Dysregulation of the Immune System in HIV/HCV-Coinfected Patients According to Liver Stiffness Status
Pilar Garcia-Broncano,
Luz Maria Medrano,
Juan Berenguer,
Juan González-García,
Mª Ángeles Jiménez-Sousa,
Ana Carrero,
Victor Hontañón,
Josep M. Guardiola,
Manuel Crespo,
Carmen Quereda,
José Sanz,
Ana Belen García-Gómez,
Jose Luis Jimenez,
Salvador Resino,
the GESIDA 3603b Study Group
Affiliations
Pilar Garcia-Broncano
Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
Luz Maria Medrano
Viral Infection and Immunity Unit, National Center of Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
Juan Berenguer
Infectious Disease/HIV Unit, Gregorio Marañón G. University Hospital, 28007 Madrid, Spain
Juan González-García
HIV Unit, Internal Medicine Service, La Paz University Hospital, 28046 Madrid, Spain
Mª Ángeles Jiménez-Sousa
Viral Infection and Immunity Unit, National Center of Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
Ana Carrero
Infectious Disease/HIV Unit, Gregorio Marañón G. University Hospital, 28007 Madrid, Spain
Victor Hontañón
HIV Unit, Internal Medicine Service, La Paz University Hospital, 28046 Madrid, Spain
Josep M. Guardiola
Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain
Manuel Crespo
Infectious Disease Unit, Internal Medicine Department, Vigo University Hospital Complex, Galicia Sur Health Research Institute, 36312 Vigo, Pontevedra, Spain
Carmen Quereda
Ramón y Cajal University Hospital, 28034 Madrid, Spain
José Sanz
Príncipe de Asturias University Hospital, 28805 Madrid, Spain
Ana Belen García-Gómez
Viral Infection and Immunity Unit, National Center of Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
Jose Luis Jimenez
Gregorio Marañón Health Research Institute, 28007 Madrid, Spain
Salvador Resino
Viral Infection and Immunity Unit, National Center of Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
the GESIDA 3603b Study Group
Membership of the GESIDA 3603b Study Group is provided in the <sup>Appendix A</sup>.
Background: Advanced cirrhosis is related to alterations in immunity. We aimed to evaluate the levels of peripheral CD4+ T cells (Tregs) and plasma cytokine in patients coinfected with human immunodeficiency virus and hepatitis C virus (HIV/HCV) according to liver fibrosis stages [evaluated as liver stiffness measure (LSM)] and their linear relationship. Methods: We performed a cross-sectional study on 238 HIV/HCV-coinfected patients (119 had <12.5 kPa, 73 had 12.5–25 kPa, and 46 had >25 kPa). Peripheral T-cell subsets were phenotyped by flow cytometry, plasma biomarkers were assessed by multiplex immunoassays, and LSM was assessed by transient elastography. Results: We found HIV/HCV-coinfected patients had higher values of CD4+ Tregs (p < 0.001), memory Tregs (p ≤ 0.001), and plasma cytokine levels [IFN-γ (p ≤ 0.05) and IL-10 (p ≤ 0.01)] compared with healthy donors and HIV-monoinfected patients. In the multivariate analysis, higher LSM values were associated with reduced levels of IL-10 (adjusted arithmetic mean ratio (aAMR) = 0.83; p = 0.019), IL-2 (aAMR = 0.78; p = 0.017), TNF-α (aAMR = 0.67; p < 0.001), and IL-17A (aAMR = 0.75; p = 0.006). When we focus on HIV/HCV-coinfected patients analyzed by LSM strata, patients with ≥25 kPa had lower values of IL-2 (aAMR = 0.66; p = 0.021), TNF-α (aAMR = 0.565; p = 0.003), and IL-17A (aAMR = 0.58; p = 0.003) than patients with <12.5 kPa. Conclusion: HIV/HCV-coinfected patients showed an immunosuppressive profile compared to healthy controls and HIV-monoinfected patients. Additionally, HIV/HCV-coinfected patients with advanced cirrhosis (LSM ≥ 25 kPa) had the lowest plasma values of cytokines related to Th1 (IL-2 and TNF-α) and Th17 (IL-17A) response.
