Sociodemographic and clinical correlates of markers of immune activation, exhaustion and platelet activation among HIV-infected patients initiating antiretroviral therapy in Dar es Salaam, Tanzania.

Abstract

Chronic inflammation and persistent immune activation (IA) during HIV infection are associated with non-AIDS complications. We investigated sociodemographic and clinical characteristics influencing IA and exhaustion (IE), and platelet activation (PA) in newly diagnosed people living with HIV (PLHIV) and identified modifiable factors for early interventions. We analysed baseline blood samples from 365 PLHIV participating in a trial investigating the effect of aspirin on IA, IE, and PA. We assessed levels of markers of monocyte activation (soluble CD14), platelet activation (soluble P-selectin), T-cell activation (CD4⁺ and CD8⁺ expressing CD69 and co-expressing CD38 and HLA-DR), and T-cell exhaustion (PD-1). The median (IQR) age of the participants was 37 (28, 45) years, with females comprising 64.7%. Advanced age significantly predicted IA and IE, but not PA. Markers of IA and IE, but not of PA, inversely correlated with CD4 counts, while directly with HIV viral load (HVL). We show that most Tanzanian PLHIV initiating antiretroviral therapy (ART) have low CD4 count, high HVL, with a considerable proportion aged above 50 years, characteristics associated with heightened IA and IE. Adjunctive therapy, when available, should target such population and at ART initiation to prevent morbidity and mortality associated with persistent IA and IE.