Gut epithelial barrier dysfunction and innate immune activation predict mortality in treated HIV infection

J Infect Dis. 2014 Oct 15;210(8):1228-38. doi: 10.1093/infdis/jiu238. Epub 2014 Apr 21.


Background: While inflammation predicts mortality in treated human immunodeficiency virus (HIV) infection, the prognostic significance of gut barrier dysfunction and phenotypic T-cell markers remains unclear.

Methods: We assessed immunologic predictors of mortality in a case-control study within the Longitudinal Study of the Ocular Complications of AIDS (LSOCA), using conditional logistic regression. Sixty-four case patients who died within 12 months of treatment-mediated viral suppression were each matched to 2 control individuals (total number of controls, 128) by duration of antiretroviral therapy-mediated viral suppression, nadir CD4(+) T-cell count, age, sex, and prior cytomegalovirus (CMV) retinitis. A similar secondary analysis was conducted in the SCOPE cohort, which had participants with less advanced immunodeficiency.

Results: Plasma gut epithelial barrier integrity markers (intestinal fatty acid binding protein and zonulin-1 levels), soluble CD14 level, kynurenine/tryptophan ratio, soluble tumor necrosis factor receptor 1 level, high-sensitivity C-reactive protein level, and D-dimer level all strongly predicted mortality, even after adjustment for proximal CD4(+) T-cell count (all P ≤ .001). A higher percentage of CD38(+)HLA-DR(+) cells in the CD8(+) T-cell population was a predictor of mortality before (P = .031) but not after (P = .10) adjustment for proximal CD4(+) T-cell count. Frequencies of senescent (defined as CD28(-)CD57(+) cells), exhausted (defined as PD1(+) cells), naive, and CMV-specific T cells did not predict mortality.

Conclusions: Gut epithelial barrier dysfunction, innate immune activation, inflammation, and coagulation-but not T-cell activation, senescence, and exhaustion-independently predict mortality in individuals with treated HIV infection with a history of AIDS and are viable targets for interventions.

Keywords: CD28; CD38; CD57; D-dimer; HIV; HLA-DR; IL-6; T-cell activation; antiretroviral therapy; cytomegalovirus; gut epithelial cell barrier; hsCRP; immune activation; intestinal fatty acid binding protein (I-FABP); mortality; sCD14; zonulin-1.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Blood Coagulation
  • Case-Control Studies
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / immunology*
  • HIV Infections / mortality
  • Humans
  • Immunity, Innate / physiology*
  • Inflammation / metabolism
  • Intestinal Mucosa / physiopathology*
  • Lymphocyte Activation
  • Male
  • Middle Aged
  • T-Lymphocytes / physiology