Factors Associated with Immune Discordant Responses in Treated HIV-infected Omani Patients

Background: Despite sustained viral control by antiretroviral therapy (ART), some HIV-infected patients do not recover normal CD4+ T cell counts. This Discordant Immune Response (DIR) increases the risk of opportunistic infections. Objective: To evaluate the factors associated with DIR in HIV-infected Omani patients attending public sector clinics. Methods: All HIV-infected patients receiving ART with regular follow-up visits were eligible for this study. The DIR group comprised patients on ART for at least two years with plasma HIV viral load < 50 copies/mL and helper CD4+ T cell counts below 350 cells/μl. The Concordant Immune Responses (CIR) group was similar to DIR but with CD4+ T cell counts above 350 cells/μl. Univariate and multivariate analyses using logistic regression models were used to assess the impact of demographic characteristics, clinical, immunological and virological parameters, type of ART regimens, tuberculosis and other opportunistic co-infections on DIR. Results: Among 153 enrolled participants, 28 and 76 patients were identified as having DIR and CIR, respectively. The multivariate analysis revealed that the only factors independently associated with DIR after adjustment were age (odds ratio [OR] 1.13; 95% confidence interval [CI] 1.04-1.23), baseline CD4+ T cell count (OR: 0.98; CI: 0.97-0.99) and baseline CD56+ cell count (OR: 0.97; CI: 0.96-0.99). Conclusion: Collectively, these findings suggest that a significant proportion of HIV-infected Omani patients develop DIR totaling 27%, and efforts should be made to improve early identification of these patients who tend to experience poor clinical outcomes.

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Etiology and Outcome of Patients with HIV Infection and Respiratory Failure Admitted to the Intensive Care Unit

Interdisciplinary Perspectives on Infectious Diseases ◽

10.1155/2013/732421 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Jose Orsini ◽

Noeen Ahmad ◽

Ashvin Butala ◽

Rosemarie Flores ◽

Truc Tran ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Hiv Infection ◽

Cell Count ◽

Hiv Viral Load ◽

Viral Loads ◽

Cell Counts ◽

Time Of Admission ◽

The Impact

Background. Although access to HAART has prolonged survival and improved quality of life, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support. Our objective is to evaluate the etiology of respiratory failure in patients with HIV infection admitted to the ICU, its relationship with the T-lymphocytes cell count as well as the use of HAART, and its impact on outcome.Methods. A single-center, prospective, and observational study among all patients with HIV-infection and respiratory failure admitted to the ICU from December 1, 2011, to February 28, 2013, was conducted.Results. A total of 42 patients were admitted during the study period. Their median CD4cell count was 123 cells/μL (mean 205.7, range 2.0–694.0), with a median HIV viral load of 203.5 copies/mL (mean 58,676, range <20–367,649). At the time of admission, 23 patients (54.8%) were receiving HAART. Use of antiretroviral therapy at ICU admission was not associated with survival, but it was associated with higher CD4cell counts and lower HIV viral loads. Twenty-five patients (59.5%) had respiratory failure secondary to non-HIV-related diseases. Mechanical ventilation was required in 36 patients (85.1%). Thirteen patients (31.0%) died.Conclusions. Noninfectious etiologies of respiratory failure account for majority of HIV-infected patients admitted to ICU. Increased mortality was observed among patients with sepsis as etiology of respiratory failure (HIV related and non-AIDS related), in those receiving mechanical ventilation, and in patients with decreased CD4cell count. Survival was not associated with the use of HAART. Complementary studies are warranted to address the impact of HAART on outcomes of HIV-infected patients with respiratory failure admitted to ICU.

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CD8+T-Cells Count in Acute Myocardial Infarction in HIV Disease in a Predominantly Male Cohort

BioMed Research International ◽

10.1155/2015/246870 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Oluwatosin A. Badejo ◽

