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Mohamed Y, Htay H, Gare J, Vallely AJB, Kelly-Hanku A, Yee WL, Agius PA, Badman SG, Pham MD, Nightingale C, Chen XS, Kombati Z, Koata A, Munnull G, Silim S, Thein W, Zaw TM, Kyaw LL, Stoové M, Crowe SM, Anderson D, Tin HH, Luchters S. The effect of the Xpert HIV-1 Qual test on early infant diagnosis of HIV in Myanmar and Papua New Guinea: a pragmatic, cluster-randomised, stepped-wedge, open-label trial. Lancet HIV 2023; 10:e220-e229. [PMID: 36871568 DOI: 10.1016/s2352-3018(23)00001-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 03/06/2023]
Abstract
BACKGROUND Despite proven benefits for child health, coverage of early infant diagnosis of HIV remains suboptimal in many settings. We aimed to assess the effect of a point-of-care early infant diagnosis test on time-to-results communication for infants vertically exposed to HIV. METHODS This pragmatic, cluster-randomised, stepped-wedge, open-label trial assessed the effect of the Xpert HIV-1 Qual early infant diagnosis test (Cepheid) on time-to-results communication, compared with standard care laboratory-based testing of dried blood spots using PCR. Hospitals were the unit of randomisation for one-way crossover from control to intervention phase. Each site had between 1 month and 10 months of control phase before transitioning to the intervention, with a total of 33 hospital-months in the control phase and 45 hospital-months in the intervention phase. We enrolled infants vertically exposed to HIV at six public hospitals: four in Myanmar and two in Papua New Guinea. Infants had to have mothers with confirmed HIV infection, be younger than 28 days, and required HIV testing to be eligible for enrolment. Health-care facilities providing prevention of vertical transmission services were eligible for participation. The primary outcome was communication of early infant diagnosis results to the infant's caregiver by 3 months of age, assessed by intention to treat. This completed trial was registered with the Australian and New Zealand Clinical Trials Registry, 12616000734460. FINDINGS In Myanmar, recruitment took place between Oct 1, 2016, and June 30, 2018; in Papua New Guinea, recruitment was between Dec 1, 2016, and Aug 31, 2018. A total of 393 caregiver-infant pairs were enrolled in the study across both countries. Independent of study time, the Xpert test reduced time to early infant diagnosis results communication by 60%, compared with the standard of care (adjusted time ratio 0·40, 95% CI 0·29-0·53, p<0·0001). In the control phase, two (2%) of 102 study participants received an early infant diagnosis test result by 3 months of age compared with 214 (74%) of 291 in the intervention phase. No safety and adverse events were reported related to the diagnostic testing intervention. INTERPRETATION This study reinforces the importance of scaling up point-of-care early infant diagnosis testing in resource-constrained and low HIV-prevalence settings, typical of the UNICEF East Asia and Pacific region. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Yasmin Mohamed
- Burnet Institute, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Hla Htay
- Burnet Institute Myanmar, Yangon, Myanmar
| | - Janet Gare
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Andrew J B Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Paul A Agius
- Burnet Institute, Melbourne, VIC, Australia; Faculty of Health, Deakin University, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Steven G Badman
- Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Minh Duc Pham
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Nightingale
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Xiang-Sheng Chen
- Chinese Academy of Medical Science, Institute of Dermatology and National Centre for STD Control, Nanjing, China
| | - Zure Kombati
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Mount Hagen General Hospital, Mount Hagen, Western Highlands Province, Papua New Guinea
| | - Amelia Koata
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Gloria Munnull
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Mount Hagen General Hospital, Mount Hagen, Western Highlands Province, Papua New Guinea
| | - Selina Silim
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Win Thein
- National Health Laboratory, Yangon, Myanmar
| | - Tin Maung Zaw
- National AIDS Program (Yangon Region), Ministry of Health and Sports, Yangon, Myanmar
| | | | | | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe; Liverpool School of Tropical Medicine, Liverpool, UK; International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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2
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Vidhyavathi V, Iqbal HS, Kanthamani K, Solomon SS, Nandagopal P, Luchters S, Pham MD, Forbes J, Crowe SM, McMurran C, Anderson DA, Balakrishnan P. Performance characteristics of an instrument-free point-of-care CD4 test (VISITECT®CD4) for use in resource-limited settings. J Int Med Res 2021; 48:300060520955028. [PMID: 32985310 PMCID: PMC7536493 DOI: 10.1177/0300060520955028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective CD4+ T lymphocyte count remains the most common biomarker of immune status
and disease progression in human immunodeficiency virus (HIV)-positive
individuals. VISITECT®CD4 is an instrument-free, low-cost point-of-care CD4
test with a cut-off of 350 CD4 cells/μL. This study aimed to evaluate
VISITECT®CD4 test's diagnostic accuracy. Methods Two hundred HIV-positive patients attending a tertiary HIV centre in South
India were recruited. Patients provided venous blood for reference and
VISITECT®CD4 tests. An additional finger-prick blood sample was obtained for
VISITECT®CD4. VISITECT®CD4's diagnostic performance in identifying
individuals with CD4 counts ≤350 cells/μL was assessed by calculating
sensitivity, specificity, positive predictive value (PPV) and negative
predictive value (NPV) taking flow cytometry as the reference. Results The overall agreement between VISITECT®CD4 and flow cytometry was 89.5% using
venous blood and 81.5% using finger-prick blood. VISITECT®CD4 showed better
performance using venous blood [sensitivity: 96.6% (95% confidence interval:
92.1%–98.9%), specificity: 70.9% (57.1%–82.4%), PPV: 89.7% (83.9%–94.0%) and
NPV: 88.6% (75.4%–96.2%)] than using finger-prick blood [sensitivity: 84.8%
(77.9%–90.2%), specificity: 72.7% (59.0%–83.9%), PPV: 89.1% (82.7%–93.8%)
and NPV: 64.5% (51.3%–76.3%)]. Conclusion VISITECT®CD4 performed well using venous blood, demonstrating its potential
utility in decentralization of CD4 testing services in resource-constrained
settings.
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Affiliation(s)
| | - Hussain Syed Iqbal
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
| | - Kannaiyan Kanthamani
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
| | - Sunil Suhas Solomon
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
- Johns Hopkins University School of Medicine, Baltimore,
USA
| | | | - Stanley Luchters
- Department of Population Health, Aga Khan University, Nairobi,
Kenya
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
- Department of Public Health and Primary Care, Ghent University,
Ghent, Belgium
| | - Minh D. Pham
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
| | | | - Suzanne M. Crowe
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
| | | | | | - Pachamuthu Balakrishnan
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
- Pachamuthu Balakrishnan, YRG Centre for AIDS
Research and Education, Voluntary Health Services Hospital Campus, Taramani,
Chennai – 600113, India.
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3
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Sacks-Davis R, Chibo D, Peach E, Aleksic E, Crowe SM, El Hayek C, Marukutira T, Higgins N, Stoove M, Hellard M. Phylogenetic clustering networks among heterosexual migrants with new HIV diagnoses post-migration in Australia. PLoS One 2020; 15:e0237469. [PMID: 32870911 PMCID: PMC7462279 DOI: 10.1371/journal.pone.0237469] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants. Methods Partial HIV pol sequences obtained from routine clinical genotype tests were linked to Victorian HIV notifications with the following exposures listed on the notification form: heterosexual sexual contact, injecting drug use, bisexual sexual contact, male-to male sexual contact or heterosexual sexual contact in combination with injecting drug use, unknown exposure. Those with heterosexual sexual contact as the only exposure were the focus of this study, with the other exposures included to better understand transmission networks. Additional reference sequences were extracted from the Los Alamos database. Maximum likelihood methods were used to infer the phylogeny and the robustness of the resulting tree was assessed using bootstrap analysis. Phylogenetic clusters were defined on the basis of bootstrap and genetic distance. Results HIV pol sequences were available for 332 of 445 HIV notifications attributed to only heterosexual sexual contact in Victoria from 2005–2014. Forty-three phylogenetic clusters containing at least one heterosexual migrant were detected, 30 (70%) of which were pairs. The characteristics of these phylogenetic clusters varied considerably by cluster size. Pairs were more likely to be composed of people living with HIV from a single country of birth (p = 0.032). Larger clusters (n≥3) were more likely to contain people born in Australian/New Zealand (p = 0.002), migrants from more than one country of birth (p = 0.013) and viral subtype-B, the most common subtype in Australia (p = 0.006). Pairs were significantly more likely to contain females (p = 0.037) and less likely to include HIV diagnoses with male-to-male sexual contact reported as a possible exposure (p<0.001) compared to larger clusters (n≥3). Conclusion Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted.
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Affiliation(s)
- Rachel Sacks-Davis
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Doris Chibo
- Victorian Infectious Disease Reference Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eman Aleksic
- Burnet Institute, Melbourne, Victoria, Australia
| | - Suzanne M. Crowe
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Carol El Hayek
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tafireyi Marukutira
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nasra Higgins
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Hepatitis Services, Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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4
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Yeoh HL, Cheng A, Palmer C, Crowe SM, Hoy JF. Frailty in men living with HIV: a cross-sectional comparison of three frailty instruments. Antivir Ther 2019; 23:117-127. [PMID: 28731422 DOI: 10.3851/imp3185] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Potent antiretroviral treatment has resulted in near normal life expectancy for people living with HIV. Consequently, there is an increased focus on comorbidities, frailty and quality of life. METHODS We assessed and compared the prevalence of frailty, associated factors and relationship with quality of life in older Australian men living with HIV in a cross-sectional study using three frailty measurements. The Frailty Phenotype, Frailty Index and Edmonton Frail Scale were applied to 93 HIV-infected men aged over 50 years, on antiretroviral therapy. Multivariable ordinal logistic regression was used to analyse the associations of frailty with covariates and quality of life. RESULTS The prevalence of frailty was 10.8% (n=10) using the Frailty Phenotype; 22.6% (n=21) using the Frailty Index and 15.1% (n=14) using the Edmonton Frail Scale. Frailty Phenotype-defined pre-frailty/frailty was associated with pre-1996 ART initiation (OR, 3.56; CI, 1.23, 10.36; P=0.020) and depression (OR, 3.74; CI, 1.24, 11.27; P=0.019). Osteoporosis, serious non-AIDS events and AIDS were associated with Frailty Index-defined frailty (OR, 4.84, CI, 1.27, 18.43, P=0.021; OR, 4.27, CI, 1.25, 14.58, P=0.020; OR, 4.62, CI, 1.30, 16.45, P=0.018, respectively) and Edmonton Frail Scale-defined frailty (OR, 7.51; CI, 1.55, 36.42; P=0.012; OR, 7.71; CI, 1.62, 36.75; P=0.010; OR, 8.53; CI, 1.70, 42.73; P=0.009, respectively), independent of age and current CD4+ T-cell count. Frailty, defined by any of the instruments, was significantly associated with poorer quality of life (P<0.001). CONCLUSIONS Identifying frailty is an increasingly important contemporary consideration of HIV care related to ageing and quality of life.
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Affiliation(s)
- Hui-Ling Yeoh
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Allen Cheng
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Clovis Palmer
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Suzanne M Crowe
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia
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5
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Alzahrani J, Hussain T, Simar D, Palchaudhuri R, Abdel-Mohsen M, Crowe SM, Mbogo GW, Palmer CS. Inflammatory and immunometabolic consequences of gut dysfunction in HIV: Parallels with IBD and implications for reservoir persistence and non-AIDS comorbidities. EBioMedicine 2019; 46:522-531. [PMID: 31327693 PMCID: PMC6710907 DOI: 10.1016/j.ebiom.2019.07.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 03/29/2019] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022] Open
Abstract
The gastrointestinal mucosa is critical for maintaining the integrity and functions of the gut. Disruption of this barrier is a hallmark and a risk factor for many intestinal and chronic inflammatory diseases. Inflammatory bowel disease (IBD) and HIV infection are characterized by microbial translocation and systemic inflammation. Despite the clinical overlaps between HIV and IBD, significant differences exist such as the severity of gut damage and mechanisms of immune cell homeostasis. Studies have supported the role of metabolic activation of immune cells in promoting chronic inflammation in HIV and IBD. This inflammatory response persists in HIV+ persons even after long-term virologic suppression by antiretroviral therapy (ART). Here, we review gut dysfunction and microbiota changes during HIV infection and IBD, and discuss how this may induce metabolic reprogramming of monocytes, macrophages and T cells to impact disease outcomes. Drawing from parallels with IBD, we highlight how factors such as lipopolysaccharides, residual viral replication, and extracellular vesicles activate biochemical pathways that regulate immunometabolic processes essential for HIV persistence and non-AIDS metabolic comorbidities. This review highlights new mechanisms and support for the use of immunometabolic-based therapeutics towards HIV remission/cure, and treatment of metabolic diseases.
