Virological and immunological characteristics of HIV-infected individuals at the earliest stage of infection

Ananworanich, Jintanat; Sacdalan, Carlo; Pinyakorn, Suteeraporn; Chomont, Nicolas; Souza, Mark de; Luekasemsuk, Tassanee; Schuetz, Alexandra; Krebs, Shelly J.; Dewar, Robin; Jagodzinski, Linda L.; Ubolyam, Sasiwimol; Trichavaroj, Rapee; Tovanabutra, Sodsai; Spudich, Serena; Valcour, Victor; Sereti, Irini; Michael, Nelson; Robb, Merlin L.; Phanuphak, Praphan; Kim, Jerome H.; Phanuphak, Nittaya

doi:10.1016/s2055-6640(20)30688-9

Cited by 80 publications

(42 citation statements)

References 33 publications

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“…We pooled all stages to encompass the breadth of disease (Supplementary Table 3). As reported elsewhere, total and integrated PBMC HIV DNA levels are higher at baseline in the later stages and decrease to 1 and 0.1 log 10 copies/10 6 PBMCs, respectively, after 48 weeks of ART; the sigmoid colon has a similar pattern [18]. Among acutely infected participants at baseline, higher plasma HIV RNA levels were correlated with higher sIL-6R, I-FABP, sCD14, HA, and D-dimer levels.…”

Section: Relationships Among Cd4 T-cell Counts Hiv Burden and Biomarkerssupporting

confidence: 76%

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Persistent, Albeit Reduced, Chronic Inflammation in Persons Starting Antiretroviral Therapy in Acute HIV Infection

Sereti¹,

Krebs

Phanuphak³

et al. 2016

CLINID

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Section: Relationships Among Cd4 T-cell Counts Hiv Burden and Biomarkerssupporting

confidence: 76%

“…Sigmoid biopsies were performed in the RV254 cohort. The frequencies of cells harboring total and integrated HIV DNA in peripheral blood mononuclear cells (PBMCs) and sigmoid colon gut biopsies were measured as described elsewhere [17,18].…”

Section: Total and Integrated Hiv Dna Measurementsmentioning

confidence: 99%

Persistent, Albeit Reduced, Chronic Inflammation in Persons Starting Antiretroviral Therapy in Acute HIV Infection

Sereti¹,

Krebs

Phanuphak³

et al. 2016

CLINID

Self Cite

224

150

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“…CD4 T-cell depletion begins shortly after infection and delaying ART compromises immune system recovery [ 138 – 141 ]. CD4 cell counts and CD4/CD8 ratios predict long-term morbidity and mortality [ 142 , 143 ]; CD4, CD8, and CD4/CD8 ratios are more likely to normalize with treatment started during AHI compared to delayed treatment [ 141 , 144 – 147 ], with CD4 cell counts normalizing within one year [ 148 ]. Very early ART (within 40 days of the estimated date of infection) is associated with a significant increase in the CD4/CD8 ratio compared to delayed ART [ 149 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Rutstein

Ananworanich

Fidler

et al. 2017

Journal of the International AIDS Society

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118

140

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Introduction: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI.Methods: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years.Results and Discussion: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI – evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting.Conclusions: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.

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“…While we did see evidence of an association between antibody levels and available measurements of the reservoir levels in our pooled cohort of treated patients, the association was not found when the ET or LT groups were considered separately. If early treatment led independently to lower antibody levels [36][37][38] and to lower HIV DNA levels [21,39], this would produce a spurious association. Further analysis of the timing of treatment and effects on reservoir size will require additional studies, larger sample numbers, and detailed analysis of alternative measurements of viral reservoir levels.…”

Section: Discussionmentioning

confidence: 99%

HIV Antibody Level as a Marker of HIV Persistence and Low-Level Viral Replication

Keating

Pilcher

Jain

et al. 2017

The Journal of Infectious Diseases

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Virological and immunological characteristics of HIV-infected individuals at the earliest stage of infection

Cited by 80 publications

References 33 publications

Persistent, Albeit Reduced, Chronic Inflammation in Persons Starting Antiretroviral Therapy in Acute HIV Infection

Persistent, Albeit Reduced, Chronic Inflammation in Persons Starting Antiretroviral Therapy in Acute HIV Infection

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

HIV Antibody Level as a Marker of HIV Persistence and Low-Level Viral Replication

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