Inflammatory profiles in older people with and without HIV in rural Uganda

Although the risk of chronic inflammation among people living with HIV is well established in younger individuals, it is less well understood whether these relationships are persistent in older people living with HIV with long-term virologic suppression. Such data are particularly sparse in sub-Saharan Africa.

We assessed five inflammatory biomarkers (hs-CRP, sCD14, sCD163, D-dimer and FABP-2) among 290 older (antiretroviral therapy) ART-treated people living with HIV and an age-similar cohort of people without HIV in rural Uganda. We fit linear and logistic multivariable regression models with each biomarker as the outcome of interest, HIV serostatus as the primary exposure of interest, and age and sex as secondary exposures. Interaction terms between HIV and either age or sex were also explored.

Among 591 participants, 49% (n = 290) were people living with HIV and 49% (n = 290) were women, the median age was 57 years (interquartile range 53-61). Adjusted linear analyses showed that people living with HIV had higher levels of sCD163 (β = 0.307, p < 0.001), D-dimer (β = 0.223, p < 0.01), and FABP-2 (β = 0.627, p < 0.001) than people without HIV. However, HIV did not modify relationships between increasing age and inflammation. In sub-analyses, we found that people living with HIV had lower levels of hs-CRP with each additional 10 years of age (β = -0.231, p < 0.01) and that women had higher D-dimer (p = 0.01), lower hs-CRP (p < 0.01) and greater increases in sCD163 with increasing age (β = 0.276, p < 0.01) than men.

Although older people living with HIV in Uganda tend to have higher biomarkers of inflammation than people without HIV, these differences appear to be stable with increasing age. Notably, older women with and without HIV tended to have higher levels of sCD163, which were exacerbated with increasing age.