Mediterranean diet adherence and systemic inflammation in people with HIV and PrEP users

Chronic low-grade inflammation contributes to long-term morbidity in people with HIV (PWH). Individuals using pre-exposure prophylaxis (PrEP) may share lifestyle factors associated with immune activation. We evaluated whether adherence to the Mediterranean diet, assessed using the Mediterranean Diet Quality Index (MED-DQI), is associated with inflammation in PWH and PrEP users.

We conducted a cross-sectional study of 82 MSM (24 PWH and 58 PrEP users). We calculated MED-DQI from 3-day dietary records and measured 45 plasma cytokines by multiplex immunoassay. Cytokine values were ln-transformed, standardized to Z-scores, and combined into a global inflammatory index as the primary outcome. We analyzed associations using Student's t-test, odds ratios (OR), and multivariable linear regression, adjusting for age, BMI, physical activity, alcohol intake, total energy intake, and recreational drug use.

Diet quality did not differ between groups (PWH 7.3 ± 1.9; PrEP 7.4 ± 1.6). Participants with lower adherence (MED-DQI ≥ 8) had a higher inflammatory index than those with better adherence (MED-DQI ≤ 7) (mean difference -0.34; 95% CI -0.62 to -0.07; p = 0.016) and higher odds of elevated inflammation (OR 2.46; 95% CI 1.01 to 6.02; p = 0.038). Of the 45 cytokines analyzed, 24 were significantly associated with MED-DQI (p < 0.05), and all remained significant after FDR correction (Benjamini-Hochberg; qFDR < 0.10). Multiple linear regression analyses confirmed these findings; IL-17A was associated with an approximately 18% higher concentration per one-point increase in MED-DQI (β = 0.165), reflecting greater inflammation with poorer adherence to the Mediterranean diet.

Our study found that adherence to the Mediterranean diet was associated with a lower global inflammatory index in both PWH and PrEP users. Lower adherence was associated with higher global inflammatory index values and elevated cytokine concentrations, suggesting differences in systemic immune activation. Even modest differences in diet quality were reflected in variations across the cytokine profile. No differences were observed between groups, suggesting these patterns were more closely associated with diet quality than group status. Diet quality may be a modifiable factor associated with inflammatory profiles. Mediterranean dietary approaches could represent a strategy to address chronic low-grade inflammation.