scholarly journals Suboptimal Immune Recovery Despite Sustained HIV Suppression Among a Yi Ethnic Population in Southwest China

2021 ◽  
Author(s):  
Liyu Chen ◽  
Chang-Hai Liu ◽  
Shuang Kang ◽  
Lingyao Du ◽  
Fanghua Ma ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Viral Suppression ◽  
Cd4 T Cell ◽  
Immune Recovery ◽  
Ethnic Population ◽  
Art Initiation ◽  
Sustained Viral Suppression ◽  
Suboptimal Immune Recovery ◽  
Cd4 T Cell Count

Abstract Objectives: Despite sustained viral suppression with effective antiretroviral therapy (ART), HIV-infected patients with suboptimal immune recovery are still at high risk of non-AIDS-related and AIDS-related events. The aim of this study was to investigate the potential determinants associated with suboptimal CD4+ T cell count recovery during free ART with sustained viral suppression among a HIV-infected Yi ethnic population in Liangshan Prefecture, an area with high HIV prevalence in China.Method: This retrospective study included all HIV-infected Yi adults (≥ 18 years and with baseline CD4+ T cell count less than 500 cells/μL) who initiated ART supported by NFATP between January 2015 and December 2018 in Zhaojue county, Liangshan Prefecture (Figure 1), and achieved virological suppression (viral load < 50 copies/mL) within 12 months after ART initiation and maintained sustained virological suppression. Univariate and multivariate log-binomial regression models were used to assess determinants of suboptimal immune recovery, producing adjusted odds ratios (aORs) and confidence intervals (CIs).Results: A total of 277 HIV-infected Yi patients (male/female, 140/137) with a mean age of 36.57 ± 7.63 years and a mean baseline CD4+ T cell count of 284.49 ± 117.11 cells/μL were included. Nearly half of the Yi patients were infected through injection drug use (48.7%, 135/277), and the prevalence of anti-HCV antibody was high (43.7%, 121/277). The free ART regimens were 91% efavirenz-based, 5.1% nevirapine-based, and 3.9% lopinavir/ritonavir-based. After a mean 3.77 ± 1.21 years of ART, optimal immune recovery (CD4+ T cell count ≥ 500 cells/μL), intermediate immune recovery (350≤CD4 < 500 cells/μL), and suboptimal immune recovery (CD4 < 350 cells/μL) occurred in 32.9%, 31%, and 36.2% of the included patients, respectively. After adjustments, multivariable analysis revealed that low pre-ART CD4+ cell count, WHO clinical stage III and IV, and coinfection with HCV were associated with suboptimal immune recovery. Conclusions: Our study support prompt ART initiation after HIV diagnosis, and curative HCV treatment in HCV/HIV co-infected patients for improving the immunological effectiveness of ART among HIV-infected Yi patients in Liangshan Prefecture.Trial registration: None

Early Immune Recovery Predicts Overall and Disease-Free Survival After Allogeneic Hematopoietic Stem Cell Transplantation.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2222-2222
Author(s):  
Jenna D. Goldberg ◽  
Junting Zheng ◽  
Juliet Barker ◽  
Farid Boulad ◽  
H.R. Castro-Malaspina ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Cell Count ◽  
Cox Model ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Cd4 T Cell ◽  
Immune Recovery ◽  
Hematopoietic Stem ◽  
Cd4 T Cell Count

