Suboptimal Immune Reconstitution among HIV-Infected Saudi Patients following Successful Antiretroviral Treatment

Background and Objectives. Variations in immune reconstitution following antiretroviral treatment (ART) among HIV patients have previously been observed. This study aims at assessing immune reconstitution after successful ART among HIV-infected Saudi patients.Methods. This retrospective study of 240 HIV-infected patients was performed between May 2010 and June 2015 in the HIV center at King Saud Hospital, Riyadh. Data were extracted for CD4, CD8 cell, and CD3/HLA-DR counts along with the viral load from patient records before and after four years of successful ART. The inclusion criterion was patients with CD4 reconstitution of either equal to or more than 400 cells/mm3with an undetectable HIV viral load following ART. Based on their presentation, the HIV patients were grouped into early treatment (ET) and delayed treatment (DT) groups with CD4 counts of 200–350 cells/mm3and less than 200 cells/mm3, respectively.Findings. The pretreatment CD8+ counts of median 865 cells/mm3(interquartile range (IQR) 774–1072) in the DT group declined to median 753 cells/mm3(IQR 574–987;p<0.0001). Moreover, there was a decline in CD8 counts from 703 cells/mm3(IQR 655–747) to 620 cells/mm3(IQR 563–645;p<0.04) in the ET group after four years of successful ART. Pretreatment activation marker (CD3/HLA-DR+) expression of median 29% in the DT group declined to 22% and in the ET group from a median of 23% to 19% after treatment. The CD4/CD8 ratio in the DT group increased from 0.14 (IQR 0.09–0.88) to 0.71 (IQR 0.54–0.9) and from 0.42 (IQR 0.35–0.55) to 0.87 (IQR 0.71–0.98) in the ET group.Conclusion. Immune reconstitution after successful ART among HIV-infected Saudi patients was associated with a CD8 T-cell population expansion with a suboptimal CD4/CD8 ratio and persistent immune activation. Early initiation of ART appears to favorably influence the CD4/CD8 ratio.

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Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

AIDS Research and Therapy ◽

10.1186/s12981-021-00336-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anita Mesic ◽

Alexander Spina ◽

Htay Thet Mar ◽

Phone Thit ◽

Tom Decroo ◽

...

Keyword(s):

Viral Load ◽

Virological Failure ◽

Antiretroviral Treatment ◽

People Living With Hiv ◽

First Line ◽

Hiv Viral Load ◽

Loss To Follow Up ◽

History Of ◽

Living With Hiv

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

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Trends in CD4 counts in HIV-infected patients with HIV viral load monitoring while on combination antiretroviral treatment: results from The TREAT Asia HIV Observational Database

BMC Infectious Diseases ◽

10.1186/1471-2334-10-361 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 17

Author(s):

Jialun Zhou ◽

Thira Sirisanthana ◽

Sasisopin Kiertiburanakul ◽

Yi-Ming A Chen ◽

Ning Han ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Treatment ◽

Treatment Results ◽

Hiv Viral Load ◽

Cd4 Counts ◽

Observational Database ◽

Viral Load Monitoring ◽

Load Monitoring

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Evaluation of a convenient vaccination schedule against hepatitis B in HIV-patients with undetectable HIV viral load

Vaccine ◽

10.1016/j.vaccine.2018.02.018 ◽

2018 ◽

Vol 36 (12) ◽

pp. 1533-1536 ◽

Cited By ~ 2

Author(s):

Sofia Kourkounti ◽

Theodoros Retsas ◽

Vassilios Paparizos ◽

Antonios Tsimpidakis ◽

Violetta Kapsimali ◽

...

Keyword(s):

Viral Load ◽

Hepatitis B ◽

Vaccination Schedule ◽

Hiv Viral Load ◽

Hiv Patients

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Rapid Decline in HIV Viral Load When Introducing Raltegravir-Containing Antiretroviral Treatment Late in Pregnancy

AIDS Patient Care and STDs ◽

10.1089/apc.2012.0283 ◽

2012 ◽

Vol 26 (12) ◽

pp. 714-717 ◽

Cited By ~ 24

Author(s):

Katarina Westling ◽

Karin Pettersson ◽

Anneli Kaldma ◽

Lars Navér

Keyword(s):

Viral Load ◽

Antiretroviral Treatment ◽

Rapid Decline ◽

Hiv Viral Load ◽

In Pregnancy

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Higher Risk Myelodysplastic Syndromes in Patients with Well-Controlled HIV Infection: Clinical Features, Treatment, and Outcome

Case Reports in Hematology ◽

10.1155/2016/8502641 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Bradley T. Williamson ◽

Heather A. Leitch

Keyword(s):

Bone Marrow ◽

Viral Load ◽

Antiretroviral Therapy ◽

Myelodysplastic Syndromes ◽

Hiv Positive ◽

Combination Antiretroviral Therapy ◽

Hiv Viral Load ◽

Hiv Patients ◽

Age Of Diagnosis ◽

Hiv Negative

Introduction. In advanced HIV prior to combination antiretroviral therapy (ART), dysplastic marrow changes occurred and resolved with ART. Few reports of myelodysplastic syndromes (MDS) in well-controlled HIV exist and management is undefined.Methods. Patients with well-controlled HIV and higher risk MDS were identified; characteristics, treatment, and outcomes were reviewed.Results. Of 292 MDS patients since 1996, 1 (0.3%) was HIV-positive. A 56-year-old woman presented with cytopenias. CD4 was 1310 cells/mL and HIV viral load <40 copies/mL. Bone marrow biopsy showed RCMD and karyotype included del(5q) and del(7q); IPSS was intermediate-2 risk. She received azacitidine at 75% dose. Cycle 2, at full dose, was complicated by marrow aplasia and possible AML; she elected palliation. Three additional HIV patients with higher risk MDS, aged 56–64, were identified from the literature. All had deletions involving chromosomes 5 and 7. MDS treatment of 2 was not reported and one received palliation; all died of AML.Conclusion. Four higher risk MDS in well-controlled HIV were below the median age of diagnosis for HIV-negative patients; all had adverse karyotype. This is the first report of an HIV patient receiving MDS treatment with azacitidine. Cytopenias were profound and dosing in HIV patients should be considered with caution.

