Antiretroviral therapy reduces but does not normalize immune and vascular inflammatory markers in adults with chronic HIV infection in Kenya.

INTRODUCTION Markers of monocyte/macrophage activation and vascular inflammation are associated with HIV-related cardiovascular diseases (CVD) and mortality. We compared these markers among African people living with HIV (PLWH) and HIV-negative adults, and examined risk factors associated with elevated biomarkers (>75% percentile) in PLWH on antiretroviral therapy (ART). DESIGN Cross-sectional study. METHODS We measured serum concentrations of a gut integrity biomarker (I-FABP), monocyte/macrophage activation biomarkers (soluble CD14 and CD163), and vascular inflammation biomarkers (soluble/circulating intercellular[sICAM-1] and vascular[sVCAM-1] cell adhesion molecules-1). We assessed the relationship of these inflammatory parameters with HIV, using logistic regression adjusting for traditional CVD risk factors. RESULTS Among the 541 participants, median age was 43 years and half were female. Among 275 PLWH, median CD4+T-cell count and duration of ART use was 509 cells/mm and 8 years respectively. PLWH had significantly higher prevalence of elevated inflammatory biomarkers compared to HIV-negative individuals even after adjustment for traditional CVD risk factors. Compared to subjects without HIV, the prevalence of elevated biomarkers was highest among persons with detectable viral load and CD4+T-cell counts≤200 cells/mm. In a sub-analysis among PLWH, nadir CD4+T-cell count≤200 cells/mm was associated with elevated sCD14; dyslipidemia with elevated sCD14, sICAM-1, and sVCAM-1; and overweight/obesity with reduced sCD14. Longer ART exposure (>4 years) was associated with reduced sVCAM-1 and sICAM-1. CONCLUSION HIV and not traditional CVD risk factors is a primary contributor of monocyte/macrophage activation and inflammation despite ART. Anti-inflammatory therapies in addition to ART may be necessary to reduce these immune dysregulations and improve health outcomes of African PLWH.