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Affiliation(s)
- Jehad Alzahrani
- Life Sciences, Burnet Institute, Melbourne, Australia; School of Medical Science, RMIT University, Melbourne, Australia
| | - Tabinda Hussain
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - David Simar
- School of Medical Sciences, UNSW, Sydney, Australia
| | | | | | - Suzanne M Crowe
- Life Sciences, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, Monash University, Melbourne, Australia
| | | | - Clovis S Palmer
- Life Sciences, Burnet Institute, Melbourne, Australia; School of Medical Science, RMIT University, Melbourne, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.
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6
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Khan SI, Reza MM, Crowe SM, Rahman M, Hellard M, Sarker MS, Chowdhury EI, Rana AM, Sacks-Davis R, Banu S, Ross AG. People who inject drugs in Bangladesh — The untold burden! Int J Infect Dis 2019; 83:109-115. [DOI: https:/doi.org/10.1016/j.ijid.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
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7
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Scorgie F, Mohamed Y, Anderson D, Crowe SM, Luchters S, Chersich MF. Qualitative assessment of South African healthcare worker perspectives on an instrument-free rapid CD4 test. BMC Health Serv Res 2019; 19:123. [PMID: 30764808 PMCID: PMC6376755 DOI: 10.1186/s12913-019-3948-x] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/04/2019] [Indexed: 01/02/2023] Open
Abstract
Background Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test. Methods Perspectives on the VISITECT® CD4 test were elicited through in-depth interviews with eight healthcare workers involved in the performance evaluation at an antenatal care facility in Johannesburg, South Africa. Audio recordings were transcribed in full and analysed thematically. Results Healthcare providers recognised the on-going relevance of CD4 testing. All eight perceived the VISITECT® CD4 test to be predominantly user-friendly, although some felt that the need for precision and optimal concentration in performing test procedures made it more challenging to use. The greatest strength of the test was perceived to be its quick turn-around of results. There were mixed views on the semi-quantitative nature of the test results and how best to integrate this test into existing health services. Participants believed that patients in this setting would likely accept the test, given their general familiarity with other point-of-care tests. Conclusions Overall, the VISITECT® CD4 test was acceptable to healthcare workers and those interviewed were supportive of scale-up and implementation in other antenatal care settings. Both health workers and patients will need to be oriented to the semi-quantitative nature of the test and how to interpret the results of tests. Electronic supplementary material The online version of this article (10.1186/s12913-019-3948-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona Scorgie
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Population Health, Aga Khan University, Nairobi, Kenya.,International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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8
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Luchters S, Technau K, Mohamed Y, Chersich MF, Agius PA, Pham MD, Garcia ML, Forbes J, Shepherd A, Coovadia A, Crowe SM, Anderson DA. Field Performance and Diagnostic Accuracy of a Low-Cost Instrument-Free Point-of-Care CD4 Test (Visitect CD4) Performed by Different Health Worker Cadres among Pregnant Women. J Clin Microbiol 2019; 57:e01277-18. [PMID: 30463898 PMCID: PMC6355532 DOI: 10.1128/jcm.01277-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3 The field performance and diagnostic accuracy of the test was assessed among HIV-infected pregnant women in South Africa. A nurse performed testing at the point-of-care using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur Trucount). In 2017, 156 patients were enrolled, providing a total of 624 Visitect CD4 tests (468 venous and 156 finger-prick samples). Of 624 tests, 28 (4.5%) were inconclusive. Generalized linear mixed modeling showed better performance of the test on venous blood (sensitivity = 81.7%; 95% confidence interval [CI] = 72.3 to 91.1]; specificity = 82.6%, 95% CI = 77.1 to 88.1) than on finger-prick specimens (sensitivity = 60.7%; 95% CI = 45.0 to 76.3; specificity = 89.5%, 95% CI = 83.2 to 95.8; P = 0.001). No difference in performance was detected by cadre of health worker (P = 0.113) or between point-of-care versus laboratory-based testing (P = 0.108). Adequate performance of Visitect CD4 with different operators and at the point of care, with no need of electricity or instrument, shows the potential utility of this device, especially for facilitating decentralization of CD4 testing services in rural areas.
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Affiliation(s)
- Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karl Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew F Chersich
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul A Agius
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Minh D Pham
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - James Forbes
- Omega Diagnostics, Ltd., Omega House, Alva, Scotland
| | | | - Ashraf Coovadia
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne M Crowe
- Burnet Institute, Melbourne, Victoria, Australia
- The Alfred Hospital and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
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9
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Crowe SM, Kintzios S, Kaltsas G, Palmer CS. A Bioelectronic System to Measure the Glycolytic Metabolism of Activated CD4+ T Cells. Biosensors (Basel) 2019; 9:bios9010010. [PMID: 30634392 PMCID: PMC6468583 DOI: 10.3390/bios9010010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/30/2018] [Accepted: 01/01/2019] [Indexed: 01/02/2023]
Abstract
The evaluation of glucose metabolic activity in immune cells is becoming an increasingly standard task in immunological research. In this study, we described a sensitive, inexpensive, and non-radioactive assay for the direct and rapid measurement of the metabolic activity of CD4+ T cells in culture. A portable, custom-built Cell Culture Metabolite Biosensor device was designed to measure the levels of acidification (a proxy for glycolysis) in cell-free CD4+ T cell culture media. In this assay, ex vivo activated CD4+ T cells were incubated in culture medium and mini electrodes were placed inside the cell free culture filtrates in 96-well plates. Using this technique, the inhibitors of glycolysis were shown to suppress acidification of the cell culture media, a response similar to that observed using a gold standard lactate assay kit. Our findings show that this innovative biosensor technology has potential for applications in metabolic research, where acquisition of sufficient cellular material for ex vivo analyses presents a substantial challenge.
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Affiliation(s)
- Suzanne M Crowe
- Life Sciences Discipline, Burnet Institute, Melbourne, VIC 3001, Australia.
- Department of Infectious Diseases, Monash University, Melbourne, VIC 3004, Australia.
- Infectious Diseases Department, The Alfred hospital, Melbourne, VIC 3004, Australia.
| | - Spyridon Kintzios
- Laboratory of Cell Technology, School of Food Science, Biotechnology and Development, Agricultural University of Athens, 11855 Athens, Greece.
| | - Grigoris Kaltsas
- Department of Electrical and Electronics Engineering, microSENSES lab, University of West Attika, 12244 Athens, Greece.
| | - Clovis S Palmer
- Life Sciences Discipline, Burnet Institute, Melbourne, VIC 3001, Australia.
- Department of Infectious Diseases, Monash University, Melbourne, VIC 3004, Australia.
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10
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Rajasuriar R, Hearps AC, Crowe SM, Anzinger JJ, Palmer CS. Suppression of monocyte inflammatory and coagulopathy responses in HIV infection. Ann Transl Med 2018; 6:277. [PMID: 30094263 DOI: 10.21037/atm.2018.06.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Anna C Hearps
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Suzanne M Crowe
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joshua J Anzinger
- Department of Microbiology, University of the West Indies, Mona, Kingston, Jamaica
| | - Clovis S Palmer
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
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11
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Masson JJR, Cherry CL, Murphy NM, Sada-Ovalle I, Hussain T, Palchaudhuri R, Martinson J, Landay AL, Billah B, Crowe SM, Palmer CS. Polymorphism rs1385129 Within Glut1 Gene SLC2A1 Is Linked to Poor CD4+ T Cell Recovery in Antiretroviral-Treated HIV+ Individuals. Front Immunol 2018; 9:900. [PMID: 29867928 PMCID: PMC5966582 DOI: 10.3389/fimmu.2018.00900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/25/2018] [Accepted: 04/11/2018] [Indexed: 01/14/2023] Open
Abstract
Untreated HIV infection is associated with progressive CD4+ T cell depletion, which is generally recovered with combination antiretroviral therapy (cART). However, a significant proportion of cART-treated individuals have poor CD4+ T cell reconstitution. We investigated associations between HIV disease progression and CD4+ T cell glucose transporter-1 (Glut1) expression. We also investigated the association between these variables and specific single nucleotide polymorphisms (SNPs) within the Glut1 regulatory gene AKT (rs1130214, rs2494732, rs1130233, and rs3730358) and in the Glut1-expressing gene SLC2A1 (rs1385129 and rs841853) and antisense RNA 1 region SLC2A1-AS1 (rs710218). High CD4+Glut1+ T cell percentage is associated with rapid CD4+ T cell decline in HIV-positive treatment-naïve individuals and poor T cell recovery in HIV-positive individuals on cART. Evidence suggests that poor CD4+ T cell recovery in treated HIV-positive individuals is linked to the homozygous genotype (GG) associated with SLC2A1 SNP rs1385129 when compared to those with a recessive allele (GA/AA) (odds ratio = 4.67; P = 0.04). Furthermore, poor response to therapy is less likely among Australian participants when compared against American participants (odds ratio: 0.12; P = 0.01) despite there being no difference in prevalence of a specific genotype for any of the SNPs analyzed between nationalities. Finally, CD4+Glut1+ T cell percentage is elevated among those with a homozygous dominant genotype for SNPs rs1385129 (GG) and rs710218 (AA) when compared to those with a recessive allele (GA/AA and AT/TT respectively) (P < 0.04). The heterozygous genotype associated with AKT SNP 1130214 (GT) had a higher CD4+Glut1+ T cell percentage when compared to the dominant homozygous genotype (GG) (P = 0.0068). The frequency of circulating CD4+Glut1+ T cells and the rs1385129 SLC2A1 SNP may predict the rate of HIV disease progression and CD4+ T cell recovery in untreated and treated infection, respectively.
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Affiliation(s)
- Jesse J R Masson
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia
| | - Catherine L Cherry
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicholas M Murphy
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,Preimplantation Genetic Diagnosis, Monash IVF, Melbourne, VIC, Australia
| | - Isabel Sada-Ovalle
- Unidad de Investigación Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Tabinda Hussain
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Riya Palchaudhuri
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia
| | - Jeffrey Martinson
- Department of Immunology-Microbiology, Rush University Medical Centre, Chicago, IL, United States
| | - Alan L Landay
- Department of Immunology-Microbiology, Rush University Medical Centre, Chicago, IL, United States
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
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12
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Marukutira T, Stoové M, Lockman S, Mills LA, Gaolathe T, Lebelonyane R, Jarvis JN, Kelly SL, Wilson DP, Luchters S, Crowe SM, Hellard M. A tale of two countries: progress towards UNAIDS 90-90-90 targets in Botswana and Australia. J Int AIDS Soc 2018; 21:e25090. [PMID: 29508945 PMCID: PMC5838412 DOI: 10.1002/jia2.25090] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/13/2018] [Indexed: 11/13/2022] Open
Abstract
UNAIDS 90-90-90 targets and Fast-Track commitments are presented as precursors to ending the AIDS epidemic by 2030, through effecting a 90% reduction in new HIV infections and AIDS-related deaths from 2010 levels (HIV epidemic control). Botswana, a low to middle-income country with the third-highest HIV prevalence, and Australia, a low-prevalence high-income country with an epidemic concentrated among men who have sex with men (MSM), have made significant strides towards achieving the UNAIDS 90-90-90 targets. These two countries provide lessons for different epidemic settings. This paper discusses the lessons that can be drawn from Botswana and Australia with respect to their success in HIV testing, treatment, viral suppression and other HIV prevention strategies for HIV epidemic control. Botswana and Australia are on target to achieving the 90-90-90 targets for HIV epidemic control, made possible by comprehensive HIV testing and treatment programmes in the two countries. As of 2015, 70% of all people assumed to be living with HIV had viral suppression in Botswana and Australia. However, HIV incidence remains above one per cent in the general population in Botswana and in MSM in Australia. The two countries have demonstrated that rapid HIV testing that is accessible and targeted at key and vulnerable populations is required in order to continue identifying new HIV infections. All citizens living with HIV in both countries are eligible for antiretroviral therapy (ART) and viral load monitoring through government-funded programmes. Notwithstanding their success in reducing HIV transmission to date, programmes in both countries must continue to be supported at current levels to maintain epidemic suppression. Scaled HIV testing, linkage to care, universal ART, monitoring patients on treatment over and above strengthened HIV prevention strategies (e.g. male circumcision and pre-exposure prophylaxis) will all continue to require funding. The progress that Botswana and Australia have made towards meeting the 90-90-90 targets is commendable. However, in order to reduce HIV incidence significantly towards 2030, there is a need for sustained HIV testing, linkage to care and high treatment coverage. Botswana and Australia provide useful lessons for developing countries with generalized epidemics and high-income countries with concentrated epidemics.
