20 research outputs found
A Stochastic Model of Latently Infected Cell Reactivation and Viral Blip Generation in Treated HIV Patients
Motivated by viral persistence in HIV+ patients on long-term anti-retroviral treatment (ART), we present a stochastic model of HIV viral dynamics in the blood stream. We consider the hypothesis that the residual viremia in patients on ART can be explained principally by the activation of cells latently infected by HIV before the initiation of ART and that viral blips (clinically-observed short periods of detectable viral load) represent large deviations from the mean. We model the system as a continuous-time, multi-type branching process. Deriving equations for the probability generating function we use a novel numerical approach to extract the probability distributions for latent reservoir sizes and viral loads. We find that latent reservoir extinction-time distributions underscore the importance of considering reservoir dynamics beyond simply the half-life. We calculate blip amplitudes and frequencies by computing complete viral load probability distributions, and study the duration of viral blips via direct numerical simulation. We find that our model qualitatively reproduces short small-amplitude blips detected in clinical studies of treated HIV infection. Stochastic models of this type provide insight into treatment-outcome variability that cannot be found from deterministic models
Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1
Massive research efforts are now underway to develop a cure for HIV
infection, allowing patients to discontinue lifelong combination antiretroviral
therapy (ART). New latency-reversing agents (LRAs) may be able to purge the
persistent reservoir of latent virus in resting memory CD4+ T cells, but the
degree of reservoir reduction needed for cure remains unknown. Here we use a
stochastic model of infection dynamics to estimate the efficacy of LRA needed
to prevent viral rebound after ART interruption. We incorporate clinical data
to estimate population-level parameter distributions and outcomes. Our findings
suggest that approximately 2,000-fold reductions are required to permit a
majority of patients to interrupt ART for one year without rebound and that
rebound may occur suddenly after multiple years. Greater than 10,000-fold
reductions may be required to prevent rebound altogether. Our results predict
large variation in rebound times following LRA therapy, which will complicate
clinical management. This model provides benchmarks for moving LRAs from the
lab to the clinic and can aid in the design and interpretation of clinical
trials. These results also apply to other interventions to reduce the latent
reservoir and can explain the observed return of viremia after months of
apparent cure in recent bone marrow transplant recipients and an
immediately-treated neonate.Comment: 8 pages main text (4 figures). In PNAS Early Edition
http://www.pnas.org/content/early/2014/08/05/1406663111. Ancillary files: SI,
24 pages SI (7 figures). File .htm opens a browser-based application to
calculate rebound times (see SI). Or, the .cdf file can be run with
Mathematica. The most up-to-date version of the code is available at
http://www.danielrosenbloom.com/reboundtimes
Stochastic modelling of the eradication of the HIV-1 infection by stimulation of latently infected cells in patients under highly active anti-retroviral therapy
HIV-1 infected patients are effectively treated with highly active anti-retroviral therapy (HAART). Whilst HAART is successful in keeping the disease at bay with average levels of viral load well below the detection threshold of standard clinical assays, it fails to completely eradicate the infection, which persists due to the emergence of a latent reservoir with a half-life time of years and is immune to HAART. This implies that life-long administration of HAART is, at the moment, necessary for HIV-1-infected patients, which is prone to drug resistance and cumulative side effects as well as imposing a considerable financial burden on developing countries, those more afflicted by HIV, and public health systems. The development of therapies which specifically aim at the removal of this latent reservoir has become a focus of much research. A proposal for such therapy consists of elevating the rate of activation of the latently infected cells: by transferring cells from the latently infected reservoir to the active infected compartment, more cells are exposed to the anti-retroviral drugs thus increasing their effectiveness. In this paper, we present a stochastic model of the dynamics of the HIV-1 infection and study the effect of the rate of latently infected cell activation on the average extinction time of the infection. By analysing the model by means of an asymptotic approximation using the semi-classical quasi steady state approximation (QSS), we ascertain that this therapy reduces the average life-time of the infection by many orders of magnitudes. We test the accuracy of our asymptotic results by means of direct simulation of the stochastic process using a hybrid multi-scale Monte Carlo scheme
Determinants of the efficacy of HIV latency-reversing agents and implications for drug and treatment design
