence interval, .83-1.0) during year 0-1 and 0.31 kg/m(2) per year (0.29-0.34) during years 1-4. In multivariable analyses, annualized BMI change during year 0-1 was associated with older age (0.15 [0.06-0.24] kg/m(2)) and CD4 nadir <199 cells/µL compared to nadir >350 (P < .001). Annualized BMI change during years 1-4 was associated with CD4 nadir <100 cells/µL compared to nadir >350 (P = .001) and black compared to white ethnicity (0.28 [0.16-0.37] kg/m(2)). Individual ART combinations differed little in their contribution to BMI change. CONCLUSIONS Increasing obesity rates in the SHCS over time occurred at the same time as aging of the SHCS population, demographic changes, earlier ART start, and increasingly widespread ART coverage. Body mass index increase after ART start was typically biphasic, the BMI increase in year 0-1 being as large as the increase in years 1-4 combined. The effect of ART regimen on BMI change was limited.
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Affiliation(s)
- Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich and University of Zurich , Switzerland
| | - Martin Iff
- Infectious Diseases Service , Kantonsspital Baselland, University of Basel , Bruderholz , Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich and University of Zurich , Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases , University Hospital Geneva , Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases , Cantonal Hospital , St. Gallen , Switzerland
| | - Christoph Hauser
- Division of Infectious Diseases , University Hospital Bern , Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases , Centre Hospitalier Universitaire Vaudois and University of Lausanne , Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases , Regional Hospital , Lugano , Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel , Switzerland
| | - Philip E Tarr
- Infectious Diseases Service , Kantonsspital Baselland, University of Basel , Bruderholz , Switzerland
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17
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Braun DL, Rauch A, Durisch N, Eberhard N, Anagnostopoulos A, Ledergerber B, Metzner KJ, Böni J, Weber R, Fehr J. Efficacy of lead-in silibinin and subsequent triple therapy in difficult-to-treat HIV/hepatitis C virus-coinfected patients. HIV Med 2014; 15:625-30. [PMID: 24894776 DOI: 10.1111/hiv.12166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 04/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The efficacy of current hepatitis C virus (HCV) triple therapy, including a protease inhibitor, is limited in HIV/HCV-coinfected patients with advanced liver fibrosis and nonresponse to previous peginterferon-ribavirin. These patients have a low chance (only 30%) of achieving a sustained virological response (SVR) during triple therapy and cannot wait for next-generation anti-HCV drugs. In a pilot study, we investigated the efficacy of a lead-in therapy with silibinin before triple therapy in difficult-to-treat patients. METHODS Inclusion criteria were HIV/HCV coinfection with advanced liver fibrosis and documented failure of previous peginterferon-ribavirin treatment. Intervention was lead-in therapy with intravenous silibinin 20 mg/kg/day for 14 days. Subsequently, peginterferon-ribavirin combined with telaprevir was initiated for 12 weeks, followed by peginterferon-ribavirin dual therapy until week 48 after initiation of triple therapy. The outcome measurements were HCV RNA after silibinin lead-in, at weeks 2, 4 and 12 of triple therapy, and SVR at week 24 after the end of treatment. RESULTS We examined six HIV/HCV-coinfected patients (four infected with genotype 1a). All had fibrosis grade METAVIR ≥F3 and were on fully suppressive antiretroviral therapy. Mean HCV RNA decline after silibinin therapy was 2.6 log10 IU/mL (range 2-3 log10 IU/mL). Five of the six patients were virologically suppressed at weeks 2 and 4, and all six at week 12 of triple therapy. One experienced a viral breakthrough thereafter. Four of five patients (80%) showed an SVR 24. One patient had an SVR 12 but has not yet reached week 24. CONCLUSIONS A lead-in with silibinin before triple therapy is highly effective and increases the probability of HCV treatment success in difficult-to-treat HIV/HCV-coinfected patients with advanced liver fibrosis and previous failure of peginterferon-ribavirin.
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Affiliation(s)
- D L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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18
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Arab-Alameddine M, Lubomirov R, Fayet-Mello A, Aouri M, Rotger M, Buclin T, Widmer N, Gatri M, Ledergerber B, Rentsch K, Cavassini M, Panchaud A, Guidi M, Telenti A, Décosterd LA, Csajka C, Battegay M, Bernasconi E, Böni J, Bucher HC, Bürgisser P, Calmy A, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Fux CA, Gorgievski M, Günthard H, Hirsch HH, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Kind C, Klimkait T, Ledergerber B, Martinetti G, Müller N, Nadal D, Paccaud F, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, de Tejada BM, Taffé P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Population pharmacokinetic modelling and evaluation of different dosage regimens for darunavir and ritonavir in HIV-infected individuals. J Antimicrob Chemother 2014; 69:2489-98. [DOI: 10.1093/jac/dku131] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- M. Arab-Alameddine
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - R. Lubomirov
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A. Fayet-Mello
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - M. Aouri
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - M. Rotger
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - T. Buclin
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - N. Widmer
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - M. Gatri
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - B. Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K. Rentsch
- Clinical Chemistry, University Hospital Basel, Basel, Switzerland
| | - M. Cavassini
- Division of Infectious Diseases, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - A. Panchaud
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - M. Guidi
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - A. Telenti
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - L. A. Décosterd
- Clinical Pharmacology Laboratory, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C. Csajka
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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19
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Schüpbach J, Bisset LR, Regenass S, Bürgisser P, Gorgievski M, Steffen I, Andreutti C, Martinetti G, Shah C, Yerly S, Klimkait T, Gebhardt M, Schöni-Affolter F, Rickenbach M, Barth J, Battegay M, Bernascon E, Böni J, Bucher HC, Bürgisser P, Burton-Jeangros C, Calmy A, Cavassini M, Dubs R, Egger M, Elzi L, Fehr J, Fischer M, Flepp M, Francioli P, Furrer H, Fux CA, Gorgievski M, Günthard H, Hasse B, Hirsch HH, Hirschel B, Hösli I, Kahlert C, Kaiser L, Keiser O, Kind C, Klimkait T, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Müller N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schmid P, Schultze D, Schöni-Affolter F, Schüpbach J, Speck R, Taffé P, Telenti A, Trkola A, Vernazza P, von Wyl V, Weber R, Yerly S. High specificity of line-immunoassay based algorithms for recent HIV-1 infection independent of viral subtype and stage of disease. BMC Infect Dis 2011; 11:254. [PMID: 21943091 PMCID: PMC3190377 DOI: 10.1186/1471-2334-11-254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 09/26/2011] [Indexed: 11/29/2022] Open
Abstract
Background Serologic testing algorithms for recent HIV seroconversion (STARHS) provide important information for HIV surveillance. We have shown that a patient's antibody reaction in a confirmatory line immunoassay (INNO-LIATM HIV I/II Score, Innogenetics) provides information on the duration of infection. Here, we sought to further investigate the diagnostic specificity of various Inno-Lia algorithms and to identify factors affecting it. Methods Plasma samples of 714 selected patients of the Swiss HIV Cohort Study infected for longer than 12 months and representing all viral clades and stages of chronic HIV-1 infection were tested blindly by Inno-Lia and classified as either incident (up to 12 m) or older infection by 24 different algorithms. Of the total, 524 patients received HAART, 308 had HIV-1 RNA below 50 copies/mL, and 620 were infected by a HIV-1 non-B clade. Using logistic regression analysis we evaluated factors that might affect the specificity of these algorithms. Results HIV-1 RNA <50 copies/mL was associated with significantly lower reactivity to all five HIV-1 antigens of the Inno-Lia and impaired specificity of most algorithms. Among 412 patients either untreated or with HIV-1 RNA ≥50 copies/mL despite HAART, the median specificity of the algorithms was 96.5% (range 92.0-100%). The only factor that significantly promoted false-incident results in this group was age, with false-incident results increasing by a few percent per additional year. HIV-1 clade, HIV-1 RNA, CD4 percentage, sex, disease stage, and testing modalities exhibited no significance. Results were similar among 190 untreated patients. Conclusions The specificity of most Inno-Lia algorithms was high and not affected by HIV-1 variability, advanced disease and other factors promoting false-recent results in other STARHS. Specificity should be good in any group of untreated HIV-1 patients.
