Systemic inflammation and liver damage in HIV/hepatitis C virus coinfection

Abstract

Objectives: Chronic hepatitis C virus (HCV) and HIV viral infections are characterized by systemic inflammation. Yet the relative levels, drivers and correlates of inflammation in these settings are not well defined.

Methods: Seventy-nine HIV-infected patients who had been receiving antiretroviral therapy (ART) for more than 2 years and who had suppressed plasma HIV levels (< 50 HIV-1 RNA copies/mL) were included in the study. Two patient groups, HCV-positive/HIV-positive and HCV-negative/HIV-positive, and a control group comprised of healthy volunteers (n = 20) were examined. Markers of systemic inflammation [interleukin (IL)-6, interferon gamma-induced protein (IP)-10, soluble tumour necrosis factor receptor-I (sTNF-RI) and sTNF-RII], monocyte/macrophage activation [soluble CD163 (sCD163), soluble CD14 and neopterin], intestinal epithelial barrier loss [intestinal fatty acid binding protein (I-FABP) and lipopolysaccharide (LPS)] and coagulation (d-dimers) were analysed. CD4 naïve T cells and CD4 recent thymic emigrants (RTEs) were enumerated.

Results: Plasma levels of IP-10, neopterin and sCD163 were higher in HCV/HIV coinfection than in HIV monoinfection and were positively correlated with indices of hepatic damage [aspartate aminotransferase (AST), alanine aminotransferase (ALT) and the AST to platelet ratio index (APRI)]. Levels of I-FABP were comparably increased in HIV monoinfection and HIV/HCV coinfection but LPS concentrations were highest in HCV/HIV coinfection, suggesting impaired hepatic clearance of LPS. Plasma HCV levels were not related to any inflammatory indices except sCD163. In coinfected subjects, a previously recognized relationship of CD4 naïve T-cell and RTE counts to hepatocellular injury was defined more mechanistically by an inverse relationship to sCD163.

Conclusions: Hepatocellular injury in HCV/HIV coinfection is linked to elevated levels of certain inflammatory cytokines and an apparent failure to clear systemically translocated microbial products. A related decrease in CD4 naïve T cells and RTEs also merits further exploration.

Keywords: CD31; HIV infections; antigens; hepatitis C; highly active antiretroviral therapy; inflammation mediators.

Fig. 1. Plasma indicators of systemic inflammation in HCV/HIV co-infected patients

Plasma concentrations of IL-6, IP-10, sCD163, neopterin, sTNF-RII and sCD14 are shown in three patient groups: co-infected with HCV/HIV, HIV monoinfected, and healthy volunteers without HIV or HCV infection. Columns with horizontal lines show medians with interquartile ranges. * – P<0.05; ** – P<0.01; *** – P<0.001 (Mann-Whitney test).

Fig. 2. Plasma concentrations of I-FABP, LPS and D-dimers in HCV/HIV coinfected and HIV monoinfected patients

Three patient groups are shown: HCV/HIV co-infected, HIV monoinfected, and healthy uninfected volunteers. Medians, interquartile ranges, upper and lower ranges are presented. ** – P <0.01; *** – P <0.001 (Mann-Whitney test).

Fig. 3. Relationship between hepatocellular damage and indices of systemic inflammation

Correlation analysis was performed using the Spearman method.

Fig. 4. Relationship between numbers of CD4⁺ recent thymic emigrants, naïve CD4⁺ T cell counts and plasma sCD163 levels in HCV/HIV co-infected subjects

Correlation analysis was performed using Spearman method.