HIV eradication studies have focused on developing latency-reversing agents (LRAs). However, it is not understood how the rate of latent reservoir reduction is affected by different steps in the process of latency reversal. Furthermore, as current LRAs are host-directed, LRA treatment is likely to be intermittent to avoid host toxicities. Few careful studies of the serial effects of pulsatile LRA treatment have yet been done. This lack of clarity makes it difficult to evaluate the efficacy of candidate LRAs or predict long-term treatment outcomes. We constructed a mathematical model that describes the dynamics of latently infected cells under LRA treatment. Model analysis showed that, in addition to increasing the immune recognition and clearance of infected cells, the duration of HIV antigen expression (i.e., the period of vulnerability) plays an important role in determining the efficacy of LRAs, especially if effective clearance is achieved. Patients may benefit from pulsatile LRA exposures compared with continuous LRA exposures if the period of vulnerability is long and the clearance rate is high, both in the presence and absence of an LRA. Overall, the model framework serves as a useful tool to evaluate the efficacy and the rational design of LRAs and combination strategies
Stochastic modelling of cellular populations: Effects of latency and feedbackl
[cat]L'objectiu principal d'aquesta tesi doctoral Ă©s l'estudi de l'efecte de les fluctuacions en poblacions acoblades en sistemes biològics, on cèl·lules en estat latent juguen un paper important. Intentant trobar el significat biològic de la dinĂ mica dels sistemes. Els punts especĂfics que volem abordar i la organitzaciĂł de la tesi estan explicats a continuaciĂł. En el CapĂtol 2, estudiem el comportament de les poblacions de cèl·lules amb estructura jerĂ rquica des del punt de vista de les propietats d'estabilitat, En particular: - 1. DivisiĂł simètrica contra asimètrica en el compartiment de les cèl·lules mare. Estudiem la robustesa de les poblacions amb estructura jerĂ rquica, depenent de si les cèl·lules mare es divideixen simètricament, asimètricament o de les dues maneres. Estudiem com la divisiĂł simètrica afecta a l'estabilitat de la poblaciĂł, ja que això tĂ© una gran importĂ ncia en la progressiĂł del cĂ ncer. - 2. La competiciĂł entre dues poblacions amb diferents tipus de divisiĂł de les cèl·lules mare. Això Ă©s crucial per trobar estratègies òptimes que maximitzin la robustesa (supervivència a llarg termini, resistència a invasions i habilitat per invadir) de poblacions amb estructura jerĂ rquica. - 3. La influència de parĂ metres com son la duplicaciĂł i el ritme de mort de cèl·lules mare, el temps de vida mitjĂ de les cèl·lules completament diferenciades, la longitud de les cadenes de diferenciaciĂł i les fluctuacions al compartiment de les cèl·lules mare en la robustesa i arquitectura òptima de les cascades de diferenciaciĂł. En el CapĂtol 3 presentem un model homogeni de combinaciĂł de HAART amb terĂ pies d'activaciĂł de les cèl·lules latents del VIH-1 a la sang. Estem interessats en: - 1. L'efecte del ritme d'activaciĂł de les cèl·lules latents en el temps mitjĂ de vida de la infecciĂł. En particular analitzem si les terĂ pies basades en incrementar aquest ritme sĂłn capaces de suprimir la infecciĂł en un temps raonable. - 2. La importĂ ncia de l'eficiència de les terĂ pies antiretrovirals, incloent els casos lĂmit en que l'eficĂ cia Ă©s del 100%, en la quantitat de cĂ rrega viral. - 3. La formulaciĂł d'una teoria asimptòtica basada en l'aproximaciĂł semi-clĂ ssica amb aproximacions quasi estacionĂ ries per descriure la dinĂ mica del procĂ©s. La precisiĂł d'aquest mètode asimptòtic Ă©s comparat amb simulacions multi-scale proposades pel Cao et al. En el CapĂtol 4, estenem el model proposat pel Rong i el Perelson a un model no homogeni de la dinĂ mica del VIH-1 en el corrent sanguini, considerant que les cèl·lules i els virus no estan distribuĂŻts de manera uniforme en la sang. Els punts especĂfics que volem estudiar sĂłn: - 1. El mecanisme que fa que apareguin els episodis de virèmia per sobre els lĂmits de detecciĂł, coneguts com viral blips. En particular volem investigar si sĂłn producte de fluctuacions estocĂ stiques degudes a la inhomogenietat o un altre mecanisme ha de ser considerat. - 2. Si l'apariciĂł dels viral blips estĂ afectada pels procediments duts a terme en el laboratori, com el temps d'espera entre les extraccions i les observacions. - 3. Si la probabilitat, l'amplitud i la freqüència dels viral blips es veu afectada pels diferents possibles tipus de producciĂł viral, Ă©s a dir, continua vs burst. En el CapĂtol 5 presentem i discutim els resultats obtinguts, i comparem, quan Ă©s possible, amb altres models o amb resultats experimentals, i discutim el treball que deixem pel futur. Els detalls relatius a qĂĽestions metodològiques, això com una introducciĂł a la modelitzaciĂł estocĂ stica fent servir equacions mestres es donen en els apèndixs. Per a aquells que no estan familiaritzats amb els models basats en equacions mestres, l'autor recomana llegir primer l'apèndix A que proporciona la base matemĂ tica per entendre el capĂtol 2. Els Apèndixs B, C i D juntament amb l'Apèndix A donen la base matemĂ tica necessĂ ria per seguir el capĂtol 3 i el capĂtol 4
