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Jacobson JM, Felber BK, Chen H, Pavlakis GN, Mullins JI, De Rosa SC, Kuritzkes DR, Tomaras GD, Kinslow J, Bao Y, Olefsky M, Rosati M, Bear J, Heptinstall JR, Zhang L, Sawant S, Hannaman D, Laird GM, Cyktor JC, Heath SL, Collier AC, Koletar SL, Taiwo BO, Tebas P, Wohl DA, Belaunzaran-Zamudio PF, McElrath MJ, Landay AL. The immunogenicity of an HIV-1 Gag conserved element DNA vaccine in people with HIV and receiving antiretroviral therapy. AIDS 2024; 38:963-973. [PMID: 38051788 PMCID: PMC11062837 DOI: 10.1097/qad.0000000000003804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The primary objective of the study was to assess the immunogenicity of an HIV-1 Gag conserved element DNA vaccine (p24CE DNA) in people with HIV (PWH) receiving suppressive antiretroviral therapy (ART). DESIGN AIDS Clinical Trials Group A5369 was a phase I/IIa, randomized, double-blind, placebo-controlled study of PWH receiving ART with plasma HIV-1 RNA less than 50 copies/ml, current CD4 + T-cell counts greater than 500 cells/μl, and nadir CD4 + T-cell counts greater than 350 cells/μl. METHODS The study enrolled 45 participants randomized 2 : 1 : 1 to receive p24CE DNA vaccine at weeks 0 and 4, followed by p24CE DNA admixed with full-length p55 Gag DNA vaccine at weeks 12 and 24 (arm A); full-length p55 Gag DNA vaccine at weeks 0, 4, 12, and 24 (arm B); or placebo at weeks 0, 4, 12, and 24 (arm C). The active and placebo vaccines were administered by intramuscular electroporation. RESULTS There was a modest, but significantly greater increase in the number of conserved elements recognized by CD4 + and/or CD8 + T cells in arm A compared with arm C ( P = 0.014). The percentage of participants with an increased number of conserved elements recognized by T cells was also highest in arm A (8/18, 44.4%) vs. arm C (0/10, 0.0%) ( P = 0.025). There were no significant differences between treatment groups in the change in magnitude of responses to total conserved elements. CONCLUSION A DNA-delivered HIV-1 Gag conserved element vaccine boosted by a combination of this vaccine with a full-length p55 Gag DNA vaccine induced a new conserved element-directed cellular immune response in approximately half the treated PWH on ART.
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Affiliation(s)
- Jeffrey M Jacobson
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Barbara K Felber
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD
| | - Huichao Chen
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - George N Pavlakis
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD
| | - James I Mullins
- Departments of Microbiology, Medicine, and Global Health, University of Washington, Seattle, WA
| | - Stephen C De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Georgia D Tomaras
- Duke Center for Human Systems Immunology, Departments of Surgery, Immunology, Molecular Genetics and Microbiology, Durham, NC
| | - Jennifer Kinslow
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Yajing Bao
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Margherita Rosati
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD
| | - Jenifer Bear
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD
| | - Jack R Heptinstall
- Duke Center for Human Systems Immunology, Departments of Surgery, Immunology, Molecular Genetics and Microbiology, Durham, NC
| | - Lu Zhang
- Duke Center for Human Systems Immunology, Departments of Surgery, Immunology, Molecular Genetics and Microbiology, Durham, NC
| | - Sheetal Sawant
- Duke Center for Human Systems Immunology, Departments of Surgery, Immunology, Molecular Genetics and Microbiology, Durham, NC
| | | | | | - Joshua C Cyktor
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA
| | - Sonya L Heath
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Ann C Collier
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Susan L Koletar