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Affiliation(s)
- Jörg Schüpbach
- University of Zurich, Institute of Medical Virology, Swiss National Center for Retroviruses, Zurich, Switzerland.
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Young J, Scherrer AU, Günthard HF, Opravil M, Yerly S, Böni J, Rickenbach M, Fux CA, Cavassini M, Bernasconi E, Vernazza P, Hirschel B, Battegay M, Bucher HC. Efficacy, tolerability and risk factors for virological failure of darunavir-based therapy for treatment-experienced HIV-infected patients: the Swiss HIV Cohort Study. HIV Med 2010; 12:299-307. [PMID: 20955357 DOI: 10.1111/j.1468-1293.2010.00885.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Darunavir was designed for activity against HIV resistant to other protease inhibitors (PIs). We assessed the efficacy, tolerability and risk factors for virological failure of darunavir for treatment-experienced patients seen in clinical practice. METHODS We included all patients in the Swiss HIV Cohort Study starting darunavir after recording a viral load above 1000 HIV-1 RNA copies/mL given prior exposure to both PIs and nonnucleoside reverse transcriptase inhibitors. We followed these patients for up to 72 weeks, assessed virological failure using different loss of virological response algorithms and evaluated risk factors for virological failure using a Bayesian method to fit discrete Cox proportional hazard models. RESULTS Among 130 treatment-experienced patients starting darunavir, the median age was 47 years, the median duration of HIV infection was 16 years, and 82% received mono or dual antiretroviral therapy before starting highly active antiretroviral therapy. During a median patient follow-up period of 45 weeks, 17% of patients stopped taking darunavir after a median exposure of 20 weeks. In patients followed beyond 48 weeks, the rate of virological failure at 48 weeks was at most 20%. Virological failure was more likely where patients had previously failed on both amprenavir and saquinavir and as the number of previously failed PI regimens increased. CONCLUSIONS As a component of therapy for treatment-experienced patients, darunavir can achieve a similar efficacy and tolerability in clinical practice to that seen in clinical trials. Clinicians should consider whether a patient has failed on both amprenavir and saquinavir and the number of failed PI regimens before prescribing darunavir.
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Affiliation(s)
- J Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
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Clerc O, Cavassini M, Böni J, Schüpbach J, Bürgisser P. Prolonged seroconversion in an elite controller of HIV-1 infection. J Clin Virol 2009; 46:371-3. [DOI: 10.1016/j.jcv.2009.09.005] [Citation(s) in RCA: 2] [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] [Received: 08/28/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
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22
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Scherrer AU, Hasse B, von Wyl V, Yerly S, Böni J, Bürgisser P, Klimkait T, Bucher HC, Ledergerber B, Günthard HF. Prevalence of etravirine mutations and impact on response to treatment in routine clinical care: the Swiss HIV Cohort Study (SHCS). HIV Med 2009; 10:647-56. [DOI: 10.1111/j.1468-1293.2009.00756.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fux CA, Simcock M, Wolbers M, Bucher HC, Hirschel B, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Elzi L, Furrer H, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Fux C, Gorgievski M, Günthard H, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Keiser O, Kind C, Klimkait T, Ledergerber B, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Perrin L, Piffaretti JC, Rauch A, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Tenofovir Use is associated with a Reduction in Calculated Glomerular Filtration Rates in the Swiss HIV Cohort Study. Antivir Ther 2007. [DOI: 10.1177/135965350701200812] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background A growing number of case reports have described tenofovir (TDF)-related proximal renal tubulopathy and impaired calculated glomerular filtration rates (cGFR). We assessed TDF-associated changes in cGFR in a large observational HIV cohort. Methods We compared treatment-naive patients or patients with treatment interruptions ≥12 months starting either a TDF-based combination antiretroviral therapy (cART) ( n=363) or a TDF-sparing regime ( n=715). The predefined primary endpoint was the time to a 10 ml/min reduction in cGFR, based on the Cockcroft-Gault equation, confirmed by a follow-up measurement at least 1 month later. In sensitivity analyses, secondary endpoints including calculations based on the modified diet in renal disease (MDRD) formula were considered. Endpoints were modelled using pre-specified covariates in a multiple Cox proportional hazards model. Results Two-year event-free probabilities were 0.65 (95% confidence interval [CI] 0.58–0.72) and 0.80 (95% CI 0.76–0.83) for patients starting TDF-containing or TDF-sparing cART, respectively. In the multiple Cox model, diabetes mellitus (hazard ratio [HR]=2.34 [95% CI 1.24–4.42]), higher baseline cGFR (HR=1.03 [95% CI 1.02–1.04] by 10 ml/min), TDF use (HR=1.84 [95% CI 1.35–2.51]) and boosted protease inhibitor use (HR=1.71 [95% CI 1.30–2.24]) significantly increased the risk for reaching the primary endpoint. Sensitivity analyses showed high consistency. Conclusion There is consistent evidence for a significant reduction in cGFR associated with TDF use in HIV-infected patients. Our findings call for a strict monitoring of renal function in long-term TDF users with tests that distinguish between glomerular dysfunction and proximal renal tubulopathy, a known adverse effect of TDF.
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Affiliation(s)
- Christoph A Fux
- Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - Mathew Simcock
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Marcel Wolbers
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | - Luigia Elzi
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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24
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Keiser O, Fellay J, Opravil M, Hirsch HH, Hirschel B, Bernasconi E, Vernazza PL, Rickenbach M, Telenti A, Furrer H, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Keiser O, Kind C, Klimkait T, Ledergerber B, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Perrin L, Piffaretti JC, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Adverse Events to Antiretrovirals in the Swiss HIV Cohort Study: Effect on Mortality and Treatment Modification. Antivir Ther 2007. [DOI: 10.1177/135965350701200808] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Antiretroviral therapy (ART) decreases morbidity and mortality in HIV-infected patients but is associated with considerable adverse events (AEs). Methods We examined the effect of AEs to ART on mortality, treatment modifications and drop-out in the Swiss HIV Cohort Study. A cross-sectional evaluation of prevalence of 13 clinical and 11 laboratory parameters was performed in 1999 in 1,078 patients on ART. AEs were defined as abnormalities probably or certainly related to ART. A score including the number and severity of AEs was defined. The subsequent progression to death, drop-out and treatment modification due to intolerance were evaluated according to the baseline AE score and characteristics of individual AEs. Results Of the 1,078 patients, laboratory AEs were reported in 23% and clinical AEs in 45%. During a median follow up of 5.9 years, laboratory AEs were associated with higher mortality with an adjusted hazard ratio (HR) of 1.3 (95% confidence interval [CI] 1.2–1.5; P<0.001) per score point. For clinical AEs no significant association with increased mortality was found. In contrast, an increasing score for clinical AEs (HR 1.11, 95% CI 1.04–1.18; P=0.002), but not for laboratory AEs (HR 1.07, 95% CI 0.97–1.17; P=0.17), was associated with antiretroviral treatment modification. AEs were not associated with a higher drop-out rate. Conclusions The burden of laboratory AEs to antiretroviral drugs is associated with a higher mortality. Physicians seem to change treatments to relieve clinical symptoms, while accepting laboratory AEs. Minimizing laboratory drug toxicity seems warranted and its influence on survival should be further evaluated.