Intragenic elements support the transcription of defective HIV-1 proviruses
Human immunodeficiency virus-1 (HIV-1) establishes a persistent proviral reservoir by integrating into the genome of infected host cells. Current antiretroviral treatments (ART) do not target this persistent population of proviruses which include latently infected cells that upon treatment interruption can be reactivated to contribute to HIV-1 rebound. Deep sequencing of persistent HIV-1 proviruses has revealed that greater than 90% of integrated HIV-1 genomes are defective and unable to produce infectious virions. We hypothesized that intragenic elements in the HIV genome support transcription of aberrant HIV-1 RNAs from defective proviruses that lack long terminal repeats (LTRs). Using an intact provirus detection assay, I observed that resting CD4+ T cells and monocyte-derived macrophages (MDMs) are biased towards generating defective HIV-1 proviruses. Multiplex reverse transcription droplet digital polymerase chain reaction (RT-ddPCR) identified env and nef transcripts which lacked 5’ untranslated regions (UTR) in acutely infected CD4+ T cells and MDMs indicating transcripts are generated that do not utilize the promoter within the LTR. 5’UTR-deficient env transcripts were also identified in a cohort of people living with HIV-1 (PLWH) on ART, suggesting that these aberrant RNAs are produced in vivo. Using 5’ rapid amplification of cDNA ends (RACE), I mapped the start site of these transcripts within the Env gene. This region bound several cellular transcription factors and functioned as a transcriptional regulatory element that could support transcription and translation of downstream HIV-1 RNAs. Transient expression of an HIV-1 5’UTR deletion construct in HEK293T cells demonstrated that HIV-1 transcripts and proteins are still produced when the 5’UTR is absent. These studies provide mechanistic insights into how defective HIV-1 proviruses are persistently expressed to potentially drive inflammation in PLWH
Modulation of HIV-specific T cell responses during standard antiretroviral treatment and immunotherapy
Seule une minorité des individus infectés par le virus de l’immunodéficience humaine (VIH) développe une réponse immunitaire capable de contrôler le virus. Chez la plupart des individus, on observe un échappement virologique et un épuisement des lymphocytes T CD8+ spécifiques du VIH. L’infection chronique non-traitée altère également les lymphocytes T CD4+ spécifiques du VIH caractérisé par l’expression accrue des récepteurs co-inhibiteurs et une signature des cellules auxiliaires T folliculaires (Tfh). La thérapie antirétrovirale (TAR) est très efficace pour supprimer durablement la charge virale dans le plasma. Néanmoins, elle ne permet pas une éradication complète du VIH car le virus persiste, intégré dans le génome des cellules réservoirs, desquelles le virus réapparaît lors de l’interruption de la thérapie. Cela démontre que l'immunité adaptive spécifiques du VIH n'est pas restaurée.
Les anticorps neutralisants à large spectre (bNAbs) représentent une alternative potentielle à la TAR. En plus de la neutralisation du virus – et contrairement à la TAR – les bNAbs ne limitent pas la disponibilité de l'antigène et peuvent engager le système immunitaire. L'administration de bNAbs à des macaques rhésus induit des réponses immunitaires adaptatives associées à un contrôle prolongé de la virémie, mais cela n’a pas été établi chez l’Homme.
Dans cette thèse, nous avons donc exploré la modulation des réponses des lymphocytes T spécifiques du VIH lors d'une TAR standard et d’une immunothérapie utilisant des bNAbs.
Dans un premier objectif nous avons analysé la modulation persistante des réponses des lymphocytes T CD4+ spécifiques du VIH chez les individus sous TAR. Nous avons pu démontrer l'expansion persistante des Tfh spécifiques au VIH avec des caractéristiques phénotypiques et fonctionnelles les distinguant des Tfh spécifiques d’antigènes viraux comparatifs (cytomégalovirus, virus de l’hépatite B). Ces caractéristiques ont été induites au cours de l’infection chronique non-traitée, persistaient pendant la TAR et étaient associées au réservoir du VIH compétent pour la traduction. Ces données suggèrent qu’une stimulation antigénique persistante, malgré une TAR efficace, maintient des modifications immunologiques notamment au niveau des Tfh.
Dans un second objectif, nous avons caractérisé les réponses T spécifiques du VIH à la suite d’un traitement utilisant des bNAbs et une interruption structurée de la TAR (IST). Des individus inclus dans une étude clinique de phase Ib ont reçu une perfusion d’une combinaison des bNAbs 10-1074 et 3BNC117 et ont démontré une suppression virale prolongée après l’IST. Chez ces participants, nous avons observé une augmentation des réponses immunitaires des lymphocytes T CD8+ et CD4+ spécifiques du VIH due à l'expansion des réponses immunitaires préexistantes et au développement de réponses ciblant de nouveaux épitopes. Cela suggère que la combinaison d’un traitement par bNAbs avec l’IST est associée au maintien de la charge virale plasmatique indétectable et à une intensification de la réponse immunitaire des lymphocytes T spécifiques du VIH.