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pablo Tebas
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David A Wohl
- Division of Infectious Diseases, Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC
| | - Pablo F Belaunzaran-Zamudio
- Contractor, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
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2
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Lake JE, Kitch DW, Kantor A, Muthupillai R, Klingman KL, Vernon C, Belaunzaran-Zamudio PF, Fichtenbaum CJ, Heath S, Perazzo H, Corey K, Brown TT, Landay A, Sattler F, Erlandson KM. The Effect of Open-Label Semaglutide on Metabolic Dysfunction-Associated Steatotic Liver Disease in People With HIV. Ann Intern Med 2024. [PMID: 38684100 DOI: 10.7326/m23-3354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
| | - Douglas W Kitch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Raja Muthupillai
- School of Engineering Medicine, Texas A&M University, Houston, Texas, and ForeSpect PLLC, Pearland, Texas
| | | | - Christina Vernon
- Social & Scientific Systems, Inc., and FHI 360, Durham, North Carolina
| | | | | | - Sonya Heath
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Hugo Perazzo
- Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Fred Sattler
- University of Southern California, Los Angeles, California
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Agyemang N, Scarsi KK, Baker P, Smeaton LM, Podany AT, Olefsky M, Woolley E, Barr E, Pham M, Mawlana S, Supparatpinyo K, Gatechompol S, Jalil EM, Gadama L, Badal-Faesen S, Van Schalkwyk M, Kayama C, Belaunzaran-Zamudio PF, Godfrey C, Cohn SE, Mngqibisa R, Haas DW. Pharmacogenetic interactions of efavirenz or rifampin and isoniazid with levonorgestrel emergency contraception during treatment of HIV or tuberculosis. Pharmacogenet Genomics 2023; 33:126-135. [PMID: 37306344 PMCID: PMC10309098 DOI: 10.1097/fpc.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In AIDS Clinical Trials Group study A5375, a pharmacokinetic trial of levonorgestrel emergency contraception, double-dose levonorgestrel (3 mg, versus standard dose 1.5 mg) offset the induction effects of efavirenz or rifampin on plasma levonorgestrel exposure over 8 h post-dose (AUC 0-8h ). We characterized the pharmacogenetics of these interactions. METHODS Cisgender women receiving efavirenz- or dolutegravir-based HIV therapy, or on isoniazid-rifampin for tuberculosis, were followed after a single oral dose of levonorgestrel. Linear regression models, adjusted for BMI and age, characterized associations of CYP2B6 and NAT2 genotypes (which affect plasma efavirenz and isoniazid exposure, respectively) with levonorgestrel pharmacokinetic parameters. RESULTS Of 118 evaluable participants, 17 received efavirenz/levonorgestrel 1.5 mg, 35 efavirenz/levonorgestrel 3 mg, 34 isoniazid-rifampin/levonorgestrel 3 mg, and 32 (control group) dolutegravir/levonorgestrel 1.5 mg. There were 73 Black and 33 Asian participants. Regardless of genotype, women on efavirenz and isoniazid-rifampin had higher levonorgestrel clearance. In the efavirenz/levonorgestrel 3 mg group, CYP2B6 normal/intermediate metabolizers had levonorgestrel AUC 0-8h values similar to controls, while CYP2B6 poor metabolizers had AUC 0-8h values of 40% lower than controls. In the isoniazid-rifampin group, NAT2 rapid/intermediate acetylators had levonorgestrel AUC 0-8h values similar to controls, while NAT2 slow acetylators had AUC 0-8h values 36% higher than controls. CONCLUSION CYP2B6 poor metabolizer genotypes exacerbate the efavirenz-levonorgestrel interaction, likely by increased CYP3A induction with higher efavirenz exposure, making the interaction more difficult to overcome. NAT2 slow acetylator genotypes attenuate the rifampin-levonorgestrel interaction, likely by increased CYP3A inhibition with higher isoniazid exposure.
