Low-level HIV viremia is associated with microbial translocation and inflammation

J Acquir Immune Defic Syndr. 2013 Feb 1;62(2):129-34. doi: 10.1097/QAI.0b013e3182745ab0.

Abstract

Background: Decrease in HIV viral load (VL) is accompanied by decrease in microbial translocation (MT) and chronic inflammation, but the behavior of these markers in patients with HIV-VL <20 copies per milliliter is unknown. The aim of this study was to determine whether strict control of HIV-VL is associated with MT and chronic inflammation.

Methods: Observational cross-sectional study.

Inclusion criteria: HIV patients receiving antiretroviral therapy and HIV-VL <200 copies per milliliter for more than 6 months.

Exclusion criteria: chronic liver disease, active infection, or antibiotic consumption. Recruitment: patients who consecutively visited the outpatient clinic in November 2011. Primary endpoint: molecular MT as determined by detection in plasma of 16S ribosomal DNA. Secondary variables: lipopolysaccharide, soluble CD14, tumor necrosis factor α, and interleukin 6. Primary explanatory variable: HIV-VL (COBAS AmpliPrep/COBAS TaqMan HIV-1 test, version 2.0) with a detection limit of 20 copies per milliliter.

Results: Fifty-two patients were included: 65% men, median age 45 years, HIV acquired predominantly through sex (75%), 40% Centers for Disease Control and Prevention stage C, and median CD4 lymphocyte count 552 cells per cubic millimeter (range, 126-1640 cells/mm). Molecular MT was observed in 46% and 18% of patients with low-level (20-200 copies/mL) and negative (<20 copies/mL) HIV-VL, respectively (P < 0.05). Plasma levels of inflammatory markers (tumor necrosis factor α and interleukin 6) were higher in patients with molecular MT (P < 0.01) and were not influenced for HIV-VL.

Conclusions: Patients with HIV infection receiving treatment and negative HIV-VL (<20 copies/mL) present less frequently MT than patients with low-level HIV viremias (20-200 copies/mL). MT is associated with higher levels of inflammation markers, independent of HIV-VL.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Retroviral Agents / therapeutic use
  • Bacterial Translocation*
  • Biomarkers / blood
  • CD4 Lymphocyte Count
  • Chi-Square Distribution
  • Chronic Disease
  • Cross-Sectional Studies
  • DNA, Bacterial / blood
  • DNA, Ribosomal / blood
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / immunology
  • HIV Infections / virology*
  • Humans
  • Inflammation / blood*
  • Inflammation / complications
  • Inflammation / virology
  • Interleukin-6 / blood
  • Lipopolysaccharide Receptors / blood
  • Lipopolysaccharides / blood
  • Male
  • Middle Aged
  • Ribosomal Proteins / genetics
  • Risk Factors
  • Statistics, Nonparametric
  • Tumor Necrosis Factor-alpha / blood
  • Viral Load*
  • Viremia / complications
  • Viremia / virology*
  • Young Adult

Substances

  • Anti-Retroviral Agents
  • Biomarkers
  • DNA, Bacterial
  • DNA, Ribosomal
  • Interleukin-6
  • Lipopolysaccharide Receptors
  • Lipopolysaccharides
  • Ribosomal Proteins
  • Rps16 protein, human
  • Tumor Necrosis Factor-alpha