Inflammation in HIV-Infected Patients: Impact of HIV, Lifestyle, Body Composition, and Demography – A Cross Sectional Cohort Study

Objectives: To examine mechanisms underlying the increased inflammatory state of HIV-infected patients, by investigating the association of HIV-related factors, demography, lifestyle, and body composition with the inflammatory marker soluble urokinase plasminogen activator receptor (suPAR). Methods: suPAR was measured in EDTA-plasma and associated with HIV-related factors (HIV-duration, combination antiretroviral treatment (cART), nadir CD4+ cell count, CD4+ cell count, and HIV RNA); demography; lifestyle; and body composition determined by Dual energy X-ray Absorptiometry (DXA) scan, in multiple linear regression analyses adjusted for biological relevant covariates, in a cross-sectional study of 1142 HIV-infected patients. Results: Increased suPAR levels were significantly associated with age, female sex, daily smoking, metabolic syndrome and waist circumference. cART was associated with 17 % lower suPAR levels. In cART-treated patients 10-fold higher HIV RNA was associated with 21 % higher suPAR, whereas there was no association in untreated patients. Patients with CD4+ cell count,350 cells/mL had 7 % higher suPAR, but we found no association with nadir CD4+ cell count or with duration of HIV-infection. Finally, suPAR was not associated with adipose tissue distribution, but strongly associated with low muscle mass. In patients infected through intravenous drug use (IDU), CD4+ cell counts,350 cells/mL were associated with 27 % lower suPAR (p = 0.03), and suPAR was 4 % lower pr. year during treatment (p = 0.05); however, there was no association with HI