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Affiliation(s)
- Nana Agyemang
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kimberly K. Scarsi
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paxton Baker
- Vanderbilt Technologies for Advanced Genomics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura M. Smeaton
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, Massachusetts
| | - Anthony T. Podany
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Maxine Olefsky
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, Massachusetts
| | | | - Elizabeth Barr
- Office of Research on Women’s Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle Pham
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sajeeda Mawlana
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | | | | | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Luis Gadama
- Johns Hopkins Research Project, Blantyre, Malawi
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
| | - Marije Van Schalkwyk
- Family Center for Research with Ubuntu, Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Cecelia Kayama
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC
| | - Susan E. Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rosie Mngqibisa
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | - David W. Haas
- Department of Medicine, Vanderbilt University School of Medicine
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
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4
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Scarsi KK, Smeaton LM, Podany AT, Olefsky M, Woolley E, Barr E, Pham M, Mawlana S, Supparatpinyo K, Gatechompol S, Jalil EM, Gadama L, Badal-Faesen S, Belaunzaran-Zamudio PF, Godfrey C, Cohn SE, Mngqibisa R. Pharmacokinetics of dose-adjusted levonorgestrel emergency contraception combined with efavirenz-based antiretroviral therapy or rifampicin-containing tuberculosis regimens. Contraception 2023; 121:109951. [PMID: 36641094 PMCID: PMC10187685 DOI: 10.1016/j.contraception.2023.109951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine if double-dose levonorgestrel emergency contraception (EC) in combination with efavirenz or rifampicin, 2 drugs known to decrease levonorgestrel exposure, resulted in similar pharmacokinetics compared to standard-dose levonorgestrel EC without drug-drug interactions. STUDY DESIGN We conducted a phase 2, open-label, multicenter, partially randomized, 4 parallel group trial in pre-menopausal females ≥16 years old without an indication for EC and not on hormonal contraception. Participants on dolutegravir-based antiretroviral therapy (ART) received levonorgestrel 1.5 mg (control group); those on rifampicin-containing tuberculosis therapy received levonorgestrel 3 mg; those on efavirenz-based ART were randomized 1:2 to levonorgestrel 1.5 mg or 3 mg. Plasma was collected through 48 hours post-dose to assess levonorgestrel pharmacokinetics. Area under the concentration-time curve (AUC) over 8 hours was the primary outcome. Levonorgestrel pharmacokinetic parameters were compared between groups using geometric mean ratios (GMR) with 90% confidence intervals. RESULTS The median (Q1, Q3) age for all participants (n = 118) was 34 (27, 41) years and BMI was 23.2 (20, 26.3) kg/m2. Participants receiving levonorgestrel 1.5mg plus efavirenz (n = 17) had 50% lower AUC0-8h compared to the control group (n = 32) [0.50 (0.40, 0.62)]. Participants receiving levonorgestrel 3 mg had a similar AUC0-8h when receiving either efavirenz (n = 35) [0.99 (0.81, 1.20)] or rifampicin (n = 34) [1.16 (0.99, 1.36)] compared to control. Levonorgestrel 3 mg resulted in similar or higher maximum concentration with either efavirenz [1.17 (0.96, 1.41)] or rifampicin [1.27 (1.09, 1.49)] compared to the control group. CONCLUSIONS Doubling the dose of levonorgestrel EC successfully increased levonorgestrel exposure over the first 8 hours in participants receiving either efavirenz-based ART or rifampicin-containing tuberculosis therapy. IMPLICATIONS Adjusting levonorgestrel emergency contraception from 1.5 mg to 3 mg improves levonorgestrel pharmacokinetic exposure in participants receiving either efavirenz-based antiretroviral regimens or rifampicin-containing tuberculosis therapy. These data support guideline recommendations to double the dose of levonorgestrel emergency contraception in persons on medications that decrease levonorgestrel exposure by inducing levonorgestrel metabolism.
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Affiliation(s)
- Kimberly K Scarsi
- College of Pharmacy, University of Nebraska Medical Center; Omaha, NE, United States.
| | - Laura M Smeaton
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, MA, United States
| | - Anthony T Podany
- College of Pharmacy, University of Nebraska Medical Center; Omaha, NE, United States
| | - Maxine Olefsky
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, MA, United States
| | | | - Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
| | - Michelle Pham
- College of Pharmacy, University of Nebraska Medical Center; Omaha, NE, United States
| | - Sajeeda Mawlana
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | | | | | - Emilia M Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Luis Gadama
- Johns Hopkins Research Project, Blantyre, Malawi
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Pablo F Belaunzaran-Zamudio
- Contractor, Division of AIDS, National Institute of Allergy and Infectious Diseases; Bethesda, MD, United States
| | | | - Susan E Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rosie Mngqibisa
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
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5
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Araújo-Pereira M, Barreto-Duarte B, Arriaga MB, Musselwhite LW, Vinhaes CL, Belaunzaran-Zamudio PF, Rupert A, Montaner LJ, Lederman MM, Sereti I, Madero JGS, Andrade BB. Relationship Between Anemia and Systemic Inflammation in People Living With HIV and Tuberculosis: A Sub-Analysis of the CADIRIS Clinical Trial. Front Immunol 2022; 13:916216. [PMID: 35812431 PMCID: PMC9260499 DOI: 10.3389/fimmu.2022.916216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
People with HIV (PWH) are at increased risk of developing active tuberculosis (TB), and anemia is a common complication in both conditions. Anemia in TB patients has been linked to immune activation, levels of inflammatory biomarkers in blood, and risk for HIV disease progression and death. In this study we show that anemia was associated with a more pronounced inflammatory profile in HIV-TB coinfected persons in a cohort of 159 individuals with advanced HIV disease (CD4 count < 100 cells/µL) recruited as part of a randomized clinical trial (NCT00988780). A panel of plasma biomarkers was assessed on plasma obtained prior to combination antiretroviral therapy (cART) initiation. We performed a series of multidimensional analyses including clinical variables and concentrations of inflammatory biomarkers to profile systemic inflammation of PWH with and without anemia. We observed that TB participants presented with moderately lower levels of hemoglobin than non-TB participants. These participants also presented a higher Degree of Inflammatory Perturbation (DIP) score, related to increased levels of IFN-γ and TNF. The DIP was associated with TB coinfection and anemia before cART initiation. Future mechanistic studies are warranted to assess the determinants of such associations and the implications on treatment outcomes.
