People with human immunodeficiency virus (HIV) have higher rates of certain comorbidities, particularly cardiovascular disease and cancer, than people without HIV1,2,3,4,5. In view of observations that somatic mutations associated with age-related clonal hematopoiesis (CH) are linked to similar comorbidities in the general population6,7,8,9,10, we hypothesized that CH may be more prevalent in people with HIV. To address this issue, we established a prospective cohort study, the ARCHIVE study (NCT04641013), in which 220 HIV-positive and 226 HIV-negative participants aged 55 years or older were recruited in Australia. Demographic characteristics, clinical data and peripheral blood were collected to assess the presence of CH mutations and to identify potential risk factors for and clinical sequelae of CH. In total, 135 CH mutations were identified in 100 (22.4%) of 446 participants. CH was more prevalent in HIV-positive participants than in HIV-negative participants (28.2% versus 16.8%, P = 0.004), overall and across all age groups; the adjusted odds ratio for having CH in those with HIV was 2.16 (95% confidence interval 1.34–3.48, P = 0.002). The most common genes mutated overall were DNMT3A (47.4%), TET2 (20.0%) and ASXL1 (13.3%). CH and HIV infection were independently associated with increases in blood parameters and biomarkers associated with inflammation. These data suggest a selective advantage for the emergence of CH in the context of chronic infection and inflammation related to HIV infection.
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The data that support the findings of this study are available from the corresponding authors upon reasonable request. This study is part of an ongoing clinical trial. Requests for additional raw and analyzed data and materials will be first reviewed by the corresponding authors to ensure that ethics obligations and trial protocols are not breached. Specifically, patient-related data may be subject to confidentiality and any request for merged patient data, including clinical information, must also be approved by the ARCHIVE study steering committee.
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The authors thank all of the individuals who participated in this study. We also acknowledge the following clinical site study coordinators: T. Vincent, Holdsworth House Medical Practice; R. Rosario, East Sydney Doctors; H. Lau, Prahran Market Clinic; F. Bascombe, St Vincent’s Hospital Sydney; D. Smith, Albion Centre; S. Price, Alfred Hospital; J. O’Brien, Monash Health; H. T. L. Tan, Taylor Square Private Clinic; B. Sinclair, Department of Sexual Health Medicine, Sydney Local Health District. We also acknowledge K. Merlin, M. Starr, B. Catlett and the Clinical Trials & Biorepository/DBS Team at St Vincent’s Centre for Applied Medical Research. Finally, we acknowledge P. Blombery, M. McBean and H. N. Goh for their assistance with ASXL1 fragment-length analysis. The Kirby Institute receives funding from the Australian Government Department of Health and Ageing. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Australian Government. We thank the following funders for fellowship and grant support: NHMRC investigator grant (1196749 to. M.A.D.), Cancer Council Victoria Dunlop Fellowship (to M.A.D.), Howard Hughes Medical Institute international research scholarship (to M.A.D.), NHMRC investigator grant (1196755 to S.-J.D.), CSL Centenary fellowship (to S.-J.D.), NHMRC postgraduate scholarship (to N.J.D.), NHMRC fellowship (1110067 to M.N.P.), Cancer Institute of NSW Future Research Leader Fellowship (15-1-01 to M.N.P.), NHMRC/MRFF investigator grant (1195030 to P.Y.), Snowdome Foundation/Maddie Riewoldt’s vision (to P.Y.), George and Yolanda Klempfner AO fellowship (to P.Y.), Gilead (to P.Y.) and NHMRC project grants (1128984 (to S.-J.D. and M.A.D.) and 1213110).
M.A.D. has been a member of advisory boards for CTX CRC, Storm Therapeutics, Celgene and Cambridge Epigenetix. S.-J.D has been a member of advisory boards for AstraZeneca. The laboratory of S.-J.D. received funding from CTx CRC and Genentech. The laboratory of M.A.D. received research funding from CTx CRC. N.J.D. received research support from Gilead Sciences. D.S. received research support and consultancy fees from Gilead Sciences, Janssen pharmaceuticals and Merck. J.H.’s institution received reimbursement for her involvement in Advisory Boards for Gilead Sciences, Merck, Sharp & Dohme and ViiV Healthcare. M.B. received support for medical advisory boards, lecturing and attendance at scientific conferences from Gilead Sciences, ViiV Healthcare and AbbVie, and his institution has received research support from Gilead Sciences, ViiV Healthcare, GSK, AbbVie, MSD, Amgen and Eli Lilly.
Peer review information Nature Medicine thanks Hossein Khiabanian, Beibei Guo, Frederik Damm and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Michael Basson was the primary editor on this article and managed its editorial process and peer review in collaboration with the rest of the editorial team.
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a. Participant enrolment and inclusion in the final analysis. In total 446 participants (220 HIV positive and 226 HIV negative) were assessed for CH. b. Study analysis design. Genomic analysis for CH was performed blinded to the HIV status of the participant. Unblinding of HIV status and statistical analysis was performed once genomic analysis by targeted deep sequencing was complete.
Extended Data Fig. 2 Correlation between duration of HIV and variant allele fraction of CH mutation and presence of two or more CH mutations.
No significant association was found between the duration of HIV in years and 1) the variant allele fraction of the CH mutation1 (figure); and 2) the presence of two or more CH mutations (OR [CI] = 0.99 [0.96–1.02], p = 0.58). 1Mean average variant allele fraction was calculated if there was more than one CH mutation present.
Interleukin-6 levels when separated by IL6R Asp358Ala polymorphism status showed no statistical difference across a. CH mutation status and b. HIV status. The centre line of the box depicts the mean IL-6 value with the lower and upper bounds of the boxes representing the 25th and 75th percentile values, respectively. The lower bound of the whisker indicates the minimum, defined as the 25th percentile minus 1.5x the interquartile range, and the upper bound of the whisker indicates the maximum, defined as the 75th percentile plus 1.5x the interquartile range. Overall p-values (figure inset) were generated using the Kruskal-Wallis test. Tests for significant differences in the median across groups were done by generating p-values using post-hoc pairwise two-sided multiple comparison analysis (Dwass, Steel, Critchlow-Fligner Method). Outliers have been removed for box plot presentation only; p-values were calculated including outliers. Outliers were defined as values greater than 1.5 times the IQR above the third quartile.
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Dharan, N.J., Yeh, P., Bloch, M. et al. HIV is associated with an increased risk of age-related clonal hematopoiesis among older adults. Nat Med 27, 1006–1011 (2021). https://doi.org/10.1038/s41591-021-01357-y
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