Abstract Abstract 2222 Poster Board II-199 Background: Immune recovery is an important determinant of outcome after allogeneic hematopoietic stem cell transplantation (alloHSCT). Previous studies have demonstrated that early recovery of absolute lymphocyte count (ALC) predicts overall (OS) and disease free survival (DFS) in conventional and partially T-cell depleted (TCD) alloHSCT. Recipients of conventional and especially TCD alloHSCT can have prolonged recovery of their immune systems, which may extend beyond one year. We have previously shown that the rate of CD4+ T cell recovery after TCD alloHSCT correlates with the risk of opportunistic infections. However, the impact of lymphocyte subset recovery on relapse and long-term survival following alloHSCT remains an important unknown. Methods: We conducted a retrospective study on 353 consecutive patients (median age 39, range 2-68) who received a fully TCD alloHSCT at MSKCC between January 1997 and December 2005. We excluded patients transplanted after 2005, because they received KGF for which pre-clinical data suggest an effect on immune recovery. Diseases included ALL (85), AML (146), CML (43), MDS (31), NHL (47), and undifferentiated leukemia (1). We excluded patients who died or did not have stable engraftment by 30 days. Immune recovery data, including ALC through day 90 and lymphocyte subsets through one year were grouped by quartile of cohort (table). The primary endpoints were OS and DFS. The score statistic from the Cox proportional hazards model defined the association of these endpoints with the values of ALC, CD4+ and CD8+ T cells, and NK cells. Subsequent to individual score tests, the Cox model determined the values associated with survival endpoints, in addition to prognostic clinical factors. Because markers were measured post-HSCT, a landmark analysis explored their prognostic significance. The landmark times were 1, 2, 3, 6, 9, and 12 months post-HSCT. Additional factors in the Cox model were: patient sex, age, number of remissions, stem cell source, and donor-recipient HLA match. The Kruskal-Wallis test evaluated if the diagnoses were associated with lymphocyte recovery. Results: In univariate analysis, high ALC at day 30 (ALC 30, p < 0.001) and day 60 (ALC 60, p = 0.015) were associated with improved OS. High ALC 30 was also associated with improved DFS (p = 0.005). Multivariate analysis demonstrated that high ALC 30 was independently associated with improved OS (p = 0.011). NK cell count at day 60 was associated with improved OS and DFS by univariate (p = 0.014, 0.010) and multivariate (p = 0.007, 0.002) analysis. Similarly, CD4+ T-cell count at 6 and 12 months predicted survival. By univariate analysis, CD4+ T-cell count at 6 and 12 months predicted OS (p = 0.007, p < 0.001) and DFS (p= 0.032, 0.002). This relationship remained with multivariate analysis. CD4+ T-cell count at 6 and 12 months independently predicted OS (p = 0.013, 0.007) and DFS (p = 0.059, 0.043). There was no association of CD8+ T cell count with OS or DFS. Other predictors of improved survival included younger age, higher degree of HLA match, peripheral blood as stem-cell source, and transplant in 1st remission. Diagnosis did not differentiate clinical outcomes except for CML patients, who had decreased DFS (but not OS) secondary to increased relapse with TCD. Finally, diagnosis was not associated with post transplant immune recovery. Discussion: We demonstrate that several measures of immune recovery, including time points as early as day 30, are important predictors of OS and DFS after fully TCD alloHSCT. Our finding that ALC 30 predicts OS in the TCD setting is consistent with prior studies in the conventional and partially TCD settings. We further demonstrate that reconstitution of NK cells and, later, CD4+ T cells predicts survival and relapse in the TCD setting. Finally, we show there is no relationship between diagnosis and immune recovery. It is likely that these findings will also apply to conventional alloHSCT given the concordance of our ALC 30 outcomes. These results may help identify patients most likely to benefit from interventions to enhance post-alloHSCT immune reconstitution. Disclosures: Castro-Malaspina: Alexion: Consultancy, Honoraria.

scholarly journals THE INFLUENCE OF HIV-1 SUBTYPES C, CRF31_BC AND B ON DISEASE PROGRESSION AND INITIAL VIROLOGIC RESPONSE TO HAART IN A SOUTHERN BRAZILIAN COHORT