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Affiliation(s)
- Tafireyi Marukutira
- Public HealthBurnet InstituteMelbourneVic.Australia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVic.Australia
| | - Mark Stoové
- Public HealthBurnet InstituteMelbourneVic.Australia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVic.Australia
| | - Shahin Lockman
- Division of Infectious DiseaseBrigham and Women's HospitalBostonMAUSA
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Lisa A Mills
- Division of Global HealthCenters for Disease Control and PreventionGaboroneBotswana
| | - Tendani Gaolathe
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
| | | | - Joseph N Jarvis
- Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Sherrie L Kelly
- Infectious Diseases ModellingBurnet InstituteMelbourneVic.Australia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
| | - David P Wilson
- Infectious Diseases ModellingBurnet InstituteMelbourneVic.Australia
| | - Stanley Luchters
- Public HealthBurnet InstituteMelbourneVic.Australia
- International Centre for Reproductive HealthGhent UniversityGhentBelgium
| | - Suzanne M Crowe
- Public HealthBurnet InstituteMelbourneVic.Australia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVic.Australia
| | - Margaret Hellard
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVic.Australia
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13
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Palmer CS, Palchaudhuri R, Albargy H, Abdel-Mohsen M, Crowe SM. Exploiting immune cell metabolic machinery for functional HIV cure and the prevention of inflammaging. F1000Res 2018; 7:125. [PMID: 29445452 PMCID: PMC5791007 DOI: 10.12688/f1000research.11881.1] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/31/2022] Open
Abstract
An emerging paradigm in immunology suggests that metabolic reprogramming and immune cell activation and functions are intricately linked. Viral infections, such as HIV infection, as well as cancer force immune cells to undergo major metabolic challenges. Cells must divert energy resources in order to mount an effective immune response. However, the fact that immune cells adopt specific metabolic programs to provide host defense against intracellular pathogens and how this metabolic shift impacts immune cell functions and the natural course of diseases have only recently been appreciated. A clearer insight into how these processes are inter-related will affect our understanding of several fundamental aspects of HIV persistence. Even in patients with long-term use of anti-retroviral therapies, HIV infection persists and continues to cause chronic immune activation and inflammation, ongoing and cumulative damage to multiple organs systems, and a reduction in life expectancy. HIV-associated fundamental changes to the metabolic machinery of the immune system can promote a state of “inflammaging”, a chronic, low-grade inflammation with specific immune changes that characterize aging, and can also contribute to the persistence of HIV in its reservoirs. In this commentary, we will bring into focus evolving concepts on how HIV modulates the metabolic machinery of immune cells in order to persist in reservoirs and how metabolic reprogramming facilitates a chronic state of inflammation that underlies the development of age-related comorbidities. We will discuss how immunometabolism is facilitating the changing paradigms in HIV cure research and outline the novel therapeutic opportunities for preventing inflammaging and premature development of age-related conditions in HIV
+ individuals.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Riya Palchaudhuri
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Hassan Albargy
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | | | - Suzanne M Crowe
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
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14
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Shehata HM, Murphy AJ, Lee MKS, Gardiner CM, Crowe SM, Sanjabi S, Finlay DK, Palmer CS. Sugar or Fat?-Metabolic Requirements for Immunity to Viral Infections. Front Immunol 2017; 8:1311. [PMID: 29085369 PMCID: PMC5649203 DOI: 10.3389/fimmu.2017.01311] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 08/18/2017] [Accepted: 09/28/2017] [Indexed: 12/20/2022] Open
Abstract
The realization that an intricate link exists between the metabolic state of immune cells and the nature of the elicited immune responses has brought a dramatic evolution to the field of immunology. We will focus on how metabolic reprogramming through the use of glycolysis and fatty-acid oxidation (sugar or fat) regulates the capacity of immune cells to mount robust and effective immune responses. We will also discuss how fine-tuning sugar and fat metabolism may be exploited as a novel immunotherapeutic strategy to fight viral infections or improve vaccine efficacy.
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Affiliation(s)
- Hesham M Shehata
- Virology and Immunology, Gladstone Institutes, San Francisco, CA, United States
| | - Andrew J Murphy
- Haematopoiesis and Leukocyte Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Man Kit Sam Lee
- Haematopoiesis and Leukocyte Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Clair M Gardiner
- School of Biochemistry and Immunology, Trinity College Dublin, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Shomyseh Sanjabi
- Virology and Immunology, Gladstone Institutes, San Francisco, CA, United States
| | - David K Finlay
- School of Biochemistry and Immunology, Trinity College Dublin, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - Clovis Steve Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
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15
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Palmer CS, Duette GA, Wagner MCE, Henstridge DC, Saleh S, Pereira C, Zhou J, Simar D, Lewin SR, Ostrowski M, McCune JM, Crowe SM. Metabolically active CD4+ T cells expressing Glut1 and OX40 preferentially harbor HIV during in vitro infection. FEBS Lett 2017; 591:3319-3332. [PMID: 28892135 PMCID: PMC5658250 DOI: 10.1002/1873-3468.12843] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 12/04/2022]
Abstract
High glucose transporter 1 (Glut1) surface expression is associated with increased glycolytic activity in activated CD4+ T cells. Phosphatidylinositide 3‐kinases (PI3K) activation measured by p‐Akt and OX40 is elevated in CD4+Glut1+ T cells from HIV+ subjects. TCR engagement of CD4+Glut1+ T cells from HIV+ subjects demonstrates hyperresponsive PI3K‐mammalian target of rapamycin signaling. High basal Glut1 and OX40 on CD4+ T cells from combination antiretroviral therapy (cART)‐treated HIV+ patients represent a sufficiently metabolically active state permissive for HIV infection in vitro without external stimuli. The majority of CD4+OX40+ T cells express Glut1, thus OX40 rather than Glut1 itself may facilitate HIV infection. Furthermore, infection of CD4+ T cells is limited by p110γ PI3K inhibition. Modulating glucose metabolism may limit cellular activation and prevent residual HIV replication in ‘virologically suppressed’ cART‐treated HIV+ persons.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Gabriel A Duette
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina
| | | | - Darren C Henstridge
- Cellular and Molecular Metabolism Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Suah Saleh
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Candida Pereira
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.,Monash Micro Imaging, Monash University, Melbourne, Australia
| | - Jingling Zhou
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - David Simar
- Inflammation and Infection Research, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Sharon R Lewin
- Department of Infectious Diseases, Monash University, Melbourne, Australia.,The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - Matias Ostrowski
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina
| | - Joseph M McCune
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia
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16
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Palmer CS, Henstridge DC, Yu D, Singh A, Balderson B, Duette G, Cherry CL, Anzinger JJ, Ostrowski M, Crowe SM. Emerging Role and Characterization of Immunometabolism: Relevance to HIV Pathogenesis, Serious Non-AIDS Events, and a Cure. J Immunol 2017; 196:4437-44. [PMID: 27207806 DOI: 10.4049/jimmunol.1600120] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/20/2016] [Indexed: 01/18/2023]
Abstract
Immune cells cycle between a resting and an activated state. Their metabolism is tightly linked to their activation status and, consequently, functions. Ag recognition induces T lymphocyte activation and proliferation and acquisition of effector functions that require and depend on cellular metabolic reprogramming. Likewise, recognition of pathogen-associated molecular patterns by monocytes and macrophages induces changes in cellular metabolism. As obligate intracellular parasites, viruses manipulate the metabolism of infected cells to meet their structural and functional requirements. For example, HIV-induced changes in immune cell metabolism and redox state are associated with CD4(+) T cell depletion, immune activation, and inflammation. In this review, we highlight how HIV modifies immunometabolism with potential implications for cure research and pathogenesis of comorbidities observed in HIV-infected patients, including those with virologic suppression. In addition, we highlight recently described key methods that can be applied to study the metabolic dysregulation of immune cells in disease states.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria 3004, Australia;
| | - Darren C Henstridge
- Cellular and Molecular Metabolism Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Di Yu
- Laboratory of Molecular Immunomodulation, School of Biomedical Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Amit Singh
- Department of Microbiology and Cell Biology, Centre for Infectious Disease and Research, Indian Institute of Science, Bangalore 560012, India
| | - Brad Balderson
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria 3004, Australia
| | - Gabriel Duette
- Instituto de Investigaciones Biomedicas en Retrovirus y SIDA, Facultad de Medicina, C1121ABG Buenos Aires, Argentina
| | - Catherine L Cherry
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria 3004, Australia; Infectious Diseases Department, The Alfred Hospital, Melbourne, Victoria 3004, Australia; School of Physiology, University of the Witwatersrand, Johannesburg, Gauteng 2000, South Africa; and
| | - Joshua J Anzinger
- Department of Microbiology, University of the West Indies, Mona, Jamaica
| | - Matias Ostrowski
- Instituto de Investigaciones Biomedicas en Retrovirus y SIDA, Facultad de Medicina, C1121ABG Buenos Aires, Argentina
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria 3004, Australia; Infectious Diseases Department, The Alfred Hospital, Melbourne, Victoria 3004, Australia
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17
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Masson JJR, Murphy AJ, Lee MKS, Ostrowski M, Crowe SM, Palmer CS. Assessment of metabolic and mitochondrial dynamics in CD4+ and CD8+ T cells in virologically suppressed HIV-positive individuals on combination antiretroviral therapy. PLoS One 2017; 12:e0183931. [PMID: 28854263 PMCID: PMC5576743 DOI: 10.1371/journal.pone.0183931] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/08/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022] Open
Abstract
Metabolism plays a fundamental role in supporting the growth, proliferation and effector functions of T cells. We investigated the impact of HIV infection on key processes that regulate glucose uptake and mitochondrial biogenesis in subpopulations of CD4+ and CD8+ T cells from 18 virologically-suppressed HIV-positive individuals on combination antiretroviral therapy (cART; median CD4+ cell count: 728 cells/μl) and 13 HIV seronegative controls. Mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) production were also analysed in total CD4+ and CD8+ T cells. Among HIV+/cART individuals, expression of glucose transporter (Glut1) and mitochondrial density were highest within central memory and naïve CD4+ T cells, and lowest among effector memory and transitional memory T cells, with similar trends in HIV-negative controls. Compared to HIV-negative controls, there was a trend towards higher percentage of circulating CD4+Glut1+ T cells in HIV+/cART participants. There were no significant differences in mitochondrial dynamics between subject groups. Glut1 expression was positively correlated with mitochondrial density and MMP in total CD4+ T cells, while MMP was also positively correlated with ROS production in both CD4+ and CD8+ T cells. Our study characterizes specific metabolic features of CD4+ and CD8+ T cells in HIV-negative and HIV+/cART individuals and will invite future studies to explore the immunometabolic consequences of HIV infection.
