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Persistent inflammatory activation in people living with HIV. Involvement in atherosclerosis

Francisco Illanes-Álvarez1,2,3, Denisse Márquez-Ruiz1,2,3, Sara Cuesta-Sancho1,2,4

  • 1Servicio de Medicina Interna, Hospital Universitario Puerta del Mar, Cádiz, Spain.

Frontiers in Medicine
|July 28, 2025
PubMed

Insights

People living with HIV (PLWH) show higher inflammatory and platelet markers, linked to atherosclerosis. Cardiovascular risk factors and inflammation independently impact subclinical atherosclerosis in PLWH.

Area of Science:

  • Cardiovascular Health
  • Infectious Diseases
  • Immunology

Background:

  • Increased atherosclerosis prevalence observed in people living with HIV (PLWH).
  • HIV infection is associated with chronic inflammation and immune dysregulation.
  • Subclinical atherosclerosis poses a significant health risk for PLWH.

Purpose of the Study:

  • To analyze inflammatory, immune, endothelial, platelet, and coagulation parameters in PLWH.
  • To investigate the relationship between these markers and subclinical atherosclerosis.
  • To identify factors influencing atherosclerosis development in PLWH.

Main Methods:

  • Study included 120 PLWH and 30 HIV-uninfected controls.
  • Measured serum levels of inflammatory markers (IL-6, sCD163, hs-CRP), NET-derived parameters, activated T lymphocytes, endothelial markers (E-selectin, VCAM-1), platelet markers (P-selectin, PF4), and coagulation markers (D-dimer).
  • Assessed subclinical atherosclerosis using carotid Doppler ultrasound in a subset of participants.

Main Results:

  • PLWH exhibited elevated levels of IL-6, sCD163, anti-nucleosome antibodies, activated T lymphocytes, platelet factor 4, and D-dimer compared to controls.
  • PLWH with carotid atherosclerotic lesions had higher cardiovascular risk scores (REGICOR, ASCVD) and IL-6 levels.
  • REGICOR score and IL-6 serum levels were identified as independent factors associated with atherosclerosis.

Conclusions:

  • Long-term viral load control in PLWH is associated with increased inflammatory, immune, platelet, and coagulation markers.
  • Subclinical atherosclerosis in PLWH is independently influenced by traditional cardiovascular risk factors and heightened inflammatory activation.
Abstract

Keywords:
HIVatherosclerosiscardiovascular risk factorsendothelial activationplatelet activationproinflammatory cytokines

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