Frederick M Hecht

University of California, San Francisco, San Francisco, California, United States

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Publications (188)1218.74 Total impact

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    ABSTRACT: There are currently no commonly used or easily accessible 'biomarkers' of hedonic eating. Physiologic responses to acute opioidergic blockade, indexed by cortisol changes and nausea, may represent indirect functional measures of opioid-mediated hedonic eating drive and predict weight loss following a mindfulness-based intervention for stress eating. In the current study, we tested whether cortisol and nausea responses induced by oral ingestion of an opioidergic antagonist (naltrexone) correlated with weight and self-report measures of hedonic eating and predicted changes in these measures following a mindfulness-based weight loss intervention. Obese women (N=88; age=46.7±13.2 years; BMI=35.8±3.8) elected to complete an optional sub-study prior to a 5.5-month weight loss intervention with or without mindfulness training. On two separate days, participants ingested naltrexone and placebo pills, collected saliva samples, and reported nausea levels. Supporting previous findings, naltrexone-induced cortisol increases were associated with greater hedonic eating (greater food addiction symptoms and reward-driven eating) and less mindful eating. Among participants with larger cortisol increases (+1 SD above mean), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b=-0.95, SE(b)=0.40, 95% CI [-1.74, -0.15], p=.021. Naltrexone-induced nausea was marginally associated with reward-based eating. Among participants who endorsed naltrexone-induced nausea (n=38), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b=-1.00, 95% CI [-1.85, -0.77], p=.024, and trended toward reduced reward-based eating, binge eating, and weight, post-intervention. Single assessments of naltrexone-induced cortisol increases and nausea responses may be useful time- and cost-effective biological markers to identify obese individuals with greater opioid-mediated hedonic eating drive who may benefit from weight loss interventions with adjuvant mindfulness training that targets hedonic eating. Copyright © 2015. Published by Elsevier Ltd.
    Appetite 04/2015; DOI:10.1016/j.appet.2015.04.062 · 2.52 Impact Factor
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    ABSTRACT: Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low, medium and high-risk groups for chronic pain. Prospective cohort study in primary care. Patients with acute low back pain (LBP; ≤30 days duration) OUTCOME MEASURES: Self-reported perceived non-recovery and chronic pain. Patients were surveyed at baseline, 6 months and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical and psychosocial variables for chronic pain outcomes, developed a CDR and assessed its performance by calculating the bootstrapped areas under the receiver operating characteristic curve (AUC) and likelihood ratios. This study was supported by NIH/NCCAM grants K23 AT002298, R21 AT004467, NIH/NCCAM K24 AT007827, the Research Evaluation and Allocation Committee (REAC) of the University of California San Francisco, and the Mount Zion Health Fund, San Francisco. The funding agencies played no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors report no conflict of interests. 605 patients enrolled. 13% had chronic pain at 6 months, 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70-0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was associated with an odds ratio of 11.1 (10.8-11.4) for developing chronic pain. Using a <5% probability of chronic pain as the cutoff for low risk and a >40% probability for high risk, likelihood ratios were 0.26 (0.14-0.48) and 4.4 (3.0-6.3) for these groups, respectively. A CDR was developed that may help primary care clinicians classify patients with strictly defined acute LBP into low, moderate and high-risk groups for developing chronic pain and performed acceptably in 1,000 bootstrapped replications. Validation in a separate sample is needed. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 03/2015; DOI:10.1016/j.spinee.2015.03.003 · 2.80 Impact Factor
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    ABSTRACT: BACKGROUND: The stability of the HIV-1 reservoir and the contribution of cellular proliferation to the maintenance of the reservoir during treatment are uncertain. Therefore, we conducted a longitudinal analysis of HIV-1 in T-cell subsets in different tissue compartments from subjects on effective antiretroviral therapy (ART). METHODS: Using single-proviral sequencing, we isolated intracellular HIV-1 genomes derived from defined subsets of CD4+ T-cells from peripheral blood, gut-associated lymphoid tissue and lymph node tissue, from eight virally suppressed subjects on long-term ART at two time points, separated by 7-9 months. RESULTS: DNA integrant frequencies were stable over time (<4-fold difference) and were highest in memory T-cells. Phylogenetic analyses showed that subjects treated during chronic infection contained viral populations with up to 73% identical sequence expansions, only three of which were observed in pre-therapy specimens. At both times points, such clonally expanded populations were found predominantly in effector memory T-cells from peripheral blood and lymph node tissue. CONCLUSIONS: Memory T-cells maintained a relatively constant HIV-1 DNA integrant pool that was genetically stable during long-term effective ART. These integrants appear to be maintained by cellular proliferation and longevity of infected cells rather than by ongoing viral replication.