Chung-Chou Chang ◽

Kaku A. So-Armah ◽

Russell P. Tracy ◽

Jason V. Baker ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

T Cell ◽

Cell Count ◽

Hiv Viral Load ◽

Cvd Risk ◽

Infected People ◽

Cell Counts ◽

Immunodeficiency Virus ◽

Male Cohort

Human Immunodeficiency Virus- (HIV-) infected persons have a higher risk for acute myocardial infarction (AMI) than HIV-uninfected persons. Earlier studies suggest that HIV viral load, CD4+T-cell count, and antiretroviral therapy are associated with cardiovascular disease (CVD) risk. Whether CD8+T-cell count is associated with CVD risk is not clear. We investigated the association between CD8+T-cell count and incident AMI in a cohort of 73,398 people (of which 97.3% were men) enrolled in the U.S. Veterans Aging Cohort Study-Virtual Cohort (VACS-VC). Compared to uninfected people, HIV-infected people with high baseline CD8+T-cell counts (>1065 cells/mm3) had increased AMI risk (adjustedHR=1.82, P<0.001, 95% CI: 1.46 to 2.28). There was evidence that the effect of CD8+T-cell tertiles on AMI risk differed by CD4+T-cell level: compared to uninfected people, HIV-infected people with CD4+T-cell counts ≥200 cells/mm3had increased AMI risk with high CD8+T-cell count, while those with CD4+T-cell counts <200 cells/mm3had increased AMI risk with low CD8+T-cell count. CD8+T-cell counts may add additional AMI risk stratification information beyond that provided by CD4+T-cell counts alone.

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Immune Dysfunction in HIV: A Possible Role for Pro- and Anti-Inflammatory Cytokines in HIV Staging

Journal of Immunology Research ◽

10.1155/2017/4128398 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Iorhen Ephraim Akase ◽

Bolanle O. P. Musa ◽

Reginald Onyedumarakwe Obiako ◽

Abdurrahman Ahmad Elfulatiy ◽

Abdullahi Asara Mohammed

Keyword(s):

T Cell ◽

Hiv Infection ◽

Cell Count ◽

Inflammatory Cytokines ◽

Opportunistic Infections ◽

Immune Dysfunction ◽

Clinical Staging ◽

Cell Counts ◽

Treatment Naïve ◽

Anti Inflammatory

HIV infection is a chronic infection that almost inevitably progresses to AIDS. The infection is characterized by the deterioration in the immune function leading to opportunistic infections and malignancies. Additionally, there is an associated immune dysfunction characterized by a persistent inflammatory state and unhealthy elaboration of both pro- and anti-inflammatory cytokines. The CD4+ T cell count has been used as a surrogate for the level of immune dysfunction that exists in patients with HIV infection. Eighty-eight (88) patients with HIV infection, forty-four (44) of whom were treatment naïve patients and forty-four (44) who were treatment-experienced patients, were recruited. The serum concentrations of cytokines IL-6 and IL-10 were carried out using R&D human Quantikine ELISA kits, while patients’ CD4+ T cell counts were evaluated using the Partec easy count kit. The serum IL-6 and IL-10 concentrations were significantly higher among the AR-naïve participants compared to the ART-experienced group. Additionally, the IL-6 and IL-10 concentrations were higher in patients with lower CD4+ T cell count compared to those with higher cell counts though this was not statistically significant. Also, both IL-6 and IL-10 concentrations were higher in patients with higher WHO clinical staging of disease, significantly so for IL-6.

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Prospective study of opportunistic infections among HIV infected patients in VSS Institute of Medical Science and Research, Burla, Sambalpur, Odisha, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20181980 ◽

2018 ◽

Vol 5 (3) ◽

pp. 566

Author(s):

P. K. Bariha ◽

M. K. Mohapatra ◽

B. K. Kullu ◽

P. C. Karua ◽

S. B. Biswal ◽

...

Keyword(s):

T Cell ◽

Prospective Study ◽

Cell Count ◽

Opportunistic Infections ◽

Oral Candidiasis ◽

Medical Science ◽

Cd4 T Cell ◽

Female Ratio ◽

Cell Counts ◽

Cd4 T Cell Count

Background: HIV destroys the CD4+T cells progressively thus making the HIV infected persons susceptible to a number of opportunistic infections (OIs).Methods: The study was conducted in the Medicine Department and ART Centre, VIMSAR. It is a prospective study from July 2016 to September 2017.Results: 86 patients register, detail history, clinical examination and investigation were done and then the data is complying in detail. Most of the patients were male (72%) male female ratio is 2.6:1. The majority of patients presented with fever, weight loss and anorexia seen in more than 73% of the study population.Conclusions: (42%) cases belonged to the CD4+T cell count range of 101-200/µl with aCD4+T cell count of 183/µl, so there is increased chance of hospitalization in patients having CD4+T cell count below 200/µl. The most common OI was tuberculosis (51%) with pleural effusion as its commonest manifestation. The second most common OI was candidiasis (43%) with most cases suffering from oral candidiasis was seen to occur at higher CD4+T cell counts than tuberculosis.

