Increased Pro-inflammatory Biomarkers and Cardiovascular Risk in Young Adults Living With Perinatal HIV in Thailand

BACKGROUND: We assessed levels of pro-inflammatory biomarkers as possible surrogate markers of cardiovascular disease (CVD) risk in Thai young adults with perinatally acquired HIV infection (YA-PHIV). METHODS: Serum samples and baseline data from YA-PHIV enrolled in a prospective cohort study from November 2020 to July 2021 at five tertiary care hospitals in Thailand were analyzed. We measured high-sensitivity C-reactive protein (hs-CRP), soluble CD163 (sCD163), and interleukin (IL)-18 levels. Data were analyzed using nonparametric methods. RESULTS: Among 347 YA-PHIV, 54% were female, the mean age was 21.7 ± 2.0 years, the median duration of antiretroviral treatment was 16.7 years (IQR 13.4-18.4), and 72 (21%) had virologic failure (HIV viral load >1000 copies/mL). The hs-CRP levels were <1.0 mg/L (low CVD risk) in 170 (49%), between 1.0-<3.0 (indicating intermediate CVD risk) in 88 (25%), and ≥3 mg/L (indicating high CVD risk) in 89 (26%). The median IL-18 level was 82.2 pg/mL (IQR 33.9-151.7), and sCD163 was 53.6 ng/mL (IQR 31.1-90.1). YA-PHIV with virologic failure had a significantly higher level for all three biomarker levels than those with virologic suppression. Increasing age was associated with hs-CRP >3 mg/L; males were more likely to have high levels of IL-18; no factors were associated with sCD163 level. CONCLUSIONS: Increased pro-inflammatory biomarkers in YA-PHIV support the presence of ongoing inflammation, particularly in those with virologic failure. HIV care for YA-PHIV should focus on virologic control and modifiable metabolic risk factors. Active monitoring for cardiovascular manifestations in YA-PHIV risk is warranted as they age.