    The Journal of Infectious Diseases 02/2015; DOI:10.1093/infdis/jiv092 · 5.78 Impact Factor
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    ABSTRACT: OBJECTIVE: To investigate the changes in running biomechanics after training in Form-Focused running using ChiRunning vs. Not-Form focused training and Self-Directed training in untrained individuals.Design: Pilot study - Randomized controlled trial. Setting: Research Institution with Tertiary Care Medical Center. Participants: Seventeen subjects (9 males, 8 females) with pre-hypertension. METHODS: Twenty-two participants were randomized to three study arms but 17 completed the study. The study arms were: 1) group-based Form-Focused running using ChiRunning (enrolled, n =10; completed, n=7); 2) group-based conventional running (enrolled, n =6; completed, n=4); 3) self-directed training with educational materials (enrolled, n =6; completed, n=6). The training schedule was prescribed for 8 weeks with 4 weeks of follow-up. All subjects completed overground running motion analyses before and after training. OUTCOMES: Ankle, knee, hip joint peak moments and powers; Average vertical loading rate (AVLR), impact peak, cadence, stride length, strike index, and stride reach. Paired T-tests were used to compare differences with-in groups over-time. RESULTS: Form-Focused group reduced their Stride Reach (P = .047) after the training but not the other groups. Form-Focused group showed a close to significant reduction in knee adduction moment (P = .051) and a reduction in the peak ankle eversion moment (P = .027). Self-Directed group showed an increase in the running speed, (P =.056) and increases in ankle and knee joint powers and moments. CONCLUSIONS: There are differences in the changes in running biomechanics between individuals trained in running form that emphazies mid-foot strike, higher cadence, and shorter stride compared to those not trained in the thise technique. These differences may be associated with reduced lower extremity stress in individuals trained in this running form but future studies are needed to confirm these findings in larger samples.
    PM&R 01/2015; DOI:10.1016/j.pmrj.2015.01.010 · 1.66 Impact Factor
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    ABSTRACT: The eradication of HIV necessitates elimination of the HIV latent reservoir. Identifying host determinants governing latency and reservoir size in the setting of antiretroviral therapy (ART) is an important step in developing strategies to cure HIV infection. We sought to determine the impact of cell-intrinsic immunity on the HIV latent reservoir. We investigated the relevance of a comprehensive panel of established anti-HIV-1 host restriction factors to multiple established virologic and immunologic measures of viral persistence in HIV-1-infected, ART-suppressed individuals. We measured the mRNA expression of 42 anti-HIV-1 host restriction factors, levels of cell-associated HIV-1 RNA, levels of total pol and 2-long terminal repeat (2-LTR) circle HIV-1 DNA and immunophenotypes of CD4 T cells in 72 HIV-1-infected individuals on suppressive ART (23 individuals initiated ART less than 1 year postinfection, and 49 individuals initiated ART greater than 1 year post-infection). Correlations were analysed using nonparametric tests. The enhanced expression of a few select host restriction factors, p21, schlafen 11 and PAF1, was strongly associated with reduced CD4 T-cell associated HIV RNA during ART (P < 0.001). In addition, our data suggested that ART perturbs the regulatory relationship between CD4 T-cell activation and restriction factor expression. Lastly, cell-intrinsic immune responses were significantly enhanced in individuals who initiated ART during early versus chronic infection and may contribute to the reduced reservoir size observed in these individuals. Intrinsic immune responses modulate HIV persistence during suppressive ART and may be manipulated to enhance the efficacy of ART and promote viral eradication through reversal of latency in vivo.
