Antiretroviral Therapy Adherence Interruptions Are Associated With Systemic Inflammation Among Ugandans Who Achieved Viral Suppression.

Authors: Musinguzi N Castillo-Mancilla J Morrow M Byakwaga H Mawhinney S Burdo TH Boum Y Muzoora C Bwana BM Siedner MJ Martin JN Hunt PW Bangsberg DR Haberer JE
Journal Reference: Journal of acquired immune deficiency syndromes (1999) 2019 Dec 01; 82(4); 386-391. doi: 10.1097/QAI.0000000000002148. Epub 2019 11 01


BACKGROUND: Residual systemic inflammation, which is associated with non-AIDS clinical outcomes, may persist despite viral suppression. We assessed the effect of antiretroviral therapy (ART) adherence interruptions on systemic inflammation among Ugandans living with HIV who were virally suppressed.

SETTING: We evaluated adults initiating first-line ART at a regional referral hospital clinic in Mbarara, Uganda.

METHODS: Plasma concentrations of interleukin-6 (IL-6), D-dimer, soluble sCD14, sCD163, the kynurenine/tryptophan (K/T) ratio, and CD8 T-cell activation (HLA-DR/CD38 coexpression) were measured at baseline and 6 months after ART initiation among participants who achieved viral suppression (

RESULTS: Of 282 participants, 70% were women, and the median age was 34 years. At baseline, median CD4 and median log viral load were 135 cells per microliter and 5.1 copies per milliliter, respectively. In the adjusted analysis, a running average adherence of

CONCLUSIONS: Increased time spent in adherence interruptions is associated with increased levels of inflammation, despite viral suppression above and beyond average adherence.