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1565Identifying Optimal HIV Viral Load (VL) Thresholds for Predicting Antiretroviral Treatment Failure (TF) Using ROC Curve Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.1111 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S416-S417

Author(s):

Robert Luo ◽

Shagufta Aslam ◽

Patrick Robinson ◽

Anne-Marie Quinson ◽

Tri Do

Keyword(s):

Viral Load ◽

Treatment Failure ◽

Roc Curve ◽

Antiretroviral Treatment ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Hiv Viral Load ◽

Antiretroviral Treatment Failure

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PDL1 expression on monocytes is associated with plasma cytokines in Tuberculosis and HIV

PLoS ONE ◽

10.1371/journal.pone.0258122 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258122

Author(s):

Wegene Tamene ◽

Meseret Abebe ◽

Liya Wassie ◽

Helina Mollalign ◽

Katrin Bauer ◽

...

Keyword(s):

Viral Load ◽

Smear Microscopy ◽

Healthy Controls ◽

Monocyte Subsets ◽

Cytokine Mrna ◽

Hiv Viral Load ◽

Hiv Patients ◽

Disease States ◽

Plasma Cytokines ◽

Treatment Naïve

Introduction PDL1 and its interaction with PD1 is implicated in immune dysfunction in TB and HIV. The expression of PDL1 on multiple subsets of monocytes as well as their associations with cytokines and microbial products have not been well studied. Method HIV (TB-HIV+), TB (TB+HIV-) and TB/HIV co-infected (TB+HIV+) patients as well as apparently healthy controls (TB-HIV-) were recruited. TB and HIV patients were treatment naïve while TB/HIV patients were both ART naïve and experienced but not yet started TB therapy. Monocyte subsets were evaluated for PDL1 expression by flow cytometry; plasma TNFα, IL6, IP10, IFNγ and IL10 were measured by Luminex; and cytokine mRNA from purified monocytes quantitated by qPCR. The association of PDL1 with cytokines, clinical and microbial indices, including HIV viral load, TB smear microscopy and TB urinary lipoarabinomannan (LAM) were assessed. Results Monocyte expression of PDL1 was significantly higher in TB, HIV and TB/HIV co-infected patients compared with healthy controls (p = 0.0001), with the highest levels in TB/HIV co-infected patients. The highest expression of PDL1 was on intermediate (CD14+CD16+) monocytes in all participant groups. PDL1 strongly correlated with HIV viral load in TB/HIV while weakly correlated in HIV. PDL1 levels moderately correlated with plasma TNFα, IL6, IP10, IFNγ and IL10 level in TB subjects whereas weakly correlated with TNFα and IP10 in HIV patients. However, cytokine mRNA from purified monocytes showed no association with either plasma cytokines or monocyte PDL1 expression, implying that if cytokines modulate PDL1, they are likely not originating from circulating monocytes themselves. These results underscore the importance of further characterization of multiple monocyte subsets and their phenotypic and functional differences in different disease states.

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The distinct epidemic characteristics of HCV co-infection among HIV-1-infected population caused by drug injection and sexual transmission in Yunnan, China

Epidemiology and Infection ◽

10.1017/s0950268819001365 ◽

2019 ◽

Vol 147 ◽

Cited By ~ 1

Author(s):

A-Mei Zhang ◽

Ming Yang ◽

Li Gao ◽

Mi Zhang ◽

Lingshuai Jiao ◽

...

Keyword(s):

Viral Load ◽

Drug Users ◽

Yunnan Province ◽

Sexual Transmission ◽

Hiv Viral Load ◽

Hiv Patients ◽

Hcv Genotype ◽

Immunodeficiency Virus ◽

Hiv 1 ◽

Genotype 3A

Abstract Hepatitis C virus (HCV) infection was frequent in human immunodeficiency virus (HIV) patients in Yunnan province. We studied the epidemic characteristics of HCV in HIV/HCV co-infected patients. Serum from 894 HIV-1 patients was collected, together with basic information and biochemical features. All samples were infected with HIV through injecting drug users (IDUs) and sexual transmission (ST). The NS5B gene was amplified and sequenced to affirm HCV genotype. In total, 202 HIV patients were co-infected with HCV, and most (81.19%) of co-infected patients were IDUs. Genotype 3b was predominant (37.62%) in these samples, and its frequency was similar in patients with IDU and ST. The frequencies of genotypes 1a, 1b, 3a, 6a, 6n, 2a and 6u were 3.96%, 16.34%, 23.76%, 6.93%, 10.40%, 0.50% and 0.50%, respectively. However, genotype 3a showed significantly different frequency in HCV patients with IDU and ST (P = 0.019). When HCV patients were divided into subgroups, the haemoglobin (HGB) level was significantly higher in patients with genotype 3a than in patients with 3b (P = 0.033), 6a (P = 0.006) and 6n (P = 0.007), respectively. Although no difference existed among HCV subgroups, HIV-viral load was identified to be positively correlated with the HGB level and CD4+ cells when dividing HCV/HIV co-infected persons into male and female groups. In conclusion, genotype 3b was the predominant HCV genotype in Yunnan HIV/HCV co-infected persons. The HGB level was higher in patients with genotype 3a than others. HIV-viral load was positively correlated with the HGB level and CD4+ cells in the male or female HCV-infected group.

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