    AIDS (London, England) 01/2015; DOI:10.1097/QAD.0000000000000572 · 6.56 Impact Factor
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    ABSTRACT: We estimate the relative transmission rate in early versus later infection amongst men who have sex with men (MSM) in San Francisco, USA, by studying the characteristics of a sample of transmitters, recruited through newly infected MSM between 1996 and 2009. Of 36 transmitters identified, 9 were recently infected based on testing history and serologic testing. The odds ratio of transmitting during early infection was 15.2 (95% CI 6.3-33.4, p<0.001) unadjusted and 8.9 (95% CI 4.1-19.4) when adjusting for self-reported antiretroviral treatment. This high transmissibility could be due to both high infectiousness and high rates of partner change or concurrency. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
    The Journal of Infectious Diseases 12/2014; DOI:10.1093/infdis/jiu831 · 5.78 Impact Factor
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    ABSTRACT: Poor sleep quality and short sleep duration are associated with increased incidence and progression of a number of chronic health conditions observed at greater frequency among the obese and those experiencing high levels of stress. Accelerated cellular aging, as indexed by telomere attrition in immune cells, is a plausible pathway linking sleep and disease risk. Prior studies linking sleep and telomere length are mixed. One factor may be reliance on leukocytes, which are composed of varied immune cell types, as the sole measure of telomere length. To better clarify these associations, we investigated the relationships of global sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), and diary-reported sleep duration with telomere length in different immune cell subsets, including granulocytes, peripheral blood mononuclear cells (PBMCs), CD8+ and CD4+ T lymphocytes, and B lymphocytes in a sample of 87 obese men and women (BMI mean = 35.4, SD = 3.6; 81.6% women; 62.8% Caucasian). Multiple linear regression analyses were performed adjusting for age, gender, race, education, BMI, sleep apnea risk, and perceived stress. Poorer PSQI global sleep quality was associated with statistically significantly shorter telomere length in lymphocytes but not granulocytes and in particular CD8+ T cells (b = -56.8 base pairs per one point increase in PSQI, SE = 20.4, p=0.007) and CD4+ T cells (b = -37.2, SE = 15.9, p = 0.022). Among separate aspects ofglobal sleep quality, low perceived sleep quality and decrements in daytime function were most related to shorter telomeres.In addition, perceived stress moderated the sleep-CD8+ telomere association. Poorer global sleep quality predicted shorter telomere length in CD8+ T cells among those with high perceived stress but not in low stress participants. These findings provide preliminary evidence that poorer global sleep quality is related to telomere length in several immune cell types, which may serve as a pathway linking sleep and disease risk in obese individuals. Copyright © 2014. Published by Elsevier Inc.
    Brain Behavior and Immunity 12/2014; DOI:10.1016/j.bbi.2014.12.011 · 6.13 Impact Factor
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    ABSTRACT: Background The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP.Methods In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios.ResultsThe proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1.ConclusionsA risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs.
    European journal of pain (London, England) 12/2014; 19(3). DOI:10.1002/ejp.615 · 3.22 Impact Factor
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    ABSTRACT: The association between the host immune environment and the size of the HIV reservoir during effective antiretroviral therapy is not clear. Progress has also been limited by the lack of a well-accepted assay for quantifying HIV during therapy. We examined the association between multiple measurements of HIV and T cell activation (as defined by markers including CD38, HLA-DR, CCR5 and PD-1) in 30 antiretroviral-treated HIV-infected adults. We found a consistent association between the frequency of CD4+ and CD8+ T cells expressing HLA-DR and the frequency of resting CD4+ T cells containing HIV DNA. This study highlights the need to further examine this relationship and to better characterize the biology of markers commonly used in HIV studies. These results may also have implications for reactivation strategies.
