Latent reservoir characterization and correlations with neurocognitive functionin

潜在储层特征及其与神经认知功能的相关性

• 批准号: 9301032
• 负责人: Mark Fredric Cotton
• 金额: $ 57.57万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-09 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9301032
• 关键词: 11 year old; 12 year old; 5 year old; 7 year old; Address; Age; Age-Months; Alpha Cell; Anti-Retroviral Agents; Biological Assay; Centers for Disease Control and Prevention (U.S.); Child; Development; Disease; Early treatment; Enrollment; Goals; Guidelines; HIV; HIV Infections; HIV Long Terminal Repeat; Immune; Immunologics; Infant; International; Intervention Studies; Kinetics; Life; Liquid substance; Measurement; Modality; Neurocognitive; Neurologic; Neurologic Effect; Nitrogen; Outcome; Output; Patients; Peripheral Blood Mononuclear Cell; Plasma; Population; Prospective Studies; RNA; Randomized; Recruitment Activity; Research; Sampling; Shapes; Site; South Africa; South African; Specimen; T-Lymphocyte; Thymus Gland; Time; Work; antiretroviral therapy; arm; cohort; infancy; neuroimaging; pediatric human immunodeficiency virus; prospective; public health relevance; purge; reconstitution; therapy development; therapy duration; virology

DESCRIPTION (provided by applicant): Latent reservoir characterization and correlations with neurocognitive functioning and thymic output over 12 years in HIV-infected children given early antiretroviral treatment in South Africa Children who participated in the Children with HIV Early Antiretroviral (CHER) Trial in Cape Town are the main population in this application. The CHER trial took place in Cape Town (1/3) and Soweto (2/3) between June 2005 and September 2011. In this study, 377 infants below 12 weeks of age were randomized at a median of 7 weeks of age to deferred antiretroviral therapy (ART) according to 2006 guidelines (ART-Def), or immediate primary ART until either Week 40 (ART-40W) or Week 96 (ART-96W). Thereafter, ART was discontinued until criteria (CD4 <20% or CDC Stage C or severe Stage B) for re-initiating ART developed. Throughout the CHER study, peripheral blood mononuclear cells (PBMCs) were collected every 3 months and stored in liquid Nitrogen. In ART-Def, median age of starting ART was 6 months. In Cape Town, 24 of 80 children randomized to early ART did not interrupt because of already having CDC C or severe Stage B disease, thus were on continuous ART from 7 weeks of age. Children from Cape Town participated in a neurodevelopmental sub-study and are now enrolled in an ongoing study describing neurocognitive functioning and neuroradiological findings for the next 3 years. Using stored samples from the CHER trial from both study sites, studies of thymic outflow (TREC etc) and also HIV reservoir are in progress using stored PBMCs. For the reservoir studies, a PCR for HIV Long Terminal Repeats (LTR) (circular and linear) is being used. This study will address total reservoir size at study exit (Wek 240) in all children with plasma HIV RNA below 400 copies/mm3 and also reservoir size in 20 children from each study arm; in ART-Def at weeks 96, 150 and 200; in ART-40W at week 40, at restarting ART and week 200 and in ART-96W at week, 96, at restarting ART and at Week 200. Through this application, we plan more detailed studies of early stored PBMC specimens from Cape Town CHER patients. As the median age of children is now 7 years of age, we plan prospective studies to further characterize the reservoir, being able to safely collect larger bloo volumes for infectivity assays and to characterize how the reservoir will decay over time. We will correlate reservoir size with neurocognitive/ neuroimaging outcome and thymic outflow in our cohort. A new cohort of HIV-infected infants initiated on ART within the first week of life will alo be studied. We aim to recruit 12 subjects per year, and will compare reservoir size in these infants with results from the CHER subjects, who were started at a median of 7 weeks of age. As the cure agenda expands and new modalities to purge the HIV reservoir become feasible, our cohort will be well placed for interventional studies.

描述（由申请方提供）：在南非接受早期抗逆转录病毒治疗的HIV感染儿童中，12年内潜在储库特征及其与神经认知功能和胸腺输出的相关性参加开普敦HIV感染儿童早期抗逆转录病毒（CHER）试验的儿童是本申请的主要人群。CHER试验于2005年6月至2011年9月在开普敦（1/3）和索韦托（2/3）进行。在这项研究中，377名12周龄以下的婴儿被随机分配至根据2006年指南（ART-Def）延迟抗逆转录病毒治疗（ART）的中位数为7周龄，或立即接受主要ART，直至第40周（ART-40 W）或第96周（ART-96 W）。此后，停止ART治疗，直至出现重新开始ART治疗的标准（CD 4 <20%或CDC C期或重度B期）。在整个CHER研究中，每3个月收集外周血单核细胞（PBMC）并储存在液氮中。在ART-Def中，开始ART的中位年龄为6个月。在开普敦，80名随机接受早期抗逆转录病毒治疗的儿童中有24名儿童没有因为已经患有CDC C或严重的B期疾病而中断治疗，因此从7周龄开始连续接受抗逆转录病毒治疗。来自开普敦的儿童参加了一项神经发育子研究，目前正在参加一项正在进行的研究，该研究描述了未来3年的神经认知功能和神经放射学结果。使用来自两个研究中心的CHER试验的储存样本，正在使用储存的PBMC进行胸腺流出（TREC等）和HIV储库研究。对于储库研究，正在使用HIV长末端重复序列（LTR）（环状和线性）的PCR。本研究将在所有血浆HIV RNA低于400拷贝/mm 3的儿童中确定研究退出时（第240周）的总储药器大小，以及每个研究组20名儿童的储药器大小;在第96、150和200周的ART-Def中;在ART-40 W中，第40周、重新启动ART时和第200周，以及在ART-96 W中，第96周、重新启动ART时和第200周。通过这一应用，我们计划对来自开普敦CHER患者的早期储存PBMC标本进行更详细的研究。由于儿童的中位年龄现在是7岁，我们计划进行前瞻性研究，以进一步表征水库，能够安全地收集更大的血液体积用于感染性测定，并表征水库如何随时间衰减。我们将在我们的队列中将储库大小与神经认知/神经影像学结局和胸腺流出量相关联。一个新的队列艾滋病毒感染的婴儿开始在第一周内的生活ART也将进行研究。我们的目标是每年招募12名受试者，并将这些婴儿的储库大小与CHER受试者的结果进行比较，CHER受试者的中位年龄为7周。随着治疗议程的扩大和新的模式，以清除艾滋病毒水库变得可行，我们的队列将很好地为干预性研究。