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The impact of diabetes on CD4 recovery in persons with HIV in an urban clinic in the United States

International Journal of STD & AIDS ◽

10.1177/0956462417717650 ◽

2017 ◽

Vol 29 (1) ◽

pp. 63-71 ◽

Cited By ~ 1

Author(s):

Julie A Zuniga ◽

Kirk A Easley ◽

Neeta Shenvi ◽

Minh L Nguyen ◽

Marcia Holstad

Keyword(s):

African American ◽

T Cell ◽

Cell Count ◽

African American Women ◽

Cd4 T Cell ◽

Cd4 Cell Count ◽

Cell Counts ◽

Cd4 Cell ◽

The Impact ◽

Cd4 T Cell Count

The purpose of this study was to exam the impact of type 2 diabetes mellitus (T2DM) on CD4 cell count trends in adults with HIV. In a longitudinal retrospective study in an urban primary care HIV clinic in the southeastern United States from 2010 to 2012, patients with HIV medical charts were audited to obtain their CD4 cell count, diabetes status, weight, and demographic information. Rates of increase of CD4 T cell count (i.e. slopes) were obtained using a linear mixed-effects model. Most of the HIV–T2DM cohort (n = 262) and HIV-only cohort (n = 2399) were African American (76%) and male (77%). The CD4 T cell counts were consistently higher in the HIV–T2DM cohort ( p < .0001). The mean rate of CD4 T cell count increase (mean ± SE) was 63 ± 9 cells/µl/year in HIV–T2DM African American women and 28 ± 7 cells/µl/year in HIV–T2DM African American men ( p = 0.003). In the multivariable slope analysis, the CD4 T cell count increase was significantly faster for HIV–T2DM African American women than for all other patients (mean difference = 30/cells/µl/year, 95% CI: 13–47; p < 0.001). Gender, race/ethnicity, and the diagnosis of diabetes influenced the recovery of CD4 cell counts.

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Rapid Clinical Progression and Its Correlates Among Acute HIV Infected Men Who Have Sex With Men in China： Findings From a 5-Year Multicenter Prospective Cohort Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.712802 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jing Zhang ◽

Xiao-jie Huang ◽

Wei-ming Tang ◽

Zhenxing Chu ◽

Qinghai Hu ◽

...

Keyword(s):

Viral Load ◽

T Cell ◽

Cell Count ◽

Rapid Progression ◽

Clinical Progression ◽

Hiv Viral Load ◽

Middle Income ◽

Cell Counts ◽

Acute Hiv ◽

Sex With Men

BackgroundIn the “treat all” era, there are few data on the nature of HIV clinical progression in middle-income countries. The aim of the current study was to prospectively analyze the clinical progression of HIV and its indicators among men in China with acute HIV who have sex with men.MethodsFrom 2009–2014 a total of 400 men with acute HIV infection (AHI) were identified among 7,893 men who have sex with men via periodic pooled nucleic acid amplification testing, and they were assigned to an AHI prospective cohort in Beijing and Shenyang, China. Rapid progression was defined as two consecutive CD4+ T cell counts < 350/µL within 3–24 months post-infection. Kaplan−Meier and Cox-regression analyses were conducted to identify predictors of rapid progression.ResultsAmong 400 men with AHI 46.5% were rapid progressors, 35.1% reached rapid progressor status by 12 months post-infection, and 63.9% reached rapid progressor status by 24 months. Rapid progression was associated with herpes simplex-2 virus coinfection (adjusted hazard ratio [aHR] 1.7, 95% confidence interval [CI] 1.2–2.3], depression (aHR 1.9, 95% CI 1.5–2.6), baseline CD4+ T cell count < 500/μL (aHR 3.5, 95% CI 2.4–5.1), higher baseline HIV viral load (aHR 1.6, 95% CI 1.2–2.3), acute symptoms lasting ≥ 2 weeks (aHR 1.6, 95% CI 1.1–2.2), higher body mass index (aHR 0.9, 95% CI 0.9–1.0), higher HIV viral load (aHR 1.7, 95% CI 1.4–2.1), set point viral load at 3 months (aHR 2.0, 95% CI 1.6–2.5), each 100-cell/μL decrease in CD4+ T cell count at 3 months (aHR 2.2, 95% CI 1.9–2.5), and baseline routine blood tests including white blood cell count < 5.32, hemoglobin ≥ 151, mean corpuscular hemoglobin ≥ 30.5, hemoglobin concentration ≥ 342, mean platelet count ≥ 342, lymphocytes ≥ 1.98, and mixed cell count ≥ 0.4 (all p < 0.05).ConclusionAlmost half of the patients underwent rapid clinical progression within 2 years after HIV infection. A treat-all policy is necessary and should be strengthened globally. Rapid progression was correlated with herpes simplex-2 virus coinfection, depression, low CD4+ T cell counts, and high set point viral load in acute infection stage. Rapid progression can be identified via simple indicators such as body mass index and routine blood test parameters in low and middle-income countries.