    PLoS ONE 10/2014; 9(10):e110731. DOI:10.1371/journal.pone.0110731 · 3.53 Impact Factor
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    ABSTRACT: HLA-B*5701 is the host factor most strongly associated with slow HIV-1 disease progression, although risk of progression may vary among patients carrying this allele. The interplay between HIV-1 evolutionary rate variation and risk of progression to AIDS in HLA-B*5701 subjects was studied using longitudinal viral sequences from high-risk progressors (HRPs) and low-risk progressors (LRPs). Posterior distributions of HIV-1 genealogies assuming a Bayesian relaxed molecular clock were used to estimate the absolute rates of nonsynonymous and synonymous substitutions for different set of branches. Rates of viral evolution, as well as in vitro viral replication capacity assessed using a novel phenotypic assay, were correlated with various clinical parameters. HIV-1 synonymous substitution rates were significantly lower in LRPs than HRPs, especially for sets of internal branches. The viral population infecting LRPs was also characterized by a slower increase in synonymous divergence over time. This pattern did not correlate to differences in viral fitness, as measured by in vitro replication capacity, nor could be explained by differences among subjects in T cell activation or selection pressure. Interestingly, a significant inverse correlation was found between baseline CD4+ T cell counts and mean HIV-1 synonymous rate (which is proportional to the viral replication rate) along branches representing viral lineages successfully propagating through time up to the last sampled time point. The observed lower replication rate in HLA-B*5701 subjects with higher baseline CD4+ T cell counts provides a potential model to explain differences in risk of disease progression among individuals carrying this allele.
    PLoS Computational Biology 09/2014; 10(9):e1003830. DOI:10.1371/journal.pcbi.1003830 · 4.83 Impact Factor
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    ABSTRACT: Events during primary HIV-1 infection have been shown to be critical for the subsequent rate of disease progression. Early control of viral replication, resolution of clinical symptoms and development of a viral setpoint have been associated with the emergence of HIV-specific CD8 T cell responses. Here we assessed which particular HIV-specific CD8 T cell responses contribute to long-term control of HIV-1.
    Journal of Virology 08/2014; 88(21). DOI:10.1128/JVI.02016-14 · 4.65 Impact Factor
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    ABSTRACT: Objective: Cross-sectional HIV incidence surveillance, using assays that distinguish ‘recent’ from ‘nonrecent’ infections, has been hampered by inadequate performance and characterization of incidence assays. In this study, the Consortium for the Evaluation and Performance of HIV Incidence Assays presents results of the first independent evaluation of five incidence assays (BED, Limiting Antigen Avidity, Less-sensitive Vitros, Vitros Avidity and BioRad Avidity). Design: A large repository of diverse specimens from HIV-positive patients was established, multiple assays were run on 2500 selected specimens, and data were analyzed to estimate assay characteristics relevant for incidence surveillance. Methods: The mean duration of recent infection (MDRI, average time ‘recent’ while infected for less than some time cut-off T) was estimated from longitudinal data on seroconverters by regression. The false-recent rate (FRR, probability of testing ‘recent’ when infected for longer than T) was explored by measuring the proportions of ‘recent’ results in various subsets of patients. Results: Assays continue to fail to attain the simultaneously large MDRI and small FRR demanded by existing performance guidelines. All assays produce high FRRs amongst