Nos travaux permettent une meilleure compréhension des réponses des lymphocytes T spécifiques du VIH au cours de la TAR et lors d’une immunothérapie. Ils peuvent contribuer au développement de stratégies thérapeutiques plus efficaces visant à contrôler la réplication virale sans la TAR.Only a small fraction of individuals infected with the human immunodeficiency virus (HIV) develops effective immune responses able to control the virus. In most individuals, the virus escapes the antiviral immune response and HIV-specific CD8+ T cell responses become exhausted. Untreated progressive HIV infection also leads to alterations in HIV-specific CD4+ T cells. This includes increased expression of co-inhibitory receptors and skewing towards a T follicular helper cell (Tfh) signature. Antiretroviral therapy (ART) is highly effective in controlling the HIV viral load at undetectable levels in the plasma. However, ART does not represent a cure as the virus integrates into the genome of infected cells from where the virus rebounds once ART is stopped. This demonstrates that the HIV-specific T cell immunity is not restored. However, the changes that are introduced during progressive infection and that are maintained after viral suppression with ART are poorly known.
Broadly neutralizing antibodies (bNAbs) represent a potential alternative to ART. In addition to virus neutralization and unlike ART, bNAbs to do not limit HIV antigen availability and can engage the immune system. bNAb administration elicited adaptive immune responses that were associated with long-lasting viral control in a simian animal model but this has not been established in HIV-infected individuals.
In this thesis, we therefore proceeded to study the modulation of HIV-specific T cell responses during standard ART and after an immunotherapeutic intervention using bNAbs.
The first objective was to better understand persistent modulation of HIV-specific CD4+ T cell responses in ART-treated individuals. Our results demonstrated the persistent expansion of HIV-specific Tfh cell responses with multiple phenotypic and functional features that differed from Tfh cells specific for comparative viral antigens (cytomegalovirus, hepatitis B virus). These features were induced during chronic untreated HIV infection, persisted during ART and correlated with the translation-competent HIV reservoir. This suggests that persistent HIV antigen expression, despite effective ART, maintains these altered immunological features specifically for Tfh responses.
For the second objective, we characterized changes in the HIV-specific CD8+ and CD4+ T cell immunity after bNAb treatment and analytical treatment interruption (ATI). For this, we used samples obtained from participants enrolled in a clinical phase Ib study that received combined infusion of bNAbs 10-1074 and 3BNC117 and demonstrated prolonged viral suppression after ATI. In these individuals, we detected an increase of HIV-specific CD8+ and CD4+ T cell responses during ART interruption when compared to baseline. Increased T cell responses were due to both expansion of pre-existing responses and the emergence of responses to new epitopes. In contrast, HIV-specific T cell responses remained unchanged in ART-treated individuals who did not receive bNAb infusions. This suggests that bNAb treatment and ATI is associated with increased HIV-specific T cell immunity while viral suppression is maintained.
Together our results contribute to a better understanding of HIV-specific T cell responses during ART and immunotherapy treatment. Our findings may help to develop more effective HIV treatment strategies to improve the host’s immune system so that HIV can be controlled without the need for ART
Recommended from our members
Dynamics of HIV treatment and social contagion
Modern-day management of infectious diseases is critically linked to the use of mathematical models to understand and predict dynamics at many levels, from the mechanisms of pathogenesis to the patterns of population-wide transmission and evolution. This thesis describes the development and application of mathematical techniques for HIV infection and dynamics on social networks. Treatment of HIV infection has improved dramatically in the past few decades but is still limited by the development of drug resistance and the inability of current therapies to completely eradicate the virus from an individual. We begin with a synthesis of the important evolutionary principles governing the HIV epidemic, emphasizing the role of modeling. We then describe a modeling framework to study the emergence of drug-resistant HIV within a patient. Our model integrates laboratory data and patient behavior, with the goal of predicting outcomes of clinical trials. Current results demonstrate how pharmacologic properties of antiretroviral drugs affect selection for drug resistance, and can explain drug-class-specific resistance risks. Thirdly, we describe models for a new class of drugs that aim to eliminate cells with latent viral infection. We provide estimates for the required efficacy of these drugs and describe the potential challenges of future clinical trials. Finally, models and mechanisms for understanding viral dynamics are increasingly finding applications outside traditional virology. They can be used to study the dynamics of behaviors, to help predict and intervene in their spread. We describe techniques for applying infectious disease models to social contagion, drawing on techniques for network epidemiology. We use this framework to interpret data on the interpersonal spread of health-related behaviors