Raghavan Avanthi, Rimmelin Dodie E, Fitch Kathleen V, Zanni Markella V
Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
Curr HIV/AIDS Rep. 2017 Dec;14(6):220-228. doi: 10.1007/s11904-017-0366-8.
The goals of this review are to (1) explore HIV-associated cardiovascular disease (CVD), neurocognitive impairment, and non-AIDS-defining cancers (NADC) as heterogeneous model disease states fuelled in part by systemic immune activation/inflammation; (2) consider sex differences in the epidemiology of these diseases in both high-resource and lower-resource settings; and (3) examine biological and environmental factors which may contribute to heightened systemic immune activation/inflammation specifically among women living with HIV (WLHIV).
The observation that WLHIV have higher levels of systemic immune activation/inflammation than men living with HIV (MLHIV) may be relevant to sex differences in select non-communicable HIV-associated comorbidities. Heightened systemic immune activation among WLHIV may be influenced by sex-specific responses to the virus and to immunomodulatory agents, as well as by behavioral choices/comorbid conditions and perturbations in the hypothalamic-pituitary-gonadal axis. Additional research is needed to elucidate region-specific drivers of heightened systemic immune activation/inflammation among WLHIV and to determine whether WLHIV who present with one immune-mediated HIV-associated comorbidity (e.g., cognitive impairment) may be at increased risk for another (e.g., CVD, NADC). This kind of research would facilitate improved risk prediction for non-communicable HIV-associated comorbidities among WLHIV and the development of targeted immunomodulatory prevention strategies.
本综述的目标是：（1）探讨与HIV相关的心血管疾病（CVD）、神经认知障碍和非艾滋病定义性癌症（NADC），这些是部分由全身免疫激活/炎症驱动的异质性疾病状态；（2）考虑在高资源和低资源环境中这些疾病流行病学的性别差异；（3）研究可能导致全身免疫激活/炎症加剧的生物学和环境因素，特别是在感染HIV的女性（WLHIV）中。
感染HIV的女性（WLHIV）比感染HIV的男性（MLHIV）具有更高水平的全身免疫激活/炎症，这一观察结果可能与某些非传染性HIV相关合并症的性别差异有关。WLHIV中全身免疫激活加剧可能受到对病毒和免疫调节剂的性别特异性反应、行为选择/合并症以及下丘脑 - 垂体 - 性腺轴紊乱的影响。需要进一步研究以阐明WLHIV中全身免疫激活/炎症加剧的区域特异性驱动因素，并确定出现一种免疫介导的HIV相关合并症（如认知障碍）的WLHIV是否患另一种合并症（如CVD、NADC）的风险增加。这类研究将有助于改善对WLHIV中非传染性HIV相关合并症的风险预测以及制定有针对性的免疫调节预防策略。