virally suppressed patients (>40%), including elite controllers and treated patients. Conclusions: Results from this first independent evaluation provide valuable information about the current performance of assays, and suggest the need for further optimization. Variation of ‘recent’/‘nonrecent’ thresholds and the use of multiple antibody-maturation assays, as well as other biomarkers, can now be explored, using the rich data generated by the Consortium for the Evaluation and Performance of HIV Incidence Assays. Consistently high FRRs amongst those virally suppressed suggest that viral load will be a particularly valuable supplementary marker. Video abstract:
    AIDS (London, England) 08/2014; 28(16). DOI:10.1097/QAD.0000000000000429 · 6.56 Impact Factor
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    ABSTRACT: A rare subset of HIV-infected individuals, designated viremic non-progressors (VNP), remain asymptomatic and maintain normal levels of CD4+ T-cells despite persistently high viremia. To identify mechanisms potentially responsible for the VNP phenotype, we compared VNPs (average >9 years of HIV infection) to HIV-infected individuals who have similar CD4+ T-cell counts and viral load, but who are likely to progress if left untreated ("putative progressors", PP), thus avoiding the confounding effect of differences related to substantial CD4+ T cell depletion. We found that VNPs, compared to PPs, had preserved levels of CD4+ stem cell memory cells (TSCM (p<0.0001), which was associated with decreased HIV infection of these cells in VNPs (r = -0.649, p = 0.019). In addition, VNPs had decreased HIV infection in CD4+ central memory (TCM) cells (p = 0.035), and the total number of TCM cells was associated with increased proliferation of memory CD4+ T cells (r = 0.733, p = 0.01). Our results suggest that, in HIV-infected VNPs, decreased infection of CD4+ TCM and TSCM, cells are involved in preservation of CD4+ T cell homeostasis and lack of disease progression despite high viremia.
    PLoS Pathogens 08/2014; 10(8):e1004345. DOI:10.1371/journal.ppat.1004345 · 8.14 Impact Factor
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    ABSTRACT: In this study, we investigated the expression levels of host restriction factors in six untreated HIV-1-positive patients over the course of infection. We found that the host restriction factor gene expression profile consistently increased over time and significantly associated with CD4(+) T cell activation and viral load. Our data are among the first to demonstrate the dynamic nature of host restriction factors in vivo over time.
    Journal of Virology 07/2014; 88(19). DOI:10.1128/JVI.01771-14 · 4.65 Impact Factor
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    ABSTRACT: Type 2 diabetes is a major health problem in many countries including India. Yoga may be an effective type 2 diabetes prevention strategy in India, particularly given its cultural familiarity.
    BMC Complementary and Alternative Medicine 07/2014; 14(1):212. DOI:10.1186/1472-6882-14-212 · 1.88 Impact Factor
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    ABSTRACT: Individuals who are heterozygous for the CCR5 delta-32 mutation provide a natural model to examine the effects of reduced CCR5 expression on HIV persistence. We evaluated the HIV reservoir in 18 CCR5 delta-32 heterozygotes and 54 CCR5 wild type individuals on suppressive antiretroviral therapy. Cell-associated HIV RNA (p=0.035), RNA:DNA transcriptional ratios (p=0.013), and frequency of detectable HIV 2-LTR circle DNA (p=0.013) were significantly lower in CD4+ T cells from CCR5 delta-32 heterozygotes. Cell-associated HIV RNA was significantly correlated with CCR5 surface expression on CD4+ T cells (r(2)=0.136, p=0.002). Our findings suggest that curative strategies should further explore manipulation of CCR5.
