title: Role of Natural Autoantibodies in Ugandans With Rheumatic Heart Disease and HIV.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) and HIV are prevalent diseases in sub-Saharan Africa, but little is known about their potential interrelationships. The objective of this study was to assess the prevalence of protective natural autoantibodies among patients with RHD in Uganda, and to determine whether the levels of these autoantibodies are affected by HIV status.
  
  
  METHODS
  Participants were grouped according to RHD and HIV status. The three control groups (RHD - HIV -, RHD - HIV +, RHD + HIV -) were age-matched to the RHD + HIV + participants. All participants underwent HIV testing and echocardiography to evaluate for RHD. Natural autoantibody levels reactive with phosphorylcholine (PC) and malondialdehyde (MDA) were measured.
  
  
  RESULTS
  We enrolled 220 participants; 21 with both RHD and HIV. Ages ranged from 10 to 60 years, with female predominance (144/220, 65%). After adjusting for age and gender, HIV infection and RHD were each associated with low IgM anti-PC (HIV: p < 0.0001 and RHD: p = 0.01). A distinct HIV ∗ RHD interaction was identified (p = 0.045) with increased IgG anti-MDA levels in HIV infected subjects without RHD, whereas IgG anti-MDA levels were decreased in HIV infected subjects with RHD.
  
  
  CONCLUSIONS
  We found that HIV and RHD are associated with alterations in natural autoantibody responses previously linked to an increased risk for atherosclerosis and autoimmune inflammatory disease.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, at Case Western Reserve School of Medicine, 9980 Carnegie Ave, Cleveland, OH 44195, United States.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Huck
authors.affiliation: Uganda Heart Institute, Mulago Hospital, Kampala Binaisa Road, Kampala, Uganda.
authors.forename: Emmy
authors.initials: E
authors.lastname: Okello
authors.affiliation: Joint Clinical Research Centre, Kampala Lubiri Ring Rd, Kampala, Uganda.
authors.forename: Grace
authors.initials: G
authors.lastname: Mirembe
authors.affiliation: Uganda Heart Institute, Mulago Hospital, Kampala Binaisa Road, Kampala, Uganda.
authors.forename: Isaac
authors.initials: I
authors.lastname: Ssinabulya
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Zidar
authors.affiliation: Medicine and Pathology, NYU School of Medicine, 462 First Avenue, New York City, NY 10016, United States.
authors.forename: Gregg J
authors.initials: GJ
authors.lastname: Silverman
authors.affiliation: Medicine and Pathology, NYU School of Medicine, 462 First Avenue, New York City, NY 10016, United States.
authors.forename: Lelise
authors.initials: L
authors.lastname: Getu
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.affiliation: Rheumatic and Immunological Diseases, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Calabrese
authors.affiliation: Infectious Diseases, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, United States.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Longenecker
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D001323:Autoantibodies / Q000097:blood*; D002648:Child; D005260:Female; D006678:HIV / Q000302:isolation & purification* / Q000472:pathogenicity; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012214:Rheumatic Heart Disease / Q000097:blood* / Q000150:complications / Q000821:virology
chemical_list: D001323:Autoantibodies