2014 ◽  
Vol 56 (3) ◽  
pp. 205-211 ◽  
Author(s):  
Cynara Carvalho Nunes ◽  
Maria Cristina Cotta Matte ◽  
Claudia Fontoura Dias ◽  
Leonardo Augusto Luvison Araújo ◽  
Luciano Santos Pinto Guimarães ◽  
...  
Keyword(s):  
Viral Load ◽  
T Cell ◽  
Cell Count ◽  
Viral Suppression ◽  
Cd4 T Cell ◽  
Lower Viral Load ◽  
Subtype B ◽  
The Impact ◽  
Hiv 1 ◽  
Cd4 T Cell Count

Background: Although most HIV-1 infections in Brazil are due to subtype B, Southern Brazil has a high prevalence of subtype C and recombinant forms, such as CRF31_BC. This study assessed the impact of viral diversity on clinical progression in a cohort of newly diagnosed HIV-positive patients. Methods: From July/2004 to December/2005, 135 HIV-infected patients were recruited. The partial pol region was subtyped by phylogeny. A generalized estimating equation (GEE) model was used to examine the relationship between viral subtype, CD4+ T cell count and viral load levels before antiretroviral therapy. Hazard ratio (Cox regression) was used to evaluate factors associated with viral suppression (viral load < 50 copies/mL at six months). Results: Main HIV-1 subtypes included B (29.4%), C (28.2%), and CRF31_BC (23.5%). Subtypes B and C showed a similar trend in CD4+ T cell decline. Comparison of non-B (C and CRF31_BC) and B subtypes revealed no significant difference in the proportion of patients with viral suppression at six months (week 24). Higher CD4+ T cell count and lower viral load were independently associated with viral suppression. Conclusion: No significant differences were found between subtypes; however, lower viral load and higher CD4+ T cell count before therapy were associated with better response.

scholarly journals Absolute CD4+ T cell count overstate immune recovery assessed by CD4+/CD8+ ratio in HIV-infected patients on treatment

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0205777 ◽  
Author(s):  
Yusnelkis Milanés-Guisado ◽  
Alicia Gutiérrez-Valencia ◽  
María Trujillo-Rodríguez ◽  
Nuria Espinosa ◽  
Pompeyo Viciana ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Cd4 T Cell ◽  
Immune Recovery ◽  
Cd4 T Cell Count

The Effect of Antiretroviral Therapy on IL-6, IL-1β, TNF-α, IFN-γ Levels and their Relationship with HIV-RNA and CD4+ T Cells in HIV Patients

2020 ◽  
Vol 18 (5) ◽  
pp. 354-361
Author(s):  
Gülay Okay ◽  
Meliha Meric Koc ◽  
Eray Metin Guler ◽  
Ayşegül Yabaci ◽  
Abdürrahim Kocyigit ◽  
...  
Keyword(s):  
T Cell ◽  
Hiv Infection ◽  
Cell Count ◽  
Cd4 T Cell ◽  
Positive Correlation ◽  
Hiv Rna ◽  
Tnf Α ◽  
Cytokine Levels ◽  
Ifn Γ ◽  
Cd4 T Cell Count

Background: Serum cytokine levels over the course of HIV infection usually increase with immunosuppression and decrease after antiretroviral treatment (ART). Objectives: The aim of the study is to compare cytokine levels between HIV-infected patients (HIP) and controls and investigate the relationship between CD4+T cell count, HIV-RNA levels, and cytokine levels. Methods: The study subjects comprised ART-naive HIP (n=30) with no comorbidities and age-and sex-matched healthy controls. We measured levels of IL-6, IL-1β, TNF-α, and IFN-γ in serum samples of HIP at the beginning and at month 6 of ART and in controls. Results: The mean age of the study subjects was 38.7 ±10.3 years, with men making up 86.7% of the study subjects (n=26). IL-6, IL-1β, and TNF-α levels were significantly higher in both ART-naive (p<0.001, p=0.002, p=0.001) and ART-experienced HIP (p<0.001) than controls. The IFN-γ level was lower in both ART-naive and ART-experienced HIP compared to controls (p=0.082 and p=0.002). There was a positive correlation between the CD4+T cell count and serum concentration of IFN- γ(r=0.320, p<0.05). While the serum IFN-γ concentration showed a negative correlation with the HIVRNA level(r=-0.412, p<0.001), the serum IL-1β, IL-6, and TNF-α concentrations showed a positive correlation with the HIV-RNA level (r=0.349, p<0.001; r:0.54, p<0.001; r:0.438, p<0.00). Conclusions: Although serum concentrations of IL-6, IL-1β and TNF-α showed a significant decrease after ART, they were still significantly higher than the controls. IFN-γ responded differently to ART compared to the other cytokines, indicating that it may play a distinct and important role in the pathogenesis of HIV infection.

scholarly journals HIV-Related Arterial Stiffness in Malawian Adults Is Associated With the Proportion of PD-1–Expressing CD8+ T Cells and Reverses With Antiretroviral Therapy

2019 ◽  
Vol 219 (12) ◽  
pp. 1948-1958 ◽  
Author(s):  
Christine Kelly ◽  
Henry C Mwandumba ◽  
Robert S Heyderman ◽  
Kondwani Jambo ◽  
Raphael Kamng’ona ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Antiretroviral Therapy ◽  
Arterial Stiffness ◽  
Cell Count ◽  
Cd8 T Cells ◽  
Sub Saharan Africa ◽  
Cd4 T Cell ◽  
Sub Saharan ◽  
Cd4 T Cell Count

Abstract Background The contribution of immune activation to arterial stiffness and its reversibility in human immunodeficiency virus (HIV)–infected adults in sub-Saharan Africa is unknown. Methods HIV-uninfected and HIV-infected Malawian adults initiating antiretroviral therapy (ART) with a CD4+ T-cell count of &lt;100 cells/μL were enrolled and followed for 44 weeks; enrollment of infected adults occurred 2 weeks after ART initiation. We evaluated the relationship between carotid femoral pulse wave velocity (cfPWV) and T-cell activation (defined as HLA-DR+CD38+ T cells), exhaustion (define as PD-1+ T cells), and senescence (defined as CD57+ T cells) and monocyte subsets, using normal regression. Results In 279 HIV-infected and 110 HIV-uninfected adults, 142 (37%) had hypertension. HIV was independently associated with a 12% higher cfPWV (P = .02) at baseline and a 14% higher cfPWV at week 10 (P = .02), but the increases resolved by week 22. CD4+ and CD8+ T-cell exhaustion were independently associated with a higher cfPWV at baseline (P = .02). At 44 weeks, arterial stiffness improved more in those with greater decreases in the percentage of CD8+ T cells and the percentage of PD-1+CD8+ T cells (P = .01 and P = .03, respectively). When considering HIV-infected participants alone, the adjusted arterial stiffness at week 44 tended to be lower in those with higher baseline percentage of PD-1+CD8+ T cells (P = .054). Conclusions PD-1+CD8+ T-cells are associated with HIV-related arterial stiffness, which remains elevated during the first 3 months of ART. Resources to prevent cardiovascular disease in sub-Saharan Africa should focus on blood pressure reduction and individuals with a low CD4+ T-cell count during early ART.

CD4+ T cell count, HIV-1 viral loads and demographic variables of newly identified patients with HIV infection in Wuhan, China

2013 ◽  
Vol 85 (10) ◽  
pp. 1687-1691 ◽  
Author(s):  
Man-Qing Liu ◽  
Li Tang ◽  
Wen-Hua Kong ◽  
Ze-Rong Zhu ◽  
Jin-Song Peng ◽  
...  
Keyword(s):  
T Cell ◽  
Hiv Infection ◽  
Cell Count ◽  
Demographic Variables ◽  
Cd4 T Cell ◽  
Viral Loads ◽  
Hiv 1 ◽  
Cd4 T Cell Count
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