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Effect of Graft Engineering and Post-Transplantation Immunosuppression Regimen on Immunophenotypic Recovery in Recipients of Unrelated Donor Bone Marrow (T-Cell Depletion Trial) in a Multicenter Randomized Phase II-III Trial.

Blood ◽

10.1182/blood.v110.11.1067.1067 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1067-1067

Author(s):

Lawrence S. Lamb ◽

John E. Wagner ◽

Nancy A. Kernan ◽

Trudy N. Small ◽

Shelly L. Carter ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Mixed Model ◽

Nk Cell ◽

First Year ◽

Free Survival ◽

Cell Counts ◽

Graft Engineering ◽

The Impact ◽

Measurement Period

Abstract T cell depletion (TCD) of donor allogeneic blood or marrow grafts can reduce the incidence and severity of acute graft-versus-host disease (GvHD) but may place the patient at risk for disease relapse. This multicenter randomized trial examined the impact of selective depletion of αβ T cells (αβTCD) + cyclosporine immunosuppression in recipients of unrelated marrow grafts vs. T-replete marrow grafts + methotrexate and cyclosporine immunosuppression. Previously reported data from this trial have shown that 3-year disease-free survival (DFS) did not differ between these groups, although the αβTCD group showed improved neutrophil recovery, decreased incidence of acute GvHD, and reduced grade III-IV toxicities. In order to further clarify these findings, we examined the impact of each graft manipulation and immunosuppression strategy on lymphocyte subset recovery and associated outcomes. Lymphocyte recovery was assessed at 1, 3, 6, 12, 18, and 24 months post-SCT. Of all patients accrued, only patients that had survived for at least one year and who had at least four separate immunophenotyping assessments were included in this analysis (unmanipulated grafts = 66/206 32.0%; αβTCD grafts 57/203 28.1%). Non-parametric pair wise tests were used to compare recovery of absolute cell counts at each measurement period. We also fit a mixed model to each individual’s data to estimate the rate of change in cell counts in the two groups. The slope estimate for each subject obtained from the mixed model was then used as a variable in models to assess DFS. The Cox proportional hazards test was used to examine associations between recovery of individual cell subsets and DFS. Recovery of total absolute CD3, αβ, γδ, CD3+CD4+, CD3+CD8+ T cell count as well as the absolute B cell count did not significantly differ between groups for at each measurement period. CD3+CD4+CD45RA naive T cell recovery remained below the expected adult normal range for all time points in both groups but was improved in patients who received unmanipulated grafts. Interestingly, NK cell absolute count recovery was significantly improved in patients that received TCD grafts over those who received unmanipulated grafts (p = 0.001) through the first year post-SCT. Analysis of the impact of individual cell subset recovery on DFS revealed that an absolute γδ T cell count greater than 1.75 x 105/ml at any time during the first year predicted for improved DFS regardless of treatment group (p = 0.05) consistent with previous single-institution reports. Although the αβTCD regimen did not result in improved DFS in this trial, these findings show that αβTCD is a reasonable graft engineering strategy that can reduce the incidence of acute GvHD without producing a significant negative impact on lymphocyte subset recovery. Indeed, patients in the αβTCD group showed markedly improved NK recovery. Approaches that are currently in early-phase trials such as post-SCT targeted T and/or NK cell therapies could be used to supplement the αβTCD regimen, potentially improving relapse-free survival.

