COVID-19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS-CoV-2
JOURNAL OF MEDICAL VIROLOGY
Authors: Mondi, Annalisa; Cimini, Eleonora; Colavita, Francesca; Cicalini, Stefania; Pinnetti, Carmela; Matusali, Giulia; Casetti, Rita; Maeurer, Markus; Vergori, Alessandra; Mazzotta, Valentina; Gagliardini, Roberta; De Zottis, Federico; Schinina, Vincenzo; Girardi, Enrico; Puro, Vincenzo; Ippolito, Giuseppe; Vaia, Francesco; Capobianchi, Maria Rosaria; Castilletti, Concetta; Agrati, Chiara; Antinori, Andrea
Abstract
Little evidence on coronavirus disease 2019 (COVID-19) in people living with HIV (PLWH) is currently available. We reported clinical and viroimmunological data of all HIV-positive patients admitted to our center with COVID-19 from March 1 to May 12, 2020. Overall, five patients were included: all were virologically-suppressed on antiretroviral therapy and CD4+ count was greater than 350 cell/mm(3)in all but two patients. Although all patients had evidence of pneumonia on admission, only one developed respiratory failure. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was never detected from nasopharyngeal swabs in two patients, whereas in the others, viral clearance occurred within a maximum of 43 days. Immunoglobulin G production was elicited in all patients and neutralizing antibodies in all but one patient. Specific-T-cell response developed in all patients but was stronger in those with the more severe presentations. Similarly, the highest level of proinflammatory cytokines was found in the only patient experiencing respiratory failure. Despite a mild presentation, patients with more pronounced immunosuppression showed high degrees of both cytokines production and immune activation. Our study did not find an increased risk and severity of COVID-19 in PLWH. Adaptative cellular immune response to SARS-CoV-2 appeared to correlate to disease severity. The mild clinical picture showed in advanced HIV patients, despite a significant T-cell activation and inflammatory profile, suggests a potential role of HIV-driven immunological dysregulation in avoiding immune-pathogenetic processes. However, other possible explanations, as a protective role of certain antiretroviral drugs, should be considered. Further larger studies are needed to better clarify the impact of HIV infection on COVID-19.
The African natural product knipholone anthrone and its analogue anthralin (dithranol) enhance HIV-1 latency reversal
JOURNAL OF BIOLOGICAL CHEMISTRY
Authors: Richard, Khumoekae; Schonhofer, Cole; Giron, Leila B.; Rivera-Ortiz, Jocelyn; Read, Silven; Kannan, Toshitha; Kinloch, Natalie N.; Shahid, Aniqa; Feilcke, Ruth; Wappler, Simone; Imming, Peter; Harris, Marianne; Brumme, Zabrina L.; Brockman, Mark A.; Mounzer, Karam; Kossenkov, Andrew V.; Abdel-Mohsen, Mohamed; Andrae-Marobela, Kerstin; Montaner, Luis J.; Tietjen, Ian
Abstract
A sterilizing or functional cure for HIV is currently precluded by resting CD4(+)T cells that harbor latent but replication-competent provirus. The "shock-and-kill" pharmacological ap-proach aims to reactivate provirus expression in the presence of antiretroviral therapy and target virus-expressing cells for elimination. However, no latency reversal agent (LRA) to date effectively clears viral reservoirs in humans, suggesting a need for new LRAs and LRA combinations. Here, we screened 216 compounds from the pan-African Natural Product Library and identified knipholone anthrone (KA) and its basic building block anthralin (dithranol) as novel LRAs that reverse viral latency at low micromolar concentrations in multiple cell lines. Neither agent's activity depends on protein kinase C; nor do they inhibit class I/II histone deacetylases. However, they are differentially modulated by oxidative stress and metal ions and induce distinct patterns of global gene expression from established LRAs. When applied in combination, both KA and anthralin synergize with LRAs representing multiple functional classes. Finally, KA induces both HIV RNA and protein in primary cells from HIV-infected donors. Taken together, we describe two novel LRAs that enhance the activities of multiple "shock-and-kill" agents, which in turn may inform ongoing LRA combination therapy efforts.