Higher ART Adherence Is Associated With Lower Systemic Inflammation in Treatment-Naive Ugandans Who Achieve Virologic Suppression

Authors

Jose R. Castillo-Mancilla, University of Colorado Anschutz Medical CampusFollow
Mary Morrow, University of Colorado Anschutz Medical Campus
Yap Boum, Epicentre, MSFFollow
Helen Byakwaga, Mbarara University of Science and Technology
Jessica E. Haberer, Massachusetts General Hospital and Harvard Medical SchoolFollow
Jeffrey N. Martin, University of California San FranciscoFollow
David Bangsberg, Portland State UniversityFollow
Samantha Mawhinney, University of Colorado Anschutz Medical Campus
Nicholas Musinguzi, Mbarara University of Science and TechnologyFollow
Yong Huang, University of California San FranciscoFollow
Russell P. Tracy, University of VermontFollow
Tricia H. Burdo, Temple University
Kenneth Williams, Boston CollegeFollow
Conrad Muzzora, Mbarara University of Science and TechnologyFollow
Peter W. Hunt, University of California San FranciscoFollow
Mark J. Siedner, Mbarara University of Science and TechnologyFollow

Published In

Journal Of Acquired Immune Deficiency Syndromes

Document Type

Citation

Publication Date

4-15-2018

Abstract

Background: Residual systemic inflammation persists despite suppressive antiretroviral therapy (ART) and is associated with non-AIDS clinical outcomes. We aimed to evaluate the association between ART adherence and inflammation in Ugandans living with HIV who were predominantly receiving nevirapine-based ART with a thymidine analog backbone and were virologically suppressed by conventional assays.

Methods: Plasma concentrations of interleukin-6 (IL-6), D-dimer, soluble (s)CD14, sCD163, and the kynurenine/tryptophan ratio, in addition to CD8+ T-cell activation, were measured at baseline and 6 months after ART initiation in treatment-naive adults who achieved an undetectable plasma HIV RNA (/mL) at their 6-month visit. Adherence was measured through medication event monitoring system and calculated as the ratio of observed/prescribed device openings per participant. We fit adjusted linear regression models to estimate the association between ART adherence and the log-transformed plasma concentrations of inflammatory biomarkers.

Results: We evaluated 282 participants (median age, 35 years; 70% women). The median (interquartile range) adherence was 93% (84–98). In the adjusted analyses, for every 10% increase in average ART adherence, we found a 15% [P < 0.0001; 95% confidence interval (CI), −21.0 to −7.9], 11% (P = 0.017; 95% CI, −18.3 to −2.0), and 3% (P = 0.028; 95% CI, −5.0 to −0.3) decrease in IL-6, D-dimer, and sCD14, respectively.

Conclusions: Higher ART adherence was associated with lower levels of biomarkers of inflammation, immune activation, and coagulopathy among Ugandans living with HIV who achieved viral suppression shortly after ART initiation. This suggests that ART adherence could have biological consequences beyond viral suppression. Whether ART adherence optimization in virologically suppressed individuals could reduce residual inflammation remains unknown.

Locate the Document

https://doi.org/10.1097/QAI.0000000000001629

DOI

10.1097/QAI.0000000000001629

Persistent Identifier

https://archives.pdx.edu/ds/psu/27278

Citation Details

Castillo-Mancilla, J. R., Morrow, M., Boum, Y., Byakwaga, H., Haberer, J. E., Martin, J. N., … Siedner, M. J. (2018). Brief Report: Higher ART Adherence Is Associated With Lower Systemic Inflammation in Treatment-Naive Ugandans Who Achieve Virologic Suppression. Journal Of Acquired Immune Deficiency Syndromes (1999), 77(5), 507–513. https://doi.org/10.1097/QAI.0000000000001629