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Affiliation(s)
- Jesse J. R. Masson
- James Cook University, Cairns, Australia
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | | | - Man K. S. Lee
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia
| | - Matias Ostrowski
- Instituto de Investigaciones Biome´dicas en Retrovirus y SIDA. Facultad de Medicina, Buenos Aires, Argentina
| | - Suzanne M. Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Clovis S. Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
- * E-mail:
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18
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Yeoh HL, Cheng AC, Cherry CL, Weir JM, Meikle PJ, Hoy JF, Crowe SM, Palmer CS. Immunometabolic and Lipidomic Markers Associated With the Frailty Index and Quality of Life in Aging HIV+ Men on Antiretroviral Therapy. EBioMedicine 2017; 22:112-121. [PMID: 28754302 PMCID: PMC5552224 DOI: 10.1016/j.ebiom.2017.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 03/24/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 01/09/2023] Open
Abstract
Chronic immune activation persists despite antiretroviral therapy (ART) in HIV+ individuals and underpins an increased risk of age-related co-morbidities. We assessed the Frailty Index in older HIV+ Australian men on ART. Immunometabolic markers on monocytes and T cells were analyzed using flow cytometry, plasma innate immune activation markers by ELISA, and lipidomic profiling by mass spectrometry. The study population consisted of 80 HIV+ men with a median age of 59 (IQR, 56-65), and most had an undetectable viral load (92%). 24% were frail, and 76% were non-frail. Frailty was associated with elevated Glucose transporter-1 (Glut1) expression on the total monocytes (p=0.04), increased plasma levels of innate immune activation marker sCD163 (OR, 4.8; CI 1.4-15.9, p=0.01), phosphatidylethanolamine PE(36:3) (OR, 5.1; CI 1.7-15.5, p=0.004) and triacylglycerol TG(16:1_18:1_18:1) (OR, 3.4; CI 1.3-9.2, p=0.02), but decreased expression of GM3 ganglioside, GM3(d18:1/18:0) (OR, 0.1; CI 0.0-0.6, p=0.01) and monohexosylceramide HexCerd(d18:1/22:0) (OR, 0.1; CI 0.0-0.5, p=0.004). There is a strong inverse correlation between quality of life and the concentration of PE(36:3) (ρ=-0.33, p=0.004) and PE(36:4) (ρ=-0.37, p=0.001). These data suggest that frailty is associated with increased innate immune activation and abnormal lipidomic profile. These markers should be investigated in larger, longitudinal studies to determine their potential as biomarkers for frailty.
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Affiliation(s)
- Hui-Ling Yeoh
- Department of Infectious Diseases, The Alfred and Monash University, Level 2, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, The Alfred and Monash University, Level 2, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Level 6, The Alfred Centre (Alfred Hospital), 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - Catherine L Cherry
- Department of Infectious Diseases, The Alfred and Monash University, Level 2, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; School of Physiology, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, 2000 Johannesburg, South Africa
| | - Jacquelyn M Weir
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Peter J Meikle
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, The Alfred and Monash University, Level 2, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Suzanne M Crowe
- Department of Infectious Diseases, The Alfred and Monash University, Level 2, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Clovis S Palmer
- Department of Infectious Diseases, The Alfred and Monash University, Level 2, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.
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19
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McMahon J, Crowe SM. Less frequent CD4 monitoring in virologically suppressed HIV. Lancet HIV 2017; 4:e233-e234. [PMID: 28411090 DOI: 10.1016/s2352-3018(17)30070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Affiliation(s)
- James McMahon
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne VIC, Australia; Burnet Institute, Melbourne, VIC, Australia
| | - Suzanne M Crowe
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne VIC, Australia; Burnet Institute, Melbourne, VIC, Australia.
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20
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Lavu E, Kave E, Mosoro E, Markby J, Aleksic E, Gare J, Elsum IA, Nano G, Kaima P, Dala N, Gurung A, Bertagnolio S, Crowe SM, Myatt M, Hearps AC, Jordan MR. High Levels of Transmitted HIV Drug Resistance in a Study in Papua New Guinea. PLoS One 2017; 12:e0170265. [PMID: 28146591 PMCID: PMC5287486 DOI: 10.1371/journal.pone.0170265] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction Papua New Guinea is a Pacific Island nation of 7.3 million people with an estimated HIV prevalence of 0.8%. ART initiation and monitoring are guided by clinical staging and CD4 cell counts, when available. Little is known about levels of transmitted HIV drug resistance in recently infected individuals in Papua New Guinea. Methods Surveillance of transmitted HIV drug resistance in a total of 123 individuals recently infected with HIV and aged less than 30 years was implemented in Port Moresby (n = 62) and Mount Hagen (n = 61) during the period May 2013-April 2014. HIV drug resistance testing was performed using dried blood spots. Transmitted HIV drug resistance was defined by the presence of one or more drug resistance mutations as defined by the World Health Organization surveillance drug resistance mutations list. Results The prevalence of non-nucleoside reverse transcriptase inhibitor transmitted HIV drug resistance was 16.1% (95% CI 8.8%-27.4%) and 8.2% (95% CI 3.2%-18.2%) in Port Moresby and Mount Hagen, respectively. The prevalence of nucleoside reverse transcriptase inhibitor transmitted HIV drug resistance was 3.2% (95% CI 0.2%-11.7%) and 3.3% (95% CI 0.2%-11.8%) in Port Moresby and Mount Hagen, respectively. No protease inhibitor transmitted HIV drug resistance was observed. Conclusions The level of non-nucleoside reverse transcriptase inhibitor drug resistance in antiretroviral drug naïve individuals recently infected with HIV in Port Moresby is amongst the highest reported globally. This alarming level of transmitted HIV drug resistance in a young sexually active population threatens to limit the on-going effective use of NNRTIs as a component of first-line ART in Papua New Guinea. To support the choice of nationally recommended first-line antiretroviral therapy, representative surveillance of HIV drug resistance among antiretroviral therapy initiators in Papua New Guinea should be urgently implemented.
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Affiliation(s)
- Evelyn Lavu
- Central Public Health Laboratory, Port Moresby, Papua New Guinea
| | - Ellan Kave
- Central Public Health Laboratory, Port Moresby, Papua New Guinea
| | - Euodia Mosoro
- Central Public Health Laboratory, Port Moresby, Papua New Guinea
| | - Jessica Markby
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Eman Aleksic
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Janet Gare
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
- Institute for Medical Research, Goroka, Papua New Guinea
| | - Imogen A. Elsum
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Gideon Nano
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - Nick Dala
- National Department of Health, Port Moresby, Papua New Guinea
| | - Anup Gurung
- World Health Organization, Port Moresby, Papua New Guinea
| | | | - Suzanne M. Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Mark Myatt
- Brixton Health, Llawryglyn, Powys, Wales, United Kingdom
| | - Anna C. Hearps
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Michael R. Jordan
- Division of Geographic Medicine and Infection Disease, Tufts Medical Center, Boston, Massachusetts, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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21
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Pham MD, Romero L, Parnell B, Anderson DA, Crowe SM, Luchters S. Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review. AIDS Res Ther 2017; 14:3. [PMID: 28103895 PMCID: PMC5248527 DOI: 10.1186/s12981-017-0131-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings. METHODS A comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference websites were searched to identify relevant studies conducted in LMICs, published in English between Jan 2006 and Dec 2015. Outcomes of interest included the proportion of patients who received treatment monitoring and health system factors related to monitoring of patients on ART under decentralized HIV service delivery models. RESULTS From 5363 records retrieved, twenty studies were included in the review; all but one was conducted in sub-Saharan African countries. The majority of studies (15/20) had relatively short follow-up duration (≤24 months), and only two studies were specifically designed to assess treatment monitoring practices. The most frequently studied follow-up period was 12 months and a wide range of treatment monitoring coverage was observed. The reported proportions of patients on ART who received CD4 monitoring ranged from very low (6%; N = 2145) to very high (95%; N = 488). The median uptake of viral load monitoring was 86% with studies in program settings reporting coverage as low as 14%. Overall, the longer the follow-up period, the lower the proportion of patients who received regular monitoring tests; and programs in rural areas reported low coverage of laboratory monitoring. Moreover, uptake in the context of research had significantly better where monitoring was done by dedicated research staff. In the absence of point of care (POC) testing, the limited capacity for blood sample transportation between clinic and laboratory and poor quality of nursing staff were identified as a major barrier for treatment monitoring practice. CONCLUSIONS There is a paucity of data on the uptake of treatment monitoring, particularly with longer-term follow-up. Wide variation in access to both virological and immunological regular monitoring was observed, with some clinics in well-resourced settings supported by external donors achieving high coverage. The feasibility of treatment monitoring, particularly in decentralized settings of HIV treatment and care may thus be of concern and requires further study. Significant investment in POC diagnostic technologies and, improving the quality of and training for nursing staff is required to ensure effective scale up of ART programs towards the targets of 90-90-90 by the year 2020.
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22
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Trevillyan JM, Gardiner EE, Andrews RK, Maisa A, Hearps AC, Al-Tamimi M, Crowe SM, Hoy JF. Decreased levels of platelet-derived soluble glycoprotein VI detected prior to the first diagnosis of coronary artery disease in HIV-positive individuals. Platelets 2016; 28:301-304. [PMID: 27848272 DOI: 10.1080/09537104.2016.1237627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
HIV-positive patients are at increased risk for coronary artery disease (CAD); changes in platelet activation may play a role. This study was performed to determine if levels of soluble glycoprotein VI (sGPVI), a platelet-specific marker of activation, were different in HIV-positive patients compared with HIV-negative controls and further if levels were predictive of CAD in HIV. Twenty-four HIV-positive individuals (HIV cases) with CAD were compared with 46 age- and sex-matched HIV-positive controls without CAD and 41 HIV-negative controls (healthy controls). Platelet activation (represented by sGPVI level) was compared 12 months and 1 month prior to CAD diagnosis. sGPVI was quantified by ELISA. sGPVI levels were higher in HIV-positive subjects (combined) than healthy controls (122.5 ng/mL [interquartile ranges (IQR) 90.3-160.5] versus 84.7 ng/mL [IQR 48.6-119.5], p <0.001). Twelve months before the event, there was no difference in sGPVI between HIV cases and HIV controls (113.4 ng/mL [IQR 85.6-141.65] versus 128.0 ng/mL [IQR 96.6-179.4], p = 0.369). One month prior to the event, sGPVI was significantly lower in HIV cases compared with HIV controls (109.0 ng/mL [IQR 79.4-123.4] versus 133.9 ng/mL [IQR 112.7-171.9], p = 0.010). These results remained significant following adjustment for possible confounders. This work demonstrates that HIV infection is associated with higher sGPVI levels. A fall in sGPVI immediately prior to first coronary artery event may reflect a loss of negative-feedback mechanism and be an important pathological step in the development of symptomatic CAD, but further work is needed to confirm these findings and determine their clinical impact.
