Peripheral neuropathy (PN) is a major comorbidity of HIV infection that is caused in part by chronic immune activation. HIV-PN is associated with infiltration of monocytes/macrophages to the dorsal root ganglia (DRG) causing neuronal loss and formation of Nageotte nodules. Here, we used an oral form of methylglyoxal-bis-guanylhydrazone (MGBG), a polyamine biosynthesis inhibitor, to specifically reduce activation of myeloid cells. MGBG is selectively taken up by monocyte/macrophages in vitro and inhibits HIV p24 expression and DNA viral integration in macrophages. Here, MGBG was administered to nine SIV-infected, CD8-depleted rhesus macaques at 21 days post-infection (dpi). An additional nine SIV-infected, CD8-depleted rhesus macaques were used as untreated controls. Cell traffic to tissues was measured by in vivo BrdU-pulse labeling. MGBG treatment significantly diminished DRG histopathology and reduced the number of CD68+ and CD163+ macrophages in DRG tissue. The number of recently trafficked BrdU+ cells in the DRG was significantly reduced with MGBG treatment. Despite diminished DRG pathology, intraepidermal nerve fiber density (IENFD) did not recover after treatment with MGBG. These data suggest that MGBG alleviated DRG pathology and inflammation.

To the Editor We read with great interest the article by Jain et al, 1 which found that heart failure (HF) mortality in young adults in the US has been increasing over the past 2 decades, with significantly higher rates in Black individuals and in those living in the southeastern US. This is in contrast to generally improved survival among Medicare beneficiaries with HF and the availability of new HF therapies in the last decade, such as angiotensin receptor neprilysin inhibitors and serum glucose cotransporter 2 inhibitors. 2 This study emphasized the importance of access to cardiac preventive services and follow-up care regardless of the patient's age as well as the need to combat racial disparities in health care. One major disparity that comes to mind is the difference in peripartum cardiomyopathy (PPCM) incidence and mortality between Black and White individuals. We wonder if the authors may be able to comment on the impact of PPCM on higher mortality in Black individuals aged 15 to 44 years.There are many past studies using death certificate data to make observations about cardiac health in the US population. 3 Conventionally, death certificate data should include multiple causes of death. Death reporting has also required physicians to designate if the deceased has been pregnant within the past year. If PPCM was included as one of the 4 contributing or underlying causes of death and recent pregnancy was characterized, there may be a way to further examine racial disparities in HF mortality in women.It is known PPCM disproportionately affects Black women, with greater than 40% of cases occurring in this group. 3 A 2022 cohort study 4 found Black and Hispanic women were more likely to experience complications of PPCM, such as cardiogenic shock and in-hospital death, despite higher use of mechanical circulatory support devices. Previous studies have hypothesized that these differences are because of socioeconomic factors, but this study found all women had similar access to HF medications. 4 To date, no clear genetic variations have been found to explain these findings. 5 Can the authors comment on whether recent pregnancy or PPCM on the death certificate could be included to further explain this racial disparity?