Timing of Antiretroviral Therapy and Systemic Inflammation in Sub-Saharan Africa: Results From the META Longitudinal Cohort Study

J Infect Dis. 2019 Aug 30;220(7):1172-1177. doi: 10.1093/infdis/jiz259.

Abstract

Chronic inflammation predicts complications in persons with human immunodeficiency virus infection. We compared D-dimer, soluble CD14, and interleukin 6 levels before and 12 months after antiretroviral therapy (ART) initiation, among individuals starting ART during earlier-stage (CD4 T-cell count >350/µL) or late-stage disease (CD4 T-cell count <200/µL). Female sex, older age, viral load, and late-stage disease were associated with pre-ART biomarkers (n = 661; P < .05). However, there were no differences in biomarkers by disease stage after 12 months of ART (n = 438; P > .05), owing to loss from observation and greater declines in biomarkers in late-stage initiators (P < .001). Earlier initiation of ART is associated with decreased inflammation, but levels seem to converge between earlier and later initiators surviving to 12 months.

Keywords: HIV; South Africa; Uganda; antiretroviral therapy; immune activation; inflammation.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Adult
  • Age Factors
  • Anti-HIV Agents / therapeutic use*
  • Biomarkers
  • CD4 Lymphocyte Count
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • HIV-1 / genetics*
  • HIV-1 / isolation & purification
  • Humans
  • Inflammation / drug therapy
  • Interleukin-6 / blood
  • Lipopolysaccharide Receptors / blood
  • Longitudinal Studies
  • Male
  • Medication Adherence
  • Sex Factors
  • South Africa
  • Time Factors
  • Uganda
  • Viral Load / genetics

Substances

  • Anti-HIV Agents
  • Biomarkers
  • CD14 protein, human
  • Fibrin Fibrinogen Degradation Products
  • IL6 protein, human
  • Interleukin-6
  • Lipopolysaccharide Receptors
  • fibrin fragment D