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Affiliation(s)
- J M Trevillyan
- a Department of Infectious Diseases , The Alfred Hospital and Monash University , Melbourne , Australia
| | - E E Gardiner
- b Department of Cancer Biology and Therapeutics , Australian National University , Canberra , Australia
| | - R K Andrews
- c Australian Centre for Blood Diseases , Monash University , Melbourne , Australia
| | - A Maisa
- d Centre for Biomedical Research , Burnet Institute , Melbourne , Australia
| | - A C Hearps
- a Department of Infectious Diseases , The Alfred Hospital and Monash University , Melbourne , Australia.,d Centre for Biomedical Research , Burnet Institute , Melbourne , Australia
| | - M Al-Tamimi
- e Immunology Section, Basic Medical Sciences Department, Faculty of Medicine , Hashemite University , Zarqa , Jordan
| | - S M Crowe
- a Department of Infectious Diseases , The Alfred Hospital and Monash University , Melbourne , Australia.,d Centre for Biomedical Research , Burnet Institute , Melbourne , Australia
| | - J F Hoy
- a Department of Infectious Diseases , The Alfred Hospital and Monash University , Melbourne , Australia
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23
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Pham MD, Agius PA, Romero L, McGlynn P, Anderson D, Crowe SM, Luchters S. Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:592. [PMID: 27769181 PMCID: PMC5073828 DOI: 10.1186/s12879-016-1931-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/13/2016] [Indexed: 01/02/2023] Open
Abstract
Background Point-of-care (POC) CD4 testing increases patient accessibility to assessment of antiretroviral therapy eligibility. This review evaluates field performance in low and middle-income countries (LMICs) of currently available POC CD4 technologies. Methods Eight electronic databases were searched for field studies published between January 2005 and January 2015 of six POC CD4 platforms: PointCare NOW™, Alere Pima™ CD4, Daktari™ CD4 Counter, CyFlow® CD4 miniPOC, BD FACSPresto™, and MyT4™ CD4. Due to limited data availability, meta-analysis was conducted only for diagnostic performance of Pima at a threshold of 350 cells/μl, applying a bivariate multi-level random-effects modelling approach. A covariate extended model was also explored to test for difference in diagnostic performance between capillary and venous blood. Results Twenty seven studies were included. Published field study results were found for three of the six POC CD4 tests, 24 of which used Pima. For Pima, test failure rates varied from 2 to 23 % across study settings. Pooled sensitivity and specificity were 0.92 (95 % CI = 0.88–0.95) and 0.87 (95 % CI = 0.85–0.88) respectively. Diagnostic performance by blood sample type (venous vs. capillary) revealed non-significant differences in sensitivity (0.94 vs 0.89) and specificity (0.86 vs 0.87), respectively in the extended model (Wald χ2(2) = 4.77, p = 0.09). Conclusions POC CD4 testing can provides reliable results for making treatment decision under field conditions in low-resource settings. The Pima test shows a good diagnostic performance at CD4 cut-off of 350 cells/μl. More data are required to evaluate performance of POC CD4 testing using venous versus capillary blood in LMICs which might otherwise influence clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1931-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
| | - Paul A Agius
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Lorena Romero
- The Alfred Hospital, The Ian Potter Library, Melbourne, VIC, Australia
| | - Peter McGlynn
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - David Anderson
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Immunology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Suzanne M Crowe
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Stanley Luchters
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.,Department of Obstetrics and Gynecology, International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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24
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Palmer CS, Anzinger JJ, Butterfield TR, McCune JM, Crowe SM. A Simple Flow Cytometric Method to Measure Glucose Uptake and Glucose Transporter Expression for Monocyte Subpopulations in Whole Blood. J Vis Exp 2016. [PMID: 27584036 DOI: 10.3791/54255] [Citation(s) in RCA: 3] [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: 12/13/2022] Open
Abstract
Monocytes are innate immune cells that can be activated by pathogens and inflammation associated with certain chronic inflammatory diseases. Activation of monocytes induces effector functions and a concomitant shift from oxidative to glycolytic metabolism that is accompanied by increased glucose transporter expression. This increased glycolytic metabolism is also observed for trained immunity of monocytes, a form of innate immunological memory. Although in vitro protocols examining glucose transporter expression and glucose uptake by monocytes have been described, none have been examined by multi-parametric flow cytometry in whole blood. We describe a multi-parametric flow cytometric protocol for the measurement of fluorescent glucose analog 2-NBDG uptake in whole blood by total monocytes and the classical (CD14(++)CD16(-)), intermediate (CD14(++)CD16(+)) and non-classical (CD14(+)CD16(++)) monocyte subpopulations. This method can be used to examine glucose transporter expression and glucose uptake for total monocytes and monocyte subpopulations during homeostasis and inflammatory disease, and can be easily modified to examine glucose uptake for other leukocytes and leukocyte subpopulations within blood.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health; Department of Infectious Diseases, Monash University; Department of Microbiology and Immunology, University of Melbourne;
| | | | | | - Joseph M McCune
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco
| | - Suzanne M Crowe
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health; Department of Infectious Diseases, Monash University; Department of Medicine, Monash University
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25
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Pham MD, Agius PA, Romero L, McGlynn P, Anderson D, Crowe SM, Luchters S. Acceptability and feasibility of point-of-care CD4 testing on HIV continuum of care in low and middle income countries: a systematic review. BMC Health Serv Res 2016; 16:343. [PMID: 27484023 PMCID: PMC4971709 DOI: 10.1186/s12913-016-1588-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/06/2015] [Accepted: 07/27/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND CD4 testing is, and will remain an important part of HIV treatment and care in low and middle income countries (LMICs). We report the findings of a systematic review assessing acceptability and feasibility of POC CD4 testing in field settings. METHODS Electronic databases were searched for studies published in English between 2005 and 2015 that describe POC CD4 platforms. Studies conducted in LMICs and under field conditions outside a laboratory environment were eligible. Qualitative and descriptive data analysis was used to present the findings. RESULTS Twelve studies were included, 11 of which were conducted in sub-Saharan countries and used one POC CD4 test (The Alere Pima CD4). Patients reported positively regarding the implementation of POC CD4 testing at primary health care and community level with ≥90 % of patients accepting the test across various study settings. Health service providers expressed preference toward POC CD4 testing as it is easy-to-use, efficient and satisfied patients' needs to a greater extent as compared to conventional methods. However, operational challenges including preference toward venous blood rather than finger-prick sampling, frequent device failures and operator errors, quality of training for test operators and supervisors, and increased staff workload were also identified. CONCLUSIONS POC CD4 testing seems acceptable and feasible in LIMCs under field conditions. Further studies using different POC CD4 tests available on the market are required to provide critical data to support countries in selection and implementation of appropriate POC CD4 technologies.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
| | | | - Lorena Romero
- The Alfred Hospital, The Ian Potter Library, Melbourne, VIC, Australia
| | - Peter McGlynn
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - David Anderson
- Burnet Institute, Melbourne, VIC, Australia
- Department of Immunology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Suzanne M Crowe
- Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred hospital Melbourne, Melbourne, Australia
- Monash School of Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
- International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Yong YK, Shankar EM, Westhorpe CL, Maisa A, Spelman T, Kamarulzaman A, Crowe SM, Lewin SR. Genetic polymorphisms in the CD14 gene are associated with monocyte activation and carotid intima-media thickness in HIV-infected patients on antiretroviral therapy. Medicine (Baltimore) 2016; 95:e4477. [PMID: 27495090 PMCID: PMC4979844 DOI: 10.1097/md.0000000000004477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
HIV-infected individuals on antiretroviral therapy (ART) are at increased risk of cardiovascular disease (CVD). Given the relationship between innate immune activation and CVD, we investigated the association of single-nucleotide polymorphisms (SNPs) in TLR4 and CD14 and carotid intima-media thickness (cIMT), a surrogate measurement for CVD, in HIV-infected individuals on ART and HIV-uninfected controls as a cross-sectional, case-control study. We quantified the frequency of monocyte subsets (CD14, CD16), markers of monocyte activation (CD38, HLA-DR), and endothelial adhesion (CCR2, CX3CR1, CD11b) by flow cytometry. Plasma levels of lipopolysaccharide, sCD163, sCD14, sCX3CL1, and sCCL2, were measured by ELISA. Genotyping of TLR4 and CD14 SNPs was also performed. The TT genotype for CD14/-260SNP but not the CC/CT genotype was associated with elevated plasma sCD14, and increased frequency of CD11b+CD14+ monocytes in HIV-infected individuals. The TT genotype was associated with lower cIMT in HIV-infected patients (n = 47) but not in HIV-uninfected controls (n = 37). The AG genotype for TLR4/+896 was associated with increased CX3CR1 expression on total monocytes among HIV-infected individuals and increased sCCL2 and fibrinogen levels in HIV-uninfected controls. SNPs in CD14/-260 and TLR4/+896 were significantly associated with different markers of systemic and monocyte activation and cIMT that differed between HIV-infected participants on ART and HIV-uninfected controls. Further investigation on the relationship of these SNPs with a clinical endpoint of CVD is warranted in HIV-infected patients on ART.
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Affiliation(s)
- Yean K. Yong
- Centre of Excellence for Research in AIDS (CERiA)
| | - Esaki M. Shankar
- Centre of Excellence for Research in AIDS (CERiA)
- Tropical Infectious Diseases Research and Education Centre (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Infection Biology and Microbiology, Department of Life Sciences, School of Basic and Applied Sciences, Central University of Tamil Nadu (CUTN), Neelakudi Campus, Tiruvarur, India
| | | | | | - Tim Spelman
- Centre for Population Health, Burnet Institute
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA)
- Infectious Disease Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Suzanne M. Crowe
- Centre for Biomedical Research
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Sharon R. Lewin
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Correspondence: Sharon R. Lewin, Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia (e-mail: )
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27
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Tan HY, Yong YK, Shankar EM, Paukovics G, Ellegård R, Larsson M, Kamarulzaman A, French MA, Crowe SM. Aberrant Inflammasome Activation Characterizes Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome. J I 2016; 196:4052-63. [DOI: 10.4049/jimmunol.1502203] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/13/2016] [Indexed: 12/31/2022]
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28
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Palmer CS, Cherry CL, Sada-Ovalle I, Singh A, Crowe SM. Glucose Metabolism in T Cells and Monocytes: New Perspectives in HIV Pathogenesis. EBioMedicine 2016; 6:31-41. [PMID: 27211546 PMCID: PMC4856752 DOI: 10.1016/j.ebiom.2016.02.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [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: 10/15/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 02/06/2023] Open
Abstract
Activation of the immune system occurs in response to the recognition of foreign antigens and receipt of optimal stimulatory signals by immune cells, a process that requires energy. Energy is also needed to support cellular growth, differentiation, proliferation, and effector functions of immune cells. In HIV-infected individuals, persistent viral replication, together with inflammatory stimuli contributes to chronic immune activation and oxidative stress. These conditions remain even in subjects with sustained virologic suppression on antiretroviral therapy. Here we highlight recent studies demonstrating the importance of metabolic pathways, particularly those involving glucose metabolism, in differentiation and maintenance of the activation states of T cells and monocytes. We also discuss how changes in the metabolic status of these cells may contribute to ongoing immune activation and inflammation in HIV- infected persons and how this may contribute to disease progression, establishment and persistence of the HIV reservoir, and the development of co-morbidities. We provide evidence that other viruses such as Epstein-Barr and Flu virus also disrupt the metabolic machinery of their host cells. Finally, we discuss how redox signaling mediated by oxidative stress may regulate metabolic responses in T cells and monocytes during HIV infection.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, Monash University, Melbourne, Australia.
| | - Catherine L Cherry
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, Monash University, Melbourne, Australia; Infectious Diseases Department, The Alfred Hospital, Melbourne, Australia; School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Isabel Sada-Ovalle
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico
| | - Amit Singh
- Department of Microbiology and Cell Biology, Centre for Infectious Disease and Research (CIDR), Indian Institute of Science, India
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, Monash University, Melbourne, Australia; Infectious Diseases Department, The Alfred Hospital, Melbourne, Australia
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Billings H, Crowe SM, Palmer CS. Does immunometabolism provide new targets to treat HIV-mediated inflammatory diseases? Future Virol 2016. [DOI: 10.2217/fvl.16.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Hugh Billings
- Centre for Biomedical Research, Burnet Institute, Melbourne 3001, Australia
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne 3001, Australia
- Department of Infectious Diseases, Monash University, Melbourne 3800, Australia
- Infectious Diseases Department, The Alfred Hospital, Melbourne 3004, Australia
| | - Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute, Melbourne 3001, Australia
- Department of Infectious Diseases, Monash University, Melbourne 3800, Australia
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30
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Abstract
Much like cancer cells, activated T cells undergo various metabolic changes that allow them to grow and proliferate rapidly. By adopting aerobic glycolysis upon activation, T cells effectively prioritize efficiency in biosynthesis over energy generation. There are distinct differences in the way CD4+ and CD8+ T cells process activation signals. CD8+ effector T cells are less dependent on Glut1 and oxygen levels compared to their CD4+ counterparts. Similarly the downstream signaling by TCR also differs in both effector T cell types. Recent studies have explored PI3K/Akt, mTORC, HIF1α, p70S6K and Bcl-6 signaling in depth providing definition of the crucial roles of these regulators in glucose metabolism. These new insights may allow improved therapeutic manipulation against inflammatory conditions that are associated with dysfunctional T-cell metabolism such as autoimmune disorders, metabolic syndrome, HIV, and cancers.
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Affiliation(s)
- Clovis S Palmer
- a Centre for Biomedical Research, Burnet Institute , Melbourne , Australia.,b Department of Infectious Diseases , Monash University , Melbourne , Australia
| | - Tabinda Hussain
- a Centre for Biomedical Research, Burnet Institute , Melbourne , Australia
| | - Gabriel Duette
- c Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina , Buenos Aires , Argentina
| | - Thomas J Weller
- d Department of Immunology , Monash University , Melbourne , Australia
| | - Matias Ostrowski
- c Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina , Buenos Aires , Argentina
| | - Isabel Sada-Ovalle
- e Laboratory of Integrative Immunology, National Institute of Respiratory Diseases Ismael CosÃ-o Villegas , Mexico City , Mexico
| | - Suzanne M Crowe
- a Centre for Biomedical Research, Burnet Institute , Melbourne , Australia.,b Department of Infectious Diseases , Monash University , Melbourne , Australia.,f Infectious Diseases Department , The Alfred Hospital , Melbourne , Australia
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Trevillyan JM, Gardiner EE, Andrews RK, Maisa A, Hearps AC, Crowe SM, Hoy JF. O21.1 Platelet derived soluble glycoprotein vi decreases prior to coronary event in hiv positive patients. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
In order to mitigate human and financial losses as a result of future global pandemics, we must plan now. As the Ebola virus pandemic declines, we must reflect on how we have mismanaged this recent international crisis and how we can better prepare for the next global pandemic. Of great concern is the increasing frequency of pandemics occurring over the last few decades. Clearly, the window of opportunity to act is closing. This editorial discusses many issues including priority emerging and re-emerging infectious diseases; the challenges of meeting international health regulations; the strengthening of global health systems; global pandemic funding; and the One Health approach to future pandemic planning. We recommend that the global health community unites to urgently address these issues in order to avoid the next humanitarian crisis.