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Affiliation(s)
- Mariana Araújo-Pereira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Programa de Pós-Graduação em Patologia Humana e Experimental, Universidade Federal da Bahia, Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - María B. Arriaga
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Laura W. Musselwhite
- Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, NC, United States
| | - Caian L. Vinhaes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, Brazil
| | - Pablo F. Belaunzaran-Zamudio
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adam Rupert
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | | | - Michael M. Lederman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Irini Sereti
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Juan G. Sierra Madero
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- *Correspondence: Bruno B. Andrade, ; Juan G. Sierra-Madero,
| | - Bruno B. Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Programa de Pós-Graduação em Patologia Humana e Experimental, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, Brazil
- *Correspondence: Bruno B. Andrade, ; Juan G. Sierra-Madero,
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6
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Smiley CL, Rebeiro PF, Cesar C, Belaunzaran-Zamudio PF, Crabtree-Ramirez B, Padgett D, Gotuzzo E, Cortes CP, Pape J, Veloso VG, McGowan CC, Castilho JL. Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study. Lancet HIV 2021; 8:e266-e273. [PMID: 33891877 PMCID: PMC8171816 DOI: 10.1016/s2352-3018(20)30358-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are few data on life expectancy gains among people living with HIV in low-income and middle-income settings where antiretroviral therapy (ART) is increasingly available. We aimed to analyse life expectancy trends from 2003 to 2017 among people with HIV beginning treatment with ART within the Caribbean, central America, and South America. METHODS We did a multisite retrospective cohort study and included people with HIV who had started treatment with ART and were aged 16 years or older between Jan 1, 2003, and Dec 31, 2017, from Caribbean, Central and South America network for HIV epidemiology (CCASAnet) sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru, who contributed person-time data from the age of 20 years until date of death, last contact, database closure, or Dec 31, 2017. We used the Chiang method of abridged life tables to estimate life expectancy at age 20 years for three eras (2003-08, 2009-12, and 2013-17) overall and by demographic and clinical characteristics at ART initiation. We used Poisson regression models to weight mortality rates to account for informative censoring. FINDINGS 30 688 people with HIV were included in the study; 17 491 (57·0%) were from the Haiti site and 13 197 (43·0%) were from all other sites. There were 2637 deaths during the study period: 1470 in Haiti and 1167 in other sites. Crude and weighted mortality rates decreased among all age groups over calendar eras. From 2003-08 to 2013-17, overall life expectancy for people with HIV at age 20 years increased from 13·9 years (95% CI 12·5-15·2) to 61·2 years (59·0-63·4) in Haiti and from 31·0 years (29·3-32·8) to 69·5 years (67·2-71·8) in other sites. Life expectancies at the end of the study period were within 10 years of those of the general population (69·9 years in Haiti and 78·0 years in all other sites in 2018). Disparities in life expectancy among people with HIV by sex or HIV transmission risk factor, CD4 cell count, level of education, and history of tuberculosis at or before ART initiation persisted across calendar eras. INTERPRETATION Life expectancy among people with HIV receiving ART has significantly improved in Latin America and the Caribbean. Persistent disparities in life expectancy among people with HIV by demographic and clinical factors at ART initiation highlight vulnerable populations in the region. FUNDING National Institutes of Health. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Casey L Smiley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Epidemiology and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carina Cesar
