In response to RFA-DA-12-009, our multidisciplinary team proposes to study the correlates, consequences, and mechanisms of increased immune activation associated with injection drug use (IDU). Key to this proposal are preliminary data that we generated during a pilot study conducted between June 2009 and September 2011. We discovered increased levels of immune activation systemically and in gut- associated lymphoid tissue (GALT) in HIV-1 uninfected IDUs. Our findings in tissue are novel and though immune activation in IDUs has been reported, an understanding of correlates and mechanism has not been addressed. Our broad term goals are to use a multifaceted approach including systems biology to explore the following questions; 1) What are the mechanisms of increased immune activation in blood and tissue associated with active IDU? 2) Can we separate the effects of 3 possible contributors to increased levels of immune activation- non-sterile injection, direct effects of opiates and chronic infection with Hepatitis C? 3) Is the heightened immune activation associated with active IDU reversible when injection ceases, and if so, what are the dynamics of the reversibility? 4) How does active injection impact immune reconstitution in HIV-1 infected IDUs on combination antiretroviral therapy (cART) and can we characterize differences qualitatively and quantitatively? To answer these complex questions we have devised a strategy to recruit a cohort of HIV- 1-uninfected and -infected active IDUs along with very carefully matched appropriate controls from whom we will collect blood, tissue, and behavioral data both cross-sectionally and longitudinally. HIV-1-infected active injectors will be treated with cART and monitored closely for virologic and immunologic responses and compared to appropriate non-injecting controls. We will measure levels of cellular activation and proliferation using markers such as CD38 and HLA-DR and Ki67 respectively on subsets of cells from blood and tissue. Levels of soluble markers of immune activation will also be measured in patient plasma. Behavioral data including drug use behaviors will be examined as correlates of immune activation and reconstitution. In response to the RFA and reflecting the most innovative aspect of this project, we will use a systems biology approach to address the issues above. We will sort specific cell populations from peripheral blood and tissue for transcriptional profiling of mRNA with the use of microarrays. In addition we will also collect cells from in vitro experiments for transcriptional profiling to study the effects of the addition and withdrawal of select opiates on specific T cell subsets. With the assistance of the Data Analysis Core established by The Rockefeller University Center for Clinical and Translational Science, we will analyze the transcriptional profiling data to identify gene signatures and pathways for correlation with markers of immune activation, immune reconstitution, and injecting behaviors. By studying the intersection of IDU and infection with HIV-1 and HCV, we aim to improve treatment outcomes in affected populations and individuals.

Public Health Relevance

In response to RFA-DA-12-009, 'Systems Biology Approaches in HIV/AIDS and Substance Use' our multidisciplinary team will use a multifaceted approach incorporating transcriptional profiling and analyses to better understand the intersection of non-sterile injection drug injection, direct effect of opiates, and infection with CV on immune activation in blood and tissue. We will explore the consequences of increased immune activation on immune reconstitution in blood and tissue during combination antiretroviral therapy using a novel systems biology approach. The intersection of IDU, HIV-1, and HCV remains an important public health issue that requires intense investigation to identify novel therapeutic targets; the results of this project have the potential and to affect the clinica management of HIV-related disease and to improve outcomes in affected individuals.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZAA1-DD (40))
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Pollock, Jonathan D
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Aaron Diamond AIDS Research Center
New York
United States
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Deren, Sherry; Cleland, Charles M; Lee, Haekyung et al. (2017) Brief Report: The Relationship Between Injection Drug Use Risk Behaviors and Markers of Immune Activation. J Acquir Immune Defic Syndr 75:e8-e12
Ruane, D; Do, Y; Brane, L et al. (2016) A dendritic cell targeted vaccine induces long-term HIV-specific immunity within the gastrointestinal tract. Mucosal Immunol 9:1340-52
Markowitz, Martin; Deren, Sherry; Cleland, Charles et al. (2016) Chronic Hepatitis C Virus Infection and the Proinflammatory Effects of Injection Drug Use. J Infect Dis 214:1376-1382
Uzzan, Mathieu; Ko, Huaibin M; Mehandru, Saurabh et al. (2016) Gastrointestinal Disorders Associated with Common Variable Immune Deficiency (CVID) and Chronic Granulomatous Disease (CGD). Curr Gastroenterol Rep 18:17
Batista, Pedro; Deren, Sherry; Banfield, Angela et al. (2016) Challenges in Recruiting People Who Use Drugs for HIV-Related Biomedical Research: Perspectives from the Field. AIDS Patient Care STDS 30:379-84
Mehandru, Saurabh; Deren, Sherry; Kang, Sung-Yeon et al. (2015) Behavioural, Mucosal and Systemic Immune Parameters in HIV-infected and Uninfected Injection Drug Users. J Addict Res Ther 6:1-8