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Affiliation(s)
- Allen G P Ross
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | | | - Mark W Tyndall
- British Columbia Centre for Disease Control, Vancouver, Canada
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Ross AGP, Ditangco RA, Belimac JG, Olveda RM, Mercado ES, Chau TNP, Crowe SM. The dire sexual health crisis among MSM in the Philippines: an exploding HIV epidemic in the absence of essential health services. Int J Infect Dis 2015; 37:6-8. [PMID: 26072039 DOI: 10.1016/j.ijid.2015.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/27/2022] Open
Abstract
The rate of HIV is exploding in the men who have sex with men (MSM) population in the Philippines. There is a paucity of information with respect to sexual behaviour, condom use, psychological health, and the prevalence of other STIs in the MSM subpopulation. At present there are no existing private or public clinical services in the country that focus on health services of MSM. We discuss the current epidemic situation and the steps needed to further define the rapidly evolving epidemic among MSM.
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Affiliation(s)
- Allen G P Ross
- Menzies Health Institute Queensland, Griffith University, Australia.
| | - Rossana A Ditangco
- National HIV/STI Prevention Program, Department of Health, The Philippines
| | - Jose G Belimac
- National HIV/STI Prevention Program, Department of Health, The Philippines
| | - Remigio M Olveda
- National HIV/STI Prevention Program, Department of Health, The Philippines
| | - Edelwisa S Mercado
- National HIV/STI Prevention Program, Department of Health, The Philippines
| | - Thao N P Chau
- Menzies Health Institute Queensland, Griffith University, Australia
| | - Suzanne M Crowe
- Department of Virology, Burnet Institute, Melbourne, Australia
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Angelovich TA, Hearps AC, Maisa A, Martin GE, Lichtfuss GF, Cheng WJ, Palmer CS, Landay AL, Crowe SM, Jaworowski A. Viremic and Virologically Suppressed HIV Infection Increases Age-Related Changes to Monocyte Activation Equivalent to 12 and 4 Years of Aging, Respectively. J Acquir Immune Defic Syndr 2015; 69:11-7. [PMID: 25647525 DOI: 10.1097/qai.0000000000000559] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 12/12/2022]
Abstract
BACKGROUND Chronic inflammation and immune activation occur in both HIV infection and normal aging and are associated with inflammatory disease. However, the degree to which HIV influences age-related innate immune changes, and the biomarkers which best reflect them, remains unclear. METHODS AND RESULTS We measured established innate immune aging biomarkers in 309 individuals including 88 virologically suppressed (VS) and 52 viremic (viral load ≤ and >50 copies per milliliter, respectively) HIV-positive individuals. Levels of soluble (ie, CXCL10, soluble CD163, neopterin) and cellular (ie, proportions of inflammatory CD16 monocytes) biomarkers of monocyte activation were increased in HIV-positive individuals and were only partially ameliorated by viral suppression. Viremic and VS HIV-positive individuals show levels of age-related monocyte activation biomarkers that are similar to uninfected controls aged 12 and 4 years older, respectively. Viremic HIV infection was associated with an accelerated rate of change of some monocyte activation markers (eg, neopterin) with age, whereas in VS individuals, subsequent age-related changes occurred at a similar rate as in controls, albeit at a higher absolute level. We further identified CXCL10 as a robust soluble biomarker of monocyte activation, highlighting the potential utility of this chemokine as a prognostic marker. IMPLICATIONS These findings may partially explain the increased prevalence of inflammatory age-related diseases in HIV-positive individuals and potentially indicate the pathological mechanisms underlying these diseases, which persist despite viral suppression.
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Affiliation(s)
- Thomas A Angelovich
- *Centre for Biomedical Research, Burnet Institute, Melbourne, Australia; †School of Applied Sciences, RMIT University, Melbourne, Australia; ‡Department of Infectious Diseases, Monash University, Melbourne, Australia; §School of Medical Sciences, University of New South Wales, Sydney, Australia; ‖Department of Microbiology and Immunology, Rush University Medical Center, Chicago, IL; ¶Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia; and #Department of Immunology, Monash University, Melbourne, Australia
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Peeling RW, Sollis KA, Glover S, Crowe SM, Landay AL, Cheng B, Barnett D, Denny TN, Spira TJ, Stevens WS, Crowley S, Essajee S, Vitoria M, Ford N. CD4 enumeration technologies: a systematic review of test performance for determining eligibility for antiretroviral therapy. PLoS One 2015; 10:e0115019. [PMID: 25790185 PMCID: PMC4366094 DOI: 10.1371/journal.pone.0115019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/17/2014] [Indexed: 12/04/2022] Open
Abstract
Background Measurement of CD4+ T-lymphocytes (CD4) is a crucial parameter in the management of HIV patients, particularly in determining eligibility to initiate antiretroviral treatment (ART). A number of technologies exist for CD4 enumeration, with considerable variation in cost, complexity, and operational requirements. We conducted a systematic review of the performance of technologies for CD4 enumeration. Methods and Findings Studies were identified by searching electronic databases MEDLINE and EMBASE using a pre-defined search strategy. Data on test accuracy and precision included bias and limits of agreement with a reference standard, and misclassification probabilities around CD4 thresholds of 200 and 350 cells/μl over a clinically relevant range. The secondary outcome measure was test imprecision, expressed as % coefficient of variation. Thirty-two studies evaluating 15 CD4 technologies were included, of which less than half presented data on bias and misclassification compared to the same reference technology. At CD4 counts <350 cells/μl, bias ranged from -35.2 to +13.1 cells/μl while at counts >350 cells/μl, bias ranged from -70.7 to +47 cells/μl, compared to the BD FACSCount as a reference technology. Misclassification around the threshold of 350 cells/μl ranged from 1-29% for upward classification, resulting in under-treatment, and 7-68% for downward classification resulting in overtreatment. Less than half of these studies reported within laboratory precision or reproducibility of the CD4 values obtained. Conclusions A wide range of bias and percent misclassification around treatment thresholds were reported on the CD4 enumeration technologies included in this review, with few studies reporting assay precision. The lack of standardised methodology on test evaluation, including the use of different reference standards, is a barrier to assessing relative assay performance and could hinder the introduction of new point-of-care assays in countries where they are most needed.
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Affiliation(s)
- Rosanna W. Peeling
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, England
- * E-mail:
| | - Kimberly A. Sollis
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, England
| | - Sarah Glover
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, England
| | - Suzanne M. Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, 3004, Victoria, Australia
| | - Alan L. Landay
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, IL, 60612, United States of America
| | - Ben Cheng
- Pangaea Global AIDS Foundation, Oakland, CA, 94607, United States of America
| | - David Barnett
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield, S10 2QD, England
| | - Thomas N. Denny
- Duke Human Vaccine Institute and Center for HIV/AIDS, Immunology and Virology Quality Assessment Center, Durham, NC, 27710, United States of America
| | - Thomas J. Spira
- Division of AIDS, STD, &TB Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, United States of America
| | | | - Siobhan Crowley
- Director Health Programs, ELMA Philanthropies, New York, NY, United States of America
| | - Shaffiq Essajee
- Clinton Health Access Initiative, Boston, MA, 02127, United States of America
| | | | - Nathan Ford
- World Health Organization, Geneva, Switzerland
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Kedzierska K, Paukovics G, Handley A, Hewish M, Hocking J, Cameron PU, Crowe SM. Interferon-gamma Therapy Activates Human Monocytes for Enhanced Phagocytosis ofMycobacterium aviumComplex in HIV-Infected Individuals. HIV Clinical Trials 2015; 5:80-5. [PMID: 15116283 DOI: 10.1310/t4r0-wbpl-q2q6-tu49] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Defective immunological function of cells of the macrophage lineage contributes to the pathogenesis of HIV-1 infection. Because monocyte/macrophage function is enhanced by cytokines such as interferon-gamma (IFN-gamma), the use of this immunomodulator is of potential clinical interest as adjunctive immunotherapy in immunosuppressed individuals. In this study, we show that adjunctive IFN-gamma treatment in an HIV-infected individual with Mycobacterium avium complex (MAC) infection increased phagocytosis of MAC by blood monocytes when compared to cells from an HIV-infected patient who was receiving standard chemotherapy alone. Enhanced phagocytic efficiency resulting from IFN-gamma therapy was associated with increased surface expression of MHC II (HLA-DR), a phagocytic receptor (CD16), and the activation marker (CD69), although the levels of activation markers were dissimilar at baseline in the two participants. These results imply that IFN-gamma may be useful in restoring antimycobacterial function in immunosuppressed patients.
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Affiliation(s)
- Katherine Kedzierska
- AIDS Pathogenesis Research Unit, Macfarlane Burnet Institute for Medical Research and Public Health, and Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Palmer CS, Ostrowski M, Balderson B, Christian N, Crowe SM. Glucose metabolism regulates T cell activation, differentiation, and functions. Front Immunol 2015; 6:1. [PMID: 25657648 PMCID: PMC4302982 DOI: 10.3389/fimmu.2015.00001] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [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: 12/02/2014] [Accepted: 01/02/2015] [Indexed: 12/13/2022] Open
Abstract
The adaptive immune system is equipped to eliminate both tumors and pathogenic microorganisms. It requires a series of complex and coordinated signals to drive the activation, proliferation, and differentiation of appropriate T cell subsets. It is now established that changes in cellular activation are coupled to profound changes in cellular metabolism. In addition, emerging evidence now suggest that specific metabolic alterations associated with distinct T cell subsets may be ancillary to their differentiation and influential in their immune functions. The "Warburg effect" originally used to describe a phenomenon in which most cancer cells relied on aerobic glycolysis for their growth is a key process that sustain T cell activation and differentiation. Here, we review how different aspects of metabolism in T cells influence their functions, focusing on the emerging role of key regulators of glucose metabolism such as HIF-1α. A thorough understanding of the role of metabolism in T cell function could provide insights into mechanisms involved in inflammatory-mediated conditions, with the potential for developing novel therapeutic approaches to treat these diseases.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Burnet Institute , Melbourne, VIC , Australia
| | - Matias Ostrowski
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Brad Balderson
- Centre for Biomedical Research, Burnet Institute , Melbourne, VIC , Australia
| | - Nicole Christian
- Department of Microbiology, The University of the West Indies , Kingston , Jamaica
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute , Melbourne, VIC , Australia ; Department of Infectious Diseases, Monash University , Melbourne, VIC , Australia ; Infectious Diseases Department, The Alfred Hospital , Melbourne, VIC , Australia
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38
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Affiliation(s)
| | - Suzanne M Crowe
- Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia; Infectious Diseases Department, The Alfred Hospital, Melbourne, VIC, Australia
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39
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Palmer CS, Anzinger JJ, Zhou J, Gouillou M, Landay A, Jaworowski A, McCune JM, Crowe SM. Glucose transporter 1-expressing proinflammatory monocytes are elevated in combination antiretroviral therapy-treated and untreated HIV+ subjects. J Immunol 2014; 193:5595-603. [PMID: 25367121 DOI: 10.4049/jimmunol.1303092] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Monocyte activation during HIV-1 infection is associated with increased plasma levels of inflammatory markers and increased risk for premature development of age-related diseases. Because activated monocytes primarily use glucose to support cellular metabolism, we hypothesized that chronic monocyte activation during HIV-1 infection induces a hypermetabolic response with increased glucose uptake. To test this hypothesis, we evaluated glucose transporter 1 (Glut1) expression and glucose uptake by monocyte subpopulations in HIV-seropositive (HIV(+)) treatment-naive individuals (n = 17), HIV(+) individuals on combination antiretroviral therapy with viral loads below detection (n = 11), and HIV-seronegative (HIV(-)) individuals (n = 16). Surface expression of Glut1 and cellular uptake of the fluorescent glucose analog 2-(N-(7-nitrobenz-2-oxa-1, 3-diazol-4-yl) amino)-2 deoxyglucose were analyzed by flow cytometry on monocyte subpopulations. Irrespective of treatment status, monocytes from HIV(+) persons had significantly increased surface expression of Glut1 compared with those from HIV(-) controls. Nonclassical (CD14(+)CD16(++)) and intermediate (CD14(++)CD16(+)) monocyte subpopulations showed higher Glut1 expression than did classical (CD14(++)CD16(-)) monocytes. Intermediate monocytes from treatment-naive HIV(+) individuals also showed increased uptake of 2-(N-(7-nitrobenz-2-oxa-1, 3-diazol-4-yl) amino)-2 deoxyglucose compared with those from HIV(-) controls. Our results show that HIV infection is associated with increased glucose metabolism in monocytes and that Glut1 expression by proinflammatory monocytes is a potential marker of inflammation in HIV-infected subjects. However, the possibility exists whereby other Gluts such as Glut3 and Glut4 may also support the influx of glucose into activated and inflammatory monocyte populations.
