Imaging and biopsy of HIV-infected individuals undergoing analytic treatment interruption

被引：2

作者：

Lau, Chuen-Yen ^{[1
]}

Adan, Matthew A. ^{[1
]}

Earhart, Jessica ^{[1
]}

Seamon, Cassie ^{[2
]}

Nguyen, Thuy ^{[3
]}

Savramis, Ariana ^{[1
]}

Adams, Lindsey ^{[3
]}

Zipparo, Mary-Elizabeth ^{[3
]}

Madeen, Erin ^{[3
]}

Huik, Kristi ^{[3
]}

Grossman, Zehava ^{[3
]}

Chimukangara, Benjamin ^{[2
]}

Wulan, Wahyu Nawang ^{[3
]}

Millo, Corina ^{[4
]}

Nath, Avindra ^{[5
]}

Smith, Bryan R. ^{[5
]}

Ortega-Villa, Ana M. ^{[6
]}

Proschan, Michael ^{[6
]}

Wood, Bradford J. ^{[7
]}

Hammoud, Dima A. ^{[8
]}

Maldarelli, Frank ^{[3
]}

机构：

[1] Natl Canc Inst NCI, Natl Inst Hlth NIH, HIV Dynam & Replicat Program, Bethesda, MD 20892 USA

[2] Natl Inst Hlth NIH, Clin Ctr CC, Crit Care Med Dept, Bethesda, MD USA

[3] Natl Canc Inst NCI, Natl Inst Hlth NIH, HIV Dynam & Replicat Program, Frederick, MD USA

[4] Natl Inst Hlth NIH, Clin Ctr CC, PET Dept, Bethesda, MD USA

[5] Natl Inst Neurol Disorders & Stroke NINDS, Natl Inst Hlth NIH, Div Neuroimmunol & Neurovirol, Bethesda, MD USA

[6] Natl Inst Allergy & Infect Dis NIAID, Natl Inst Hlth NIH, Biostat Res Branch, Bethesda, MD USA

[7] Natl Inst Hlth NIH, Clin Ctr CC, Intervent Radiol Radiol & Imaging Sci, Bethesda, MD USA

[8] Natl Inst Hlth NIH, Clin Ctr CC, Radiol & Imaging Sci, Bethesda, MD USA

来源：

FRONTIERS IN MEDICINE | 2022年 / 9卷

关键词：

HIV; reservoir; treatment interruption; PET/CT; biopsy; clinical trial; HIV persistence; ANTIRETROVIRAL THERAPY; FDG-PET/CT; VIRAL LOAD; SET-POINT; T-CELLS; TOMOGRAPHY; PATIENT; TIME; ADULTS; FUSION;

D O I：

10.3389/fmed.2022.979756

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: HIV persistence during antiretroviral therapy (ART) is the principal obstacle to cure. Lymphoid tissue is a compartment for HIV, but mechanisms of persistence during ART and viral rebound when ART is interrupted are inadequately understood. Metabolic activity in lymphoid tissue of patients on long-term ART is relatively low, and increases when ART is stopped. Increases in metabolic activity can be detected by F-18-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and may represent sites of HIV replication or immune activation in response to HIV replication. Methods: FDG-PET imaging will be used to identify areas of high and low metabolic uptake in lymphoid tissue of individuals undergoing long-term ART. Baseline tissue samples will be collected. Participants will then be randomized 1:1 to continue or interrupt ART via analytic treatment interruption (ATI). Image-guided biopsy will be repeated 10 days after ATI initiation. After ART restart criteria are met, image-guided biopsy will be repeated once viral suppression is re-achieved. Participants who continued ART will have a second FDG-PET and biopsies 12-16 weeks after the first. Genetic characteristics of HIV populations in areas of high and low FDG uptake will be assesed. Optional assessments of non-lymphoid anatomic compartments may be performed to evaluate HIV populations in distinct anatomic compartments. Anticipated results: We anticipate that PET standardized uptake values (SUV) will correlate with HIV viral RNA in biopsies of those regions and that lymph nodes with high SUV will have more viral RNA than those with low SUV within a patient. Individuals who undergo ATI are expected to have diverse viral populations upon viral rebound in lymphoid tissue. HIV populations in tissues may initially be phylogenetically diverse after ATI, with emergence of dominant viral species (clone) over time in plasma. Dominant viral species may represent the same HIV population seen before ATI. Discussion: This study will allow us to explore utility of PET for identification of HIV infected cells and determine whether high FDG uptake respresents areas of HIV replication, immune activation or both. We will also characterize HIV infected cell populations in different anatomic locations. The protocol will represent a platform to investigate persistence and agents that may target HIV populations.

引用

页数：16

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