Inflammation and gut leakage remains elevated in people with HIV despite early antiretroviral treatment

Liz Highleyman
Original Article:

Inflammatory changes and damage to the gut begin very soon after initial HIV infection, and may not return to normal even when people start antiretroviral therapy (ART) very early, researchers reported at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI) last month in Seattle. Biomarkers of inflammation, coagulation and fibrosis increased early on, and while they generally decreased after starting ART, they did not fall to levels seen in HIV-negative people.
Netanya Sandler Utay of the University of Texas Medical Branch, Jintanat Ananworanich of the US Military HIV Research Program and colleagues aimed to determine whether ART started during acute HIV infection would normalise biomarkers of gut damage, inflammation and coagulation that predict morbidity and mortality during chronic HIV infection.

This analysis included 78 participants in the on-going SEARCH (RV254) study who were diagnosed during acute HIV infection and started ART within 0 to 5 days. The cohort is made up of people who sought HIV testing in Bangkok, Thailand, most of whom are men who have sex with men. More than 90% were male and the median age was 28 years. There was also a control group of 109 people without HIV infection; this group was matched for age but included more women (23%).

Among the HIV-positive participants, the median CD4 T-cell count at study entry was 384 cells/mm3 (range 293-525) and the median HIV viral load was 5.6 log10 copies/ml. Using Ananworanich’s 4th generation staging system, 20 people were diagnosed during stage 1 of infection (HIV RNA positive; median 12 days after HIV acquisition), 15 during stage 2 (p24 antigen positive; median 16 days) and 43 during stage 3 (HIV antibody positive; median 18 days). About 40% started a standard ART regimen consisting of efavirenz (Sustiva) plus tenofovir/emtricitabine (the drugs in Truvada), while more than half started a more intensive regimen containing the same three drugs plus maraviroc (Celsentri/Selzentry) and raltegravir (Isentress).

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