title: Persistent microbial translocation and immune activation in HIV-1-infected South Africans receiving combination antiretroviral therapy.
abstract: BACKGROUND
  Microbial translocation contributes to immune activation and disease progression during chronic human immunodeficiency virus type 1 (HIV-1) infection. However, its role in the African AIDS epidemic remains controversial. Here, we investigated the relationship between markers of monocyte activation, plasma lipopolysaccharide (LPS), and HIV-1 RNA in South Africans prioritized to receive combination antiretroviral therapy (cART).
  
  
  METHODS
  Ten HIV-1-negative African controls and 80 HIV-1-infected patients with CD4 T cell counts <200 cells/microL were sampled prior to (n=60) or during (n=20) receipt of effective cART. Viral load was measured by Nuclisens; LPS by the Limulus amoebocyte lysate assay; monocyte and T cell subsets by flow cytometry; and soluble CD14, cytokines, and chemokines by enzyme-linked immunosorbent assay and customized Bio-Plex plates.
  
  
  RESULTS
  Three distinct sets of markers were identified. CCL2, CXCL10, and CD14(+)CD16(+) monocyte levels were positively correlated with HIV-1 viremia. This finding, together with cART-induced normalization of these markers, suggests that their upregulation was driven by HIV-1. Plasma interleukin-6 was associated with the presence of opportunistic coinfections. Soluble CD14 and tumor necrosis factor were linked to plasma LPS levels and, as observed for LPS, remained elevated in patients receiving effective cART.
  
  
  CONCLUSIONS
  Microbial translocation is a major force driving chronic inflammation in HIV-infected Africans receiving cART. Prevention of monocyte activation may be especially effective at enhancing therapeutic outcomes.
authors.affiliation: MRC Unit for Inflammation and Immunity, Department of Immunology, Faculty of Health Sciences, University of Pretoria and the Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa. edana_cassol@dfci.harvard.edu
authors.forename: Edana
authors.initials: E
authors.lastname: Cassol
authors.forename: Susan
authors.initials: S
authors.lastname: Malfeld
authors.forename: Phetole
authors.initials: P
authors.lastname: Mahasha
authors.forename: Schalk
authors.initials: S
authors.lastname: van der Merwe
authors.forename: Sharon
authors.initials: S
authors.lastname: Cassol
authors.forename: Chris
authors.initials: C
authors.lastname: Seebregts
authors.forename: Massimo
authors.initials: M
authors.lastname: Alfano
authors.forename: Guido
authors.initials: G
authors.lastname: Poli
authors.forename: Theresa
authors.initials: T
authors.lastname: Rossouw
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology* / Q000382:microbiology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000276:immunology; D006801:Humans; D008070:Lipopolysaccharides / Q000097:blood*; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D008070:Lipopolysaccharides; D012367:RNA, Viral