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Affiliation(s)
- Olivia Keiser
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Jacques Fellay
- Division of Infectious Diseases and Institute of Microbiology, University Hospital Lausanne, CHUV, Switzerland
| | - Milos Opravil
- Division of Infectious Diseases, University Hospital Zürich, Switzerland
| | - Hans H Hirsch
- Infectious Diseases and Hospital Epidemiolgy, University Hospital and Institute for Medical Microbiology, University of Basel, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Switzerland
| | - Pietro L Vernazza
- Division of Infectious Diseases, Kantonsspital St. Gallen, Switzerland
| | | | - Amalio Telenti
- Division of Infectious Diseases and Institute of Microbiology, University Hospital Lausanne, CHUV, Switzerland
| | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Bern, University of Bern, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother and Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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Simcock M, Blasko M, Karrer U, Bertisch B, Pless M, Blumer L, Vora S, Robinson JO, Bernasconi E, Terziroli B, Moirandat-Rytz S, Furrer H, Hirschel B, Vernazza P, Sendi P, Rickenbach M, Bucher HC, Battegay M, Koller MT, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirsch H, Hirschel B, Hösli IH, Kahlert C, Kaiser L, Karrer U, Kind C, Klimkait T, Ledergerber B, Martinetti G, Martinez B, uUller NM, Nadal D, Opravil M, Paccaud F, Pantaleo G, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Treatment and Prognosis of AIDS-Related Lymphoma in the Era of Highly Active Antiretroviral Therapy: Findings from the Swiss HIV Cohort Study. Antivir Ther 2007. [DOI: 10.1177/135965350701200609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the characteristics of combination antiretroviral therapy (cART) administered concomitantly with chemotherapy and to establish prognostic determinants of patients with AIDS-related non-Hodgkin's lymphoma. Methods The study included 91 patients with AIDS-related non-Hodgkin's lymphoma from the Swiss HIV Cohort Study enrolled between January 1997 and October 2003, excluding lymphomas of the brain. We extracted AIDS-related non-Hodgkin's lymphoma- and HIV-specific variables at the time of lymphoma diagnosis as well as treatment changes over time from charts and from the Swiss HIV Cohort Study database. Cox regression analyses were performed to study predictors of overall and progression-free survival. Results During a median follow up of 1.6 years, 57 patients died or progressed. Thirty-five patients stopped chemotherapy prematurely (before the sixth cycle) usually due to disease progression; these patients had a shorter median survival than those who completed six or more cycles (14 versus 28 months). Interruptions of cART decreased from 35% before chemotherapy to 5% during chemotherapy. Factors associated with overall survival were CD4+ T-cell count (<100 cells/μl) (hazard ratio [HR] 2.95 [95% confidence interval (CI) 1.53–5.67], hepatitis C seropositivity (HR 2.39 [95% CI 1.01–5.67]), the international prognostic index score (HR 1.98–3.62 across categories) and Burkitt histological subtypes (HR 2.56 [95% CI 1.13–5.78]). Conclusions Interruptions of cART were usually not induced by chemotherapy. The effect of cART interruptions on AIDS-related non-Hodgkin's lymphoma prognosis remains unclear, however, hepatitis C seropositivity emerged as a predictor of death beyond the well-known international prognostic index score and CD4+ T-cell count.
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Affiliation(s)
- Mathew Simcock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Monika Blasko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Urs Karrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Barbara Bertisch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Miklos Pless
- Division of Oncology, University Hospital Basel, Switzerland
| | - Liisa Blumer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Samir Vora
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | | | | | | | | | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Bern, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | | | - Pedram Sendi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Martin Rickenbach
- Data Centre of the Swiss HIV Cohort Study, University Hospital Lausanne, Switzerland
| | - Heiner C Bucher
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Michael T Koller
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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26
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Wolbers M, Battegay M, Hirschel B, Furrer H, Cavassini M, Hasse B, Vernazza PL, Bernasconi E, Kaufmann G, Bucher HC, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirsch H, Hirschel B, Hösli IH, Kahlert C, Kaiser L, Karrer U, Kind C, Klimkait T, Ledergerber B, Martinetti G, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. CD4 + T-Cell Count Increase in HIV-1-Infected Patients with Suppressed Viral Load Within 1 year after start of antiretroviral therapy. Antivir Ther 2007. [DOI: 10.1177/135965350701200602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background CD4+ T-cell recovery in patients with continuous suppression of plasma HIV-1 viral load (VL) is highly variable. This study aimed to identify predictive factors for long-term CD4+ T-cell increase in treatment-naive patients starting combination antiretroviral therapy (cART). Methods Treatment-naive patients in the Swiss HIV Cohort Study reaching two VL measurements <50 copies/ml >3 months apart during the 1st year of cART were included ( n=1,816 patients). We studied CD4+ T-cell dynamics until the end of suppression or up to 5 years, subdivided into three periods: 1st year, years 2–3 and years 4–5 of suppression. Multiple median regression adjusted for repeated CD4+T-cell measurements was used to study the dependence of CD4+ T-cell slopes on clinical covariates and drug classes. Results Median CD4+ T-cell increases following VL suppression were 87, 52 and 19 cells/μl per year in the three periods. In the multiple regression model, median CD4+ T-cell increases over all three periods were significantly higher for female gender, lower age, higher VL at cART start, CD4+ T-cell <650 cells/μ l at start of the period and low CD4+ T-cell increase in the previous period. Patients on tenofovir showed significantly lower CD4+T-cell increases compared with stavudine. Conclusions In our observational study, long-term CD4+ T-cell increase in drug-naive patients with suppressed VL was higher in regimens without tenofovir. The clinical relevance of these findings must be confirmed in, ideally, clinical trials or large, collaborative cohort projects but could influence treatment of older patients and those starting cART at low CD4+ T-cell levels.
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Affiliation(s)
- Marcel Wolbers
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Berne, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Pietro L Vernazza
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Gilbert Kaufmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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27
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Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Keiser O, Kind C, Klimkait T, Ledergerber B, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Perrin L, Bijker JC, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S, Elzi L, Spoerl D, Voggensperger J, Nicca D, Simcock M, Bucher HC, Spirig R, Battegay M. A Smoking Cessation Programme in HIV-Infected Individuals: A Pilot Study. Antivir Ther 2006. [DOI: 10.1177/135965350601100611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Antiretroviral therapy (ART) is a risk factor for cardiovascular disease (CVD) and smoking the most important modifiable cardiovascular risk factor. Methods We prospectively evaluated a smoking cessation programme (SCP) in HIV-infected individuals (intervention: counselling and nicotine replacement therapy). Primary endpoint was the smoking cessation rate at 12 months; secondary endpoints were CVD morbidity and mortality. Controls were a not randomized control group of smokers not participating in the SCP. Results Four-hundred and seventeen of 680 (61%) patients were smokers, and 34 of these participated in the SCP. Of these 34 individuals, 82% were male, the median age was 43 years, prior AIDS was recorded in 29%, and depressive disorder was recorded in 18%. Twenty-five (74%) patients were receiving ART. Additional risk factors were dyslipidaemia (68%), a prior cardiovascular event (24%), hypertension (15%), and a family history of CVD in 2/34 (6%) individuals. According to the Framingham equation, the 10-year risk of CVD was higher in SCP participants than in controls (11.2% versus 8.5%, P=0.06). At termination of the SCP, 17/34 (50%) individuals had stopped smoking compared with 57/383 (15%) controls. Self-reported smoking abstinence for ≥12 months was 13/34 (38%) in the intervention group and 27/383 (7%) in the control group (odds ration 6.2, 95% confidence interval 2.8–14.3). During the follow-up, two SCP participants and 4 controls experienced a myocardial infarction. One patient in the control group died of CVD. Conclusions SCP in HIV-infected individuals is feasible and should be encouraged. The long-term impact of smoking cessation on CVD morbidity and mortality should be evaluated in comparative trials.
