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Protease inhibitor monotherapy is associated with a higher level of monocyte activation, bacterial translocation and inflammation

INTRODUCTION: Monotherapy with protease-inhibitors (MPI) may be an alternative to cART for HIV treatment. We assessed the impact of this strategy on immune activation, bacterial translocation and inflammation. METHODS: We performed a cross-sectional study comparing patients on successful MPI (n=40)...

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Detalles Bibliográficos
Autores principales: Torres, Berta, Guardo, Alberto C, Leal, Lorna, Leon, Agathe, Lucero, Constanza, Alvarez-Martinez, Míriam J, Martinez, Miguel J, Vila, Jordi, Martínez-Rebollar, María, González-Cordón, Ana, Gatell, Josep M, Plana, Montserrat, García, Felipe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185085/
https://www.ncbi.nlm.nih.gov/pubmed/25280865
http://dx.doi.org/10.7448/IAS.17.1.19246
Descripción
Sumario:INTRODUCTION: Monotherapy with protease-inhibitors (MPI) may be an alternative to cART for HIV treatment. We assessed the impact of this strategy on immune activation, bacterial translocation and inflammation. METHODS: We performed a cross-sectional study comparing patients on successful MPI (n=40) with patients on cART (n=20). Activation, senescence, exhaustion and differentiation stage in CD4+ and CD8+ T lymphocyte subsets, markers of monocyte activation, microbial translocation, inflammation, coagulation and low-level viremia were assessed. RESULTS: CD4+ or CD8+ T lymphocyte subset parameters were not significantly different between both groups. Conversely, as compared with triple cART, MPI patients showed a higher proportion of activated monocytes (CD14+ CD16−CD163+ cells, p=0.031), soluble markers of monocyte activation (sCD14 p=0.004, sCD163 p=0.002), microbial translocation (lipopolysaccharide (LPS)-binding protein; LBP p=0.07), inflammation (IL-6 p=0.04) and low-level viremia (p=0.035). In a multivariate model, a higher level of CD14+ CD16−CD163+ cells and sCD14, and presence of very low-level viremia were independently associated with MPI. Monocyte activation was independently associated with markers of inflammation (IL-6, p=0.006), microbial translocation (LBP, p=0.01) and low-level viremia (p=0.01). CONCLUSIONS: Patients on MPI showed a higher level of monocyte activation than patients on standard therapy. Microbial translocation and low-level viremia were associated with the high level of monocyte activation observed in patients on MPI. The long-term clinical consequences of these findings should be assessed.