Derry Heather M, Johnston Carrie D, Brennan-Ing Mark, Karpiak Stephen, Burchett Chelsie O, Zhu Yuan-Shan, Siegler Eugenia L, Glesby Marshall J
Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
Brain Behav Immun Health. 2021 Aug 31;17:100342. doi: 10.1016/j.bbih.2021.100342. eCollection 2021 Nov.
As they age, people living with HIV (PLWH) experience greater rates of inflammation-related health conditions compared to their HIV-negative peers. Because early life adversity can exaggerate proinflammatory effects of later physiological challenges, inflammation may be higher among PLWH with these combined risks, which could inform intervention approaches to mitigate multimorbidity. In this cross-sectional analysis, we investigated individual and combined effects of childhood sexual abuse (CSA) history and physiological burden (Veterans Aging Cohort Study Index scores) on serum cytokine and C-reactive protein (CRP) levels among PLWH. Participants (n = 131; age 54 and older) were patients at an outpatient HIV clinic who completed a psychosocial survey and biomedical research visit as part of a larger study. 93% were virally suppressed, and 40% reported experiencing sexual abuse in childhood. Composite cytokine levels (summarizing IL-6, TNF-α, IFN-γ), CRP, and disease burden did not differ significantly between those who had a history of CSA and those who did not. Participants with greater disease burden had higher composite cytokine levels ( = 0.29, = 0.001). The disease burden by CSA interaction effect was a significant predictor of composite cytokine levels (but not CRP), and remained significant after controlling for age, sex, race, BMI, anti-inflammatory medication use, selective serotonin reuptake inhibitor use, depressive symptoms, and smoking status (F(1, 114) = 5.68, = 0.02). In follow-up simple slopes analysis, greater disease burden was associated with higher cytokine levels among those with CSA history (b = 0.03, SE = 0.008, <0.001), but not among those without CSA history. Further, in the context of greater disease burden, individuals with a CSA history tended to have higher cytokine levels than those without a CSA history (b = 0.38, SE = 0.21, p = 0.07). These data suggest that the physiological sequelae of childhood trauma may persist into older age among those with HIV. Specifically, links between physiological burden and inflammation were stronger among survivors of CSA in this study. The combined presence of CSA history and higher disease burden may signal a greater need for and potential benefit from interventions to reduce inflammation, an area for future work.
随着年龄增长，与未感染艾滋病毒的同龄人相比，感染艾滋病毒的人（PLWH）患炎症相关健康问题的几率更高。由于早年的逆境会加剧后期生理挑战的促炎作用，在同时面临这些综合风险的PLWH中，炎症水平可能更高，这可能为减轻多种疾病的干预方法提供依据。在这项横断面分析中，我们调查了童年性虐待（CSA）史和生理负担（退伍军人老龄化队列研究指数评分）对PLWH血清细胞因子和C反应蛋白（CRP）水平的个体及综合影响。参与者（n = 131；年龄54岁及以上）是一家门诊艾滋病毒诊所的患者，他们作为一项更大规模研究的一部分，完成了一项社会心理调查和生物医学研究访问。93%的人病毒得到抑制，40%的人报告童年曾遭受性虐待。有CSA史和无CSA史的人在复合细胞因子水平（汇总白细胞介素-6、肿瘤坏死因子-α、干扰素-γ）、CRP和疾病负担方面没有显著差异。疾病负担较重的参与者复合细胞因子水平较高（β = 0.29，p = 0.001）。CSA与疾病负担的交互作用效应是复合细胞因子水平（而非CRP）的显著预测因素，在控制了年龄、性别、种族、体重指数、抗炎药物使用、选择性5-羟色胺再摄取抑制剂使用、抑郁症状和吸烟状况后仍具有显著性（F(1, 114) = 5.68，p = 0.02）。在后续的简单斜率分析中，疾病负担较重与有CSA史的人细胞因子水平较高相关（b = 0.03，标准误 = 0.008，p<0.001），但与无CSA史的人无关。此外，在疾病负担较重的情况下，有CSA史的个体细胞因子水平往往高于无CSA史的个体（b = 0.38，标准误 = 0.21，p = 0.07）。这些数据表明，童年创伤的生理后遗症在艾滋病毒感染者中可能会持续到老年。具体而言，在本研究中，CSA幸存者生理负担与炎症之间的联系更强。CSA史和较高疾病负担的共同存在可能表明更需要减少炎症的干预措施，且可能从中受益，这是未来工作的一个领域。