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Affiliation(s)
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
| | | | - R Weber
- Chairman of the Scientific Board
| | - S Yerly
- Chairman of the Scientific Board
| | - Luigia Elzi
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
| | - David Spoerl
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
| | - Jacqueline Voggensperger
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
- Outpatient Department of Internal Medicine, University Hospital Basel
| | - Dunja Nicca
- Outpatient Department of Internal Medicine, University Hospital Basel
- Institute of Nursing Sciences, University of Basel
| | - Mathew Simcock
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
- Basel Institute for Clinical Epidemiology, University Hospital Basel
| | - Heiner C Bucher
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
- Basel Institute for Clinical Epidemiology, University Hospital Basel
| | | | - Manuel Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
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28
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Seemayer CA, Böni J, Steiger J, Schüpbach J, Mihatsch MJ. No indication for activation of exogenous retroviruses in patients with renal allograft rejection. Clin Nephrol 2006; 65:324-7. [PMID: 16724652 DOI: 10.5414/cnp65324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM Reactivation of latent BK virus in kidney-transplanted patients results in severe graft dysfunction. The role of retroviruses infecting also latently target cells is not investigated so far in this setting. We determined the presence or induction of retroviruses in sera of immunosuppressed patients with renal allografts at the timepoint of organ rejection or ongoing polyomavirus nephropathy. PATIENTS AND METHODS Sera of patients with acute kidney rejection or polyomavirus nephropathy (n=25) and controls (n=8) were tested for reverse transcriptase activity by the ultrasensitive product enhanced reverse transcriptase (PERT) assay. In parallel, kidney biopsies were investigated for histological signs of kidney rejection or polyomavirus nephropathy confirmed by either immunofluorescence or immunohistochemistry. RESULTS None of the investigated sera, specifically those of patients with ongoing BK virus nephropathy, indicated reverse transcriptase activity. CONCLUSION Our results do not support the idea of the induction of known or unknown retroviruses in patients with kidney transplantation, even under highly immunosuppressive therapies.
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Affiliation(s)
- C A Seemayer
- Institute for Pathology, University Hospital Basle, Switzerland
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29
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Aceto L, Karrer U, Grube C, Oberholzer R, Hasse B, Presterl E, Böni J, Kuster H, Trkola A, Weber R, Günthard HF. [Primary HIV-1 infection in Zurich: 2002-2004]. Praxis (Bern 1994) 2005; 94:1199-205. [PMID: 16128207 DOI: 10.1024/0369-8394.94.32.1199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Acute HIV-infection mostly presents with unspecifc symptoms. Thus the acute retroviral syndrome is often not readily recognized. Here we present an interim analysis of a prospective study from 62 patients with documented acute HIV infection acquired between January 2002-August 2004 in the greater Zurich area. 61.5% of patients were infected by homosexual contacts, mostly with HIV-1 subtype B, 34% acquired infection by heterosexual contacts, often with non-B-virus subtypes. Transmission occurred in all sexually active age groups (18-72 years). Clinical symptoms presented as follows: fever (77%), pharyngitis (56%), fatigue (52%), gastrointestinal symptoms (45%), rash (39%). On first physician contact, an ARS was only suspected in 27% of the cases. Patients primarily called on their family doctors (37.5%), went to see larger walk in clinics or emergency rooms (37.5%), and 16% were hospitalised. In 16% of patients other sexually transmitted diseases were diagnosed contemporaneously. Drug resistant virus (single class resistance) was transmitted in only one patient.
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Affiliation(s)
- L Aceto
- Abteilung für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich
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30
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Young J, Weber R, Rickenbach M, Furrer H, Bernasconi E, Hirschel B, Tarr PE, Vernazza P, Battegay M, Bucher HC, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fantelli K, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirschel B, Kaiser L, Kind C, Klimkait T, Lauper U, Ledergerber B, Opravil M, Paccaud F, Pantaleo G, Perrin L, Piffaretti JC, Rudin C, Schmid P, Schüpbach J, Speck R, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Lipid Profiles for Antiretroviral-Naive Patients Starting Pi- and Nnrti-Based Therapy in the Swiss HIV Cohort Study. Antivir Ther 2005. [DOI: 10.1177/135965350501000511] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Blood lipid abnormalities in patients on highly active antiretroviral therapy (HAART) have been associated with exposure to protease inhibitors (PIs), particularly ritonavir. First therapy with a non-nucleoside reverse transcriptase inhibitor (NNRTI) leads to relatively favourable lipid profiles. We report on medium-term lipid profiles (up to 5 years) for antiretroviral-naive patients starting NNRTI- and PI-based HAART in the Swiss HIV Cohort Study. Methods Since April 2000, blood samples taken at visits scheduled every 6 months have been analysed for cholesterol and triglyceride concentrations. For 1065 antiretroviral-naive patients starting HAART after April 2000, we estimated changes in concentration over time using multivariate linear regression with adjustment for baseline covariates, use of lipid-lowering drugs and whether the sample was taken in a fasting state. Results Non-high density lipoprotein (HDL) cholesterol levels increase with increasing exposure to either PI- or NNRTI-based therapy, HDL cholesterol levels increase and triglyceride levels decrease with increasing exposure to NNRTI-based therapy, whereas triglyceride levels increase with increasing exposure to PI-based therapy. Between NNRTI-based therapies, there is a slight difference in triglyceride levels, which tend to increase with increasing exposure to efavirenz and to decrease with increasing exposure to nevirapine. Of the three common PI-based therapies, nelfinavir appears to have a relatively favourable lipid profile, with little change with increasing exposure. Of the other two PI therapies, lopinavir with ritonavir has a more favourable profile than indinavir with ritonavir, with smaller increases in both non-HDL cholesterol and triglycerides and an increase in HDL cholesterol. Increasing exposure to abacavir is associated with a decrease in the level of triglycerides. Conclusion In general, NNRTI-based therapy is associated with a more favourable lipid profile than PI-based therapy, but different PI-based therapies are associated with very different lipid profiles. Nelfinavir appears to have a relatively favourable lipid profile. Of the two boosted PI therapies, lopinavir appears to have a more favourable lipid profile than indinavir.