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Affiliation(s)
- Clovis S Palmer
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3004, Australia;
| | - Joshua J Anzinger
- Department of Microbiology, The University of the West Indies, Mona, Kingston 7, Jamaica, West Indies
| | - Jingling Zhou
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3004, Australia
| | - Maelenn Gouillou
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3004, Australia
| | - Alan Landay
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, IL 60612
| | - Anthony Jaworowski
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria 3800, Australia; Department of Immunology, Monash University, Melbourne, Victoria 3004, Australia
| | - Joseph M McCune
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143; and
| | - Suzanne M Crowe
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria 3800, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia 3800
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40
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Abstract
Increased life expectancy due to improved efficacy of cART has uncovered an increased risk of age-related morbidities in HIV+ individuals and catalyzed significant research into mechanisms driving these diseases. HIV infection increases the risk of non-communicable diseases common in the aged, including cardiovascular disease, neurocognitive decline, non-AIDS malignancies, osteoporosis, and frailty. These observations suggest that HIV accelerates immunological ageing, and there are many immunological similarities with the aged, including shortened telomeres, accumulation of senescent T cells and altered monocyte phenotype/function. However, the most critical similarity between HIV+ individuals and the elderly, which most likely underpins the heightened risk of non-communicable diseases, is chronic inflammation and associated immune activation. Here, we review the similarities between HIV+ individuals and the aged regarding the pathogenesis of inflammatory diseases, the current evidence for mechanisms driving these processes and discuss current and potential therapeutic strategies for addressing inflammatory co-morbidity in HIV+ infection.
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Affiliation(s)
- Anna C Hearps
- Centre for Biomedical Research, Burnet Institute, GPO Box 2248, Melbourne, VIC, 3001, Australia,
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41
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Gare J, Ryan CE, David M, Timbi D, Kaima P, Kombati Z, Imara U, Kelly-Hanku A, Siba PM, Crowe SM, Hearps AC. Presence of HIV drug resistance in antiretroviral therapy-naive and -experienced patients from Papua New Guinea. J Antimicrob Chemother 2014; 69:2183-6. [PMID: 24722838 DOI: 10.1093/jac/dku089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/14/2022] Open
Abstract
OBJECTIVES The optimal benefits of antiretroviral therapy (ART) can be compromised by the emergence of HIV drug resistance (HIVDR) resulting in treatment failure. ART was introduced in Papua New Guinea (PNG) in 2004, yet biological data on HIVDR are lacking. The aim of the study was to investigate levels of HIVDR in ART-naive and -experienced patients in PNG. METHODS We recruited, interviewed and collected blood from 108 ART-naive and 102 ART-experienced patients from two Highlands provinces of PNG. Dried blood spots were tested for HIVDR from all patients with detectable plasma viral load of ≥200 copies/mL using established in-house assays. RESULTS The PCR amplification success was 90.6% (n = 96) and 66.7% (n = 12) using dried blood spots from ART-naive and -experienced patients, respectively. Transmitted drug resistance was detected in 2.1% (n = 2) of samples from ART-naive patients; acquired drug resistance was detected in 50% (n = 6) of samples from ART-experienced individuals. CONCLUSIONS Our data showed that transmitted drug resistance in PNG is low and acquired drug resistance is higher with 12.7% of the ART-experienced patients failing treatment. As ART access is rapidly expanding in PNG, monitoring of drug resistance is paramount for early detection of treatment failure.
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Affiliation(s)
- Janet Gare
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claire E Ryan
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - Matthew David
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Diana Timbi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Petronia Kaima
- HIV/STI Highlands Region, National Department of Health, Mt Hagen, Western Highlands Province, Papua New Guinea
| | - Zure Kombati
- Pathology Department, Mt Hagen General Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea
| | - Ulato Imara
- Michael Alpers Clinic, Goroka General Hospital, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter M Siba
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Suzanne M Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anna C Hearps
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Affiliation(s)
- Clovis S. Palmer
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - Suzanne M. Crowe
- Centre for Biomedical Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
- Department of Medicine and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
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Smit PW, Sollis KA, Fiscus S, Ford N, Vitoria M, Essajee S, Barnett D, Cheng B, Crowe SM, Denny T, Landay A, Stevens W, Habiyambere V, Perriens JH, Peeling RW. Systematic review of the use of dried blood spots for monitoring HIV viral load and for early infant diagnosis. PLoS One 2014; 9:e86461. [PMID: 24603442 PMCID: PMC3945725 DOI: 10.1371/journal.pone.0086461] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Dried blood spots (DBS) have been used as alternative specimens to plasma to increase access to HIV viral load (VL) monitoring and early infant diagnosis (EID) in remote settings. We systematically reviewed evidence on the performance of DBS compared to plasma for VL monitoring and EID. METHODS AND FINDINGS Thirteen peer reviewed HIV VL publications and five HIV EID papers were included. Depending on the technology and the viral load distribution in the study population, the percentage of DBS samples that are within 0.5 log of VL in plasma ranged from 52-100%. Because the input sample volume is much smaller in a blood spot, there is a risk of false negatives with DBS. Sensitivity of DBS VL was found to be 78-100% compared to plasma at VL below 1000 copies/ml, but this increased to 100% at a threshold of 5000 copies/ml. Unlike a plasma VL test which measures only cell free HIV RNA, a DBS VL also measures proviral DNA as well as cell-associated RNA, potentially leading to false positive results when using DBS. The systematic review showed that specificity was close to 100% at DBS VL above 5000 copies/ml, and this threshold would be the most reliable for predicting true virologic failure using DBS. For early infant diagnosis, DBS has a sensitivity of 100% compared to fresh whole blood or plasma in all studies. CONCLUSIONS Although limited data are available for EID, DBS offer a highly sensitive and specific sampling strategy to make viral load monitoring and early infant diagnosis more accessible in remote settings. A standardized approach for sampling, storing, and processing DBS samples would be essential to allow successful implementation. TRIAL REGISTRATION PROSPERO Registration #: CRD42013003621.
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Affiliation(s)
- Pieter W. Smit
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kimberly A. Sollis
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan Fiscus
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Shaffiq Essajee
- HIV, Medicine and Science, Clinton Health Access Initiative, New York, New York, United States of America
| | - David Barnett
- Department of Haematology, UK NEQAS for Leucocyte Immunophenotyping, Sheffield, United Kingdom
| | - Ben Cheng
- Department of Technology and Innovation, Pangaea Global AIDS Foundation, San Fransisco, California, United States of America
| | - Suzanne M. Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Thomas Denny
- Department of Medicine, Duke Human Vaccine Institute and Center for HIV/AIDS Vaccine Immunology, Durham, North Carolina, United States of America
| | - Alan Landay
- Department of Immunology- Microbiology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Rosanna W. Peeling
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Sollis KA, Smit PW, Fiscus S, Ford N, Vitoria M, Essajee S, Barnett D, Cheng B, Crowe SM, Denny T, Landay A, Stevens W, Habiyambere V, Perrins J, Peeling RW. Systematic review of the performance of HIV viral load technologies on plasma samples. PLoS One 2014; 9:e85869. [PMID: 24558359 PMCID: PMC3928047 DOI: 10.1371/journal.pone.0085869] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 09/27/2013] [Accepted: 12/02/2013] [Indexed: 01/06/2023] Open
Abstract
Background Viral load (VL) monitoring is the standard of care in developing country settings for detecting HIV treatment failure. Since 2010 the World Health Organization has recommended a phase-in approach to VL monitoring in resource-limited settings. We conducted a systematic review of the accuracy and precision of HIV VL technologies for treatment monitoring. Methods and Findings A search of Medline and Embase was conducted for studies evaluating the accuracy or reproducibility of commercially available HIV VL assays. 37 studies were included for review including evaluations of the Amplicor Monitor HIV-1 v1.5 (n = 25), Cobas TaqMan v2.0 (n = 11), Abbott RealTime HIV-1 (n = 23), Versant HIV-1 RNA bDNA 3.0 (n = 15), Versant HIV-1 RNA kPCR 1.0 (n = 2), ExaVir Load v3 (n = 2), and NucliSens EasyQ v2.0 (n = 1). All currently available HIV VL assays are of sufficient sensitivity to detect plasma virus levels at a lower detection limit of 1,000 copies/mL. Bias data comparing the Abbott RealTime HIV-1, TaqMan v2.0 to the Amplicor Monitor v1.5 showed a tendency of the Abbott RealTime HIV-1 to under-estimate results while the TaqMan v2.0 overestimated VL counts. Compared to the Amplicor Monitor v1.5, 2–26% and 9–70% of results from the Versant bDNA 3.0 and Abbott RealTime HIV-1 differed by greater than 0.5log10. The average intra and inter-assay variation of the Abbott RealTime HIV-1 were 2.95% (range 2.0–5.1%) and 5.44% (range 1.17–30.00%) across the range of VL counts (2log10–7log10). Conclusions This review found that all currently available HIV VL assays are of sufficient sensitivity to detect plasma VL of 1,000 copies/mL as a threshold to initiate investigations of treatment adherence or possible treatment failure. Sources of variability between VL assays include differences in technology platform, plasma input volume, and ability to detect HIV-1 subtypes. Monitoring of individual patients should be performed on the same technology platform to ensure appropriate interpretation of changes in VL. Prospero registration # CD42013003603.
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Affiliation(s)
- Kimberly A. Sollis
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pieter W. Smit
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susan Fiscus
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Shaffiq Essajee
- HIV, Medicine and Science, Clinton Health Access Initiative, New York, New York, United States of America
| | - David Barnett
- Department of Haematology, United Kingdom National External Quality Assessment Service (UK NEQAS) for Leucocyte Immunophenotyping, Sheffield, United Kingdom
| | - Ben Cheng
- Department of Technology and Innovation, Pangaea Global AIDS Foundation, San Fransisco, California, United States of America
| | - Suzanne M. Crowe
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Thomas Denny
- Department of Medicine, Duke Human Vaccine Institute and Center for HIV/AIDS Vaccine Immunology, Durham, North Carolina, United States of America
| | - Alan Landay
- Department of Immunology- Microbiology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jos Perrins
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Rosanna W. Peeling
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Palmer CS, Ostrowski M, Gouillou M, Tsai L, Yu D, Zhou J, Henstridge DC, Maisa A, Hearps AC, Lewin SR, Landay A, Jaworowski A, McCune JM, Crowe SM. Increased glucose metabolic activity is associated with CD4+ T-cell activation and depletion during chronic HIV infection. AIDS 2014; 28:297-309. [PMID: 24335483 PMCID: PMC4293200 DOI: 10.1097/qad.0000000000000128] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [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: 01/14/2023]
Abstract
OBJECTIVES Glucose metabolism plays a fundamental role in supporting the growth, proliferation and effector functions of T cells. We investigated the impact of HIV infection on key processes that regulate glucose uptake and metabolism in primary CD4 and CD8 T cells. DESIGN AND METHODS Thirty-eight HIV-infected treatment-naive, 35 HIV+/combination antiretroviral therapy, seven HIV+ long-term nonprogressors and 25 HIV control individuals were studied. Basal markers of glycolysis [e.g. glucose transporter-1 (Glut1) expression, glucose uptake, intracellular glucose-6-phosphate, and L-lactate] were measured in T cells. The cellular markers of immune activation, CD38 and HLA-DR, were measured by flow cytometry. RESULTS The surface expression of the Glut1 is up-regulated in CD4 T cells in HIV-infected patients compared with uninfected controls. The percentage of circulating CD4Glut1 T cells was significantly increased in HIV-infected patients and was not restored to normal levels following combination antiretroviral therapy. Basal markers of glycolysis were significantly higher in CD4Glut1 T cells compared to CD4Glut1 T cells. The proportion of CD4Glut1 T cells correlated positively with the expression of the cellular activation marker, HLA-DR, on total CD4 T cells, but inversely with the absolute CD4 T-cell count irrespective of HIV treatment status. CONCLUSION Our data suggest that Glut1 is a potentially novel and functional marker of CD4 T-cell activation during HIV infection. In addition, Glut1 expression on CD4 T cells may be exploited as a prognostic marker for CD4 T-cell loss during HIV disease progression.
