Cross-sectional study to identify host plasma biomarkers and Somalogic disease prognosis scores associated with cellular HIV-1 RNA expression in ART suppressed persons

About This Grant

PROJECT SUMMARY Antiretroviral therapy (ART) results in suppression of Human Immunodeficiency Virus (HIV) replication, increase in CD4+ T cell count, and partial restoration of immune responses. Yet despite suppressive ART, both transcriptionally silent and transcriptionally active [i.e. cell-associated RNA (CA-RNA)] HIV viruses remain in various CD4+ T cell subsets in persons living with HIV (PLWH) and are proposed to contribute to residual immune activation, lower immune reconstitution and development of comorbidities. Much attention has been given in our field to the clinical significance of continued HIV expression after ART, but we still lack plasma host biomarkers that could illustrate the impact of CA-RNA or could link CA-RNA to future risk for comorbidities. Part of the limitation to address this gap has been that studies attempting to find a correlation between HIV reservoir levels and plasma markers of immune activation have included only a limited number host cellular or plasma variables, have not started with a pre-defined cohort with known reservoir levels, have not linked variables to predefined prognostic biomarkers, and/or have yielded inconsistent results (see background). This R21 now addresses these limitations by studying a cohort with known HIV reservoir levels and by introducing recent advances in Somalogic-based technology inclusive of (a) measuring a large set (at least 7000) of plasma proteins and (b) determining links of predefined host biomarker "signatures" to risk scores for comorbidity outcomes as shown by our preliminary data and other studies. This R21 proposal is possible as a result of the collection through the BEAT-HIV Martin Collaboratory program of plasma and peripheral blood mononuclear cells (PBMC) from 94 ART suppressed PLWH with known distribution of HIV proviral DNA measured by the Intact Provirus Assay (IPDA) which in turn is associated with CA-RNA. Specifically, we hypothesize that in PLWH on suppressive ART the levels of cell-associated HIV RNA will be associated with a) plasma host proteomic biomarkers, and b) pre-defined clinical comorbidity risk scores for cardiovascular, liver/kidney, and metabolic disease following age adjustment. We will test this hypothesis by the following specific aims: (1) identify host plasma biomarkers among 7000 protein measures that will best predict PLWH on ART with higher CA-RNA independently of age, and (2) determine if plasma clinical prognostic scores for comorbidity risks of cardiovascular, liver/kidney, and metabolic disease are higher in PLWH on ART with high CA-RNA when adjusted for age. Completion of this R21 proposal will provide foundational data to further evaluate the usage of biomarker changes in future RO1s describing strategies targeting transcriptionally active reservoirs on ART. The long-term impact of this proposal is its potential to advance cure-directed strategies targeting HIV expressing cells (i.e., immune-based, gag- pol/CARD8 activating, etc.) and to make possible early determinations in biomarker changes of significance to prognosis risk profiles upon a reduction of persistent HIV reservoirs.