5th International AIDS Society Conference on HIV Pathogenesis and Treatment Cape Town - July 19 - 22, 2009

A 14-DAY TREATMENT WITH A CYCLOOXYGENASE 2 (COX-2) INHIBITOR REDUCES INFLAMMATION IN THE LYMPHOID TISSUES OF HIV-INFECTED PATIENTS WITHOUT HAART - A PILOT STUDY WITH POSITRON EMISSION TOMOGRAPHY (PET/CT) ASSESSMENT

IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOAB206

N. Witvrouw¹, G. Darcis², G. Gaudray³, N. Schaaf-Lafontaine⁴, R. Hustinx⁵, K. Schepers⁶, M. Moutschen², C. Meuris^2
1CHU Liege, Nuclear Medicine, Liege, Belgium, ²University of Liege/CHU Liege, AIDS Reference Center, Liege, Belgium, ³University of Liege, GIGA Research, Liege, Belgium, ⁴University of Liege/CHU Liege, Laboratory of Hematology, Liege, Belgium, ⁵University of Liege/CHU Liege, Nuclear Medicine, Liege, Belgium, ⁶Université Libre de Bruxelles (ULB)/Erasme Hospital, AIDS Reference Center, Brussels, Belgium

BACKGROUND: Immune activation plays a major role in the pathogenesis of the complications induced by HIV infection. Previous studies by biopsy or PET/CT have demonstrated persistent inflammation in the lymphoid organs of HIV infected patients, with potentially irreversible consequences on the properties of these microenvironments. Macrophages infected with HIV upregulate COX-2 and the release of PGE2 participates in the neurological complications of HIV infection.

OBJECTIVE: To determine if blocking PGE2 secretion by a COX-2 inhibitor can reduce FDG uptake in the lymphoid tissues and improve immunologic parameters of HIV infected patients without HAART.

METHODOLOGY: 7 patients infected with HIV-1 (6 with chronic infection and 1 with primary HIV infection) without HAART were included in the trial. FDG PET/CT studies were performed following standard oncological procedures on day 0 and 14 (posttreatment with Celecoxib 200 mg bid). Any increased nodal uptake in the cervical, axillary, mediastinal, mesenteric, iliac and inguinal regions was recorded. The Standardized Uptake Value (SUV_max) was measured in the ROIs and the lesion to liver activity ratios were calculated. Both the sum of the SUVmax and SUV ratios were calculated to obtain a global metabolic score.

RESULTS: at baseline, all patients showed increased FDG uptake in various nodal stations. After treatment with celecoxib, six patients with chronic infection showed a statistically significant decrease in global metabolic score ranging from 9 to 28%. No decrease was observed in the subject with PHI. Viral load remained stable but there was a strong increase of CD4/CD8 ratio in all patients (0.31±0.70 vs. 0.51 ± 0.11, p=0.04). There was a selective decrease of CD8+ CD38+ T cells which failed to reach statistical significance.

CONCLUSIONS: PGE2 secretion plays a role in the increased metabolic activity of lymphoid tissues in HIV-infected patients without HAART and might also take part in their immunologic abnormalities.

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2009-07-22
MOAB206
Oral Abstract Session: MOAB2 - Cardiovascular Disease: to HAART or not to HAART

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