Abstract:
Background: Cytokines network impact on Human Immunodeficiency Virus (HIV)
pathogenesis, viral latency; infection reservoirs; persistent immune activation and
chronic inflammation. Highly Active Antiretroviral Therapy (HAART) maintains low
HIV Viral Load (VL) but immune activation level and chronic inflammation remain
high in HIV infected /AIDS individuals compared to HIV naïve population.
Immunological markers to assess immune status, chronic inflammation in HIV
infected /AIDS individuals have not been resolved.
Objective: To determine plasma cytokine levels, peripheral T cell activation markers
and their relationship with HIV VL in HIV infected /AIDS individuals initiating and
those who had completed six months on HAART in Rwanda.
Methods: This was a comparative cross sectional study in HAART naïve and with
HAART for six months for population above 18 years in five provinces of Rwanda.
The matching groups approach based on sex and systematic sampling within the
groups were used to enroll fifty patients in each group. Fifteen HIV naive individuals
were included in the study as controls. Flow cytometry was used to determine
cytokine levels and T cell activation markers expression while a revised WHO
questionnaire was used to collect sociodemographic and clinical data for study
subjects. R Studio statistic package and graph Pad Prism 7 package were used for
descriptive and analytical statistic of the data at initiation and after six months of
HAART treatment to address specific objectives. Statistical significance differences
and the correlation between assessed parameters were determined at p-value ≤0.05.
Results: At the initiation of HAART, Interleukin (IL)-2, IL-10, IL-6 plasma levels,
Cluster of Differentiation (CD)69, CD154 expression were high while IFN-γ and
TNF-α were low compared to its levels after six months HAART. There was no
statistically significant difference between CD69 and CD154 activation markers coexpression
on CD8+T cell at initiation and after six months of HAART (p-value =
0.167). IL-10, IL- 6 and CD69 expression on CD4+T cell correlated more with HIV
VL (p value = 0.001).
Conclusions: Th-2 cytokines milieu mediate HIV/AIDS immunity before HAART
and tended to shift to Th-1 cytokines milieu following successful HAART treatment
after six months. CD69 and CD154 express differently on T cells at initiation and
after six months of HAART. IL- 6, IL-10 plasma level and CD69 T cell activation
markers are good correlate for HIV VL.
Recommendations: This study recommended IL-10, IL-6 plasma levels and CD69
expression on CD4+T cell as alternative immunological biomarkers and a longitudinal
study design that to address cytokine levels, T cell activation markers expression and T
cell exhaustion in HIV/AIDS.