- Investigaciones Clínicas, Fundación Huésped, Buenos Aires, Argentina
| | - Pablo F Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Brenda Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Eduardo Gotuzzo
- Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
| | - Claudia P Cortes
- Fundación Arriarán and University of Chile School of Medicine, Santiago, Chile
| | - Jean Pape
- Center for Global Health, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Valdiléa G Veloso
- Instituto Nacional de Infectiologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Catherine C McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
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7
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Figueroa MI, Camiro-Zuñiga A, Belaunzaran-Zamudio PF, Sierra Madero J, Andrade Villanueva J, Arribas JR, Lama JR, Cecchini DM, Lopardo G, Crabtree-Ramírez B, Gun A, Patterson P, Fink VI, Sued OG, Cahn P. The effect of protease inhibitor-based dual antiretroviral regimens on CD4/CD8 ratio during the first year of therapy in ART-naïve patients with HIV-infection. HIV Med 2020; 22:254-261. [PMID: 33336523 DOI: 10.1111/hiv.13008] [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: 08/11/2020] [Revised: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of protease inhibitor (PI)-based dual therapy on CD4/CD8 ratio during the first year of therapy in antiretroviral therapy (ART)-naïve patients using data from randomized controlled clinical trials. METHODS We pooled data from the GARDEL and ANDES studies, both randomized controlled clinical trials that recruited ART-naïve people living with HIV and randomly assigned them to receive PI-based dual therapy (DT) or triple therapy (TT) aiming to compare viral efficacy. We compared median CD4/CD8 ratios and the proportion of patients with CD4/CD8 ratio > 1 at 48 weeks after ART initiation in both treatment arms using the Mann-Whitney U-test and the χ2 test. We performed subgroup analysis for patients > 50 years old, with baseline CD4 counts ≤ 200 cells/μL, viral load > 100 000 HIV RNA copies/mL, and ritonavir-boosted lopinavir-based therapy. RESULTS We analysed data from 571 patients: 292 on DT and 279 on TT. No differences were observed in CD4/CD8 ratio (0.632 vs. 0.617, P = 0.729) or in the proportion of patients with CD4/CD8 ratio > 1 (17.9% vs. 19.3%, P = 0.678) 48 weeks after ART initiation. Subgroup analysis showed no further differences. CONCLUSION The impact of PI-based DT regimens on the CD4/CD8 ratio during the first year of treatment for ART-naïve patients is similar to that of TT.
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Affiliation(s)
| | | | - P F Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J Sierra Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - J R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Perú
| | | | - G Lopardo
- Centro de Estudios Infectológicos, Buenos Aires, Argentina
| | - B Crabtree-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Gun
- Fundación Huésped, Buenos Aires, Argentina
| | | | - V I Fink
- Fundación Huésped, Buenos Aires, Argentina
| | - O G Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - P Cahn
- Fundación Huésped, Buenos Aires, Argentina
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8
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Piñeirua-Menéndez A, Flores-Miranda R, Sánchez-Nava D, Ortega-Pérez R, Belaunzaran-Zamudio PF, Pérez-Patrigeon S, Cárdenas-Ochoa A, Oseguera-Moguel J, Galindo-Uribe J, Orihuela-Sandoval C, Vázquez-Ortiz Z, Vázquez-Lamadrid J, Morelos-Guzmán M, Rosales-Uvera S, Crabtree-Ramírez B, Sierra-Madero J. Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease. Open Forum Infect Dis 2020; 7:ofaa297. [PMID: 32818141 PMCID: PMC7423298 DOI: 10.1093/ofid/ofaa297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/μL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.
