IL-17/IL-10 ratio and Viral Load changes in HIV-1 Patients on First-Line Antiretroviral Therapy at Moi Teaching And Referral Hospital, Kenya

Abstract

Abstract Background Persistent low-level viremia (pLLV) in HIV-1 patients on combination antiretroviral therapy (cART) poses a clinical challenge, potentially driving immune activation and increasing the risk of virologic rebound. While the IL-17/IL-10 ratio plays a key role in immune regulation, its significance in pLLV remains under-explored, particularly in sub-Saharan Africa. This study assessed the variations in viral load (VL), with IL-17/IL-10 ratio in HIV-1 patients on first-line cART at Moi Teaching And Referral Hospital, Kenya. Objective To determine the viral load and evaluate the IL-17/IL-10 ratio in HIV-1 patients on first-line cART with persistent low-level viremia compared to virally suppressed patients at Moi Teaching And Referral Hospital, Kenya. Methodology This cross-sectional study recruited 82 HIV-1 patients on first-line cART, 41 pLLV (VL 50–500 copies/ml), and 41 virally suppressed participants (VL <50 copies/ml), age and gender matched 1:1. Patients were purposively sampled from the Moi Teaching And Referral Hospital, Medical Records System (MRS) from January 2021 to December 2022. Blood samples were collected in EDTA and analysed for IL-17 and IL-10 via ELISA (Zeptometrix, USA). Viral loads were determined using Abbott Real-Time PCR (version 4.0, USA). The IL-17/IL-10 ratios were calculated to evaluate immune balance. Data was analyzed using STATA version 15. Mann-Whitney U-test was used to compare ratios between the groups; p ≤ 0.05 was considered statistically significant. Results The median (IQR) VL in the studied HIV-1 patients with pLLV was 407.5 (314.5-445.0) copies/ml. HIV-1-suppressed patients had a slightly higher mean IL-17/IL-10 ratio of 0.556 vs 0.552 in pLLV, P=0.433, and was positively correlated (rho= 0.453, p=0.003) to reduced viral load and hence viral suppression. The odds (95% CI) of being suppressed were decreased by IL-17, 0.938(0.691-1.273), but increased by IL-10, 1.106(0.675-1.811), though not statistically significant. Conclusion The study found no statistically significant difference in IL-17/IL-10 ratios between pLLV and virally suppressed HIV-1 patients on cART. While these findings suggest a possible involvement of IL-17/IL-10 immune balance in viral control, they remain exploratory. Further research with larger cohorts is needed to clarify these relationships and to determine whether cytokine biomarkers could complement existing tools for monitoring treatment responses in resource-limited settings. Recommendation Given the exploratory nature of the findings, it is recommended that future studies investigate the role of inflammation/anti-inflammatory cytokine ratios, such as IL-17/IL-10, in larger and more diverse HIV-1 patient cohorts. Incorporating these biomarkers into clinical research may provide additional insights into immune regulation and treatment response, particularly in settings where viral load testing is limited. Validation of these cytokine ratios could support the development of cost-effective adjunct tools for HIV-1 monitoring and management in resource-constrained environments.