HIV INFECTION IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL TREATMENT AND SOME OF ITS ASSOCIATED COMPLICATIONS Edited by Elaheh Aghdassi HIV Infection in the Era of Highly Active Antiretroviral Treatment and Some of Its Associated Complications Edited by Elaheh Aghdassi Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work Any republication, referencing or personal use of the work must explicitly identify the original source Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher No responsibility is accepted for the accuracy of information contained in the published articles The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book Publishing Process Manager Silvia Vlase Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright oriontrail, 2011 Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org HIV Infection in the Era of Highly Active Antiretroviral Treatment and Some of Its Associated Complications, Edited by Elaheh Aghdassi p cm ISBN 978-953-307-701-7 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter Metabolic Alterations of HIV Infection E.F Silva Chapter Endothelial Dysfunction in HIV 17 Vani Subbarao, David Lowe, Reza Aghamohammadzadeh and Robert J Wilkinson Chapter HIV-Infection: The Role of Insulin Resistance and Alternative Treatments Elaheh Aghdassi 37 Chapter Bone Metabolism and HIV Infection Stefano Coaccioli Chapter Pulmonary Manifestations of HIV Disease 67 Muhwa J Chakaya Chapter HIV Associated Neuropathies Katrin Hahn and Ingo Husstedt Chapter Spondylodiscitis and HIV – Diagnosis and Treatment Strategies 121 Jan Siewe, Kourosh Zarghooni and Rolf Sobottke Chapter Acute Abdomen and HIV Infection 141 Christophoros Kosmidis, Georgios Anthimidis and Kalliopi Vasiliadou Chapter Nosocomial Infections in Patients with Human Immunodeficiency Virus (HIV) Olga Perovic and Ashika Singh Chapter 10 57 107 151 Oral Manifestations of Paediatric HIV Infection 165 Omolola Orenuga, Mutiat Obileye, Christiana Sowole and Gbemisola Agbelusi VI Contents Chapter 11 Natural Killer Cells from HIV Infected Slow Progressors Who Carry the Protective HLA-B*27 Allele and Inhibitory KIR3DL1 Receptors Have Elevated Poly-Functional Potential Compared to Bw6 Homozygotes 193 Nicole F Bernard, Carlos Melendez-Pena, Philomena Kamya, Christos M Tsoukas, Mohamed-Rachid Boulassel, Jean-Pierre Routy, Réjean Thomas, Pierre Côté, Colin Kovacs, Stephen A Migueles, Mark Connors, Martin Potter, Marianne Harris and Cecile L Tremblay Preface Human Immunodeficiency Virus (HIV) infection was once considered a deadly disease The HIV virus has been associated with immune system suppression and a number of associated morbidities However, advancement in HIV care and treatment has been revolutionary in the history of medicine Today, HIV infection is no longer thought of as a death sentence, but a manageable condition The impact of antiretroviral therapy on the natural history of HIV infection is indisputable, resulting in dramatic reductions in morbidity and mortality and improvements in the quality of life However, the requirement for a life-long therapy with antiretroviral drugs has been associated with long-term metabolic toxicities and iatrogenic dysmorphias, termed lipodystrophy, that have increased the complexity of managing people living with HIV Of more recent significant concern is the finding that the metabolic consequences of lipodystrophy and antiretroviral treatment are strong mediators for the development of cardiovascular disease, diabetes, other metabolic abnormalities and osteoporosis and will have important implications for the future health and survival of the people living with HIV infection Therefore, new interventions are needed for education, disease modification, risk reduction and coping with these important co-morbidities in the setting of HIV This purpose of this book was to bring a group of experts together to review some of the metabolic complications associated with HIV infection and antiretroviral treatments Dr Elaheh Aghdassi The University Health Network, Toronto Canada 198 HIV Infection in the Era of Highly Active Antiretroviral Treatment and Some of Its Associated Complications incubator All stimulation data shown is from cells that generated a positive result in the PMA and ionomycin stimulation condition Cells were stained for viability using the Aqua LIVE/DEAD® fixable dead cell stain kit (Invitrogen, Burlington, Ontario, Canada) following manufacturer’s instructions Cells were then stained for cell surface markers with anti-CD56-APC, anti-CD16-Pacific Blue (BD Biosciences), anti-CD3-ECD and CD158e-PE (ie: Z27-PE, Beckman Coulter, Mississauga, Ontario, Canada) for 30 After washing with phosphate buffered saline (PBS) containing 1% FBS (Wisent), cells were fixed and permeabilized using the Fix and Perm Kit (Invitrogen) and stained for intracellular cytokines using anti-IFN--Alexa 700 and antiTNF--PE-Cy7 (BD Biosciences) Cells were washed and fixed with 1% paraformaldehyde solution (Fisher Scientific, Ottawa Ontario, Canada) and kept in the dark at 4oC until acquisition 2.5 Flow cytometry analysis Between 400,000 and 500,000 events were acquired per sample using an LSRII flow cytometer (BD Biosciences) Analysis for NK cell activation was performed using FlowJo software version 9.1 (Tree Star, San Carlos, CA) The functional profiles of stimulated NK cells were determined using a gating strategy where NK cells were defined as CD3-CD56+/CD16+/- Boolean gating was used to identify seven NK cell functional profiles, i.e trifunctional NK cells (CD107a+ IFN-+ TNF-+), bi-functional NK cells (any combination of two of these functions) and mono-functional NK cells (any single one of these functions) All results for the frequency of individual functional subsets were background corrected by subtracting the frequency of positive NK cells in the unstimulated subset Corrected results were used to generate the percent contribution of each functional subset to the total NK cells response to K562 Results reported as subset frequency or percent contribution of a subset to the total K562 response showed a high level of correlation with each other (Boulet et al 2010) 2.6 Statistical analysis GraphPad Instat 3.05 and GraphPad Prism 5.04 were used for statistical analyses and graphical presentations A Kruskal-Wallis test was used to assess the significance of between group differences in age, duration of infection at the time point tested, CD4 counts, CD8 counts and VL Mann-Whitney U tests were used to test the significance of between group differences in the percent contribution of an NK cell functional subset to the total NK cell response A Spearman correlation test was used to test the significance of the trend towards declining tri-functional potential with 3DL1/HLA-B genotype combinations A p value of