Immunity to Human Immunodeficiency Virus (HIV) in Children with Chronic HIV Infection Receiving Highly Active Antiretroviral Therapy

Our objective was to describe the CD4-mediated human immunodeficiency virus (HIV)-specific cell-mediated immunity (CMI) and its virologic and immunologic correlates in children with chronic HIV infection on highly active antiretroviral therapy (HAART). Twelve HIV-infected children on stable antiretroviral therapy with a median level of CD4(+) lymphocytes (CD4%) of 25.5% and a median viral load (VL) of 786 HIV RNA copies/ml were enrolled in this study. Nine of these children were also cytomegalovirus (CMV) seropositive. Blood mononuclear cells, stimulated with HIV and CMV antigens, were used to measure lymphocyte proliferation and to enumerate gamma interferon (IFN-γ)-producing CD4(+) cells. HIV CMI and CMV CMI were detected in similar proportions of patients and correlated with each other, although the HIV responses were less robust. HIV lymphocyte proliferation significantly increased with lower HIV VL and showed a trend to increase with higher CD4% and longer time on HAART. The in vitro IFN-γ response to HIV or CMV was not affected by CD4%, VL, or HAART. Pediatric patients with established HIV infection on HAART frequently exhibit HIV CMI despite undetectable HIV replication. We concluded that the association between HIV CMI and CMV CMI indicates that the same factors govern responsiveness to either antigen

Cross talk of c-Jun N-terminal kinase and p38 map kinase modulate insulin and TNFα-stimulated VCAM-1 expression in rat aorta endothelial cells

VCAM-1 cell surface expression was determined by flow cytometry in rat aorta endothelial cells stimulated with insulin and/or Tumor Necrosis Factor-a in the absence or presence of short-hairpin RNA inhibitors of c-Jun N-terminal Kinase (JNK) and p38 MAP Kinase. Cells transfected with insulin alone exhibited moderate increases in cell surface VCAM-1 expression, whereas cells stimulated with TNFα alone or in combination with insulin, exhibited a significant (P, 0.05) increase in VCAM-1 surface expression. Cells transfected with shJNK alone showed increased VCAM-1 expression at the cell surface as compared to mock-transfected positive controls. In contrast, cells transfected with shp38 exhibited significant decreased insulin-stimulated VCAM-1 expression at the cell surface, but only moderate decreased VCAM-1 expression in cells stimulated by TNFα alone in combination with insulin. Interestingly, in cells first tranfected with shJNK and then shp38, VCAM-1 expression appeared to increase in an additive fashion. In contrast, cells transfected with shp38 first then shJNK, VCAM-1 expression exhibited increased VCAM-1 expression even in the presence of shp38. One can conclude that JNK is a potent negative regulator of insulin- and TNFα-stimulated cell surface expression of VCAM-1, whereas p38 is mild positive regulator of insulin-, but not TNFα-stimulated VCAM-1 expression. JNK appears to be a more potent mediator of insulin- and TNFα-stimulated cells surface VCAM-1 expression than p38 MAP Kinase. Thus, it could be a therapeutic target for amelioration of inflammation-associated VCAM-1 expression and its sequelae of events that lead to atherosclerosis

HIV infection is associated with reduced serum alpha-1-antitrypsin concentrations

Purpose: Several observations suggest the presence of HIV-suppressive factors in the fluid phase of blood. Alpha-1-antitrypsin (AAT), the most abundant serine protease inhibitor in the circulation, has potent anti-HIV activity in vitro, and may function as an endogenous HIV suppressor. Therefore, we assessed serum AAT concentrations for association with HIV infection. Methods: In this cross-sectional study, serum AAT concentrations were measured in 66 persons with HIV infection and in 45 healthy persons (Controls). In the HIV-infected group, antiretroviral therapy (ART) use was assessed and CD4+ T cell levels and plasma HIV RNA were quantified. Results: Median AAT concentration was significantly lower in the HIV-infected group (1.64 mg/mL) in comparison with Controls (1.94 mg/mL; p=0.001). AAT reduction was most pronounced in the HIV-infected subgroup with CD4+ T cell levels > 200 cells/µL in comparison with Controls (p < 0.01). Serum AAT concentrations < 1.0 mg/mL are clinically significant, and concentrations below this level were identified in 4.5% of the HIV-infected group and in no Control subjects. No association between AAT levels and viral load or use of ART was observed in HIV-infected subjects. Conclusion: The association between reduced serum AAT concentration and HIV infection is consistent with a role for AAT as an endogenous HIV suppressor

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease