Inflammation

Inflammation and Treating the Aging HIV Population

Inflammation was first described in 1 AD as redness, warmth, swelling, and pain. The definition later evolved to include 5 pillars of inflammation: fever, erythema, oedema, pain, loss of function. This is how Tuesday’s Plenary Session, “Inflammation: Taming the Flames,” began at the Conference on Retroviruses and Opportunistic Infections 2019.

Presenter Irini Sereti, MD, from the National Institute of Allergy and Infectious Diseases, opened her session with a history of inflammation and a review of inflammatory pathways.

Inflammation in HIV is chronic and has been linked with disease progression, even pre-seroconversion or at primary infection. Higher inflammation has been reported among people who do not achieve high CD4 cell counts, Dr Sereti said during her presentation.

D-dimer, IL-6, sCD14, and C-reative protein biomarkers are independent predictors of mortality and noncommunicable diseases among individuals with HIV who are taking antiretroviral therapy (ART).

“Inflammation is really at the root of many of the diseases we’re faced with today,” Dr Sereti segued.

Cancer, cardiovascular disease including myocardial infarction, bone mineral density, chronic obstructive pulmonary disease and bacterial pneumonia, incident diabetes, neurocognitive testing, and frailty are all caused by inflammation.

“This is important because many of these diseases are diseases of aging, and we know that our [HIV] population, thanks to our successful antiretroviral therapy, is also aging.” It is projected that 73% of the HIV population will be 50 years of age or older by 2030.

Dr Sereti also spoke about how women with HIV have a higher risk for inflammation than men, which may be caused by gene dosage effects of chromosome X genes, miRNA enrichment in X chromosomes, or hormone responsive promoter elements. Overall, women with HIV have a higher relative risk for cardiovascular and cerebrovascular disease, higher innate immune responses to HIV proteins, and higher CD8 T-cell activation at similar HIV viral loads as men.

In summary, Dr Sereti made the following points:

  • Inflammation is connected with mortality and noncommunicable diseases in people living with HIV.
  • Therapeutic targeting of inflammation is challenging because the immune system is complex, and there may be a need for individualization.
  • Research strategy could benefit from pathogenesis studies as well as study designs that target higher-risk populations.
  • Management strategy should focus on diagnosing as early as possible, treating with the best possible choice of ART, and addressing comorbidities more aggressively.
  • Whatever needs to be added to ART should be simple, scalable, and sustainable.

—Amanda Balbi

 

Reference:

Sereti I. Inflammation: Taming the flames. Session presented at: Conference on Retroviruses and Opportunistic Infections 2019; March 4-7, 2019; Seattle, WA. http://www.croiconference.org/sessions/inflammation-taming-flames. Accessed March 7, 2019.