2 research outputs found
Immediate antiviral therapy appears to restrict resting CD4 + cell HIV-1 infection without accelerating the decay of latent infection
HIV type 1 (HIV-1) persists within resting CD4 + T cells despite anti-retroviral therapy (ART). To better understand the kinetics by which resting cell infection (RCI) is established, we developed a mathematical model that accurately predicts (r = 0.65, P = 2.5 × 10 -4) the initial frequency of RCI measured about 1 year postinfection, based on the time of ART initiation and the dynamic changes in viremia and CD4 + T cells. In the largest cohort of patients treated during acute seronegative HIV infection (AHI) in whom RCI has been stringently quantified, we found that early ART reduced the generation of latently infected cells. Although RCI declined after the first year of ART in most acutely infected patients, there was a striking absence of decline when initial RCI frequency was less than 0.5 per million. Notably, low-level viremia was observed more frequently as RCI increased. Together these observations suggest that (i) the degree of RCI is directly related to the availability of CD4 + T cells susceptible to HIV, whether viremia is controlled by the immune response and/or ART; and (ii) that two pools of infected resting CD4 + T cells exist, namely, less stable cells, observable in patients in whom viremia is not well controlled in early infection, and extremely stable cells that are established despite early ART. These findings reinforce and extend the concept that new approaches will be needed to eradicate HIV infection, and, in particular, highlight the need to target the extremely small but universal, long-lived latent reservoir
PowerPoint Slides for: Pregnancy Outcomes in Patients with Glomerular Disease Attending a Single Academic Center in North Carolina
<p><b><i>Background:</i></b> Contemporary data regarding pregnancy
outcomes in US patients with primary glomerular diseases are lacking. We
aimed to report fetal and maternal outcomes among women with
biopsy-proven primary glomerular disease who received obstetric care at a
single large academic US center. <b><i>Methods:</i></b> All women with a
biopsy-confirmed primary glomerular disease diagnosis and without
end-stage kidney disease who received obstetric care at the University
of North Carolina (UNC) Hospitals (1996-2015) were identified using the
Glomerular Disease Collaborative Network registry and the UNC Hospitals
Perinatal Database. The primary study outcome was perinatal death
(stillbirth at >20 weeks or neonatal death). Secondary outcomes
included premature birth (<37 weeks), birth weight, preeclampsia, and
kidney function changes (postpartum vs. baseline). Demographics,
clinical characteristics, and outcomes were compared across glomerular
disease subtypes. <b><i>Results:</i></b> Among 48 pregnancies in 43 women (IgA nephropathy <i>n</i> = 17, focal segmental glomerulosclerosis [FSGS] <i>n</i> = 16, membranous nephropathy <i>n</i> = 6, minimal change disease <i>n</i>
= 4), 13% of pregnancies resulted in perinatal death and 48% of babies
were born prematurely. From a maternal perspective, 33% of pregnancies
were complicated by preeclampsia, 39% by a doubling of urinary protein,
and 27% by a ≥50% increase in serum creatinine. Outcome differences
across glomerular disease subtypes were not statistically significant,
although decline in kidney function appeared most frequent in FSGS. <b><i>Conclusion:</i></b>
Adverse pregnancy outcomes are frequently observed in women with
glomerular disease. The independent influence of glomerular disease
subtype on outcomes requires further study. More widespread reporting
and analysis of pregnancy outcomes in women with glomerular disease are
urgently needed.</p