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STING and cGAS gene expressions were downregulated among HIV-1-infected persons after antiretroviral therapy

Virology Journal ◽

10.1186/s12985-021-01548-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Lorena Leticia Peixoto de Lima ◽

Allysson Quintino Tenório de Oliveira ◽

Tuane Carolina Ferreira Moura ◽

Ednelza da Silva Graça Amoras ◽

Sandra Souza Lima ◽

...

Keyword(s):

Gene Expression ◽

Viral Load ◽

T Cell ◽

Antiretroviral Therapy ◽

Cell Count ◽

Enzyme Linked Immunosorbent Assay ◽

Type I ◽

Α Level ◽

The Impact ◽

Hiv 1

Abstract Background The HIV-1 epidemic is still considered a global public health problem, but great advances have been made in fighting it by antiretroviral therapy (ART). ART has a considerable impact on viral replication and host immunity. The production of type I interferon (IFN) is key to the innate immune response to viral infections. The STING and cGAS proteins have proven roles in the antiviral cascade. The present study aimed to evaluate the impact of ART on innate immunity, which was represented by STING and cGAS gene expression and plasma IFN-α level. Methods This cohort study evaluated a group of 33 individuals who were initially naïve to therapy and who were treated at a reference center and reassessed 12 months after starting ART. Gene expression levels and viral load were evaluated by real-time PCR, CD4+ and CD8+ T lymphocyte counts by flow cytometry, and IFN-α level by enzyme-linked immunosorbent assay. Results From before to after ART, the CD4+ T cell count and the CD4+/CD8+ ratio significantly increased (p < 0.0001), the CD8+ T cell count slightly decreased, and viral load decreased to undetectable levels in most of the group (84.85%). The expression of STING and cGAS significantly decreased (p = 0.0034 and p = 0.0001, respectively) after the use of ART, but IFN-α did not (p = 0.1558). Among the markers evaluated, the only markers that showed a correlation with each other were STING and CD4+ T at the time of the first collection. Conclusions ART provided immune recovery and viral suppression to the studied group and indirectly downregulated the STING and cGAS genes. In contrast, ART did not influence IFN-α. The expression of STING and cGAS was not correlated with the plasma level of IFN-α, which suggests that there is another pathway regulating this cytokine in addition to the STING–cGAS pathway.

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Lymphocyte subset analysis to evaluate the prognosis of HIV-negative patients with pneumocystis pneumonia

BMC Infectious Diseases ◽

10.1186/s12879-021-06124-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fan Jin ◽

Jing Xie ◽

Huan-ling Wang

Keyword(s):

T Cell ◽

Cell Count ◽

Lymphocyte Subsets ◽

Nk Cell ◽

Cd8 T Cell ◽

Pneumocystis Pneumonia ◽

Lymphocyte Subset ◽

Cd4 T Cell ◽

Cell Counts ◽

Hiv Negative

Abstract Objectives We analysed the peripheral blood lymphocyte subsets of human immunodeficiency virus (HIV)-negative patients infected with pneumocystis pneumonia (PCP) to determine the relationships between the levels of different types of lymphocytes and the prognosis of patients. Methods We retrospectively reviewed HIV-negative patients with PCP diagnosed in our department. All the eligible patients underwent lymphocyte subset analysis on admission. Results A total of 88 HIV-negative PCP patients were enrolled in the study. In univariate analyses, low CD4+ T cell count, low CD8+ T cell count, and low natural killer cell (NK cell) count were associated with higher in-hospital mortality. CD8+ T cell count ≤300/μL was found to be an independent risk factor for poor prognosis in multivariate logistical regression analysis (p = 0.015, OR = 11.526, 95% CI = 1.597–83.158). Although low CD4+ T cell and NK cell counts were not independent risk factors, the mortality rates of PCP patients decreased as the CD4+ T cell and NK cell counts increased. Conclusion The immune process of Pneumocystis jirovecii infection is complex but important. We propose that lymphocyte subsets could give clinicians a better understanding of patient immune status, helping with the early identification of potentially lethal infections and treatment decision making, such as adjusting the immunosuppressive regimen and choosing an appropriate patient monitoring level.

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