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    ABSTRACT: Background: There is intense interest in the role of programmed death 1 (PD-1) in causing persistent T-cell dysfunction in HIV infection. However, the impact of HIV infection and antiretroviral treatment (ART) on the expression of PD-1 on T cells is still poorly defined. Methods: PD-1 was measured longitudinally in a cohort of recently HIV-infected individuals (n = 121) who started ART early (<6 months after infection) vs. later (>= 2 years after infection). PD-1 was also measured cross-sectionally in a diverse cohort of chronically HIV-infected adults (n 206). Results: PD-1 expression levels were high on CD8(+) T cells during early HIV infection. PD-1 levels increased on both CD4(+) and CD8(+) T cells populations in those who delayed therapy (11 and 10%/year, respectively). PD-1 levels declined and were similar in those treated early vs. late after 1 year of ART. In both cohorts, PD-1 expression on CD4(+) T cells was associated with CD4(+) T-cell activation (CD38(+)HLA-DR+) and inversely with CD4(+) cell count. In contrast, PD-1 expression on CD8(+) T cells was most strongly associated with CD8(+) T-cell activation and with plasma viral load in viremic individuals. Conclusion: Across two large cohorts of untreated and treated individuals, we found consistent associations between HIV RNA levels, CD8(+) T-cell activation and PD-1 expression on CD8(+) T cells. In contrast, CD4(+) T-cell counts and CD4(+) T-cell activation were more consistent correlates of PD-1 expression on CD4(+) T cells. PD-1 expression appears to be driven by both direct antigen and homeostatic pathways. (C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
    AIDS (London, England) 05/2014; 28(12). DOI:10.1097/QAD.0000000000000314 · 6.56 Impact Factor
  • Journal of alternative and complementary medicine (New York, N.Y.) 05/2014; 20(5):A72. DOI:10.1089/acm.2014.5189.abstract · 1.52 Impact Factor
  • Journal of alternative and complementary medicine (New York, N.Y.); 05/2014
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    ABSTRACT: A low CD4/CD8 ratio in elderly HIV-uninfected adults is associated with increased morbidity and mortality. A subset of HIV-infected adults receiving effective antiretroviral therapy (ART) fails to normalize this ratio, even after they achieve normal CD4+ T cell counts. The immunologic and clinical characteristics of this clinical phenotype remain undefined. Using data from four distinct clinical cohorts and three clinical trials, we show that a low CD4/CD8 ratio in HIV-infected adults during otherwise effective ART (after CD4 count recovery above 500 cells/mm3) is associated with a number of immunological abnormalities, including a skewed T cell phenotype from naïve toward terminally differentiated CD8+ T cells, higher levels of CD8+ T cell activation (HLADR+CD38+) and senescence (CD28- and CD57+CD28-), and higher kynurenine/tryptophan ratio. Changes in the peripheral CD4/CD8 ratio are also reflective of changes in gut mucosa, but not in lymph nodes. In a longitudinal study, individuals who initiated ART within six months of infection had greater CD4/CD8 ratio increase compared to later initiators (>2 years). After controlling for age, gender, ART duration, nadir and CD4 count, the CD4/CD8 ratio predicted increased risk of morbidity and mortality. Hence, a persistently low CD4/CD8 ratio during otherwise effective ART is associated with increased innate and adaptive immune activation, an immunosenescent phenotype, and higher risk of morbidity/mortality. This ratio may prove useful in monitoring response to ART and could identify a unique subset of individuals needed of novel therapeutic interventions.
    PLoS Pathogens 05/2014; 10(5):e1004078. DOI:10.1371/journal.ppat.1004078 · 8.06 Impact Factor

Publication Stats

10k Citations
1,218.74 Total Impact Points

Institutions

  • 2000–2015
    • University of California, San Francisco
      • • Osher Center for Integrative Medicine
      • • Department of Medicine
      • • Division of Hospital Medicine
      San Francisco, California, United States
  • 2012
    • Karolinska Institutet
      • Department of Microbiology, Tumor and Cell Biology (MTC)
      Stockholm, Stockholm, Sweden
  • 2008–2012
    • CSU Mentor
      • Department of Medicine
      Long Beach, California, United States
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      • Department of Medicine
      Torrance, CA, United States
  • 2011
    • University of Hawaiʻi at Mānoa
      • Department of Tropical Medicine, Medical Microbiology and Pharmacology
      Honolulu, Hawaii, United States
  • 2001–2011
    • San Francisco VA Medical Center
      San Francisco, California, United States
  • 2006–2010
    • University of California, San Diego
      • Department of Medicine
      San Diego, California, United States
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • Blood Systems Research Institute
      San Francisco, California, United States
  • 2009
    • Ragon Institute of MGH, MIT and Harvard
      Charlestown, Maryland, United States
  • 2003
    • Blood Centers of the Pacific
      San Francisco, California, United States