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Affiliation(s)
- Clovis S Palmer
- aCentre for Biomedical Research, Burnet Institute, Melbourne, Australia bInstituto de Investigaciones Biomédicas en Retrovirus y SIDA. Facultad de Medicina, Buenos Aires, Argentina cCentre for Population Health, Burnet Institute, Melbourne dLaboratory of Molecular Immunomodulation, School of Biomedical Sciences, Monash University, Clayton eCellular and Molecular Metabolism Laboratory, Baker IDI Heart and Diabetes Institute fDepartment of Infectious Diseases, Monash University gInfectious Diseases Department, The Alfred hospital, Melbourne, Australia hDepartment of Immunology/Microbiology, Rush University Medical Center, Chicago, Illinois iDivision of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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46
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Westhorpe CLV, Schneider HG, Dunne M, Middleton T, Sundararajan V, Spelman T, Carter V, Crowe SM, Dart A, Mijch A, Kotsanas D, Woolley I. C-reactive protein as a predictor of cardiovascular risk in HIV-infected individuals. Sex Health 2014; 11:580-2. [PMID: 25435195 DOI: 10.1071/sh14130] [Citation(s) in RCA: 9] [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] [Received: 07/06/2014] [Accepted: 10/03/2014] [Indexed: 01/08/2023]
Abstract
UNLABELLED Background In some studies HIV infection confers approximately two-fold higher risk of cardiac events compared with the general population. C-reactive protein (CRP) is a well-characterised biomarker of cardiac events in the general population and is also elevated in patients with HIV infection. The aim of this study was to determine the predictive value of CRP for cardiac events in HIV-infected individuals. METHODS We retrospectively analysed CRP levels in stored plasma samples from HIV-infected patients who did or did not experience a coronary event in a case-controlled manner. All CRP measurements were performed using a high-sensitivity assay (hs-CRP). RESULTS Of the study participants with samples available, we found slightly elevated hs-CRP levels in the cardiac cases (median 3.5, IQR 1.6-14.4, n=23) compared with controls (median 2.6, IQR1.2-8.3, n=49) which were shown to not be statistically significant P=0.20. Analysis of CRP as a binary variable (≥5mgL(-1)) was also not statistically significant (OR: 1.32, 95% CI 0.48-3.63). CONCLUSIONS CRP levels may indicate elevated risk of future cardiac events, however this must be interpreted with caution due to the generalised elevation of CRP during HIV infection. CRP has no predictive value for atherosclerosis, and further research is required to improve early prediction of cardiovascular disease in HIV infection.
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Affiliation(s)
- Clare L V Westhorpe
- Macfarlane Burnet Institute for Medical Research and Public Health, Prahran, Vic. 3004, Australia
| | - Hans G Schneider
- Alfred Pathology Service, Alfred Health, Commercial Road, Prahran, Vic. 3004, Australia
| | - Mandy Dunne
- Macfarlane Burnet Institute for Medical Research and Public Health, Prahran, Vic. 3004, Australia
| | - Tracey Middleton
- Victorian Infectious Diseases Reference Laboratory, Wreckyn Street, North Melbourne, Vic. 3051, Australia
| | - Vijaya Sundararajan
- Department of Human Services Victoria, Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - Tim Spelman
- Macfarlane Burnet Institute for Medical Research and Public Health, Prahran, Vic. 3004, Australia
| | - Vanessa Carter
- Department of Nutrition, The Alfred Hospital, Commercial Road, Prahran, Vic. 3004, Australia
| | - Suzanne M Crowe
- Macfarlane Burnet Institute for Medical Research and Public Health, Prahran, Vic. 3004, Australia
| | - Anthony Dart
- Department of Cardiology, The Alfred Hospital, Commercial Road, Prahran, Vic. 3004, Australia
| | - Anne Mijch
- Department of Medicine, Central and Eastern Clinical School, Monash University, Melbourne, Vic. 3004, Australia
| | - Despina Kotsanas
- Department of Infectious Diseases, Monash Health, Clayton Road, Clayton, Vic. 3168, Australia
| | - Ian Woolley
- Department of Medicine, Central and Eastern Clinical School, Monash University, Melbourne, Vic. 3004, Australia
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47
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Tan HY, Yong YK, Lim SH, Ponnampalavanar S, Omar SFS, Pang YK, Kamarulzaman A, Price P, Crowe SM, French MA. Tuberculosis (TB)-associated immune reconstitution inflammatory syndrome in TB-HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes. Sex Health 2014; 11:532-9. [DOI: 10.1071/sh14093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
Background
Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication of antiretroviral therapy (ART) in countries with high rates of endemic TB, but data from South-East Asia are incomplete. Identification of prevalence, risk factors and treatment outcomes of TB-IRIS in Malaysia was sought. Methods: A 3-year retrospective study was conducted among TB-HIV co-infected patients treated at the University of Malaya Medical Centre. Simple and adjusted logistic regressions were used to identify the predictors for TB-IRIS while Cox regression was used to assess the influence of TB-IRIS on long-term CD4 T-cell recovery. Results: One hundred and fifty-three TB-HIV patients were enrolled, of whom 106 had received both anti-TB treatment (ATT) and ART. The median (IQR) baseline CD4 T-cell count was 52 cells μL–1 (13–130 cells μL–1). Nine of 96 patients (9.4%) developed paradoxical TB-IRIS and eight developed unmasking TB-IRIS, at a median (IQR) time of 27 (12–64) and 19 (14–65) days, respectively. In adjusted logistic regression analysis, only disseminated TB was predictive of TB-IRIS [OR: 10.7 (95% CI: 1.2–94.3), P = 0.032]. Mortality rates were similar for TB-IRIS (n = 1, 5.9%) and non-TB-IRIS (n = 5, 5.7%) patients and CD4 T-cell recovery post-ART was not different between the two groups (P = 0.363). Conclusion: Disseminated TB was a strong independent predictor of TB-IRIS in Malaysian HIV-TB patients after commencing ART. This finding underscores the role of a high pathogen load in the pathogenesis of TB-IRIS; so interventions that reduce pathogen load before ART may benefit HIV patients with disseminated TB.
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Tippett E, Cameron PU, Marsh M, Crowe SM. Characterization of tetraspanins CD9, CD53, CD63, and CD81 in monocytes and macrophages in HIV-1 infection. J Leukoc Biol 2013; 93:913-20. [PMID: 23570947 DOI: 10.1189/jlb.0812391] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 11/24/2022] Open
Abstract
Tetraspanins are a family of membrane-organizing proteins that mediate diverse functions. Little is known of their expression or function in myeloid cells. Here, expression of CD9, CD53, CD63, and CD81, tetraspanins that have been implicated in HIV-1 pathogenesis, were characterized in normal monocyte subsets, in MDM, and in HIV-1-infected donors. We show that tetraspanins are expressed differentially by monocyte subsets, with higher CD9 and CD63 and lower CD53 and CD81 levels on CD14++CD16- monocytes compared with CD14++CD16+ and CD14+CD16++ subsets. Maturation of monocytes resulted in increased CD9 expression and apparent relocation of CD63 and CD53 from surface to intracellular membranes. Expression was modulated by cytokines, and CD9 was a marker of anti-inflammatory and CD53 a marker of proinflammatory MDM. Tetraspanin expression on monocyte subsets from HIV-1-infected donors receiving antiretroviral therapy was unchanged compared with that in uninfected donors. However, CD53 expression was inversely correlated with viral load in HIV-1-infected donors not on therapy. This study is the first to comprehensively characterize tetraspanin expression on monocyte subsets and macrophages in health and during HIV-1 infection. It demonstrates regulation of tetraspanin expression by cytokines, and CD53 expression as a novel correlate of a proinflammatory phenotype. This paper characterizes tetraspanins in myeloid cells and shows that tetraspanins are expressed differentially in monocyte subsets and are modified in inflammatory conditions.
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Affiliation(s)
- Emma Tippett
- Centre for Virology, The Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.
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Merati TP, Ryan CE, Spelmen T, Wirawan DN, Bakta IM, Otto B, Oelrichs RB, Crowe SM. CRF01_AE dominates the HIV-1 epidemic in Indonesia. Sex Health 2013; 9:414-21. [PMID: 22958472 DOI: 10.1071/sh11121] [Citation(s) in RCA: 10] [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] [Received: 08/31/2011] [Accepted: 04/05/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The HIV epidemic in Indonesia remains concentrated in vulnerable populations, namely injecting drug users (IDUs), commercial sex workers (CSWs) and men who have sex with men (MSM). We aimed to determine the HIV-1 subtypes present in Indonesia and to establish the extent of the viral overlap between individuals with different risk factors. METHODS Venous blood samples were collected from HIV-positive individuals primarily from sexually transmissible infection clinics and drug rehabilitation centres in Bali and Jakarta, and applied to filter paper. A polymerase chain reaction-based assay designed to amplify a 330-bp region of the HIV-1 envelope was used to determine HIV-1 subtype result and to perform phylogenetic analysis. RESULTS Of the 175 individuals recruited to the study, a subtype result was obtained for 108 (62%). Four subtypes were found to exist in the population, CRF01_AE (n=96, 88.9%), B (n=10, 9.3%), C (n=1, 0.9%) and G (n=1, 0.9%). Of these 108 individuals, 65 (60%) were IDUs, and the remaining 40% were CSWs, MSM, transgender individuals, people with multiple sexual partners or those with no obvious risk factor. CRF01_AE was found to be more common among IDUs with 100% of individuals infected with this subtype. Subtype B was more common among MSM and CSWs (P=<0.001). Phylogenetic analysis revealed a lack of viral segregation between risk groups. CONCLUSIONS In Indonesia, CRF01_AE continues to dominate the HIV epidemic, although HIV subtype B is responsible for a significant number of sexually acquired infections.
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Aleksic E, Merker M, Cox H, Reiher B, Sekawi Z, Hearps AC, Ryan CE, Lee AV, Goursaud R, Malau C, O'Connor J, Cherry CL, Niemann S, Crowe SM. First molecular epidemiology study of Mycobacterium tuberculosis in Kiribati. PLoS One 2013; 8:e55423. [PMID: 23383187 PMCID: PMC3561247 DOI: 10.1371/journal.pone.0055423] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/22/2012] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis incidence rates in Kiribati are among the highest in the Western Pacific Region, however the genetic diversity of circulating Mycobacterium tuberculosis complex strains (MTBC) and transmission dynamics are unknown. Here, we analysed MTBC strains isolated from culture positive pulmonary tuberculosis (TB) cases from the main TB referral centre between November 2007 and October 2009. Strain genotyping (IS6110 typing, spoligotyping, 24-loci MIRU-VNTR and SNP typing) was performed and demographic information collected. Among 73 MTBC strains analysed, we identified seven phylogenetic lineages, dominated by Beijing strains (49%). Beijing strains were further differentiated in two main branches, Beijing-A (n = 8) and -B (n = 28), that show distinct genotyping patterns and are characterized by specific deletion profiles (Beijing A: only RD105, RD207 deleted; Beijing B: RD150 and RD181 additionally deleted). Many Kiribati strains (59% based on IS6110 typing of all strains) occurred in clusters, suggesting ongoing local transmission. Beijing-B strains and over-crowded living conditions were associated with strain clustering (likely recent transmission), however little evidence of anti-tuberculous drug resistance was observed. We suggest enhanced case finding amongst close contacts and continued supervised treatment of all identified cases using standard first-line drugs to reduce TB burden in Kiribati. Beijing strains can be subdivided in different principle branches that might be associated with differential spreading patterns in the population.
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Affiliation(s)
- Eman Aleksic
- Centre for Virology, Burnet Institute, Melbourne, Australia.
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