Chintanaphol Michelle, Sacdalan Carlo, Pinyakorn Suteeraporn, Rerknimitr Rungsun, Ridtitid Wiriyaporn, Prueksapanich Piyapan, Sereti Irini, Schuetz Alexandra, Crowell Trevor A, Colby Donn J, Robb Merlin L, Phanuphak Nittaya, Ananworanich Jintanat, Spudich Serena S, Kroon Eugène
Department of Neurology, Yale University, New Haven, CT, USA.
SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
J Virus Erad. 2020 Feb 20;6(1):7-10. doi: 10.1016/S2055-6640(20)30011-X.
The gut-associated lymphoid tissue (GALT) is a major reservoir of HIV-1 established early in acute HIV-1 infection (AHI). Sampling tissue from GALT can provide information about viral reservoirs and immune responses but may be complicated during AHI for reasons such as high viral replication, CD4 T cell depletion and immune activation. Risk of adverse events (AEs) associated with research sigmoid colon biopsies was assessed in participants with AHI in Bangkok, Thailand.
Between 2009 and 2016, 170 biopsies collected from the sigmoid colon were performed during AHI and at follow-up visits (median 24 weeks post AHI diagnosis). Adverse event incidence was evaluated, as well as the associations of procedure timing, repetition and clinical parameters with AE risk. Negative binomial regression models were used to calculate incidence rate ratios and 95% confidence intervals.
Among 103 participants (median age of 27 years, 97.1% male, 96.1% men who have sex with men), 87 sigmoidoscopies were completed during AHI and 83 at a follow-up visit. Approximately 30 biopsies were obtained per procedure for assessment of colonic viral load and HIV-1 reservoir, immunohistochemistry or phenotypic assays. All 11 AEs were grade 1 (6.5%) and included abdominal discomfort ( = 5, 2.9%), mild rectal bleeding ( = 5, 2.9%) and difficulty passing stool ( = 1, 0.6%). Biopsy-related AE risk was not significantly associated with age, HIV-1 RNA, CD4 T cell count, or number and time of biopsy.
Complications of sigmoidoscopy with biopsy in participants with AHI were infrequent and mild. Longitudinal sampling of the sigmoid colon to evaluate the gut-associated HIV-1 reservoir can be safely performed as part of research studies.
肠道相关淋巴组织（GALT）是急性HIV-1感染（AHI）早期建立的HIV-1主要储存库。从GALT采集组织可提供有关病毒储存库和免疫反应的信息，但在AHI期间可能会因病毒高复制、CD4 T细胞耗竭和免疫激活等原因而变得复杂。在泰国曼谷的AHI参与者中评估了与研究性乙状结肠活检相关的不良事件（AE）风险。
2009年至2016年期间，在AHI期间及随访（AHI诊断后中位24周）时进行了170次乙状结肠活检。评估不良事件发生率，以及操作时间、重复次数和临床参数与AE风险的关联。使用负二项回归模型计算发病率比和95%置信区间。
在103名参与者（中位年龄27岁，97.1%为男性，96.1%为男男性行为者）中，87次乙状结肠镜检查在AHI期间完成，83次在随访时完成。每次操作约获取30次活检样本，用于评估结肠病毒载量和HIV-1储存库、免疫组织化学或表型分析。所有11例AE均为1级（6.5%），包括腹部不适（n = 5，2.9%）、轻度直肠出血（n = 5，2.9%）和排便困难（n = 1，0.6%）。活检相关AE风险与年龄、HIV-1 RNA、CD4 T细胞计数或活检次数及时间无显著关联。
AHI参与者中乙状结肠镜检查活检的并发症少见且轻微。作为研究的一部分，可以安全地对乙状结肠进行纵向采样以评估肠道相关的HIV-1储存库。