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Affiliation(s)
| | - Jim Young
- Institut für klinische Epidemiologie, Universitätsspital Basel, Basel, Switzerland
| | - Rainer Weber
- Abteilung für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich, Zürich, Switzerland
| | - Martin Rickenbach
- Swiss HIV Cohort Study Co-ordination Centre, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hansjakob Furrer
- Klinik und Poliklinik für Infektiologie, Universitätsspital Bern, Bern, Switzerland
| | - Enos Bernasconi
- Servizio di Malattie Infettive, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Bernard Hirschel
- Division des Maladies Infectieuses, Hôpital Universitaire de Genève, Genève, Switzerland
| | - Philip E Tarr
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pietro Vernazza
- Departement Innere Medizin, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Manuel Battegay
- Klinik für Infektiologie, Universitätsspital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Institut für klinische Epidemiologie, Universitätsspital Basel, Basel, Switzerland
- Klinik für Infektiologie, Universitätsspital Basel, Basel, Switzerland
| | - M Battegay
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - E Bernasconi
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - J Böni
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - H Bucher
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - Ph Bürgisser
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - S Cattacin
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Cavassini
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - R Dubs
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Egger
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - L Elzi
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - P Erb
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - K Fantelli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Fischer
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Flepp
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Fontana
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
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31
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Young J, Rickenbach M, Weber R, Furrer H, Bernasconi E, Hirschel B, Tarr PE, Vernazza P, Battegay M, Bucher HC, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Dubs R, Egger M, Elzi L, Erb P, Fantelli K, Fischer M, Flepp M, Fontana A, Furrer H, Gorgievski M, Günthard H, Hirschel B, Kaiser L, Kind C, Klimkait T, Ledergerber B, Lauper U, Opravil M, Paccaud F, Pantaleo G, Perrin L, Piffaretti JC, Rickenbach M, Rudin C, Schmid P, Schüpbach J, Speck R, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Body Fat Changes among Antiretroviral-Naive Patients on Pi- and Nnrti-Based Haart in the Swiss HIV Cohort Study. Antivir Ther 2005. [DOI: 10.1177/135965350501000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Body fat changes are common in patients with HIV. For patients on protease inhibitor (PI)-based highly active antiretroviral therapy (HAART), these changes have been associated with increasing exposure to therapy in general and to stavudine in particular. Our objective is to show whether such associations are more or less likely for patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. Methods We included all antiretroviral-naive patients in the Swiss HIV Cohort Study starting HAART after April 2000 who had had body weight, CD4 cell count and plasma HIV RNA measured between 6 months before and 3 months after starting HAART, and at least one assessment of body fat changes after starting HAART. At visits scheduled every 6 months, fat loss or fat gain is reported by agreement between patient and physician. We estimate the association between reported body fat changes and both time on therapy and time on stavudine, using conditional logistical regression. Results Body fat changes were reported for 85 (9%) out of 925 patients at their first assessment; a further 165 had only one assessment. Of the remaining 675 patients, body fat changes were reported for 156 patients at a rate of 13.2 changes per 100 patient-years. Body fat changes are more likely with increasing age [odds ratio (OR) 1.18 (1.00–1.38) per 10 years], with increasing BMI [OR 1.06 (1.01–1.11)] and in those with a lower baseline CD4 cell count [OR 0.91 (0.83–1.01) per 100 cells/μl]. There is only weak evidence that body fat changes are more likely with increasing time on HAART [OR 1.16 (0.93–1.46)]. After adjusting for time on HAART, fat loss is more likely with increasing stavudine use [OR 1.70 (1.34–2.15)]. There is no evidence of an association between reported fat changes and time on NNRTI therapy relative to PI therapy in those patients who used either one therapy or the other [OR 0.98 (0.56–1.63)]. Conclusion Fat loss is more likely to be reported with increasing exposure to stavudine. We find no evidence of major differences between PI and NNRTI therapy in the risk of reported body fat changes.
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Affiliation(s)
| | - Jim Young
- Institut für klinische Epidemiologie, Universitätsspital Basel, Basel, Switzerland
| | - Martin Rickenbach
- Swiss HIV Cohort Study Coordination Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rainer Weber
- Departement Innere Medizin, Universitätsspital Zurich, Switzerland
| | - Hansjakob Furrer
- Klinik und Poliklinik für Infektiologie, Universitätsspital, Bern, Switzerland
| | - Enos Bernasconi
- Servizio di Malattie Infettive, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Bernard Hirschel
- Division des Maladies Infectieuses, Hôpital Universitaire de Genève, Geneva, Switzerland
| | - Philip E Tarr
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pietro Vernazza
- Departement Innere Medizin, Kantonsspital St Gallen, Saint Gallen, Switzerland
| | - Manuel Battegay
- Klinik für Infektiologie, Universitätsspital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Institut für klinische Epidemiologie, Universitätsspital Basel, Basel, Switzerland
- Klinik für Infektiologie, Universitätsspital Basel, Basel, Switzerland
| | - M Battegay
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - E Bernasconi
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - J Böni
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - H Bucher
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - Ph Bürgisser
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - S Cattacin
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - R Dubs
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Egger
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - L Elzi
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - P Erb
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - K Fantelli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Fischer
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - M Flepp
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Fontana
- Centre Hospitalier Universitaire Vaudois, Lausanne
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32
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Affiliation(s)
- J Böni
- Swiss National Center for Retroviruses, University of Zurich, Switzerland
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33
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Hasse B, Hummel Y, Böni J, Schüpbach J, Flepp M, Günthard HF. [25-year-old therapy naive patient with 3 class resistant HIV infection]. Praxis (Bern 1994) 2003; 92:601-605. [PMID: 12705183 DOI: 10.1024/0369-8394.92.13.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The wide use of potent antiretroviral therapy has significantly reduced mortality and morbidity in patients infected with the HI-Virus. Good individual tolerance and regular intake of an adequate drug regimen often lead to a substantial recovery of impaired immunologic function. In a substantial fraction of patients drug resistant virus is emerging. In the last decade transmission of such viruses to newly infected patients has been reported in several countries. Especially transmission of multidrug-resistant virus is of major concern. We report a case of a 25 year-old Swiss man with a newly diagnosed HIV-infection with a multidrug-resistant virus. In connection to this case we discuss the importance of resistance testing in newly diagnosed patients.
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Affiliation(s)
- B Hasse
- Abteilung für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich.
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34
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Abstract
Peptides of the V3 loop of the HIV-1 envelope glycoprotein gp120 have been shown to bind with high affinity to the immunophilins cyclophilin (Cyp) A, CypB and the FK506-binding protein 12 (FKBP12) [10]. We investigated whether immunophilins affect HIV-1 infection by assuming they are able to bind to the V3 loop of gp120. T cells and peripheral blood mononuclear cells were infected with T-cell-tropic or macrophage-tropic HIV-1 strains, respectively, in the presence of different concentrations of immunophilins. P24 antigen ELISA and real-time PCR measurements demonstrated that exogenously added immunophilins do not influence HIV-1 infection. CypA is known to interact with the HIV-1 Gag polyprotein and to be incorporated into the virions. This incorporation can be prevented by cyclosporin A (CsA) resulting in a decreased yield of infectious virus, the mechanism of which is unknown. We measured a normal production of proviral DNA in the first round of infection in CsA treated cells but afterwards, infection was decreased if CsA was present. Pre-treatment of the HIV-1 inocula with CsA, blocking the function of virus-associated CypA, did not inhibit the ensuing yield of infection. We therefore may conclude that endogenous CypA exerts its action after reverse transcription but before virus maturation, probably during capsid formation. FK520, an immunosuppressor which binds to FKBP, had no effect on HIV-1 infection.
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Affiliation(s)
- D Minder
- Institute of Biochemistry, University of Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
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35
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Braun U, Camenzind D, Meli M, Böni J, Ossent P. [Clinical findings and diagnostic procedure in a dairy sheep with visna]. SCHWEIZ ARCH TIERH 2001; 143:550-3. [PMID: 11727674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The goal of this report was to describe the clinical signs and diagnosis of Visna in a seven-year-old East Friesian milk sheep. A striking feature was that the ewe's behaviour changed frequently. At one time, the ewe was somnolent. A few minutes later, the sheep was alert and eating hay. The ewe was thin. It had a slight head tilt and a severe generalised ataxia. Based on the neurological symptoms and chronic weight loss, a tentative diagnosis of visna was made. Serological testing for maedi-visna was positive, and the ewe was euthanised. A postmortem examination was performed, and lung and brain samples were collected aseptically. Cell cultures from these organs were positive for viral enzymatic reverse transcriptase and for maedi-visna RNA.
