Viral Load in Blood and Lymph Tissues of HIV-Infected Individuals

This study is currently recruiting participants.
Verified September 2013 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by:
National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:
NCT00001316
First received: November 3, 1999
Last updated: March 14, 2014
Last verified: September 2013
  Purpose

Our laboratory has previously demonstrated that lymph nodes are a major reservoir for human immunodeficiency virus (HIV) and a major site of active virus replication in infected individuals(1-3). There is at least a 10 fold greater viral burden per given number of CD4+ T lymphocytes obtained from the lymph nodes versus the peripheral blood in the same infected individual. These data have been accumulated predominantly in individuals with progressive generalized lymphadenopathy (CDC Class A1 and A2). It is unclear at present whether this pattern holds true for all categories of HIV infected individuals. We have proposed that the seeding of lymph nodes by HIV early in the course of HIV infection and the persistent production of virus in lymph nodes throughout the course of infection are major factors in the pathogenesis of HIV in virtually all infected individuals. In addition, it is likely that the selective perturbations of various T cell subsets (i.e., V-B classes of CD4+T cells) that have been observed in peripheral blood are much more dramatic in the lymph node given the greater viral burden in the lymph node compared to the peripheral blood. In order to investigate this hypothesis, it is essential that we study simultaneously lymph nodes and peripheral blood from the same individuals and that we study different individuals at various stages of disease from early in the course of infection (CDC Class A) to advanced disease (CDC Class B and C). If, as we suspect, there is active virus replication in the lymph node early in the course of infection, even at a time when there is little virus burden or active replication in the peripheral blood, this would justify anti-retroviral therapy at the earliest possible time in the course of infection. In addition, in certain patients who are about to initiate treatment with an anti-retroviral agent such as zidovudine or didanosine through their private physician, it would be important to know whether treatment actually reduces the viral burden and virus replication in lymph nodes. The effect of therapy on viral burden and replication will be compared in the lymph node versus peripheral blood mononuclear cells and both of these parameters will be compared with the level of plasma viremia.


Condition
HIV Infection
Viremia

Study Type: Observational
Official Title: A Study of Viral Burden in Peripheral Blood Versus Lymphoid and Bone Marrow Tissue in HIV-Infected Individuals

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Further study details as provided by National Institutes of Health Clinical Center (CC):

Estimated Enrollment: 300
Study Start Date: March 1992
Detailed Description:

Several years ago, we and others demonstrated that lymph nodes are a major reservoir for human immunodeficiency virus (HIV) and a major site of active virus replication in infected individuals. Subsequent studies from our group showed that virologic cross talk between B cells and CD4+ T cells occurs within the microenvironment of lymphoid tissues (LT), and that immunosuppressive CD25+CD4+ regulatory T (Treg) cells enriched in the LT. Furthermore, Treg cells isolated from the LT are particularly effective in suppressing HIV-specific cytolytic activity. More recently, follicular helper (Tfh) CD4+ T cells have been described in LT and found to play an important role in providing help to B cells during germinal center reactions. These Tfh cells are expanded in HIV-infected viremic individuals and their numbers correlate with frequencies of germinal center B cells, consistent with longstanding observations of HIV-induced GC hyperplasia in untreated infected individuals. Despite the increased frequencies of Tfh and GC B cells in LT, there is also evidence for reduced immune function due to over-expression of negative regulatory molecules. We are currently investigating several issues related to the impact of HIV infection/replication on the immune competence and homing profiles of numerous cell types within the LT. Given the paucity of Tfh and GC B cells in the peripheral blood, these studies are more appropriately conducted with tissue samples. We will also pursue immunological, migrational and virologic characteristics of various cell types including B cells and their subsets and CD4+, CD8+ and NK cells in the LT and bone marrow (BM) tissue. In this regard, the BM is both the site of B-cell development and the only known long-lived repository of plasma cells that are responsible for maintaining humoral immunity. While HIV infection has been shown to impair hematopoiesis in the BM, very little is known regarding the effect of HIV infection on plasma cells that home back to the BM after maturation.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria
  • INCLUSION CRITERIA:

    1. HIV infection must be documented by a licensed ELISA and confirmed either by Western blot, or plasma viremia.
    2. Aged 18 years or older.
    3. Ability to give informed, written consent.
    4. The following laboratory values:

      1. Absolute neutrophil count of greater than 1000/mm3.
      2. PT, PTT within normal limits.
      3. Adequate blood counts (HIV positive volunteers: hemoglobin greater than or equal to 9.0 g/dL, HCT greater than or equal to 28%, platelets greater than or equal to 75,000; HIV negative volunteers: hemoglobin greater than or equal to 12.0 g/dL, HCT greater than or equal to 38%, platelets greater than or equal to 150,000).
      4. Blood pressure less than or equal to 180/100; pulse rate 50-100, unless a lower pulse rate is considered normal for the volunteer.
    5. HIV negative individuals will qualify as control subjects.
    6. Patients must have a clinically palpable lymph node in an easily accessible location.

EXCLUSION CRITERIA:

  1. Women who are pregnant and/or breast-feeding.
  2. Currently abusing alcohol or other drugs, including narcotics or cocaine.
  3. Patients with AIDS dementia or with an AIDS related malignancy other than minimal Kaposi's sarcoma.
  4. No Aspirin or Non-Steroidal Anti-inflammatory medications (NSIADs) 7 days prior to procedure. Acetaminophen (Tylenol) is permitted at any time.
  5. Any medical condition for which the PI feels LN BX might be contraindicated.
  6. Subjects in which sedation is planned. Use of narcotics (other than as prescribed by a physician) or cocaine less than 1 week prior to the date of biopsy will be excluded.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00001316

Contacts
Contact: Gabbie M Diaz, R.N. (301) 435-8019 diazgm@mail.nih.gov
Contact: Susan Moir, Ph.D. (301) 402-4559 sm221a@nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)    800-411-1222 ext TTY8664111010    prpl@mail.cc.nih.gov   
Sponsors and Collaborators
Investigators
Principal Investigator: Susan Moir, Ph.D. National Institute of Allergy and Infectious Diseases (NIAID)
  More Information

Additional Information:
Publications:
ClinicalTrials.gov Identifier: NCT00001316     History of Changes
Other Study ID Numbers: 920125, 92-I-0125
Study First Received: November 3, 1999
Last Updated: March 14, 2014
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Lymph Node
Polymerase Chain Reaction (PCR)
Viremia
In Situ Hybridization
AIDS
Excisional Biopsy
RNA/DNA

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Viremia
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Sepsis
Systemic Inflammatory Response Syndrome
Inflammation
Pathologic Processes

ClinicalTrials.gov processed this record on April 20, 2014