title: Systemic inflammation and residual viraemia in HIV-positive adults on protease inhibitor monotherapy: a cross-sectional study.
abstract: BACKGROUND
  Increased levels of markers of systemic inflammation have been associated with serious non-AIDS events even in patients on fully suppressive antiretroviral therapy. We explored residual viremia and systemic inflammation markers in patients effectively treated with ritonavir-boosted protease inhibitor monotherapy (PImono).
  
  
  METHODS
  HIV-infected adults with persistent HIV-RNA<50 copies/ml and treated with either a) PImono or b) standard triple-drug cART were recruited for this cross-sectional, exploratory study. Plasma samples were tested for high-sensitivity CRP (hsCRP), Serum Amyloid A (SAA), soluble CD14, IL-6, IL-8 and Cytochrome C. HIV-RNA was measured by real-time PCR (detection limit of 10 copies/ml).
  
  
  RESULTS
  81 patients were recruited (31% on PImono). Two out of 25 (8%) and 3 of 56 (5.4%) patients from the PImono and cART groups respectively had detectable HIV-RNA. Significant correlation between SAA and hsCRP was observed (0.804). No difference between groups was found on prevalence of hsCRP>3 mg/l (21% vs 20% in the PImono and cART groups respectively; p=0.577) or SAA>6.4 mg/l (38% vs 22% in the PImono and cART groups respectively; P=0.172). In a univariate analysis IL6 and IL8 levels were associated with SAA>6.4 mg/l (OR=1.74 and 1.46; 95% CI=1.00-3.03 and 1.06-2.01; p=0.051 and 0.02 respectively) and hsCRP>3 mg/l in (OR=2.00 and 1.37; 95% CI=1.09-3.69 and 1.02-1.85; p=0.026 and 0.039 respectively).
  
  
  CONCLUSIONS
  We found no evidence of increased levels of inflammatory biomarkers or higher prevalence of residual viraemia in patients effectively suppressed on PImono as compared with patients on standard cART.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK. A.Arenas-Pinto@ucl.ac.uk.|MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK. A.Arenas-Pinto@ucl.ac.uk.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Arenas-Pinto
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK. A.Milinkovic@ucl.ac.uk.
authors.forename: Ana
authors.initials: A
authors.lastname: Milinkovic
authors.affiliation: The Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK. dimitra.peppa@nhs.net.|Research Department of Infection and Immunity, University College London, London, UK. dimitra.peppa@nhs.net.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Peppa
authors.affiliation: The Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK. amckendry@doctors.org.uk.
authors.forename: Anna
authors.initials: A
authors.lastname: McKendry
authors.affiliation: Research Department of Infection and Immunity, University College London, London, UK. M.Maini@ucl.ac.uk.
authors.forename: Mala
authors.initials: M
authors.lastname: Maini
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK. R.Gilson@ucl.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000627:therapeutic use*; D019438:Ritonavir / Q000627:therapeutic use*; D000685:Serum Amyloid A Protein / Q000032:analysis; D014766:Viremia / Q000150:complications / Q000188:drug therapy*
chemical_list: D015415:Biomarkers; D017320:HIV Protease Inhibitors; D015850:Interleukin-6; D016209:Interleukin-8; D011480:Protease Inhibitors; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein; D019438:Ritonavir