ObjectivesThe aim of the study was to test the hypothesis that microbial translocation, quantified by levels of lipopolysaccharide (LPS) and subsequent monocyte activation [soluble (sCD14)], is associated with hypertension in HIV-infected individuals. MethodsIn this exploratory substudy, 42 patients were recruited from a larger, longitudinal HIV-infected cohort study on blood pressure. LPS and sCD14 levels were measured retrospectively at the time of nadir CD4 cell count, selecting untreated HIV-infected patients with both advanced immunodeficiency and preserved immunocompetence at the time of nadir. Patients with later sustained hypertension (n = 16) or normotension (n = 26) throughout the study were identified. LPS was analysed using the Limulus Amebocyte Lysate colorimetric assay (Lonza, Walkersville, MD) and sCD14 using an enzyme-linked immunosorbent assay (ELISA). Nonparametric statistical tests were applied. ResultsIn the HIV-infected patients [median (interquartile range) age 42 (32-46) years; 79% male and 81% Caucasian], LPS and sCD14 levels were both negatively correlated with nadir CD4 cell count. Plasma levels of LPS (P < 0.001) and sCD14 (P = 0.024) were elevated in patients with later hypertension compared with patients with normotension. There was a stepwise increase in the number of patients with hypertension across tertiles of LPS (P = 0.001) and sCD14 (P = 0.007). Both LPS and sCD14 were independent predictors of elevated blood pressure after adjustment for age and gender. For each 10-unit increase in LPS (range 66-272 pg/ml), the increment in mean blood pressure in the first period of blood pressure recording was 0.86 (95% confidence interval 0.31-1.41) mmHg (P = 0.003). ConclusionsAs LPS and sCD14 were both independently associated with elevated blood pressure, microbial translocation may be linked to the development of hypertension.Keywords: HIV infection, hypertension, lipopolysaccharide, nadir CD4 cell count, soluble CD14. Accepted 5 December 2012 IntroductionNon-AIDS-related morbidities such as hypertension, cardiovascular disease (CVD), malignancy, and renal, liver and bone diseases have emerged as increasing clinical problems in HIV-infected patients [1]. In fact, non-AIDS-related mortality today exceeds AIDS-related mortality in populations with access to antiretroviral therapy (ART) [2]. A premature ageing process has been suggested to occur in HIV-infected individuals for which several contributing factors have been proposed, including viral replication, drug toxicity, lifestyle factors, and persistent immune Primary HIV infection is characterized by massive T-cell depletion in the gastrointestinal mucosa with subsequent enhanced translocation of bacterial products such as lipopolysaccharide (LPS) and flagellin from the intestinal lumen into the systemic circulation [3,4]. LPS is a potent inducer of immune response and inflammation through the innate immune system. Soluble CD14 (sCD14) is a marker of monocyte activation and is shed from monocytes upon LPS stimulation [5]. Microbial tr...
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