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Affiliation(s)
- U Braun
- Departement für Innere Veterinärmedizin, Universität Zürich
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Schüpbach J, Böni J, Flepp M, Tomasik Z, Joller H, Opravil M. Antiretroviral treatment monitoring with an improved HIV-1 p24 antigen test: an inexpensive alternative to tests for viral RNA. J Med Virol 2001; 65:225-32. [PMID: 11536227 DOI: 10.1002/jmv.2024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Monitoring of viral RNA has become indispensable for the management of HIV-1 infection, but is expensive. This study investigated whether a highly improved test for p24 antigen could serve as an alternative. Thirty-four patients enrolled during 1997 into two treatment studies were tested prospectively for viral RNA by the Roche HIV-1 Monitor and for p24 antigen using signal-amplification-boosted ELISA of heat-denatured plasma. P24 antigen was detectable in 75.8% of 178 samples and HIV RNA in 73.9% of 138 samples. The half-life of p24 antigen in the first phase of effective treatment was 1.6 +/-.4 days (RNA, 1.7 +/-.8). An apparent second, slower decay phase had a half-life of 42 +/- 16 days. Treatment failure occurred in 14 patients. Secondary treatment failures with RNA rebounds from undetectable levels to < or = 10(3) copies/ml in two patients with an undetectable viral load and 10(3) HIV RNA copies/ml, respectively, at baseline were not detected by p24 antigen but carried a low risk for secondary resistance mutations. The other 12 failures were on average detected 29 days earlier by p24 antigen than by RNA (P =.0204), owing to slightly more frequent testing for p24 than for RNA (2.7 vs. 2.4 tests). Average costs for p24 antigen testing up to a failure were only 20.5% of those for RNA (P <.0001). These results indicate that heat-denatured, amplification-boosted p24 antigen measurement can be used as a simple and inexpensive alternative to HIV RNA testing for monitoring treatment.
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Affiliation(s)
- J Schüpbach
- Swiss National Center for Retroviruses, University of Zürich, Zürich, Switzerland.
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Bisset LR, Bosbach S, Tomasik Z, Lutz H, Schüpbach J, Böni J. Quantification of in vitro retroviral replication using a one-tube real-time RT-PCR system incorporating direct RNA preparation. J Virol Methods 2001; 91:149-55. [PMID: 11164496 DOI: 10.1016/s0166-0934(00)00259-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The methodological and logistic benefits gained from assessing in vitro antiretroviral replication using one-tube real-time RT-PCR procedures are currently diminished by a continuing need for prior RNA isolation. We now report a simple and inexpensive modification of a commercially available one-tube RT-PCR assay, consisting of detergent-based virus lysis in the presence of a ribonuclease inhibitor, which can be used to directly quantify retroviral RNA levels in culture supernatant. This approach circumvents the potential loss of RNA inherent to RNA-isolation procedures based on prior extraction and demonstrates a dynamic range of at least 4 logs. Using in vitro culture systems incorporating either HIV-1 or FIV, we show that this ability to isolate retroviral RNA directly during the RT-PCR process can provide an equivalent alternative to one of the more time and resource-consuming steps in quantifying in vitro retroviral RNA levels.
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Affiliation(s)
- L R Bisset
- Swiss National Center for Retroviruses, University of Zürich, Gloriastrasse 30, CH-8028 Zürich, Switzerland
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38
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Schüpbach J, Tomasik Z, Nadal D, Ledergerber B, Flepp M, Opravil M, Böni J. Use of HIV-1 p24 as a sensitive, precise and inexpensive marker for infection, disease progression and treatment failure. Int J Antimicrob Agents 2000; 16:441-5. [PMID: 11118855 DOI: 10.1016/s0924-8579(00)00272-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV RNA is an acknowledged marker of disease activity and predictive of progression, while the p24 antigen is considered unsuitable. This is at odds with the fact that viral pathogenesis is usually mediated by proteins. One might expect that p24, if analyzed properly, might even be superior to RNA. This hypothesis was investigated in clinical studies using a sensitive and precise p24 test (heat-mediated immune complex dissociation with signal amplification-boosted ELISA). This test was as sensitive and specific as the polymerase chain reaction (PCR) for viral RNA (200-400 copy detection), an overall better predictor of CD4 decline and survival, while RNA prevailed in predicting AIDS. The lower costs of p24 testing also permit a closer monitoring of patients with an earlier detection of anti-retroviral treatment failures.
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Affiliation(s)
- J Schüpbach
- Swiss National Center for Retroviruses, University of Zurich, Gloriastrasse 30, CH-8028 Zurich, Switzerland.
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39
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Fischer M, Günthard HF, Opravil M, Joos B, Huber W, Bisset LR, Ott P, Böni J, Weber R, Cone RW. Residual HIV-RNA levels persist for up to 2.5 years in peripheral blood mononuclear cells of patients on potent antiretroviral therapy. AIDS Res Hum Retroviruses 2000; 16:1135-40. [PMID: 10954888 DOI: 10.1089/088922200414974] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The long-term response of 10 asymptomatic, antiretroviral therapy-naive HIV-1-infected patients to potent combination antiretroviral therapy was characterized by monitoring levels of HIV-1 RNA in plasma, peripheral blood mononuclear cells (PBMC), and lymphoid tissue using highly sensitive HIV-1 RNA assays. Although plasma viral loads were continuously suppressed to levels below 50 HIV-1 RNA copies/ml for up to 2.5 years (60-128 weeks), HIV-1 RNA was still detectable at very low levels (1 to 49 HIV-1 RNA copies/ml) in 25% of the samples. In corresponding PBMC specimens, residual HIV-RNA was detectable in as much as 91% of samples tested (1 to 420 HIV-1 RNA copies/microg total RNA). Similarly, HIV-1 RNA levels in lymphoid tissue also remained detectable at a high frequency (86%). A highly significant correlation was demonstrated between therapy-induced change in PBMC HIV-1 RNA levels and change in plasma HIV-1 RNA levels (r2 = 0.69; p = 0.003). These findings support the concept that measurement of HIV-1 RNA in the easily accessible PBMC compartment is relevant for evaluating the potency of current and future antiretroviral therapies.
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Affiliation(s)
- M Fischer
- Department of Internal Medicine, University Hospital Zurich, Switzerland.
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40
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Ledergerber B, Flepp M, Böni J, Tomasik Z, Cone RW, Lüthy R, Schüpbach J. Human immunodeficiency virus type 1 p24 concentration measured by boosted ELISA of heat-denatured plasma correlates with decline in CD4 cells, progression to AIDS, and survival: comparison with viral RNA measurement. J Infect Dis 2000; 181:1280-8. [PMID: 10751136 DOI: 10.1086/315366] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [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: 06/08/1999] [Revised: 10/27/1999] [Indexed: 11/03/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) RNA and p24 antigen concentrations were determined in plasma samples from 169 chronically infected patients (median CD4 cell count, 140 cells/microL; range, 0-1500 cells/microL). p24 quantification involved heat-mediated immune complex dissociation and tyramide signal amplification-boosted ELISA, which has a diagnostic sensitivity similar to that of RNA quantification by a commercial polymerase chain reaction kit. In Cox's proportional hazard models adjusted for CD4 cell count, both RNA (P<.005) and p24 (P=.043) levels were significant predictors of progression to AIDS. Measurement of p24 was superior to measurement of RNA in the model for survival (P=.032 vs. P=.19). p24 level was a significant predictor of CD4 cell decline in models adjusted for CD4 cell counts and was superior or equivalent to RNA level, depending on the group analyzed. Stratification by CD4 cell counts at baseline showed that the superiority of p24 measurement was more pronounced at lower levels of CD4 cells (<200/microL). p24 level may be of interest as a simple and inexpensive predictive marker of disease progression.
