PLoS ONE (Jan 2019)

HIV infection is associated with elevated biomarkers of immune activation in Ugandan adults with pneumonia.

  • Richard J Wang,
  • Julia Moore,
  • Daniela Moisi,
  • Emily G Chang,
  • Patrick Byanyima,
  • Sylvia Kaswabuli,
  • Emmanuel Musisi,
  • Ingvar Sanyu,
  • Abdulwahab Sessolo,
  • Rejani Lalitha,
  • William Worodria,
  • J Lucian Davis,
  • Kristina Crothers,
  • Jue Lin,
  • Michael M Lederman,
  • Peter W Hunt,
  • Laurence Huang

DOI
https://doi.org/10.1371/journal.pone.0216680
Journal volume & issue
Vol. 14, no. 5
p. e0216680

Abstract

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IntroductionPneumonia is an important cause of morbidity and mortality in persons living with human immunodeficiency virus (HIV) infection. How immune activation differs among HIV-infected and HIV-uninfected adults with pneumonia is unknown.MethodsThe Inflammation, Aging, Microbes, and Obstructive Lung Disease (I AM OLD) Cohort is a prospective cohort of adults with pneumonia in Uganda. In this cross-sectional analysis, plasma was collected at pneumonia presentation to measure the following 12 biomarkers: interleukin 6 (IL-6), soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2), high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer, soluble CD27 (sCD27), interferon gamma-inducible protein 10 (IP-10), soluble CD14 (sCD14), soluble CD163 (sCD163), hyaluronan, and intestinal fatty acid binding protein. We asked whether biomarker levels differed between HIV-infected and HIV-uninfected participants, and whether higher levels of these biomarkers were associated with mortality.ResultsOne hundred seventy-three participants were enrolled. Fifty-three percent were HIV-infected. Eight plasma biomarkers-sTNFR-1, sTNFR-2, hsCRP, D-dimer, sCD27, IP-10, sCD14, and hyaluronan-were higher among participants with HIV infection, after adjustment for pneumonia severity. Higher levels of 8 biomarkers-IL-6, sTNFR-1, sTNFR-2, hsCRP, IP-10, sCD14, sCD163, and hyaluronan-were associated with increased 2-month mortality.ConclusionsAs in other clinical contexts, HIV infection is associated with a greater degree of immune activation among Ugandan adults with pneumonia. Some of these are also associated with short-term mortality. Further study is needed to explore whether these biomarkers might predict poor long-term outcomes-such as the development of obstructive lung disease-in patients with HIV who have recovered from pneumonia.