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Affiliation(s)
- A Piñeirua-Menéndez
- Centro Nacional para la Prevención y Control del VIH y del SIDA, Ciudad de México
| | - R Flores-Miranda
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Medicina Interna, Ciudad de México
| | - D Sánchez-Nava
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - R Ortega-Pérez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Medicina Interna, Ciudad de México
| | - P F Belaunzaran-Zamudio
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
| | - S Pérez-Patrigeon
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - A Cárdenas-Ochoa
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
| | - J Oseguera-Moguel
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - J Galindo-Uribe
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - C Orihuela-Sandoval
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - Z Vázquez-Ortiz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - Jorge Vázquez-Lamadrid
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - M Morelos-Guzmán
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - S Rosales-Uvera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - B Crabtree-Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
| | - J Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
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9
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Belaunzaran-Zamudio PF, Caro-Vega Y, Giganti MJ, Castilho JL, Crabtree-Ramirez BE, Shepherd BE, Mejía F, Cesar C, Moreira RC, Wolff M, Pape JW, Padgett D, McGowan CC, Sierra-Madero JG. Frequency of non-communicable diseases in people 50 years of age and older receiving HIV care in Latin America. PLoS One 2020; 15:e0233965. [PMID: 32555607 PMCID: PMC7299309 DOI: 10.1371/journal.pone.0233965] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/15/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A growing population of older adults with HIV will increase demands on HIV-related healthcare. Nearly a quarter of people receiving care for HIV in Latin America are currently 50 years or older, yet little is known about the frequency of comorbidities in this population. We estimated the prevalence and incidence of non-communicable diseases (NCDs) among people 50 years of age or older (≥50yo) receiving HIV care during 2000-2015 in six centers affiliated with the Caribbean, Central and South American network for HIV epidemiology (CCASAnet). METHODS We estimated the annual prevalence, and overall prevalence and incidence of cardiovascular diseases, diabetes, hypertension, dyslipidemia, psychiatric disorders, chronic liver and renal diseases, and non-AIDS-defining cancers, and multimorbidity (more than one NCD) of people ≥50yo receiving care for HIV. Analyses were performed according to age at enrollment into HIV care (<50yo and ≥50yo). RESULTS We included 3,415 patients ≥50yo, of whom 1,487(43%) were enrolled at age ≥50 years. The annual prevalence of NCDs increased from 32% to 68% and multimorbidity from 30% to 40% during 2000-2015. At the last registered visit, 53% of patients enrolled <50yo and 50% of those enrolled ≥50yo had at least one NCD. Most common NCDs at the last visit in each age-group at enrollment were dyslipidemia (36% in <50yo and 28% in ≥50yo), hypertension (17% and 18%), psychiatric disorders (15% and 10%), and diabetes (11% and 12%). CONCLUSIONS The prevalence of NCDs and multimorbidity in people ≥50 years receiving care for HIV in CCASAnet centers in Latin America increased substantially in the last 15 years. Our results make evident the need of planning for provision of complex, primary care for aging adults living with HIV.
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Affiliation(s)
- Pablo F. Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanink Caro-Vega
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mark J. Giganti
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jessica L. Castilho
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Brenda E. Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rodrigo C. Moreira
- Fundacão Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Marcelo Wolff
- Department of Infectious Diseases, Fundación Arriarán, Santiago de Chile, Chile
| | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
| | - Catherine C. McGowan
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Juan G. Sierra-Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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10
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Sierra-Madero JG, Belaunzaran-Zamudio PF, Crabtree-Ramírez B, Magis-Rodriguez C. Mexico's fragmented health system as a barrier to HIV care. Lancet HIV 2019; 6:e74-e75. [PMID: 30723010 DOI: 10.1016/s2352-3018(18)30356-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/18/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Juan G Sierra-Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Pablo F Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Brenda Crabtree-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Magis-Rodriguez
- Dirección de Atención Integral, Centro Nacional para la Prevención y el control del VIH y del sida (CENSIDA), Mexico City, Mexico
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11
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Lopez Luis BA, Valdivia-Cayoja AR, Belaunzaran-Zamudio PF, Soto-Ramírez LE. An immunocompromised patient & multiorgan cystic echinococcosis. QJM 2019; 112:215-217. [PMID: 30605541 DOI: 10.1093/qjmed/hcy306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/21/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- B A Lopez Luis
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
| | - A R Valdivia-Cayoja
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
| | - P F Belaunzaran-Zamudio
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
| | - L E Soto-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
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12
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Belaunzaran-Zamudio PF, Mosqueda-Gomez JL, Macias-Hernandez A, Rodríguez-Ramírez S, Sierra-Madero J, Beyrer C. Burden of HIV, Syphilis, and Hepatitis B and C Among Inmates in a Prison State System in Mexico. AIDS Res Hum Retroviruses 2017; 33:524-533. [PMID: 28094553 DOI: 10.1089/aid.2016.0271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We studied the prevalence of HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV) infection and associated risk behaviors in the prison state system of Guanajuato, Mexico between September 2011 and February 2012. Blood samples were drawn from adult inmates in all State prisons who agreed to participate in this cross-sectional study. Data on risk behaviors were collected by using self-administered questionnaires. The prevalence of HIV, syphilis, HBV, and HCV infection was 0.6% [95% confidence interval (CI) = 0.2-1.1], 0.7% (95% CI = 0.4-1.0), 0.4 (95% CI = 0.04-0.74), and 4.8 (95% CI = 3.6-5.9), respectively. Female inmates had a higher prevalence of HIV (1.5% vs. 0.6%, p = .05), whereas male inmates had a higher prevalence of HCV (1% vs. 5%, p = .008). Twenty percent (n = 443, 95% CI = 15-26) of the participants were tattooed during incarceration, and most of them were tattooed with recycled materials. Around 60% (57%, 95% CI = 49-65) used drugs before incarceration, and 9.2% (n = 205) used injected drugs. During incarceration, 30% (95% CI = 23-39) used drugs and 43 continued injecting (20% of users). Consistent condom use was low among men before incarcerations but decreased by half during incarceration. The highest consistent condom use before incarceration was among men who have sex with men (MSM) (17.7%, 95% CI = 14-22), but it decreased (9%, 95% CI = 3-14) during incarceration. The prevalence of HIV, HBV, HCV, and syphilis in these inmates is higher than that of the local adult population. Most inmates had sex in prison, but few used condoms consistently. Access to condoms is apparently harder for MSM. Interventions to increase condom use, reduce use of shared or recycled materials for tattooing and injecting drugs, and treatment for drug abuse are needed.
