在接受抗逆转录病毒治疗的HIV感染成年人中，肥胖与更高程度的炎症和单核细胞激活有关。

Obesity is associated with greater inflammation and monocyte activation among HIV-infected adults receiving antiretroviral therapy.

作者信息

Conley Lois J, Bush Timothy J, Rupert Adam W, Sereti Irini, Patel Pragna, Brooks John T, Baker Jason V

机构信息

aDivision of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia bAIDS Monitoring Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick cNational Institute of Allergy and Infectious Disease (NIAID), NIH, Bethesda, Maryland dDepartment of Medicine, University of Minnesota eDivision of Infectious Diseases, Hennepin County Medical Center, Minneapolis, Minnesota, USA.

出版信息

AIDS. 2015 Oct 23;29(16):2201-7. doi: 10.1097/QAD.0000000000000817.

DOI:10.1097/QAD.0000000000000817

PMID:26544583

Abstract

OBJECTIVES

Among virally suppressed HIV-infected persons, we examined the relationship between obesity and alterations in key clinical markers of immune activation and inflammation. These markers have also been associated with excess HIV-related cardiovascular disease and mortality.

METHODS

We evaluated data from virally suppressed participants in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy, including inflammatory biomarkers (interleukin-6 and highly sensitive C-reactive protein), monocyte biomarkers [soluble CD163 (sCD163), sCD14], and monocyte immunophenotypes. We assessed associations with these immunologic measures and obesity, via logistic regression preadjustment and postadjustment for demographic and clinical factors, homeostatic model assessment of insulin resistance, and leptin levels.

RESULTS

Among 452 evaluable participants, median (interquartile range) age was 41 (36-48) years, CD4 cell count was 475 (308-697) cells/μl, and 21% were obese (BMI ≥ 30 kg/m). In univariable models, obesity, smoking, and lower CD4 cell count were associated with higher measures of inflammation and monocyte activation. After adjustment, obesity remained independently associated with elevated levels (highest vs. lower two tertiles) of interleukin-6 [odds ratio (OR) 1.96; P = 0.02], highly sensitive C-reactive protein (OR 2.79; P < 0.001) and sCD163 (OR 1.94; P = 0.02), and elevated frequency of CD14CD16 (OR 1.77; P = 0.03) and CD14dimCD16 (OR 1.97; P = 0.01). Adjusting for homeostatic model assessment of insulin resistance and leptin modestly affected associations for obesity with inflammation and monocyte activation.

CONCLUSION

Obesity was prevalent and independently associated with greater monocyte activation and systemic inflammation. Research is needed to determine how adipose tissue excess is functionally related to persistent immunologic abnormalities among HIV-infected persons with viral suppression.

摘要

目的

在病毒得到抑制的HIV感染者中，我们研究了肥胖与免疫激活和炎症的关键临床标志物改变之间的关系。这些标志物还与HIV相关的心血管疾病和死亡率过高有关。

方法

我们评估了“了解有效治疗时代HIV/AIDS自然史研究”中病毒得到抑制的参与者的数据，包括炎症生物标志物（白细胞介素-6和高敏C反应蛋白）、单核细胞生物标志物[可溶性CD163（sCD163）、sCD14]以及单核细胞免疫表型。我们通过对人口统计学和临床因素、胰岛素抵抗的稳态模型评估以及瘦素水平进行逻辑回归预调整和后调整，评估了这些免疫指标与肥胖之间的关联。

结果

在452名可评估的参与者中，年龄中位数（四分位间距）为41（36 - 48）岁，CD4细胞计数为475（308 - 697）个/μl，21%的人肥胖（BMI≥30kg/m²）。在单变量模型中，肥胖、吸烟和较低的CD4细胞计数与更高的炎症和单核细胞激活指标相关。调整后，肥胖仍然独立地与白细胞介素-6水平升高（最高三分位数与较低两个三分位数相比）[比值比（OR）1.96；P = 0.02]、高敏C反应蛋白（OR 2.79；P < 0.001）和sCD163（OR 1.94；P = 0.02）以及CD14⁺CD16⁺（OR 1.77；P = 0.03）和CD14⁻dimCD16⁺（OR 1.97；P = 0.01）频率升高相关。对胰岛素抵抗的稳态模型评估和瘦素进行调整后，肥胖与炎症和单核细胞激活之间的关联受到轻微影响。