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Soluble endothelial protein C receptor (sEPCR) as an inflammatory biomarker in naive HIV-infected patients during ART
S Chiappetta1, M Ripa2, L Galli3
1IRCCS San Raffaele Scientific Institute, Milan, Italy Università Vita-Salute San Raffaele, Medicina e Chirurgia, Milan, Italy chiappetta.stefania@hsr.it.
Insights
Soluble endothelial protein C receptor (sEPCR) significantly decreased in HIV patients on antiretroviral therapy (ART). sEPCR levels correlated with immune recovery and viral load reduction, suggesting its role in chronic HIV infection management.
Area of Science:
- Infectious Diseases
- Immunology
- Hematology
Background:
- Non-AIDS-related comorbidities are leading causes of mortality in HIV patients post-antiretroviral therapy (ART).
- Soluble endothelial protein C receptor (sEPCR) is a potential biomarker for disease monitoring in HIV.
- Understanding sEPCR dynamics is crucial for managing HIV-associated comorbidities.
Purpose of the Study:
- To determine if sEPCR levels decrease after 48 weeks of ART in ART-naive HIV patients.
- To compare sEPCR levels between chronic HIV infection (CHI) and primary HIV infection (PHI).
- To analyze the correlation between sEPCR and immunovirological parameters (HIV RNA, CD4 count) and inflammation markers (IL-6, D-dimer).
Main Methods:
- Analysis of sEPCR in 33 CHI and 19 PHI patients naive to ART.
- Comparison of sEPCR with HIV RNA, CD4 cell count, IL-6, and D-dimer (DD).
- Assessment of changes after 48 weeks of ART.
Main Results:
- In CHI patients, sEPCR significantly decreased after 48 weeks of ART (P=.0006).
- Baseline sEPCR correlated with CD4 cell increase (r=+0.463, P=.007) and HIV RNA decrease (r=-0.363, P=.038) in CHI patients.
- In PHI patients, sEPCR remained stable (P=.35), but correlations were found between D-dimer and IL-6 changes, and between D-dimer and sEPCR changes.
Conclusions:
- sEPCR decrease after ART suggests its role in reflecting endothelial damage and coagulant pathway activation in chronic HIV infection.
- In primary HIV infection, sEPCR may indirectly indicate inflammation through its association with IL-6 and D-dimer.
- Further research with larger sample sizes is needed to confirm these findings and elucidate the precise role of sEPCR in HIV pathogenesis and management.
Background:
After the advent of ART, non-AIDS-related comorbidities are the main causes of death in HIV patients. Multiple biomarkers have been studied as markers of disease. We wanted to test soluble endothelial protein C receptor (sEPCR) in an HIV setting.
Objectives:
The primary objective was to determine whether sEPCR decreases after 48 weeks of ART in naive HIV patients. Secondary objectives were to compare sEPCR levels between patients with chronic HIV infection (CHI) and primary HIV infection (PHI) and to analyse if there is a correlation between sEPCR and both immunovirological parameters and different markers of inflammation.
Patients And Methods:
We analysed sEPCR in 33 patients with CHI and 19 patients with PHI naive to ART. sEPCR was compared together with immunovirological parameters (HIV RNA and CD4 cell count) and IL-6 or D-dimer (DD).
Results And Conclusions:
After 48 weeks of ART, in CHI, the sEPCR decrease was significant (P = 0.0006) and sEPCR at baseline was correlated with both CD4 cell increase (r = +0.463, P = 0.007) and HIV RNA decrease (r = -0.363, P = 0.038). In PHI, sEPCR was stable (P = 0.35); there was a correlation between 48 week DD change and IL-6 change (r = +0.696, P = 0.0009) and also between 48 week DD change and sEPCR change (r = +0.553, P = 0.014). Despite the small sample size, we hypothesize that sEPCR levels reflect coagulant pathway activation caused by the endothelial damage during chronic infection more than a marker of the cytokine storm that occurs during PHI. Alternatively, in PHI, the link found between sEPCR and DD secondary to IL-6 suggests sEPCR is an indirect marker of inflammation.
