Medicine/Infectious Diseases, University of Colorado-AMC, Aurora, CO, USA.
Institute for Global Health, University College London, London, United Kingdom.
J Int AIDS Soc. 2019 Jun;22(6):e25297. doi: 10.1002/jia2.25297.
Suboptimal ART adherence, despite HIV viral suppression, has been associated with chronic residual inflammation. Whether this association extends to individuals who initiate ART during early HIV infection remains unknown, which was the objective of this study.
Plasma levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein, serum amyloid A protein (SAA), IL-27, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, D-dimer and the CD4+/CD8+ T-cell ratio, were analysed at baseline and eight months after ART initiation in treatment-naïve participants with HIV and CD4+ T-cells >500 cells/mm enrolled in the immediate arm of START. Adherence was assessed by seven-day self-report. Multivariable linear regression was utilized to analyse the association between ART adherence and each biomarker at the eight-month visit in participants who achieved virologic suppression (<50 copies/mL).
We evaluated 1627 participants (422 female) who achieved virologic suppression at the eight-month visit in the period between 2009 and 2013. Median (IQR) CD4+ T-cell count before ART was 651 (585, 769) cells/mm . Incomplete adherence was reported in 109 (7%) participants at the eight month visit. After adjusting for covariates, plasma IL-6 was 1.12 (95% CI, 1.00 to 1.26; p = 0.047) fold higher in participants reporting incomplete versus 100% adherence. A similar association for SAA was observed in an exploratory analysis (1.29 (95% CI 1.04 to 1.60); p = 0.02). No significant differences in other biomarkers were observed.
Incomplete ART adherence was associated with higher IL-6 levels in individuals who achieved virologic suppression early after ART initiation in START. A potential similar association for SAA requires confirmation. These findings suggest a role for identifying strategies to maximize ART adherence even during virologic suppression. ClinicalTrials.gov number: NCT00867048.
尽管艾滋病毒得到了抑制，但抗逆转录病毒治疗（ART）依从性不佳仍与慢性残留炎症有关。在开始接受抗逆转录病毒治疗（ART）的早期感染艾滋病毒的个体中，这种关联是否存在尚不清楚，这是本研究的目的。
在 2009 年至 2013 年期间，在立即开始治疗的 START 研究中，对 1627 名（422 名女性）治疗初治、艾滋病毒 CD4+ T 细胞>500 个/毫米 3 的参与者，在开始接受 ART 后 8 个月时，分析了基线和 IL-6、高敏 C 反应蛋白、血清淀粉样蛋白 A 蛋白（SAA）、IL-27、可溶性细胞间黏附分子-1、可溶性血管细胞黏附分子-1、D-二聚体和 CD4+/CD8+ T 细胞比值等血浆炎症标志物的水平。通过 7 天的自我报告评估依从性。利用多变量线性回归分析在达到病毒学抑制（<50 拷贝/毫升）的参与者中，在第 8 个月就诊时，ART 依从性与每个生物标志物之间的关联。
我们评估了 1627 名参与者（422 名女性），他们在 2009 年至 2013 年期间达到了第 8 个月的病毒学抑制。在开始接受 ART 之前，中位数（IQR）CD4+ T 细胞计数为 651（585，769）个/毫米 3 。在第 8 个月就诊时，有 109 名（7%）参与者报告不完全依从。调整协变量后，报告不完全依从的参与者的血浆 IL-6 水平比完全依从的参与者高 1.12 倍（95%CI，1.00 至 1.26；p=0.047）。在探索性分析中，也观察到 SAA 的类似关联（1.29（95%CI 1.04 至 1.60）；p=0.02）。其他生物标志物未见显著差异。
在开始接受抗逆转录病毒治疗（ART）后早期达到病毒学抑制的参与者中，ART 依从性不完全与更高的 IL-6 水平相关。对于 SAA 的潜在类似关联需要进一步确认。这些发现表明，需要确定策略以最大限度地提高 ART 依从性，即使在病毒学抑制时也是如此。临床试验注册号：NCT00867048。