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Affiliation(s)
- B Ledergerber
- Division of Infectious Diseases, Department of Medicine, Zurich University Hospital, Zurich, Switzerland
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41
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Bürgisser P, Vernazza P, Flepp M, Böni J, Tomasik Z, Hummel U, Pantaleo G, Schüpbach J. Performance of five different assays for the quantification of viral load in persons infected with various subtypes of HIV-1. Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2000; 23:138-44. [PMID: 10737428 DOI: 10.1097/00126334-200002010-00005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five methods for the assessment of plasma viral load (VL) were evaluated in 103 seropositive patients infected with various subtypes of HIV-1. The methods included three RNA-based assays (Amplicor Monitor 1.5, Quantiplex version 2.0, NucliSens), one ultrasensitive reverse transcriptase (PERT) assay and one "boosted" p24 antigen (Ag) enzyme immunoassay (EIA). Subtyping was based on sequencing in env. The sensitivities were, in decreasing order, Amplicor > PERT > p24 Ag > NucliSens > Quantiplex. The low sensitivity of NucliSens was related to the missing of several non-B (A, E, F, G) or recombinant strains, whereas that of Quantiplex did not depend on subtype. In the 1 group O sample and 4 group M samples, only PERT assay or p24Ag EIA produced a positive result. In the quantitative range, correlation was best between Amplicor and Quantiplex (r = 0.8848), fair between Amplicor and NucliSens (r = 0.7064) or PERT assay (r = 0.7266), lowest between Amplicor and p24Ag EIA (r = 0.3989). Amplicor underestimated VL in 1 subtype E sample. Thus, Amplicor performed best in terms of sensitivity (compared with all other assays) and accuracy (compared with NucliSens, PERT assay, and p24Ag) for non-B subtypes in group M samples. PERT assay appears useful for VL assessment in infections by group O or other highly divergent viruses.
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Affiliation(s)
- P Bürgisser
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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42
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Böni J, Pyra H, Gebhardt M, Perrin L, Bürgisser P, Matter L, Fierz W, Erb P, Piffaretti JC, Minder E, Grob P, Burckhardt JJ, Zwahlen M, Schüpbach J. High frequency of non-B subtypes in newly diagnosed HIV-1 infections in Switzerland. J Acquir Immune Defic Syndr 1999; 22:174-9. [PMID: 10843532 DOI: 10.1097/00126334-199910010-00010] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HIV-1 subtypes were determined in newly diagnosed residents of Switzerland. Blood was anonymously collected from patients with a first confirmed positive HIV-1 test result. Viral DNA from the env V3-V5 region was amplified by nested polymerase chain reaction (PCR) and screened for subtype B by heteroduplex mobility assay. All amplicons not identified as B were sequenced. From November 1996 to February 1998, 206 samples were analyzed. Main transmission risks were unprotected heterosexual (55.7%) or homosexual (27.1%) sexual contact or intravenous drug use (12.9%). Subtype B dominated in patients of Swiss, other European, American, or Asian citizenship; particularly high frequencies were found in homosexuals (97%) and drug users (94%). Non-B subtypes including A, C, D, E, F, G, H, a possible B/F recombinant, and a sequence related to J were present in 28.2% (95% confidence interval [CI], 22.9%-35.0%). Non-B were frequent in African citizens (95%), heterosexually infected individuals (44%), and women (43%). Heterosexually infected Swiss males harbored non-B strains in 18% and females in 33%. The results document a change in the epidemiology of newly diagnosed HIV-1 infections in Switzerland: predominance of heterosexual transmission and a high frequency of non-B subtypes.
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Affiliation(s)
- J Böni
- Swiss National Center for Retroviruses, University of Zurich
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43
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Nadal D, Böni J, Kind C, Varnier OE, Steiner F, Tomasik Z, Schüpbach J. Prospective evaluation of amplification-boosted ELISA for heat-denatured p24 antigen for diagnosis and monitoring of pediatric human immunodeficiency virus type 1 infection. J Infect Dis 1999; 180:1089-95. [PMID: 10479135 DOI: 10.1086/315012] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The performance in pediatric human immunodeficiency virus type 1 (HIV-1) infection of a signal-amplification boosted ELISA for HIV-1 p24 antigen in plasma after heat-mediated immune complex dissociation was prospectively compared with polymerase chain reaction-based procedures. Diagnostic sensitivity and specificity of the p24 antigen test were 100% and 99.2%, respectively. Quantification revealed RNA in 85.7% and p24 antigen in 87.4% of 230 samples from 25 infected children. Concentrations of these indices in individual samples correlated (P<.0001). Introduction or modification of antiretroviral treatment showed concordant responses of RNA and p24 antigen in 39 (90.7%) of 43 instances. The treatment-induced changes in concentrations of RNA were higher than those of p24 antigen in 11 instances. In 1 instance, however, the concentration change of p24 antigen was greater than that of RNA (P=. 002). Variation of RNA concentrations was more marked than that of p24 antigen (P=.002). The p24 antigen test was equivalent to PCR for diagnosing and monitoring pediatric HIV-1 infection.
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Affiliation(s)
- D Nadal
- Pediatric Infectious Diseases Unit, Universitäts-Kinderklinik, CH-8032 Zurich, Switzerland.
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44
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Leutenegger CM, Klein D, Hofmann-Lehmann R, Mislin C, Hummel U, Böni J, Boretti F, Guenzburg WH, Lutz H. Rapid feline immunodeficiency virus provirus quantitation by polymerase chain reaction using the TaqMan fluorogenic real-time detection system. J Virol Methods 1999; 78:105-16. [PMID: 10204701 DOI: 10.1016/s0166-0934(98)00166-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An improved quantitative polymerase chain reaction (qPCR) method based on a combination of real-time detection and the 5'-3' nuclease activity of the Taq DNA polymerase was developed to quantify the provirus load of feline immunodeficiency virus (FIV), a lentivirus of veterinary importance and an animal model for AIDS research. Two fluorogenic probes were designed to detect FIV provirus in genomic DNA of peripheral lymphocytes and tissues infected with different FIV subtypes. The most sensitive assay can detect one copy of FIV provirus. The assay showed excellent precision within-run and between-runs. Comparison of the TaqMan system with a conventional seminested PCR assay revealed a comparable detection limit and good correlation. Furthermore the design of the two probes allowed the detection of various FIV isolates of clade A and B.
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Affiliation(s)
- C M Leutenegger
- Department of Internal Veterinary Medicine, University of Zurich, Switzerland.
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45
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Schüpbach J, Böni J. Sensitivity of heat-denatured p24 antigen in the diagnosis of pediatric HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 18:399-400. [PMID: 9704953 DOI: 10.1097/00042560-199808010-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Abstract
Microbial superantigens (SAGs) have been implicated in the pathogenesis of human autoimmune diseases. Preferential expansion of the Vveta7 T cell receptor positive T cell subset in patients suffering from acute-onset type I diabetes has indicated the presence of a surface membrane-bound SAG. Here, we have isolated a novel mouse mammary tumor virus-related human endogenous retrovirus. We further show that the N-terminal moiety of the envelope gene encodes an MHC class II-dependent SAG. We propose that expression of this SAG, induced in extrapancreatic and professional antigen-presenting cells, leads to beta-cell destruction via the systemic activation of autoreactive T cells. The SAG encoded by this novel retrovirus thus constitutes a candidate autoimmune gene in type I diabetes.
