article · Japanese Journal of Infectious Diseases
Persistent immune activation and immune exhaustion during HIV infection are linked to non-AIDS complications. An investigation of 365 newly diagnosed individuals living with HIV in Dar es Salaam, Tanzania, assessed markers of monocyte activation, platelet activation, T-cell activation, and T-cell exhaustion before initiating antiretroviral therapy. Participants were drawn from a trial testing the effects of aspirin. Most patients presented with low CD4 counts and high viral loads, with a notable group aged over fifty years. The findings reveal that older age significantly predicts higher immune activation and exhaustion, but does not predict platelet activation. Furthermore, markers of immune activation and exhaustion correlated directly with HIV viral load and inversely with CD4 cell counts. These findings suggest that future adjunctive therapies aimed at curbing inflammation-driven complications should target older individuals presenting with low CD4 counts and high viral loads right at the start of antiretroviral treatment.
Even with antiretroviral drugs, ongoing immune activation can lead to long-term health complications and early death for people living with HIV. Identifying the specific patient groups most vulnerable to persistent inflammation allows healthcare providers to plan targeted clinical interventions. This understanding helps guide the delivery of supplemental treatments right at the beginning of HIV care to reduce long-term, non-AIDS health risks.
This early-stage observational research highlights patient groups that could benefit from adjunctive therapies alongside standard antiretroviral regimens. Potential users include pharmaceutical developers and clinical researchers designing targeted intervention strategies or clinical trials for anti-inflammatory therapies. The work remains at an early, exploratory stage, establishing clinical correlates rather than a finalised product or near-market treatment protocol.
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Chronic inflammation and persistent immune activation (IA) during HIV infection are associated with non-AIDS complications. We investigated sociodemographic and clinical characteristics influencing IA and exhaustion (IE), and platelet activation (PA) in newly diagnosed people living with HIV (PLHIV) and identified modifiable factors for early interventions. We analysed baseline blood samples from 365 PLHIV participating in a trial investigating the effect of aspirin on IA, IE, and PA. We assessed levels of markers of monocyte activation (soluble CD14), platelet activation (soluble P-selectin), T-cell activation (CD4⁺ and CD8⁺ expressing CD69 and co-expressing CD38 and HLA-DR), and T-cell exhaustion (PD-1). The median (IQR) age of the participants was 37 (28, 45) years, with females comprising 64.7%. Advanced age significantly predicted IA and IE, but not PA. Markers of IA and IE, but not of PA, inversely correlated with CD4 counts, while directly with HIV viral load (HVL). We show that most Tanzanian PLHIV initiating antiretroviral therapy (ART) have low CD4 count, high HVL, with a considerable proportion aged above 50 years, characteristics associated with heightened IA and IE. Adjunctive therapy, when available, should target such population and at ART initiation to prevent morbidity and mortality associated with persistent IA and IE.
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DOI: 10.7883/yoken.jjid.2025.104
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