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Affiliation(s)
- Pablo F. Belaunzaran-Zamudio
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubiran,” Mexico City, Mexico
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan L. Mosqueda-Gomez
- Departamento de Microbiología de la Universidad de Guanajuato en León Guanajuato, León, Guanajuato, Mexico
- Centro Ambulatorio para la Prevención y Atención en SIDA e Infecciones de Transmisión Sexual de León, León, Guanajuato, Mexico
| | - Alejando Macias-Hernandez
- Departamento de Microbiología de la Universidad de Guanajuato en León Guanajuato, León, Guanajuato, Mexico
| | - Sonia Rodríguez-Ramírez
- Departamento de Microbiología de la Universidad de Guanajuato en León Guanajuato, León, Guanajuato, Mexico
| | - Juan Sierra-Madero
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Chris Beyrer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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13
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Manion M, Andrade BB, DerSimonian R, Gu W, Rupert A, Musselwhite LW, Sierra-Madero JG, Belaunzaran-Zamudio PF, Sanne I, Lederman MM, Sereti I. Country of residence is associated with distinct inflammatory biomarker signatures in HIV-infected patients. J Virus Erad 2017; 3:24-33. [PMID: 28275455 PMCID: PMC5337418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Inflammation and coagulation biomarkers are independent predictors of morbidity and mortality in HIV-infected patients. The impact of country of residence on these biomarkers is unknown and was investigated in persons at similar stages of HIV infection. METHODS Cryopreserved plasma specimens were analysed from 267 ART-naive patients with CD4 cell counts <100 cells/μl from Mexico (n=124) and South Africa (n=143). Biomarkers were compared and dimension reduction analyses were performed to highlight biosignatures according to nationality, gender and tuberculosis co-infection. RESULTS Mexican patients were significantly different from South Africans with regard to age, gender, CD4 cell count, haemoglobin, presence of AIDS-defining illness and prevalence of active tuberculosis. After adjusting for baseline characteristics, patients from Mexico had higher levels of IFN-γ, IL-8, and CXCL-10 whereas patients from South Africa had higher levels of fibrinogen, LTB4, P-selectin, protein S, and sCD40 ligand. The effect of country on the profile of biomarker expression was stronger than gender differences and tuberculosis co-infection. CONCLUSION Inflammation and coagulation biomarkers vary significantly by country. Further studies are needed to evaluate how these differences may contribute to HIV pathogenesis and prognosis in diverse populations and how they can be accounted for in studies using biomarkers as surrogate end points.
