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Editorial
. 2017 Oct 1;3(4):212-217.
doi: 10.1016/S2055-6640(20)30316-2.

The evaluation of risk-benefit ratio for gut tissue sampling in HIV cure research

Vikram Mehraj, Peter Ghali  1 , Rayoun Ramendra, Cecilia Costiniuk, Bertrand Lebouché, Rosalie Ponte, Robert Reinhard  2 , Jose Sousa  3 , Nicolas Chomont, Eric A Cohen, Petronela Ancuta, Jean-Pierre Routy
Affiliations
Editorial

The evaluation of risk-benefit ratio for gut tissue sampling in HIV cure research

Vikram Mehraj et al. J Virus Erad. .

Abstract

Introduction: Antiretroviral therapy (ART) does not cure HIV infection due to the persistence of HIV reservoirs in long-lived memory CD4 T cells present in the blood, lymph nodes, intestinal tract, and other tissues. Interest grows in obtaining gut-tissue samples for HIV persistence studies, which poses an ethical challenge to provide study volunteers with adequate information on risks and benefits. Herein we assess the risks and benefits of undergoing gut biopsy procedures for HIV pathogenesis and reservoir studies.

Methods: A group discussion was organised with physicians and community representatives on performing either a flexible sigmoidoscopy or a colonoscopy. Consensus was reached on conducting colonoscopy in persons ≥50 years. Thirty HIV-infected, ART-treated and nine uninfected participants were recruited. Colonoscopy was performed to collect 30 gut mucosal biopsies. When present, polyps were removed and abnormal mucosal findings were biopsied for pathological analysis. Participants were interviewed on potential discomfort following colonoscopic examination.

Results: The HIV-infected and uninfected groups were comparable in terms of age and gender with more men who have sex with men (MSM) in the former group. Abnormal colonoscopic findings were observed in 43.6% of all the participants and did not differ by HIV status. In total, 24 polyps were removed with a higher mean number of polyps removed in HIV-infected versus uninfected participants (1.7 vs 1.0, P=0.013). The number of polyps marginally correlated with inverted CD4:CD8 ratio. Based on our findings, colonoscopic examination was safe to use for gut biopsy procedures where almost half of the participants had polyps removed.

Conclusion: Participation in the study provided colon cancer screening as an ancillary benefit that participants could have received in standard medical care, thus mitigating burdens of invasive procedures. Dialogue between community representatives and clinical researchers can increase participation and advance HIV cure research.

Keywords: HIV cure research, colonoscopy, risks/benefits, polyps, gut mucosal biopsy, ageing.

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Figures

Figure 1.
Figure 1.
Distribution of abnormal colonoscopic findings in HIV-infected and uninfected participants. One participant from the HIV-infected group had asymptomatic colitis in the sigmoid colon
Figure 2.
Figure 2.
Correlation of number of polyps with CD4:CD8 ratio in the study participants. All the participants with two or more polyps belonged to HIV-infected group. The correlation coefficient was calculated using Spearman's rank correlation test
See this image and copyright information in PMC

References

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