秘鲁感染HIV的男性和女性在接受抑制性抗逆转录病毒治疗之前及期间的炎症生物标志物。
Biomarkers of inflammation in HIV-infected Peruvian men and women before and during suppressive antiretroviral therapy.
作者信息
Ticona Eduardo, Bull Marta E, Soria Jaime, Tapia Kenneth, Legard Jillian, Styrchak Sheila M, Williams Corey, Mitchell Caroline, La Rosa Alberto, Rosa Alberto L A, Coombs Robert W, Frenkel Lisa M
机构信息
aHospital Nacional dos de Mayo, Lima, Peru bDepartment of Pediatrics, University of Washington cCenter for Global Infectious Disease Research, Seattle Children's Hospital Research Institute dDepartment of Global Health eDepartment of Obstetrics and Gynecology, University of Washington, Seattle, Washington fInvestigaciones Médicas en Salud (INMENSA), Lima, Peru gDepartment of Medicine hDepartment of Laboratory Medicine, University of Washington, Seattle, Washington, USA. *Eduardo Ticonaa and Marta E. Bull contributed equally to the writing of this article. †Currently involved with the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) program, Seattle Children's Hospital, Seattle, Washington, USA. ‡Currently with the Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.
出版信息
AIDS. 2015 Aug 24;29(13):1617-22. doi: 10.1097/QAD.0000000000000758.
OBJECTIVE
Inflammatory biomarkers associated with cardiovascular disease are elevated in HIV-infected persons. These biomarkers improve with antiretroviral therapy (ART) but do not normalize to values observed in HIV-uninfected adults. Little is known regarding biomarkers of inflammation in HIV-infected Peruvians, in whom an increased burden of infectious diseases may exacerbate inflammation, and women, in whom sex difference may alter inflammation compared with men.
METHODS
Peruvians initiating first-line ART were enrolled in a prospective observational study. Individuals with suppression of HIV RNA plasma loads to less than 30 copies/ml when determined quarterly over 24 months of ART, had biomarkers of inflammation and cellular activation measured pre-ART and at 24-months of ART, and evaluated for associations with sex and clinical parameters.
RESULTS
Pre-ART high-sensitivity C-reactive protein (hsCRP) values of men were in the high-risk cardiovascular disease category (>3.0 mg/l) more frequently compared with women (P = 0.02); most women's values were in the low/average-risk categories. At 24 months of suppressive ART, hsCRP concentrations decreased in men (P = 0.03), but tended to increase in women, such that the proportion with high-risk hsCRP did not differ by sex. Pre-ART, soluble CD163 concentrations were higher in women compared with men (P = 0.02), and remained higher after 24 months of suppressive ART (P = 0.02). All other inflammatory biomarkers (P < 0.03) decreased across sexes. Biomarker concentrations were not associated with BMI or coinfections.
CONCLUSION
Elevated inflammatory biomarkers persisted despite 24 months of suppressive ART in a subset of Peruvians, and to a greater extent in women compared with men. These findings suggest that lifestyle or pharmacologic interventions may be required to optimize the health of HIV-infected Peruvians, particularly women.
目的
与心血管疾病相关的炎症生物标志物在HIV感染者中升高。这些生物标志物在接受抗逆转录病毒治疗（ART）后有所改善，但未恢复到未感染HIV的成年人的水平。关于感染HIV的秘鲁人的炎症生物标志物知之甚少，在这些人中，传染病负担的增加可能会加剧炎症，而女性与男性相比，性别差异可能会改变炎症情况。
方法
启动一线ART的秘鲁人参加了一项前瞻性观察性研究。在ART的24个月期间每季度测定一次，HIV RNA血浆载量抑制到低于30拷贝/ml的个体，在ART前和ART 24个月时测量炎症和细胞活化的生物标志物，并评估其与性别和临床参数的关联。
结果
与女性相比，男性ART前高敏C反应蛋白（hsCRP）值处于心血管疾病高风险类别（>3.0mg/l）的频率更高（P = 0.02）；大多数女性的值处于低/平均风险类别。在抑制性ART治疗24个月时，男性的hsCRP浓度下降（P = 0.03），但女性则趋于升高，因此高风险hsCRP的比例在性别上没有差异。ART前，女性的可溶性CD163浓度高于男性（P = 0.02），在抑制性ART治疗24个月后仍较高（P = 0.02）。所有其他炎症生物标志物（P < 0.03）在两性中均下降。生物标志物浓度与BMI或合并感染无关。
结论
在一部分秘鲁人中，尽管进行了24个月的抑制性ART治疗，炎症生物标志物仍持续升高，且女性比男性更为明显。这些发现表明，可能需要生活方式或药物干预来优化感染HIV的秘鲁人的健康，尤其是女性。
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