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

Tracking Information
First Submitted Date	November 3, 1999
First Posted Date	November 4, 1999
Last Update Posted Date	March 29, 2018
Study Start Date	March 18, 1992
Primary Completion Date	Not Provided
Current Primary Outcome Measures; (submitted: September 11, 2014)	We also wish to investigate the HIV-specific B-cell and T-cell responses in the different subsets of cells in both peripheral blood, aswell as BM and LT of HIV-infected individuals. [ Time Frame: Throughout ]; In addition, we wish to delineate the precise nature of the immunoregulatory mechanisms and altered homing patterns that contribute to the perturbations in the phenotype and functions of various lymphocyte subsets in peripheral blood versus the ... [ Time Frame: Throughout ]; The purpose of this project is to determine the relative burden of human immunodeficiency virus (HIV) and/or associated changes in hematopoiesis and immune activation as well as HIV-specific responses in the various subsets of peripheral blood m... [ Time Frame: Throughout ]
Original Primary Outcome Measures	Not Provided
Change History	Complete list of historical versions of study NCT00001316 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures	Not Provided
Original Secondary Outcome Measures	Not Provided
Current Other Outcome Measures	Not Provided
Original Other Outcome Measures	Not Provided
Descriptive Information
Brief Title	Viral Load in Blood and Lymph Tissues of HIV-Infected Individuals
Official Title	A Study of Viral Burden in Peripheral Blood Versus Lymphoid and Bone Marrow Tissue in HIV-Infected Individuals
Brief Summary	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.
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, relatively little is known regarding the effect of HIV infection on plasma cells that home back to the BM after maturation.
Study Type	Observational
Study Design	Observational Model: Cohort; Time Perspective: Prospective
Target Follow-Up Duration	Not Provided
Biospecimen	Not Provided
Sampling Method	Not Provided
Study Population	Not Provided
Condition	HIV Infection
Intervention	Not Provided
Study Groups/Cohorts	Not Provided
Publications *	Perreau M, Savoye AL, De Crignis E, Corpataux JM, Cubas R, Haddad EK, De Leval L, Graziosi C, Pantaleo G. Follicular helper T cells serve as the major CD4 T cell compartment for HIV-1 infection, replication, and production. J Exp Med. 2013 Jan 14;210(1):143-56. doi: 10.1084/jem.20121932. Epub 2012 Dec 17.; Cubas RA, Mudd JC, Savoye AL, Perreau M, van Grevenynghe J, Metcalf T, Connick E, Meditz A, Freeman GJ, Abesada-Terk G Jr, Jacobson JM, Brooks AD, Crotty S, Estes JD, Pantaleo G, Lederman MM, Haddad EK. Inadequate T follicular cell help impairs B cell immunity during HIV infection. Nat Med. 2013 Apr;19(4):494-9. doi: 10.1038/nm.3109. Epub 2013 Mar 10.; Lindqvist M, van Lunzen J, Soghoian DZ, Kuhl BD, Ranasinghe S, Kranias G, Flanders MD, Cutler S, Yudanin N, Muller MI, Davis I, Farber D, Hartjen P, Haag F, Alter G, Schulze zur Wiesch J, Streeck H. Expansion of HIV-specific T follicular helper cells in chronic HIV infection. J Clin Invest. 2012 Sep;122(9):3271-80. doi: 10.1172/JCI64314. Epub 2012 Aug 27.
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status	Recruiting
Estimated Enrollment; (submitted: September 11, 2014)	400
Original Enrollment; (submitted: June 23, 2005)	300
Study Completion Date	Not Provided
Primary Completion Date	Not Provided
Eligibility Criteria	INCLUSION CRITERIA: HIV infection must be documented by a licensed ELISA and confirmed either by Western blot, or plasma viremia. Aged 18 years or older. Ability to give informed, written consent. The following laboratory values: Absolute neutrophil count of greater than 1000/mm3. PT, PTT within normal limits (unless PTT is elevated in presence of positive lupus anticoagulant in a subject with no prior history of abnormal bleeding). 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 11.2 g/dL, HCT greater than or equal to 34.1%, platelets greater than or equal to 150,000). Blood pressure less than or equal to 180/100; pulse rate 50-100, unless a lower pulse rate is considered normal for the volunteer. HIV negative individuals will qualify as control subjects. Patients must have a clinically palpable lymph node in an easily accessible location. EXCLUSION CRITERIA: Women who are pregnant and/or breast-feeding.; Currently abusing alcohol or other drugs, including narcotics or cocaine.; Patients with AIDS dementia or with an AIDS related malignancy other than minimal Kaposi's sarcoma.; No Aspirin or Non-Steroidal Anti-inflammatory medications (NSIADs) 7 days prior to procedure. Acetaminophen (Tylenol) is permitted at any time.; Any medical condition for which the PI feels LN BX might be contraindicated.; 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.
Sex/Gender	Sexes Eligible for Study: All
Ages	18 Years and older (Adult, Senior)
Accepts Healthy Volunteers	Yes
Contacts	Contact: Catherine A Seamon, R.N. (301) 402-3481 cseamon@cc.nih.gov Contact: Susan Moir, Ph.D. (301) 402-4559 sm221a@nih.gov
Listed Location Countries	United States
Removed Location Countries	Belgium
Administrative Information
NCT Number	NCT00001316
Other Study ID Numbers	920125; 92-I-0125
Has Data Monitoring Committee	Not Provided
U.S. FDA-regulated Product	Not Provided
IPD Sharing Statement	Not Provided
Responsible Party	National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) )
Study Sponsor	National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators	Not Provided
Investigators	Principal Investigator: Susan Moir, Ph.D. National Institute of Allergy and Infectious Diseases (NIAID)
PRS Account	National Institutes of Health Clinical Center (CC)
Verification Date	July 12, 2017