Systemic inflammation and residual viraemia in HIV-positive adults on protease inhibitor monotherapy: a cross-sectional study

Abstract

BackgroundIncreased levels of markers of systemic inflammation have been associated with serious non-AIDS events even in patients on fully suppressive antiretroviral therapy. We explored residual viremia and systemic inflammation markers in patients effectively treated with ritonavir-boosted protease inhibitor monotherapy (PImono).MethodsHIV-infected adults with persistent HIV-RNA <50 copies/ml and treated with either a) PImono or b) standard triple-drug cART were recruited for this cross-sectional, exploratory study. Plasma samples were tested for high-sensitivity CRP (hsCRP), Serum Amyloid A (SAA), soluble CD14, IL-6, IL-8 and Cytochrome C. HIV-RNA was measured by real-time PCR (detection limit of 10 copies/ml).Results81 patients were recruited (31% on PImono). Two out of 25 (8%) and 3 of 56 (5.4%) patients from the PImono and cART groups respectively had detectable HIV-RNA. Significant correlation between SAA and hsCRP was observed (0.804). No difference between groups was found on prevalence of hsCRP >3 mg/l (21% vs 20% in the PImono and cART groups respectively; p = 0.577) or SAA >6.4 mg/l (38% vs 22% in the PImono and cART groups respectively; P = 0.172). In a univariate analysis IL6 and IL8 levels were associated with SAA >6.4 mg/l (OR = 1.74 and 1.46; 95% CI = 1.00 – 3.03 and 1.06 – 2.01; p = 0.051 and 0.02 respectively) and hsCRP >3 mg/l in (OR = 2.00 and 1.37; 95% CI = 1.09 – 3.69 and 1.02 – 1.85; p = 0.026 and 0.039 respectively).ConclusionsWe found no evidence of increased levels of inflammatory biomarkers or higher prevalence of residual viraemia in patients effectively suppressed on PImono as compared with patients on standard cART.

Incomplete ART adherence is associated with higher inflammation in individuals who achieved virologic suppression in the START study

“…In the HIV arena, SAA has been proposed as a marker of very acute HIV infection and to have early antiviral properties [46]. Comparatively, SAA has been found to correlate with other biomarkers of inflammation including CRP, IL-6 and IL-8 in chronic HIV infection [47], and with the development of opportunistic disease [48], but not mortality or early treatment discontinuation, in the SMART study [26]. In START, SAA was also found to be strongly correlated with biomarkers of vascular inflammation including hsCRP, sICAM and sVCAM, which translated into an increased risk of AIDS-related events in participants who had higher concentrations of SAA [24].…”

Virgin coconut oil extract mitigates testicular‐induced toxicity of alcohol use in antiretroviral therapy

“…This has been linked to some fundamental altered therapeutic indices which addresses HIV virology, pathogenesis, and response to antiretroviral treatments (Kumar et al ., ). The global expansion of access to highly active antiretroviral therapy (HAART) has recorded significant improvement in the management of HIV/AIDS (Arenas‐Pinto et al ., ). HAART has a positive impact on AIDS patients’ survival with a sharp decline in morbidity and reduction in new HIV cases (Bendavid et al ., ; Chang et al ., ).…”

Impact of intensification with raltegravir on HIV-1-infected individuals receiving monotherapy with boosted PIs

“…17 , 18 Although residual plasma viraemia below the detection limit of standard assays (<50 HIV-1 RNA copies/mL) has been suggested to be the origin of viral failures in this context, there is no clear evidence available. 19 , 20 In the present single-arm pilot study, we evaluated the effect of intensification with raltegravir on HIV-1-infected individuals on maintenance PI/r monotherapy by measuring changes in residual viraemia, low-level viral replication, HIV-1 DNA reservoirs, T cell immune activation and soluble inflammatory biomarkers.…”