Failure to clear intra-monocyte HIV infection linked to persistent neuropsychological testing impairment after first-line combined antiretroviral therapy.

HIV-associated neurocognitive disorders (HAND) persist despite plasma HIV RNA suppression with antiretrovirals (ARV). Sequestered reservoirs in the central nervous system and circulating monocytes are theorized to contribute to persistent brain injury. We previously demonstrated that elevated intracellular HIV DNA from circulating cells was associated with HAND in ARV-treated and ARV-naive subjects. We now report that failure to suppress intra-monocyte HIV DNA 3.5 years after initiating ARV is linked to persistent HAND and subjects with dementia are least likely to suppress intra-monocyte HIV DNA at 3.5 years. These findings suggest that antiviral strategies may need to target intra-monocyte HIV DNA.

Discordant plasma and cerebral spinal fluid cytokines/chemokines in relation to HIV-1-associated dementia.

Monocytes and macrophages serve as HIV-1 reservoirs and may indirectly lead to HIV-1-associated dementia via neurotoxic cytokine/chemokine production. It remains unknown if peripheral monocytes and macrophages are responsible for the presence of circulating and cerebral spinal fluid cytokine/chemokine. The purpose of this evaluation was to determine the relationship between inflammatory and chemoattractant cytokine/chemokine in the periphery and the CNS among individuals with HIV-1-associated dementia and normal cognition. To accomplish this, we utilized specimens from the Hawaii Aging with HIV Cohort to assay plasma, cerebral spinal fluid, and cultured peripheral monocyte and macrophage supernatant cytokine/chemokines from individuals with HIV-1-associated dementia and normal cognition by ELISA, relative real-time PCR, and protein macroarrays. To further characterize the activated cells that may be responsible for HIV-1-associated dementia, inverse-PCR was used to identify sites of viral integration. Different mediators of inflammation, and chemoattraction from monocyte and macrophage supernatants, plasma, and cerebral spinal fluid were identified in HIV-1-associated dementia versus normal cognition. The data suggest unique pathways leading to cytokine/chemokine release in the periphery versus the brain region. This may have implications in delineating a cause and effect in HIV-1-associated dementia pathogenesis.

Preferential HIV-1 integration sites in macrophages and HIV-associated malignancies.

HIV-infected individuals are at risk for developing certain types of cancers. While there are data to show that non-random HIV integration may occur, our goal was to identify preferential genomic sites where HIV integration might be targeted leading to oncogenesis. Initially, a linker-primer PCR strategy was used to identify HIV integration in isolated macrophages. Inverse-PCR was then used to analyze specimens from patients diagnosed with HIV-associated malignancies. From isolated macrophages, integration near a toll-like receptor on chromosome 4 was found. Necropsy tissues from 11 cases were analyzed with 1 tumor specimen found to have HIV integrated in chromosome 22q13.2 and within 300 kb of HSCBCIP1 (CAP-binding protein complex interacting homologue). Tumor-specific primers were then used to screen uninvolved tissue from the same patient, which did not amplify the site-specific region. This report demonstrates that in both an in vitro system and human malignant tissue, specific viral integration can be identified.