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Review
. 2017 Dec;14(6):220-228.
doi: 10.1007/s11904-017-0366-8.

Sex Differences in Select Non-communicable HIV-Associated Comorbidities: Exploring the Role of Systemic Immune Activation/Inflammation

Avanthi Raghavan  1 , Dodie E Rimmelin  1 , Kathleen V Fitch  1 , Markella V Zanni  2
Affiliations
Review

Sex Differences in Select Non-communicable HIV-Associated Comorbidities: Exploring the Role of Systemic Immune Activation/Inflammation

Avanthi Raghavan et al. Curr HIV/AIDS Rep. 2017 Dec.

Abstract

Purpose of the review: The goals of this review are to (1) explore HIV-associated cardiovascular disease (CVD), neurocognitive impairment, and non-AIDS-defining cancers (NADC) as heterogeneous model disease states fuelled in part by systemic immune activation/inflammation; (2) consider sex differences in the epidemiology of these diseases in both high-resource and lower-resource settings; and (3) examine biological and environmental factors which may contribute to heightened systemic immune activation/inflammation specifically among women living with HIV (WLHIV).

Recent findings: The observation that WLHIV have higher levels of systemic immune activation/inflammation than men living with HIV (MLHIV) may be relevant to sex differences in select non-communicable HIV-associated comorbidities. Heightened systemic immune activation among WLHIV may be influenced by sex-specific responses to the virus and to immunomodulatory agents, as well as by behavioral choices/comorbid conditions and perturbations in the hypothalamic-pituitary-gonadal axis. Additional research is needed to elucidate region-specific drivers of heightened systemic immune activation/inflammation among WLHIV and to determine whether WLHIV who present with one immune-mediated HIV-associated comorbidity (e.g., cognitive impairment) may be at increased risk for another (e.g., CVD, NADC). This kind of research would facilitate improved risk prediction for non-communicable HIV-associated comorbidities among WLHIV and the development of targeted immunomodulatory prevention strategies.

Keywords: HIV; Inflammation; Non-communicable diseases; Sex differences; Women.

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Conflict of interest statement

Conflicts of interest: Dr. Zanni received grant support to her institution from Gilead Sciences. She has also participated in a Scientific Advisory Board Meeting for Roche Diagnostics.

Avanthi Raghavan, Dodie Rimmelin, and Kathleen V. Fitch declare no conflict of interest.

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