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Affiliation(s)
- Maura Manion
- National Institute of Allergy and Infectious Diseases,
National Institutes of Health (NIH),
Bethesda,
MD,
USA
| | - Bruno B. Andrade
- Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz,
Fundação Oswaldo Cruz,
Salvador,
Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative,
Fundação José Silveira,
Salvador,
Brazil,Curso de Medicina,
Faculdade de Tecnologia e Ciências (FTC),
Salvador,
Brazil
| | - Rebecca DerSimonian
- National Institute of Allergy and Infectious Diseases,
National Institutes of Health (NIH),
Bethesda,
MD,
USA
| | - Wenjuan Gu
- Leidos Biomedical Inc,
Frederick,
MD,
USA
| | | | - Laura W Musselwhite
- Duke Hubert Yeargan Center for Global Health,
Duke University,
Durham,
NC,
USA
| | - Juan G. Sierra-Madero
- Departamento de Infectologia,
Instituto Nacional de Ciencias Medicas y Nutricion,
Mexico City,
Mexico
| | - Pablo F Belaunzaran-Zamudio
- Departamento de Infectologia,
Instituto Nacional de Ciencias Medicas y Nutricion,
Mexico City,
Mexico,Division de Investigacion, Facultad de Medicina,
Universidad Nacional Autonoma de Mexico,
Mexico City,
Mexico
| | - Ian Sanne
- University of the Witwatersrand,
Johannesburg,
South Africa
| | | | - Irini Sereti
- National Institute of Allergy and Infectious Diseases,
National Institutes of Health (NIH),
Bethesda,
MD,
USA,Corresponding author: Irini Sereti,
Clinical and Molecular Retrovirology Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases,
National Institutes of Health,
Bldg 10, Rm 11B-07A, 10 Center Drive, MSC 1876,
Bethesda,
MD20892,
USA
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14
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Manion M, Andrade BB, DerSimonian R, Gu W, Rupert A, Musselwhite LW, Sierra-Madero JG, Belaunzaran-Zamudio PF, Sanne I, Lederman MM, Sereti I. Country of residence is associated with distinct inflammatory biomarker signatures in HIV-infected patients. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Musselwhite LW, Andrade BB, Ellenberg SS, Tierney A, Belaunzaran-Zamudio PF, Rupert A, Lederman MM, Sanne I, Sierra Madero JG, Sereti I. Vitamin D, D-dimer, Interferon γ, and sCD14 Levels are Independently Associated with Immune Reconstitution Inflammatory Syndrome: A Prospective, International Study. EBioMedicine 2016; 4:115-23. [PMID: 26981576 PMCID: PMC4776072 DOI: 10.1016/j.ebiom.2016.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 01/03/2023] Open
Abstract
To determine the immunological profile most important for IRIS prediction, we evaluated 20 baseline plasma biomarkers in Acquired Immunodeficiency Syndrome (AIDS) patients initiating antiretroviral therapy (ART). Patients were enrolled in a randomized, placebo-controlled ART initiation trial in South Africa and Mexico to test whether maraviroc could prevent IRIS. Participants were classified prospectively as having IRIS within 6 months of ART initiation. Twenty plasma biomarkers were measured at study enrollment for 267 participants. Biomarkers were tested for predicting IRIS with adjustment for covariates chosen through forward stepwise selection. Sixty-two participants developed IRIS and of these 19 were tuberculosis (TB)-IRIS. Baseline levels of vitamin D and higher d-dimer, interferon gamma (IFNγ), and sCD14 were independently associated with risk of IRIS in multivariate analyses. TB-IRIS cases exhibited a distinct biosignature from IRIS related to other pathogens, with increased levels of C-reactive protein (CRP), sCD14, IFNγ, and lower levels of Hb that could be captured by a composite risk score. Elevated markers of Type 1 T helper (Th1) response, monocyte activation, coagulation and low vitamin D were independently associated with IRIS risk. Interventions that decrease immune activation and increase vitamin D levels warrant further study.
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Affiliation(s)
- Laura W. Musselwhite
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA
- Duke Hubert Yeargan Center for Global Health, Duke University, 310 Trent Drive, Duke Box 90518, Durham, NC 27708, USA
| | - Bruno B. Andrade
- Laboratory of Parasitic Diseases, NIAID, NIH, 50 South Drive, Bethesda, MD 20892, USA
- Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazilian Institute for Tuberculosis Research, José Silveira Foundation, Salvador, Brazil
| | - Susan S. Ellenberg
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 611 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-602, USA
| | - Ann Tierney
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 611 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-602, USA
| | - Pablo F. Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México City, México
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, México
| | - Adam Rupert
- Leidos Biomedical Inc., 11951 Freedom Drive, Reston, VA 20190, USA
| | - Michael M. Lederman
- Case Western Reserve University School of Medicine, 2061 Cornell Rd, Cleveland, OH 44106, USA
| | - Ian Sanne
- University of Witwatersrand, Johannesburg, South Africa
| | - Juan G. Sierra Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México City, México
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA
- Corresponding author at: Clinical and Molecular Retrovirology Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 10, Room 11B-07A, Bethesda, MD 20892, USA.Clinical and Molecular Retrovirology SectionLaboratory of ImmunoregulationNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBuilding 10, Room 11B-07ABethesdaMD20892USA
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