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MESH Headings
- Adolescent
- Adult
- Amino Acid Sequence
- Antibodies, Viral/immunology
- Autoantibodies/immunology
- B-Lymphocytes/cytology
- B-Lymphocytes/immunology
- Base Sequence
- Cells, Cultured
- Child
- Child, Preschool
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/virology
- Genome, Viral
- Humans
- Infant
- Infant, Newborn
- Islets of Langerhans/immunology
- Islets of Langerhans/virology
- Mammary Tumor Virus, Mouse/classification
- Mammary Tumor Virus, Mouse/enzymology
- Mammary Tumor Virus, Mouse/immunology
- Membrane Glycoproteins/immunology
- Membrane Proteins
- Molecular Sequence Data
- Phylogeny
- RNA-Directed DNA Polymerase/metabolism
- Superantigens/genetics
- Superantigens/immunology
- Viral Envelope Proteins/immunology
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Affiliation(s)
- B Conrad
- Department of Genetics and Microbiology, University of Geneva Medical School, Switzerland
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47
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Böni J, Opravil M, Tomasik Z, Rothen M, Bisset L, Grob PJ, Lüthy R, Schüpbach J. Simple monitoring of antiretroviral therapy with a signal-amplification-boosted HIV-1 p24 antigen assay with heat-denatured plasma. AIDS 1997; 11:F47-52. [PMID: 9143600 DOI: 10.1097/00002030-199706000-00001] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Virus load determination has become indispensable for the management of HIV patients, but depends on expensive assays of a low throughput. We evaluated whether a highly improved HIV-1 p24 antigen detection procedure which involves heat-mediated immune complex dissociation and signal-amplification-boosted enzyme-linked immunosorbent assay (ELISA) was suitable for antiretroviral treatment monitoring. DESIGN AND METHODS Virus load in plasma was determined for 127 plasma samples taken at 0, 2, 6, 12, 18, 24, 30 and 36 weeks from 23 patients with CD4+ T cells < 50 x 10(6)/l who received indinavir 800 mg three times daily in addition to prior antiretroviral treatment. Tests included polymerase chain reaction (PCR) for viral RNA, measured prospectively with the Roche Amplicor kit, and retrospective batch testing of heat-denatured samples for p24 antigen by the DuPont HIV-1 p24 Core Profile ELISA linked with a tyramide signal amplification step. Particle-associated reverse transcriptase (RT) by the product-enhanced RT (PERT) assay was determined as an independent third-opinion viral load marker. RESULTS p24 antigen was detected as sensitively as viral RNA. Overall detection during a median observation time of 25 weeks (range, 0-39) amounted to 75.6% for antigen and 73.6% for RNA. The antigen detection limit was 0.2 pg/ml. Antigen was detectable in all 23 baseline samples, whereas RNA was undetectable in one. Antigen and RNA levels in 79 samples positive for both markers correlated with r = 0.714 (P < 0.0001). Average changes in levels of p24 antigen and RNA at eight timepoints correlated with r = 0.982 (P < 0.0001). In individual patients, the two parameters behaved similarly, and in certain cases virtually identically. RT activity was measurable in all samples. CONCLUSIONS The performance of this antigen detection procedure is comparable to RNA PCR, thus providing a simple, high throughput alternative in monitoring the efficacy of antiretroviral treatment.
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Affiliation(s)
- J Böni
- Swiss National Centre for Retroviruses, University of Zurich, Switzerland
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48
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Weissmahr RN, Schüpbach J, Böni J. Reverse transcriptase activity in chicken embryo fibroblast culture supernatants is associated with particles containing endogenous avian retrovirus EAV-0 RNA. J Virol 1997; 71:3005-12. [PMID: 9060660 PMCID: PMC191429 DOI: 10.1128/jvi.71.4.3005-3012.1997] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We have recently shown that live attenuated virus vaccines produced on chicken-derived cells contain low levels of particle-associated reverse transcriptase (RT). In both virus and corresponding control harvests produced on chicken embryo fibroblasts, these activities were present at significantly higher concentrations than in the vaccines. In order to identify the putative retrovirus sequence responsible for this activity, a novel method for the selective PCR amplification of particle-associated retrovirus RNA that uses DNA primers complementary to the primer binding sites of the known exogenous retroviruses in combination with an anchor primer was applied. A product of the endogenous avian retrovirus family EAV-0, termed EAV-0(B1), was reproducibly generated with a tRNA(Trp)-derived primer from the RT peak fraction of a sucrose density gradient run with a harvest of a live attenuated measles vaccine. In contrast, no products were detected with primers derived from tRNA(Pro), tRNA(Lys)1,2 or tRNA(Lys)3. In the same fraction, genomic RNA of EAV-0(B1) was demonstrated by long PCR. Analysis of several sucrose density gradients from different harvests of various manufacturers demonstrated accumulation of, and colocalization with, RT activity for the EAV-0(B1) RNA but not for a chicken cellular mRNA. Synthesis of cDNA from EAV-0(B1) RNA was shown by endogenous RT reaction. Furthermore, complexes of naturally primed EAV-0(B1) RNA with RT were demonstrated. Taken together, these data strongly suggest that EAV-0 is able to produce virus-like particles with an active RT.
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Affiliation(s)
- R N Weissmahr
- Swiss National Center for Retroviruses, University of Zurich
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49
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Schüpbach J, Flepp M, Pontelli D, Tomasik Z, Lüthy R, Böni J. Heat-mediated immune complex dissociation and enzyme-linked immunosorbent assay signal amplification render p24 antigen detection in plasma as sensitive as HIV-1 RNA detection by polymerase chain reaction. AIDS 1996; 10:1085-90. [PMID: 8874624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare heat denaturation and acidification as immune complex dissociation (ICD) methods in adult HIV-1 infection and to increase the sensitivity by a signal-amplification-boosted HIV-1 p24 antigen enzyme-linked immunosorbent assay (ELISA). DESIGN Prospective and retrospective blinded study of paired serum and plasma samples from 245 patients (112 of class A, 66 of B, 67 of C of the Centers for Disease Control and Prevention 1993 classification). METHODS Plasma and sera were prospectively tested for antigen by ELISA using native, acidified, or heat-denatured material. Retrospective tests included batch analysis of heat-denatured samples for antigen by the signal-amplification-boosted ELISA and for viral RNA. RESULTS With serum, native antigen was reactive in 26.5%. Acidification increased the rate to 53.1% (P < or = 0.0001), but was inefficient at a CD4+ count > or = 500 x 10(6)/l. Heat denaturation further elevated the rate to 67.8% (P < or = 0.0007) and the use of plasma to 78.0% (P < or = 0.008). The boosted ELISA, performed with plasma samples diluted 1 :6, which eliminated the problem of heat-induced sample coagulation, was confirmed positive in 89.5% of serum and 97.8% of plasma samples. RNA was detected in 95.7%. CONCLUSION Heat-mediated ICD combined with a signal-amplification-boosted ELISA detects HIV-1 expression as sensitively as a polymerase chain reaction kit for viral RNA, but at only a fraction of the cost. The procedure uses a 50 microliters plasma sample and should be fully automatable.
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Affiliation(s)
- J Schüpbach
- Swiss National Centre for Retroviruses, University of Zurich, Switzerland
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50
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Jendis J, Strack B, Volkmann S, Böni J, Mölling K. Inhibition of replication of fresh HIV type 1 patient isolates by a polypurine tract-specific self-complementary oligodeoxynucleotide. AIDS Res Hum Retroviruses 1996; 12:1161-8. [PMID: 8844020 DOI: 10.1089/aid.1996.12.1161] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A previously described self-complementary oligodeoxynucleotide termed triplex-forming oligodeoxynucleotide (TFO A), 54 bases in length, designed against the polypurine tract of HIV-1 RNA, inhibited viral replication at a 1 to 3 microM concentration in acutely infected cells, whereas antisense and scrambled sequence oligodeoxynucleotides were ineffective. Three HIV-1 viral isolates from patients of clinical categories A1, B, and C3 were transmitted to peripheral blood mononuclear cells and tested for production of p24 antigen and syncytium formation in the absence and in the presence of either TFO A or a control oligodeoxynucleotide of randomized sequence. No p24 antigen or syncytia were detected for up to 30 days when TFO A was added to the cells. Viability of the cells was found not to be affected by the drugs compared to controls within 2 weeks. Analysis of viral DNA synthesis by PCR for the LTR and gag gene indicated no DNA signal, suggesting that TFO A affects viral replication before formation of a DNA provirus. Measurements of the stability of TFO A indicate a half-life of about 2 hr. A two-dimensional computer fold analysis of TFO A suggested a self-complementary hairpin-loop configuration with GC-rich stems and single-stranded 5' and 3' ends. Since intracellular triplex formation may not be an efficient process, the observed inhibitory effect may be due to a direct inhibition of the RT and RNase H enzyme activities by the oligodeoxynucleotide. However, a triple-helix effect on the incoming RNA may play a role as well.
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Affiliation(s)
- J Jendis
- Institut für Medizinische Virologie, Universität Zürich, Switzerland
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